Table 3.
Test case findings about knowledge of providers in diagnosing and managing pre-eclampsia/eclampsia by facility and provider type
| Knowledge parameter assessed through the test case | Total (475) | CI [95% Conf. Interval] | PHC (204) | HF-PUBLIC (147) | HF-PVT (124) | P Value* | Nurse/ANM (248) | Doctors (138) | Obstetricians (89) | P Value** |
|---|---|---|---|---|---|---|---|---|---|---|
| Initial assessment for pre-eclampsia/eclampsia | ||||||||||
| Check blood pressure | 94.9 | 92.6-96.7 | 96.1 | 92.5 | 96.0 | 0.269 | 92.7 | 97.8 | 96.6 | 0.066 |
| Assess consciousness | 6.1 | 4.1-8.7 | 3.4 | 8.2 | 8.1 | 0.107 | 3.6 | 6.5 | 12.4 | 0.012 |
| Measure fetal heart rate | 66.7 | 62.3-71 | 67.2 | 63.3 | 70.2 | 0.480 | 56.9 | 72.5 | 85.4 | <0.001 |
| Assess urine for protein | 55.2 | 50.6-59.7 | 51.0 | 57.1 | 59.7 | 0.260 | 38.3 | 65.9 | 85.4 | <0.001 |
| Diagnosis and management of severe pre-eclampsia | ||||||||||
| Diagnose severe pre-eclampsia | 78.5 | 74.6-82.1 | 78.4 | 83.0 | 73.4 | 0.159 | 67.7 | 85.5 | 97.8 | <0.001 |
| Administer magnesium sulphate | 46.3 | 41.8-50.9 | 36.8 | 51.7 | 55.6 | 0.001 | 30.2 | 50.7 | 84.3 | <0.001 |
| Administer anti-hypertensive drugs if diastolic BP > 110 mm Hg | 72.6 | 68.4-76.6 | 69.6 | 71.4 | 79.0 | 0.165 | 67.7 | 74.6 | 83.1 | 0.016 |
| Immediately refer to higher facility | 34.5 | 30.3-39 | 51.0 | 33.3 | 8.9 | <0.001 | 39.9 | 42.8 | 6.7 | <0.001 |
| Diagnosis and management of eclampsia | ||||||||||
| Diagnose eclampsia | 80.4 | 76.6-83.9 | 77.9 | 86.4 | 77.4 | 0.089 | 67.7 | 92.0 | 97.8 | <0.001 |
| Administer oxygen | 24.2 | 20.4-28.3 | 16.2 | 33.3 | 26.6 | 0.001 | 14.9 | 29.0 | 42.7 | <0.001 |
| Administer magnesium sulphate | 65.1 | 60.6-69.3 | 61.3 | 66 | 70.2 | 0.251 | 51.2 | 69.6 | 96.6 | <0.001 |
| Administer anti-hypertensive drugs if diastolic BP > 110 mm Hg | 54.1 | 49.5-58.7 | 47.1 | 58.5 | 60.5 | 0.027 | 44.8 | 58.0 | 74.2 | <0.001 |
| Follow up after initial management of eclampsia | ||||||||||
| Administer repeat dose of magnesium sulphate if woman is still seizing | 32.6 | 28.4-37.1 | 27.9 | 36.1 | 36.3 | 0.167 | 19.4 | 36.2 | 64.0 | <0.001 |
| Administer anti-hypertensive drugs if diastolic BP > 110 mm Hg | 51.4 | 46.8-55.9 | 49.5 | 51.7 | 54.0 | 0.726 | 45.2 | 54.3 | 64.0 | 0.007 |
| Induce labour | 30.5 | 26.4-34.9 | 20.1 | 40.1 | 36.3 | <0.001 | 21.8 | 25.4 | 62.9 | <0.001 |
| Maintain intake/output record | 14.1 | 11.1-17.6 | 11.8 | 17.0 | 14.5 | 0.375 | 8.9 | 15.2 | 27.0 | <0.001 |
| Monitor magnesium sulphate toxicity | 18.1 | 14.7-21.9 | 16.7 | 18.4 | 20.2 | 0.724 | 12.9 | 18.1 | 32.6 | <0.001 |
HF- Higher Facility; CHC - Community Health Centre; TH – Taluka (sub district) Hospital; DH – District Hospital; PVT - Private Hospital; ANM – Auxiliary Nurse Midwife.
*Pearson’s chi-square test for independence between providers by facilities.
**Pearson’s chi-square test for independence between providers by provider type.