Assessment of Compliance with National Guidelines on the Management of Severe Preeclampsia and Eclampsia in Public Health Facilities in Bayelsa State

Abstract

Background: The Federal Ministry of Health in Nigeria developed a national guideline for the management of severe preeclampsia/eclampsia (Severe PE/E). Effective compliance with these guidelines is essential for delivery of quality care to women with these conditions. This study sought to determine the availability of the national guidelines and assess compliance by healthcare workers (HCWs) in public health facilities in Bayelsa State. Methodology: This is a mixed-method (quantitative and qualitative) descriptive study involving 155 HCWs responding to a self-administered structured questionnaire and  29 in-depth interviews  with health facility managers in 16 randomly selected health facilities in Bayelsa state.  Thirty-six questions and 16 questions assessed knowledge of severe preeclampsia and compliance with guideline respectively among respondents. Respondents were scored and graded as poor, fair and good level of knowledge and compliance. Chi-squared test and logistic regression were used to identify factors influencing level of compliance with the national guideline. The in-depth interviews were analyzed along thematic areas using NVivo 11.0 QSR software. Level of significance was set at p<0.05. Results: Slightly above half of the respondents (58.1%) had at least a local treatment guideline in their facility. However, only 69 study respondents (44.5%) knew about the existence of a national guideline on the management of Severe PE/E and even less than this (36.1%) reported that the national guideline was available in their centres. Less than a fifth of participants (17.4%) were found to have good level of compliance with the guidelines. The factors that influenced compliance included level of healthcare (OR – 26.13; p – 0.001) and level of knowledge. (OR- 53.90; p<0.001). From the in-depth interviews the main theme affecting compliance is non-availability of the national guideline at the centres. Conclusion: The level of compliance with the national guideline on the management of severe PE/E is low in Bayelsa state. Level of knowledge among health workers and non-availability of these guidelines are contributory factors. Training of health workers and provision of the guideline at all levels of care are recommended to guarantee quality care for women with severe PE/E.