Home Maya Ale was living in a scenic village on the banks of the Seti River in central Nepal, about 20 miles from the city of Pokhara and the nearest hospital. Like many women in rural Nepal, she had limited access to health care. While pregnant with her second child, Home Maya suffered a seizure—a telltale sign of eclampsia.

Alarmed by her condition, Mrs. Ale’s husband brought her to the nearest health clinic where staff referred her to the hospital in Pokhara. When the family arrived at the Western Regional Hospital, Mrs. Ale was semiconscious and in serious condition. Fortunately for this 25-year-old mother, she was in a hospital where staff had been trained to diagnose, treat and monitor this life-threatening complication.

Mrs. Ale survived this obstetric emergency with treatment and delivered a healthy baby boy. Other young women and mothers haven’t been as lucky. Pre-eclampsia/eclampsia (PE/E) is now the second leading cause of maternal death in Nepal with recent evidence showing that PE/E accounts for 21% of all maternal deaths.

In response, the government of Nepal, with the help of USAID’s Maternal and Child Health Integrated Program (MCHIP), is focusing on ways to address this problem and help prevent pregnant women from developing this condition. MCHIP has developed a three-pronged strategy in this effort:

Prevention of PE/E

The World Health Organization (WHO) has identified calcium as one of the most effective and low-cost interventions among pregnant women for prevention of PE/E in a calcium-deficient setting such as Nepal. MCHIP is partnering with the USAID-funded bilateral Nepal Family Health Program II (NFHP II) under the leadership of the Family Health Division (FHD) of the Ministry of Health and Population (MOHP) to test the acceptability of calcium in two forms (tablets and powder) among pregnant women for three months in two village development committees (VDCs) of Banke district in southwestern Nepal.

Based on this study, FHD plans to scale up the findings through community-based volunteers in several districts. MCHIP with NFHP II will implement calcium supplementation district-wide in one district, and other districts supported by different development partners. This innovative project will demonstrate whether the government public health system including female community health volunteers (FCHVs) can successfully distribute calcium for large-scale coverage and compliance.

Screening and Diagnosis of PE/E

To diagnose PE/E, pregnant women need to be screened for high blood pressure and protein in their urine to detect proteinuria. Unfortunately, many antenatal care (ANC) clinics in Nepal are not able to routinely offer screening.

MCHIP will test a new low-technology proteinuria test that can be used in peripheral ANC clinics where proteinuria screening is not available—and even at the household level. The Program will work with the largest, tertiary care hospital for maternal and newborn health in Nepal, The Paropakar Maternity and Women's Hospital (PMWH), during the summer using this new test on routinely-collected urine samples. The study will determine its specificity and sensitivity to existing standard tests. If the test is comparable, MCHIP will then bring the test to a rural ANC setting to determine whether healthcare workers, FCHVs and pregnant women can effectively use and interpret the test.

Treatment and Management of PE/E

WHO has identified magnesium sulphate as the best evidence-based practice to treat PE/E. While magnesium sulphate is included in the National Medical Standards Volume III and the Essential Drugs List, it is not yet systematically provided through the healthcare system to all women who require this life-saving care.

Under the ACCESS Program, Jhpiego worked with the Nepal Society of Obstetricians and Gynecologists (NESOG) to strengthen the use of magnesium sulphate to treat severe PE/E at 22 facilities throughout Nepal. Results showed that facilities can manage severe PE/E appropriately: 11 of the 22 facilities (i.e., 50%) were performing at 80% or higher. MCHIP will build on these results, working with FHD and development partners to further strengthen PE/E management especially with the rapid increase of institutional deliveries with the national free maternity care program (Aama Programme).