Capacity of Ugandan Public Sector Health Facilities to Manage Hypertensive Disorders in Pregnancy
Oral Antihypertensive Therapy: A Pathway to Efficiently Reduce Maternal Complications from Severe Hypertension in Low Resource Environments:
Hypertensive disorders of pregnancy (HDP) an important cause of severe morbidity and mortality among mothers and babies. In Africa and Asia, nearly 1 in 10 of all maternal deaths associated with HDP. In Latin America, more than 1 in 4 of maternal deaths associated with complications of hypertension.
HDP include chronic HTN, gestational HTN, preeclampsia, and preeclampsia superimposed on chronic HTN Treatment of severe hypertension in pregnancy reduces serious maternal complications such as cerebral edema and hemorrhage.
WHO guidance on BP monitoring in pregnancy
BP monitoring key component of antenatal and postnatal care . WHO recommends 8 ANC visits with BP and proteinuria measured at each visit . Postpartum: BP measured shortly after birth. If normal, the second BP should be taken within 6 hours. More frequent monitoring of blood pressure recommended for women with poorly controlled BP either in the facility or at home .
Hypertensive Disorders of Pregnancy (HDP) in Uganda
In Uganda, HDP were the second leading cause of maternal death in 2018. Among Ugandan women who received ANC for their most recent birth in the past 5 years, only 71.8% had their BP measured and 39.4% had proteinuria assessed (Uganda DHS 2016) .
Surveys of essential supplies for treatment of general hypertension have found poor availability of essential equipment including BP devices and urine test strips (Rogers 2018; Musinguzi 2015)
Medications for treatment of HPD
Vital: Used to diagnose and treat life-threatening conditions, or which are considered medicine of choice or ”first line” items in their therapeutic category. Their unavailability would cause serious harm and side effects. They must be available ALWAYS.
Essential: used to treat common illnesses, maybe less severe but nevertheless significant, or which are second line items in their therapeutic categories.
- No antihypertensive (AHT) medication listed as a ‘vital’ medicine for supply at Health Center III level.
- No oral AHT listed as a ‘vital’ medicine for supply at Health Centre IV or higher.