Transcript PE/E Management Strategies at different levels

PE/E Management Strategies at
different levels
Pius Okong M.Med, PhD
Associate Professor
Nsambya Hospital, FIGO SM&NHC
Timely management
Elements
CEmOC
• Diagnosis
YES
• Treat
YES
• Monitor
YES
• Plan delivery
YES
• Delivery
YES
BEmOC
YES
Initiate
YES
No
Y/N
Family/Co
Recog
Cont.
?
No
?
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
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
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
CEmONC Facilities
Who?
• Midwives
• Doctors
• Anaethetists
• Laboratory tech
CEmONC Facilities
What? Processes
1. Emergency preparedness/critically ill patient
2. Drills for the teams?
3. Consumables
4. Tools
5. Use of Mag Sulphate for PE, prenatal and
continuing pregnancy
Evidence about use of Mag/sulphate and timing of
delivery etc.
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?