Improving preeclampsia and eclampsia care: Tested changes and guidance from East Central Uganda
Hypertensive disorders of pregnancy are one of the leading causes of severe morbidity, disability and death among mothers and their babies. In Africa, about 10% of maternal deaths are associated with hypertensive disorders in pregnancy ; in Uganda, they were the third leading cause of maternal death in 2015/16. Preeclampsia, a condition that affects 5% of all pregnancies worldwide, and eclampsia stand out as the most challenging of the hypertensive disorders affecting pregnancy.
From June 2015 through March 2017 the USAID Applying Science to Strengthen and Improve Systems (ASSIST) Project implemented an improvement activity in a “slice” of the health care system in Jinja, Uganda to improve the quality of primary antenatal care (ANC) services through implementation of an integrated package of antenatal care best practices that includes early detection, initial management and referral of the most common obstetric conditions with an emphasis on improving screening, diagnosis, treatment and referral of preeclampsia/eclampsia as one of the major causes of preventable maternal death.
This activity generated important learning about effective models for improving delivery of quality care for PE/E including early recognition, initial treatment, and referral from primary care to the hospital level as well as addressing quality gaps at the hospital level. The changes implemented by quality improvement (QI) teams that are discussed in this document demonstrate effective ways to overcome common gaps in preeclampsia/eclampsia care in a low-resource environment, improve the quality of antenatal care for pregnant women, and reduce maternal and newborn mortality.