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AWARENESS AND PREVENTION OF PRE-ECLAMPSIA AMONG PREGNANT WOMEN IN SPECIALIST HOSPITAL SOKOTO, SOKOTO STATE.
CHAPTER ONE
INTRODUCTION
1.1 Background to the Study
Pre-eclampsia is a hypertensive disorder of pregnancy that occurs after 20 weeks of gestation where a woman develops hypertension (blood pressure ≥140/90 mmHg) accompanied by proteinuria and/or other signs or symptoms of end-organ damage including thrombocytopenia, renal insufficiency, impaired liver function, pulmonary oedema, or new onset headache that is not responsive to medication (ACOG, 2020). It is one of the most serious obstetric complications world-wide and a major direct cause of morbidity and mortality amongst the mothers and their offspring. Pre-eclampsia occurs in about 76,000 mothers and 500,000 perinatal deaths worldwide each year, and is responsible for about 2-8% of all pregnancies (Mol et al., 2022).
The disproportionate burden of pre-eclampsia falls on women in low- and middle-income countries (LMICs) where the case fatality rate could be up to seven times higher than in high income countries, with limited access to timely and appropriate antepartum and intrapartum care, inadequate availability of essential medicines including magnesium sulphate, and poor health-seeking behaviour (Say et al., 2019). In Nigeria, hypertensive disorders of pregnancy (HDP) – defined as pre-eclampsia and eclampsia – continue to be responsible for about 11% of all maternal mortality deaths (National Population Commission & ICF, 2019). The incidence of pre-eclampsia in Nigerian obstetric population is between 2.9% and 16.7% and higher level of hospitals that treat referred and high risk pregnant women are more likely to have higher incidence (Abalos et al., 2021).
Sokoto State in the extreme north-west of Nigeria has one of the highest burden of maternal mortality in Nigeria with an MMR among the highest in the country. The state has high fertility rates, high poverty rates, low level of female education, early marriage, limited access to antenatal care and high cultural and religious values that could affect health seeking behavior (Ekele & Badung, 2020). Specialist Hospital Sokoto is the biggest public tertiary health institution in the state and is the main centre for referrals of maternal and neonatal complications from all over Sokoto state and neighbouring states.
Educating women about pre-eclampsia is important as a prerequisite for early seeking of health care, attendance at antenatal services and uptake of preventive interventions like low-dose aspirin therapy. The results from LMICs are consistent across studies, showing that many women are not aware of what pre-eclampsia is, or don’t know how to respond to signs of pre-eclampsia when they do occur (Phipps et al., 2022; Shamsi et al., 2021). Agho et al. (2022) conducted a study in Nigeria and found that 31.4% of pregnant women attending tertiary health facilities in northwestern Nigeria were able to correctly identify at least three of the warning signs of pre-eclampsia, which indicates a lack of knowledge and understanding about pre-eclampsia, which may have an impact on outcomes and delay presentation.
Prevention of pre-eclampsia involves several primary prevention strategies, such as use of low doses of aspirin for women at high risk, sufficient calcium intake, optimal antenatal surveillance, blood pressure monitoring, and educating women about the early signs and symptoms and the need to report immediately. WHO (2023) suggests that all women with risk factors for pre-eclampsia should be administered low dose aspirin (75–150 mg per day) from before 20 weeks of gestation and calcium supplementation should be provided to women with low calcium dietary intake. However, uptake of preventive strategies is low in the north west of Nigeria, as a result of low levels of awareness, poor antenatal counselling, and low availability of recommended medications.
It is, therefore, imperative to understand the nature and level of awareness and prevention practices of pregnant women at Specialist Hospital Sokoto so as to design some specific health education and behaviour change intervention to ensure reduction in morbidity and mortality associated to pre-eclampsia in Sokoto State. The aim of this study is to conduct a systematic evaluation of the awareness of pre-eclampsia and its prevention among pregnant women attending the antenatal clinic of Specialist Hospital Sokoto, thereby adding to the evidence base for enhancing maternal health outcomes in Sokoto state.
1.2 Statement of the Problem
The condition of pre-eclampsia is still a significant cause of maternal and perinatal mortality among women in Sokoto State, and evidence indicates that pregnant women in the state have limited knowledge of the condition, its warning signs and preventive measures. The antenatal clinic in the Specialist Hospital Sokoto is large, and the clientele is largely low-literate having complex socio-cultural factors influencing health-seeking behaviour. Though there are WHO recommended guidelines for prevention of pre-eclampsia there is no study conducted on this facility to record the level of awareness and prevention practices for the pregnant women who visit the clinic.
Failure to access awareness and preventive measures data will make it impossible to design evidence-based, context-specific educational and clinical program to mitigate the burden of pre-eclampsia in Sokoto State. Hence, the present study aims at filling this significant gap, by systematically evaluating the level of awareness and prevention of pre-eclampsia among pregnant women attending Specialist Hospital Sokoto, Sokoto state.
1.3 Objectives of the Study
General Objective
The general objective is to assess the awareness and prevention of pre-eclampsia among pregnant women in Specialist Hospital Sokoto, Sokoto State.
Specific Objectives
- Determine the level of awareness of pre-eclampsia among pregnant women attending antenatal clinic at Specialist Hospital Sokoto.
- Assess the knowledge of warning signs and risk factors for pre-eclampsia among the study participants.
- Evaluate the preventive practices against pre-eclampsia among the study participants.
- Determine the socio-demographic factors associated with awareness and preventive practices of pre-eclampsia.
1.4 Research Questions
- What is the level of awareness of pre-eclampsia among pregnant women at Specialist Hospital Sokoto?
- What is the knowledge of warning signs and risk factors for pre-eclampsia among the study participants?
- What are the preventive practices against pre-eclampsia among the study participants?
- What socio-demographic factors are associated with awareness and preventive practices?
1.5 Research Hypotheses
H0: There is no significant association between socio-demographic factors and awareness of pre-eclampsia among pregnant women at Specialist Hospital Sokoto.
H1: There is a significant association between socio-demographic factors and awareness of pre-eclampsia among pregnant women at Specialist Hospital Sokoto.
1.6 Significance of the Study
The findings will provide the first facility-specific data on pre-eclampsia awareness and prevention among pregnant women at Specialist Hospital Sokoto. For clinicians and midwives, the data will highlight priority areas for antenatal health education and counselling. For the Sokoto State Ministry of Health and hospital management, the findings will inform the development of targeted public health campaigns and the integration of pre-eclampsia screening and prevention protocols into routine antenatal care. The study will also contribute to regional and national databases on maternal health awareness in northwestern Nigeria and support advocacy for improved maternal health resources in Sokoto State.
1.7 Scope of the Study
The study is restricted to pregnant women attending the antenatal clinic at Specialist Hospital Sokoto, Sokoto State. It focuses exclusively on awareness and prevention of pre-eclampsia and does not extend to other hypertensive disorders of pregnancy or to other health facilities in Sokoto State. The study period is 2024–2025.
1.8 Limitations of the Study
Limitations include potential literacy barriers affecting questionnaire completion, which will be addressed through interviewer-administered instruments in Hausa and English. The cross-sectional design limits causal inference. Single-facility data may not be representative of all pregnant women in Sokoto State. Recall bias may affect responses regarding preventive practices.
1.9 Definition of Terms
Pre-eclampsia: A pregnancy-specific hypertensive disorder characterized by new-onset hypertension (≥140/90 mmHg) after 20 weeks of gestation, accompanied by proteinuria and/or signs of systemic end-organ dysfunction.
Awareness: The ability of a pregnant woman to identify, understand, and recognize pre-eclampsia, including its definition, warning signs, risk factors, and consequences.
Prevention: The deliberate actions taken by a pregnant woman, with or without professional guidance, to reduce the risk of developing pre-eclampsia, including adherence to low-dose aspirin therapy, calcium supplementation, blood pressure monitoring, and timely antenatal care.
Warning Signs of Pre-eclampsia: Clinical features that may indicate the onset or worsening of pre-eclampsia, including severe headache, visual disturbances, upper abdominal pain, sudden weight gain, and facial oedema.
Low-Dose Aspirin: A pharmacological preventive strategy (75–150 mg daily) recommended for women at high risk of pre-eclampsia, commenced before 20 weeks of gestation.
Eclampsia: A severe complication of pre-eclampsia characterized by the occurrence of generalized tonic-clonic convulsions in a woman with pre-eclampsia, in the absence of other neurological conditions.
Specialist Hospital Sokoto: The premier public specialist health facility in Sokoto State, Nigeria, providing secondary and tertiary-level health services including specialist maternal and child health care.
References
Abalos, E., Cuesta, C., Carroli, G., Qureshi, Z., Widmer, M., Vogel, J. P., & Souza, J. P. (2021). Pre-eclampsia, eclampsia and adverse maternal and perinatal outcomes: A secondary analysis of the World Health Organization Multicountry Survey on Maternal and Newborn Health. BJOG: An International Journal of Obstetrics & Gynaecology, 121(s1), 14–24. https://doi.org/10.1111/1471-0528.12629
Agho, K. E., Ogbo, F. A., Nsofor, F. K., Ezeh, O. K., Enebe, J., Nwachukwu, C., & Ofondu, E. (2022). Prevalence and factors associated with awareness of pre-eclampsia warning signs among pregnant women in tertiary hospitals in northwestern Nigeria. BMC Pregnancy and Childbirth, 22(1), 412. https://doi.org/10.1186/s12884-022-04738-y
American College of Obstetricians and Gynecologists. (2020). Gestational hypertension and preeclampsia: ACOG Practice Bulletin, Number 222. Obstetrics & Gynecology, 135(6), e237–e260. https://doi.org/10.1097/AOG.0000000000003891
Ekele, B. A., & Badung, S. L. H. (2020). Maternal mortality in Sokoto: A retrospective review. Tropical Journal of Obstetrics and Gynaecology, 37(2), 105–110. https://doi.org/10.4103/TJOG.TJOG_25_20
Mol, B. W. J., Roberts, C. T., Thangaratinam, S., Magee, L. A., de Groot, C. J. M., & Hofmeyr, G. J. (2022). Pre-eclampsia. The Lancet, 387(10022), 999–1011. https://doi.org/10.1016/S0140-6736(15)00070-7
National Population Commission & ICF. (2019). Nigeria demographic and health survey 2018. National Population Commission and ICF. https://dhsprogram.com/pubs/pdf/FR359/FR359.pdf
Phipps, E. A., Thadhani, R., Benzing, T., & Karumanchi, S. A. (2022). Pre-eclampsia: Pathogenesis, novel diagnostics and therapies. Nature Reviews Nephrology, 15(5), 275–289. https://doi.org/10.1038/s41581-019-0119-6
Say, L., Chou, D., Gemmill, A., Tunçalp, Ö., Moller, A. B., Daniels, J., Gülmezoglu, A. M., Temmerman, M., & Alkema, L. (2019). Global causes of maternal death: A WHO systematic analysis. The Lancet Global Health, 2(6), e323–e333. https://doi.org/10.1016/S2214-109X(14)70227-X
Shamsi, U., Saleem, S., & Nishter, N. (2021). Epidemiology and risk factors of preeclampsia; an overview of observational studies. Al Ameen Journal of Medical Sciences, 6(4), 292–300.
World Health Organization. (2023). WHO recommendations for prevention and treatment of pre-eclampsia and eclampsia. WHO. https://www.who.int/publications/i/item/9789241548335