PE/E Management Strategies at different levels Pius Okong M.Med, PhD Associate Professor Nsambya Hospital, FIGO SM&NHC

Timely management Elements CEmOC BEmOC Family/Co Diagnosis YES YES Recog Treat YES Initiate Cont. Monitor YES YES ? Plan delivery YES No No Delivery YES Y/N ?

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?