Terms of Reference (TOR)
Technical Advisory Group (TAG)
for Reducing Pre-eclampsia/Eclampsia (PE/E)
Background
One of the leading causes of maternal mortality and morbidity worldwide—preeclampsia/eclampsia (PE/E)— contributes to 12% of maternal deaths (>60,000
deaths annually)1. It also causes an increased risk of perinatal mortality.
There are three ways to address PE/E and save the lives of women and their babies:
1. Preventing PE/E in
Pregnant Women
(Primary
Prevention)
The World Health Organization (WHO) has identified
calcium as one of the most effective and low-cost
intervention among pregnant women for prevention of
PE/E in a calcium-deficient setting such as Nepal. Use of
calcium was found to reduce the incidence of PE/E by
almost 65% (Atallah et al, 2006).
2. Early Detection of
PE/E (Secondary
Prevention)
Pre-eclampsia can be detected before symptoms appear by
screening pregnant women for high blood pressure
(diastolic blood pressure is above 90) and detecting protein
in urine. Regular screening of blood pressure and urine is
not performed and appropriate screening tools are not
readily available for use in low-resource settings.
3. Managing and
Treating PE/E
(Tertiary
Prevention)
WHO has identified magnesium sulfate as the most
effective and low-cost medication for treatment of
eclampsia.
In women with severe pre-eclampsia, magnesium sulfate
was found to reduce the occurrence of eclampsia by more
than 50% and maternal deaths by 46% (Duley et al, 2002).
To assist the government in developing technically-sound strategies to address
PE/E and implementing them at scale for public health impact, a technical advisory
group (TAG) focused on prevention, detection and treatment of PE/E.
TAG Role and Responsibilities
The role of this PE/E TAG will be to advise and ensure the overall technical
quality of prevention, detection and treatment strategies, approaches and
World Health Organization (WHO). 1994. Mother-baby package: Implementing safe motherhood in countries.
Geneva.
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interventions that are appropriate for the country context and incorporate
global evidence, emerging innovations and in-country experiences.
Specific responsibilities of this TAG will:

Review current policies, strategies and activities related to PE/E.

Identify missing information, data or research for better understanding of the
PE/E situation in the country.

Suggest appropriate and practical interventions for the country on the basis of
review and global best practices to reduce maternal morbidity and mortality due
to PE/E.

Develop strategies in coordination with other maternal and newborn health
activities to strengthen prevention, detection and treatment of PE/E

Support the Ministry of Health to implement new strategies in the following
phases:
o Develop an implementation plan and strategy to design the appropriate
interventions for primary, secondary and tertiary prevention from
community to facilities including all relevant issues (such as activities,
logistics/procurement, coverage, costs and monitoring indicators) and
timeline
o Conduct research studies, as needed
o Develop phase-wise plan for national scale-up for larger or national
coverage
o Implement the interventions in phase-wise manner according to the scaleup plan to achieve public health impact utilizing government and
community-based systems to reach the maximize numbers of women
o Monitor and support implementation—including a mid-term review of
progress, documentation of lesson learned, emerging evidence and
challenges
o Share in different national level forums

Provide a forum to address issues related to PE/E, in consultation with incountry stakeholders and development partners as needed.
TAG Membership and Composition
Advisor:
Chair:
General Secretary:
Members:
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1.
2.
3.
4.
5.
6.
Various MOH officials
Representative, UNICEF
Representative, USAID
Representative, WHO
Representative, UNFPA
Representative, DFID
The TAG will lead strategy development, implementation, M&E and related
research. It will ensure PE/E efforts are developed and implemented to coordinate
with and maximize related maternal, neonatal and child health and nutrition
efforts with other divisions and ministries. Because the nature of this TAG is to
gather evidence-based practice to advise MOH on priorities, appropriate strategies
and interventions from international experience in the country context, the TAG
will be open to involving additional technical advisors, visiting technical experts
and other government officials as and when available.
TAG Meeting Frequency
The PE/E TAG will meet quarterly or as frequently as needed to coordinate all
PE/E-related activities.
TAG meetings will be scheduled by the Chair and communicated to TAG members
with an agenda and supporting documents in advance of meetings. TAG meetings
will be minuted, and meeting notes will be shared with members. The TAG will
designate point people and a system for routine communication as needed.
Deliverables
1. TAG meeting minutes documenting discussion, recommendations and next steps
2. Recommended PE/E research topics, strategies and implementation plan to
MOH
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