Rapid Response Brief: Options for Controlling Adverse Outcomes of Pre-eclampsia in Lower Health Facilities Before and During Transfer to Higher Facilities for Care

Summary

Pre-eclampsia (PE) is a life-threatening pregnancy complication and the second leading cause of maternal deaths in Uganda, with approximately 80% of maternal deaths in Mukono District attributed to PE occurring before and during referrals to higher-level health facilities. Despite training healthcare workers on the use of magnesium sulphate (MgSO4) and providing access to the drug, administration at lower-level facilities remains low due to fears of side effects and toxicity. This brief synthesizes evidence on interventions to improve PE management at lower health facilities before and during transfer to higher-level care. Effective strategies include behavioral change interventions such as clinical audits with feedback, refresher training, and reminders; clinical interventions like maintaining well-stocked emergency trays and use of checklists; and technological interventions including mobile health applications and WhatsApp-based referral communication platforms. The evidence suggests that combining multiple interventions targeting health worker behavior and care processes is essential to reduce adverse maternal and neonatal outcomes associated with PE. However, the impact of these interventions on outcomes remains underexplored. This brief aims to inform decision-making for health system strengthening in Uganda to improve PE management and reduce maternal mortality.

Policy message

Strengthening antenatal care, providing health education for mothers and their communities about the danger signs of preeclampsia, and ensuring consistent availability of skilled human resource, essential drugs, supplies, commodities, and equipment for the management of PE are essential to ensure timely access and management of PE.

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