Adherence and challenges in implementing national guidelines on management of severe pre-eclampsia and eclampsia by health workers at Mbarara regional referral hospital

BACKGROUND: Pre-eclampsia/eclampsia remain conditions of public concern and the second leading causes of maternal mortality in Uganda. For this reason, Uganda Ministry of Health (MOH) adapted the WHO guidelines for management of pre-eclampsia/eclampsia and implemented them in order to standardize care across all health workers who provide care to patients with these conditions. Despite this effort, the morbidity and mortality from these conditions has not changed.

OBJECTIVE: The main purpose was to assess health workers’ adherence to Ugandan guidelines set for management of severe pre-eclampsia and eclampsia and explore the challenges affecting their implementation.

METHODS: A mixed method study was done. The study was done in Mbarara Regional Referral Hospital. A checklist that was a template of the Pritchard Uganda MOH guidelines was used to collect data from hospital records of 2018 for quantitative analysis and a qualitative interview guide was used to obtain data from health workers to explore challenges that influence adherence to guideline of managing severe pre-eclampsia eclampsia. Descriptive statistics such frequencies, percentages and means were used to determine the level of adherence. Content analysis was used to analyze the qualitative data.

RESULTS: A total of 72 records were reviewed. There was 50% adherence of the ten items on the protocol. The best items of the protocols adhered to was anti-hypertensive and magnesium sulfate administration started within 20 minutes of admission at 72 (100%) and 67(93.1%). There was a significant figure of 54 (75%) of the patients who missed to be seen by obstetrician within 15-30 minutes of admission and monitoring of deep tendon reflexes plus respiratory rate 45 (62.5%). The sub-optimal adherence to guidelines was mainly influenced by inadequate resources especially human resource and lack feedback from senior members.

CONCLUSION: The study showed a situation of care in discordance with the prescribed standards. The sub-optimal adherence to standards was mainly influenced by inadequate resources especially human resource and lack of feedback from senior members.

RECOMMENDATION: More emphasis should be put on all indicators. There is overall need for regular feedback, improvement in documentation and provision of appropriate logistics if these are not available for emergency conditions to ensure better patient management.