10 The Role of Community Health Workers and Midwives in Low-Resource Settings: The Implementation of Community-Based Preeclampsia Screening

Speaker(s): Abdilla Fi Qisthy Wibowo ; Rahma Haryunita Ega Prosfera ; Yunda Reka Permata

Facilitator : Camella Main

Abstract:  Background: Hypertensive disorders of pregnancy remain a leading cause of maternal death in low- and middle-income countries (LMICs), where delayed recognition of preeclampsia reflect inequities in specialist care access. Midwives and community health workers (CHWs) provide much community-level antenatal contact, yet their role in routine blood pressure screening remains unserused.

 Objective: This scoping review examines implementation strategies, barriers, facilitators, and referral pathways for community based preeclampsia screening by midwives and CHWs in LMICs.

 Methods: Guided by the PCC framework and reported using PRISMA ScR, we searched Scopus, PubMed, and Web of Science for studies describing primary level screening for preeclampsia by midwives and/or CHWs in LMICs. Of 89 records identified, 59 were title and abstract screened, 14 full texts assessed, and 9 studies included. Data were charted and synthesised thematically.

 Results: Nine studies (Indonesia, Mozambique, Nigeria, India, Ecuador, and South Africa) reported screening packages combining blood pressure measurement, danger sign assessment and decision support tools linked to referral. Evidence was largely qualitative or mixed methods (Indonesia: 68 participants; multi country: 205 providers). One Nigerian study quantified community treatment/referral (8,790 women, 142 MgSO4 and 124 methyldopa doses, 126 urgent referrals, no complications). Recurrent constraints were training gaps, limited device access/trust, unclear roles, documentation burden, and transport or facility readiness.

 Conclusion: Findings support scalable midwife/CHW led screening packages to strengthen early detection and referral. For Indonesia, priorities include standardised training, validated devices, a clear scope of practice, strengthened documentation, and reliable referral transport. Future research should assess equity, fidelity, and referral completion.

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