Pre-eclampsia, a hypertensive disorder during pregnancy, is a significant cause of maternal and neonatal morbidity and mortality. The CLIP trial aimed to assess whether community-level interventions could reduce adverse pregnancy outcomes by addressing delays in triage, transport, and treatment. The study involved community health workers (CHWs) in Karnataka, India, who used a mobile health (mHealth) app to guide clinical assessments, initial treatments, and referrals.
Key Findings
- Community health workers, including Accredited Social Health Activists (ASHAs) and Auxiliary Nurse Midwives (ANMs), were able to undertake all aspects of the mHealth app-guided visits.
- Women with eight or more mHealth-guided contacts experienced fewer stillbirths, supporting WHO guidance.
- Community-level interventions alone did not significantly improve primary composite outcomes without enhanced facility care.
Implementing CLIP Outcomes in Practice
Practitioners can leverage these findings to enhance maternal health outcomes in their communities:
- Train Community Health Workers: Invest in training CHWs to use mHealth apps for guiding clinical assessments and initial treatments. Ensure they are proficient in measuring blood pressure and testing for proteinuria.
- Engage the Community: Conduct community engagement sessions to raise awareness about the signs and symptoms of pre-eclampsia. Involve key stakeholders such as community leaders, pregnant women, and their families.
- Increase Contact Frequency: Aim for at least eight antenatal contacts per pregnancy to reduce stillbirths. Regular monitoring and follow-up can make a significant difference.
- Enhance Facility Care: While community interventions are crucial, they must be complemented by improved facility-based care. Advocate for better resources, training, and protocols in healthcare facilities.
Encouraging Further Research
The CLIP trial underscores the need for a comprehensive approach to maternal health. Researchers should focus on:
- Exploring the integration of community and facility-based interventions to maximize impact.
- Investigating the long-term effects of community-level interventions on maternal and neonatal health.
- Developing scalable models that can be adapted to different regions and healthcare settings.
By implementing these strategies and continuing research, practitioners can contribute to reducing maternal and neonatal mortality and morbidity. To read the original research paper, please follow this link: Community level interventions for pre-eclampsia (CLIP) in India: A cluster randomised controlled trial.
