PE/E Management Strategies at different levels

1
PE/E Management Strategies at different levels

• Pius Okong M.Med, PhD
• Associate Professor
• Nsambya Hospital, FIGO SMNHC

2
Timely management

• Elements CEmOC BEmOC
  Family/Co
• Diagnosis YES YES
  Recog
• Treat YES Initiate
  Cont.
• Monitor YES YES
  ?
• Plan delivery YES No
  No
• Delivery YES Y/N
  ?

3
PE/E Case management

• Diagnosis
• Prevent seizures Min 24 hrs, Mag Sulphate
• Control/stabilize BP Antihypertensive IV
• Evaluate cond. of Baby
• Evaluate mother LFT,RFT,CBC
• Monitoring

4
Family/Community level

• Who?
• Pregnant woman/support person
• CHW
• What?
• Knowledge to recognize seizures and symptoms
• Plan for emergency, transfer to BeOC facility
• Little or No information on CHW roles? Urine
  testing at home? Lack of evidence Research

5
Basic EON Care Facility

• Who?
• Midwives/Lab Assistant
• Clinical officers/Nurses
• What?
• Diagnosis symptoms/exam/urine testing?
• Initiate Mag Sulphate, Anti HT
• Monitoring BP, for seizures, fetus, urine etc
• Communication/Transfer to CEmONC
• Evidence about early treatment beneficial

6
CEmONC Facilities

• Who?
• Midwives
• Doctors
• Anaethetists
• Laboratory tech

7
CEmONC Facilities

• What? Processes
• Emergency preparedness/critically ill patient
• Drills for the teams?
• Consumables
• Tools
• Use of Mag Sulphate for PE, prenatal and
  continuing pregnancy
• Evidence about use of Mag/sulphate and timing of
  delivery etc.

8
Challenges

• Evidence for
• Research to fill the gaps at community level CHW
  information, diagnosis, urine testing and what
  medications?
• Modeling the complex aspects of case management
  in health facilities
• Case management audits accountability and health
  care quality?