Suggested Indicators for Monitoring and Evaluation of Programs to Detect and Treat Severe

Suggested Indicators for Monitoring and Evaluation of Programs to Detect and Treat Severe Pre-Eclampsia/ Eclampsia during Pregnancy Below you find a relatively small menu of indicators that can be used to monitor and evaluate programs that are intended to improve screening and treatment of pre-eclampsia and eclampsia. One useful M&E resource that provides guidance on how to select and measure indicators related to antepartum and postpartum hemorrhage in the larger context of emergency obstetric care is WHO’s “Monitoring Emergency Obstetric Care: A Handbook,” published in 2009.

OUTPUT INDICATORS Service Readiness  Number/percentage of antenatal care providers trained in PE/E screening and management in the last three years , either preservice or inservice training (including BP and urine protein testing and treatment of severe PE/E with MgSO4)  Number/percentage of health facilities reporting a stock-out of MgSO4 in the past month or the specified time period  Number/percentage of health facilities reporting a stock-out of urine protein test supplies in the past month or the specified time period  Number/percentage of health facilities with functional BP equipment available in the target service delivery area (ANC clinic , maternity, admissions, etc.) in the past month or the specified time period  Number/percentage of health facilities offering delivery services that report they offer parenteral administration of anti-convulsants to women with pre-eclampsia or eclampsia

Service Delivery  Percentage of first visit ANC clients with prior pregnancies who were asked if they had experienced any complications during a prior pregnancy  Percentage of ANC clients who had their blood pressure checked  Percentage of ANC clients who had their urine tested for protein  Percentage of ANC clients who were asked if they had experienced danger signs (severe headache, blurred vision and/or swelling of the hands or face)  Number of severe pre-eclampsia and eclampsia cases treated  Number/percentage of cases of severe pre-eclampsia and eclampsia that were managed using MgSO4  Number/percentage of health facilities offering delivery services that administered parenteral anti- convulsants for pre-eclampsia or eclampsia in the past three months  Number/percentage of health facilities offering delivery services that performed newborn resuscitation in the past three months (with bag and mask)  Number/percentage of health facilities qualified to provide comprehensive EMOC that performed C- section in the past three months  Number/percentage of health facilities qualified to provide comprehensive EMOC that performed blood transfusion in the past three months

OUTCOME INDICATORS

 Percentage of women with a live birth in the specified time period who received antenatal care and had their blood pressure checked  Percentage of women with a live birth in the specified time period who received antenatal care and had a urine sample taken  Percentage of women with a live birth in the specified time period who received antenatal care and were counseled about danger signs of pregnancy complications (specifically, severe headache and/or swelling of the hands or face if possible)  Percentage of women with a live birth in the specified time period who received calcium supplements during pregnancy  Percentage of women with a live birth in the specified time period who were treated for convulsions during pregnancy or shortly after birth  Percentage of live births in the specified time period attended by a skilled birth attendant1

IMPACT INDICATORS  Maternal mortality ratio  Direct obstetric case fatality rate (disaggregated for severe pre-eclampsia/eclampsia, if possible)  Estimated number of deaths averted from severe pre-eclampsia/eclampsia during pregnancy (statistical modeling using the Lives Saved Tool2)  Percentage of screened pregnant women with severe pre-eclampsia/eclampsia

KEY DATA SOURCES WITH CORRESPONDING PE/E INDICATORS3 DATA SOURCE INDICATOR Household survey (DHS,  Maternal mortality ratio MICS, other)  Percentage of live births in the specified time period attended by a skilled birth attendant  Percentage of women with a live birth in the specified time period who received antenatal care and had their blood pressure checked  Percentage of women with a live birth in the specified time period who received antenatal care and had a urine sample taken  Percentage of women with a live birth in the specified time period who received antenatal care and were counseled about danger signs of pregnancy complications (specifically, severe headache and/or swelling of the hands or face if possible)  Percentage of women with a live birth in the specified time period who received calcium supplements during pregnancy  Percentage of women with a live birth in the specified time period who were treated for convulsions during pregnancy or shortly after birth Facility survey (SPA,  Direct obstetric case fatality rate (disaggregated for severe pre- SAM, other) eclampsia/eclampsia, if possible)  Estimated number of deaths averted from severe pre-eclampsia/eclampsia during pregnancy (statistical modeling using the Lives Saved Tool)  Number/percentage of antenatal care providers trained in PE/E screening and management in the last three years , either preservice or inservice training (including BP and urine protein testing and treatment of severe PE/E with MgSO4)

1 The WHO definition of a skilled birth attendant includes doctors, nurses and midwives. It does not include traditional birth attendants. 2 The Lives Saved Tool includes intervention effectiveness values for Calcium supplementation, Case management of pregnancy, and Comprehensive Emergency Obstetric Care which can be used to estimate deaths averted from hypertensive diseases in pregnancy 3 Some indicators are repeated in the table as they are collected through multiple methods/sources. Page 2 DATA SOURCE INDICATOR

 Number/percentage of health facilities reporting a stock-out of MgSO4 in the past month or the specified time period  Number/percentage of health facilities reporting a stock-out of urine protein test supplies in the past month or the specified time period  Number/percentage of health facilities with functional BP equipment available in the target service delivery area (ANC clinic , maternity, admissions, etc.) in the past month or the specified time period  Percentage of first visit ANC clients with prior pregnancies who were asked if they had experienced any complications during a prior pregnancy  Percentage of ANC clients who had their blood pressure checked  Percentage of ANC clients who had their urine tested for protein  Percentage of ANC clients who were asked if they had experienced danger signs (severe headache, blurred vision and/or swelling of the hands or face)  Number/percentage of cases of severe pre-eclampsia and eclampsia that were managed using MgSO4  Number/percentage of health facilities offering delivery services that report they offer parenteral administration of anti-convulsants to women with pre-eclampsia or eclampsia  Number/percentage of health facilities offering delivery services that administered parenteral anti-convulsants for pre-eclampsia or eclampsia in the past three months  Number/percentage of health facilities offering delivery services that performed newborn resuscitation in the past three months (with bag and mask)  Number/percentage of health facilities qualified to provide comprehensive EMOC that performed C-section in the past three months  Number/percentage of health facilities qualified to provide comprehensive EMOC that performed blood transfusion in the past three months HMIS (monthly facility  Direct obstetric case fatality rate (disaggregated for severe pre- reports, district reports, eclampsia/eclampsia, if possible) logistics management  Percentage of screened pregnant women with severe pre- information systems, etc.) eclampsia/eclampsia  Number/percentage of health facilities reporting a stock-out of MgSO4 in the past month or the specified time period  Number/percentage of health facilities reporting a stock-out of urine protein test supplies in the past month or the specified time period  Number of severe pre-eclampsia and eclampsia cases treated  Number/percentage of cases of severe pre-eclampsia and eclampsia that were managed using MgSO4 Supervision reports and  Number/percentage of antenatal care providers trained in PE/E screening training information and management in the last three years , either preservice or inservice systems training (including BP and urine protein testing and treatment of severe PE/E with MgSO4)  Number/percentage of health facilities reporting a stock-out of MgSO4 in the past month or the specified time period  Number/percentage of health facilities reporting a stock-out of urine protein test supplies in the past month or the specified time period