15 The ability and safety of community-based health workers to initiate lifesaving therapies for pre-eclampsia in Ogun State, Nigeria: An analysis of 294 community treatments with MGSO4 and/or methyldopa

Introduction Pre-eclampsia and its associated complications are the leading cause of maternal death in Nigeria. Many of these deaths occur at home or in primary health centres. Nevertheless, management of pre-eclampsia is limited to secondary and tertiary facilities. In Nigeria, community-based health workers serve as a bridge between the community and health facilities; therefore, these providers may be key in reducing the incidence of adverse pregnancy outcomes by way of early detection and treatment. Objectives This study aimed to assess the ability of community-based health workers to safely administer methyldopa, magnesium sulphate, and complete referral to a higher level facility when indicated. Methods The Community Level Intervention for Pre-eclampsia (CLIP) study was implemented by community-based health workers in Ogun State, Nigeria. These providers (i.e., Community Health Extension Workers, Health Assistants, midwives and nurses) utilized a mHealth platform to guide antenatal and postnatal visits, pre-eclampsia treatment with oral methyldopa (one dose = 750 mg) and intramuscular magnesium sulphate (one dose = 10 mg) prior to referral, based on evidence-based practice and the miniPIERS (Pre-eclampsia Integrated Estimated of RiSk) model. Results Findings of this study indicate that community-based health workers in Nigeria safely administered 137 doses of magnesium sulphate; this resulted in no infections or hematomas. Fifty-one doses of magnesium sulphate were given by community health extension workers, while nurses administered sixty-four: the high rate of administration by nurses can be explained by turf protection as well as their seniority within the health system. In addition, there were 139 doses of methyldopa administered, and a total of 127 urgent referrals completed. No safety concerns were reported. Conclusion These findings confirm the ability of community-based health workers to safely administer magnesium sulphate for severe pre-eclampsia with appropriate training; this is a big step towards reducing the negative impact of pre-eclampsia in Nigeria. The use of task-sharing, therefore, could drastically reduce the three delays (triage, transport and treatment) associated with high maternal mortality and morbidity in rural communities in low and middle-income countries.