Identifying and Reviewing Policies for Pre-eclampsia and Eclampsia in Bangladesh

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Sajeda Amin, Population Council.

Research reveals no national policy for detection, treatment, and management of PE/E.
 
In Bangladesh, national policymakers understand the impact that PE/E has on the maternal mortality rate, however formal policies for its detection and treatment are lacking. Until recently, national policy on the detection, treatment, and management of pre-eclampsia and eclampsia were largely unknown.

In Bangladesh, the government policy on PE/E falls under the broader issue of maternal health. The government has a Standard Operating Procedure (SOP) for the prevention and management of PE/E at the secondary and tertiary levels. However, the government has yet to formalize any policy on PE/E prevention and management at the community level. Ending Eclampsia’s review of published and unpublished literature; interviews with policymakers, partners, and OB/GYNs; and survey of reproductive health program managers in the country reveals that national policymakers understand the high impact PE/E has on maternal mortality. A protocol on the detection and management of PE/E has been developed, tested, and approved for implementation at the community level but has not yet been widely circulated, thus many program managers and service providers are unaware of the policy. Clinical practices for the secondary and tertiary levels are generally established, but the translation of these policies down to the facility level is lacking.

Researchers found:

  • There is a formal policy on PE/E prevention and management at secondary and tertiary levels, but a policy does not exist for primary health facilities. This inconsistency leaves policymakers confused about how PE/E is treated and managed at the community level;
  • Policymakers favor task shifting to lower-level cadres of providers, except for community skilled birth attendants and community health care providers;
  • MgSO4, calcium gluconate, and antihypertensive drugs are essential to provide comprehensive treatment of PE/E but are not supplied to primary health facilities, which instead refer patients to higher-level facilities equipped with the drugs, causing delays in receiving care; and
  • For higher-level facilities, MgSO4, calcium gluconate, and antihypertensives are procured at the central level but shortages are common and distribution is irregular.
  • Country: Bangladesh
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