Pre-Eclampsia/ Eclampsia is the second largest cause of maternal mortality in India; it causes 14% of maternal deaths and is associated with four times higher risk of newborn deaths. WHO has recommended Magnesium Sulphate as the most effective, safe and low cost drug to treat this obstetric complication. Magnesium Sulphate is also included in the list of essential drugs in India and in the package of basic emergency obstetric care expected to be available at all facilities.

However, FRCH's recent study of emergency obstetric services documented the non-availability of treatment for pre-Eclampsia/ Eclampsia in sub-district and rural hospitals. It was also found that users were unaware of symptoms and had no information on where to seek treatment for it.

The FRCH has submitted a proposal to the State Health Systems Resource Centre, Maharashtra, for operations research study to address the knowledgepractice gap in this area.

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The Objectives of the research are :

To document barriers to treatment of pre-Eclampsia/ Eclampsia in public health system in Maharashtra To assess the effectiveness of targeted interventions to change provider and user behaviour with regard to treatment of pre-Eclampsia / Eclampsia To create evidence for feasibility of continuum of care for pre-Eclampsia/ Eclampsia in public health systems in Maharashtra

The operations research project proposes to develop intervention strategies aimed at increasing health care providers' knowledge and confidence in the use of Magnesium Sulphate on the one hand, and increasing awareness of pregnant women and their families about the symptoms of this complication on the other. The study would cover two blocks in one of the predominantly tribal districts of Maharashtra. Interventions are being proposed at all Primary Health Centres and Rural Hospitals in the area. Data would be collected from 50% of the facilities before and after the interventions. A community-level survey would be conducted in 100 villages before and after the interventions.

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The operations research project is expected to :

Provide evidence on use of selected interventions to address barriers to treatment of pre-Eclampsia / Eclampsia in public facilities in Maharashtra Be useful to improve availability and uptake of these services Be helpful in reduction of maternal deaths caused by Eclampsia Serve as a model for application to other areas of emergency obstetric care

Support : State Health Systems Resource Centre, Government of Maharashtra Contact persons : Bharat Randive, Sarika Chaturvedi