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Monday, September 09, 2013

Esha Homenauth: A Student Perspective: Pre-eclampsia/Eclampsia in the Developing World

Pre-eclampsia is a condition that occurs as a result of elevated blood pressure during pregnancy. It can cause several health complications including eclampsia (seizures), kidney and liver damage, and, ultimately, death. Pre-eclampsia accounted for 63,000 deaths worldwide in 2002, and is characterized as the second direct cause of maternal mortality. According to the World Health Organization, living in a developing country increases the risk of dying due to complications of pre-eclampsia by 300 fold, compared to that of a developed country.(EngenderHealth, 2007. 15 p.)Multiple randomized controlled trials show that magnesium sulphate (MgSO4) is the essential, most effective, safe and affordable drug available to treat pre-eclampsia and eclampsia. However, only about half the countries in the world adhere to the WHO's recommendation to use MgSO4. In 2009, the maternal mortality ratio (MMR) for India was documented as 212/100,000 livebirths. MgSO4 is on the list of essential medicines in India, however many women succumb to eclampsia and this accounts for 26% maternal deaths In Maharashtra state, India.

A study by Chaturvedi et al, published in,vol. 31 no. 3 of the Journal of Health, Population and Nutrition is the first study of its kind that reports on the availability of treatment for eclampsia in public facilities throughout rural India. The researchers focused on the public sector with the knowledge that impoverished women are more likely to forgo treatment when accessing health care from private facilities due to financial limitations. MgSO4 was used exclusively in private facilities for eclampsia treatment; however, health professionals in the public industries were conflicted about the use of MgSO4 due to risky outcomes. The availability of MgSO4 injections was unevenly distributed among hospitals with some hospitals having more or less of the recommended number of 50 MgSO4 injections. Gaps in policy practice for the use of MgSO4, poor inventory management and poor monitoring processes are reasons suggested for the profound occurrences of eclampsia among pregnant woman in rural India.

As a Health Studies student, I find that this study provides important information regarding medical care provisions for women living in poverty in India to be a great inequality. Studies have been done that highlight the effect of the two-tiered health system in India on the health of local population and knowledge of the influence of the private sector stifling the minimal resources in India is well documented. However, this article focuses solely on the public sector. Though multiple studies address how inequality exists between developed and developing nations, this article focuses on how the effects of inequality trickles down to local populations through limited access to resources, in this case, the availability of MgSO4 treatment. As such, discrepancies in health outcomes exists between the public and private sector due to poorer pregnant women being unable to afford the drugs to treat the onset or pre-eclampsia or eclampsia.

In developed countries, pre-eclampsia or eclampsia may be a condition often unheard of, but in the developing world, half a million women are affected. With Bioline International providing open access to this journal, fundamental information targeted to these marginalized societies can be brought to attention and strategies can be implemented in order to prevent poorer women from being victimized.

Chaturvedi, S., Randive, B., Mistry, M. (2013) Availability of Treatment for Eclampsia in Public Health Institutions in Maharashtra, India. Journal of Health, Population and Nutrition, 31(1), 78-85

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