Severe Pre-Eclampsia and Eclampsia in Pregnancy

Intro

Severe pre-eclampsia and eclampsia in pregnancy: Disparities in healthcare system between low and high income countries

Introduction

To create achievement in this modern era of society,reproductive health of women has an unlimited impacttowards national, international and global health concerns. Among them, severe pre-eclampsia and eclampsia areglobal health problems which contribute towards increased postpartum psychosis,increasedlifelong hypertension and other health related issues which inflatesthe percentage towards 2-8% of all pregnancies and related with 9-26% of maternal deaths internationally and 15% of preterm births (World Health Organization, 2005). Severe pre- eclampsia, eclampsia, sepsis, unsafe abortion, post-partum haemorrhage (PPH) and prolonged labour are the major derivativesof maternal death worldwide (Duley, 2009; Steegers et al, 2010).

As stated by Millennium Development Goals report 2015, later 1990, the maternal death ratio has declined by 45 percent worldwide, and most of the reduction has occurred after 2000. Most of the reduction has occurred after 2000. The percentage of maternal mortality had diminished by 64 percent from 1990 to 2013 globally. Whereas, in Sub-Saharan Africa  it dropped by 49 percent (United Nation MDG Report, 2015).

Getting all antenatal visits, using contraceptive methods prior and after pregnancy period, willing to allow skilled birth attendant to assist in the process of childbirth, media advertisement of the adverse effects of home delivery etc. have supported towards maintaining the decrease drift of the maternal mortality ratio after 2000. Within Northern Africa, an improved ratio of 59 percentages in mortality rate has shown in 1990 in the MDG report, 2015. The quantity of expectant women who obtained four or more than four antenatal visits raised from 50 percent to 89 percent since 1990 to 2015. Contraceptive manifestation among women aged 15 to 49, married or in a harmony, increased from 55 percent to 64 per cent in the year between1990 to 2015 globally. Skill health personnel globally assisted over and above, 71 percent of births in 2014 which helps to fall the death rate during delivery (United Nation MDG Report, 2015).

Justification/ Rationale

The predicted trend of maternal death was 183 in 2005 (World Health Organization, 2005). The fifth attention of Millennium Development Goal was 75% diminution of the maternal mortality ratio (MMR) from 1990 to 2015. From 1990 to 2015, maternal mortality worldwide dropped by 44% (WHO, UNICEF, World Bank, 2016). Roughly, 830 women die from pregnancy and childbirth related medical issues globally per day according to the (WHO fact sheet, November 2016). Between 2016 and 2030, according to the Sustainable Development Goals’ target, we aim at dropping the maternal mortality ratio which is fewer than 70 maternal deaths per 1 million live child birth worldwide by 2030 (Alkema et al., 2016).

Severe pre-eclampsia and eclampsia are the main causes of death of childbearing mother. These diseases help to develop postpartum psychosis and lifelong hypertension after giving childbirth so that if the mother stays alive she gets these groups of diseases afterwards which leads towards decrease in QALY (Quality adjusted life Index) by adding an amount of maternal morbidity ratio which is a threat to conceive further. In these regards, I am concentrating on the topics of pre-eclampsia and eclampsia now, which can be prevented by prudent and proactive management of respective health care system.

Healthcare system varies in different socio-economic condition of the country e.g. the United Kingdom abide by the rules of ‘Beveridge Model’ whereas low income countries e.g. south Asia, South Africa stands by ‘Out-of-Pocket Model’. Among the four basic models (Beveridge model, Bismark model, national health insurance model, out of pocket model), the Beveridge model is arranged and funded by the government through income tax payment or National Insurance. It is perhaps the world’s purest model of Health care system. United Kingdom is following this model where we do not need to pay any doctor’s bill, which is a progressive facilitator towards reducing maternal mortality on the way to attaining goals and encouraging people towards getting more and more touch with the physicians.

On the other hand, poor nations e.g. South Africa, Bangladesh, India, Pakistan, Bhutan, etc. counties are following the out of pocket model whereas they do not have any organized healthcare system. The basic rule in much model is the rich gets the medical care because they could provide healthcare professionals with monetary amounts and the poor lag behind and die. Besides, there is scarcity of knowledge, education, and vehicle to go to a doctor even in case of life threatening condition of those people. Moreover, women are portrayed as a second gender in those deprived countries so there are also inequities in social position, which leads them towards lack of access to the health care system. Sometimes there are other issue which lead pregnant women to stay at home and deliver babies such as environmental hazards e.g. flood, drought, heavy rain, tornado, etc. Living in geographically hard to reach areas, cultural trends, natural disasters make them to do so.

This health care system of ‘Beveridge model’ achieves 0% maternal mortality ratio in 2015 in case of eclampsia and pre-eclampsia related maternal mortality ratio (REF). So to reduce maternal death related to eclampsia and pre-eclampsia in low income countries, we can follow this best model’s management system. In most the articles, literatures, journals had taken the data of eclampsia and pre-eclampsia together because eclampsia is the end stage of pre-eclampsia condition including convulsion, so it is nearly impossible to discuss them separately. For this above reason, I am discussing both of the issues altogether as an overall view.

A significant number of perinatal deaths of mother in some areas of the world reflects discrimination in access to health facilities and highlights the gap between rich and poor. Maternal mortality and morbidity are higher among the poor rural populations in developing nations. Practically all maternal demises (99%) occur in developing countries. For an example in sub-Saharan Africa, more than half of these maternal deaths occur as well as in South Asia, nearly one-third of these unpredictable deaths occur due to the delicate and humanitarian settings. According to the recent data of World health organization, the maternal mortality ratio in developing countries in 2015 was 239 per 1 million live births opposed to 12 per 1 million live births in developed countries (WHO Factsheet, 2016).

In rural Bangladesh, more than 75% of neonatal births as well as delivery occur at home in the absence of skilled birth attendant (Sikder et al., 2014). As a consequence, the majority of obstetric complications defined as acute conditions such as sepsis, eclampsia, haemorrhage, and obstructed labour that can cause maternal deaths arise in the home (Belizán, Buekens, Althabe, & Bergel, 2006)

Healthcare system professionals are more in quantities in the urban setting than in the rural healthcare system in the out-of-pocket model, whereas we can see the equal distribution of caregivers and physicians in Beveridge Model.

Healthcare system delivery issues that impact on transport and healthcare access and care