PEE Management Strategies at different levels Pius Okong
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PE/E Management Strategies at different levels Pius Okong M. Med, Ph. D Associate Professor Nsambya Hospital, FIGO SM&NHC
Timely management Elements CEm. OC • Diagnosis YES • Treat YES • Monitor YES • Plan delivery YES • Delivery YES BEm. OC 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 Be. OC 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 CEm. ONC Evidence about early treatment beneficial
CEm. ONC Facilities Who? • Midwives • Doctors • Anaethetists • Laboratory tech
CEm. ONC 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?
