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PREVALENCE AND ASSOCIATED FACTORS OF PRE-ECLAMPSIA AMONG PREGNANT WOMEN ATTENDING ANTENAL CARE

ABSTRACT

Women die from a wide range of complications in pregnancy, childbirth or after delivery, and amidst these complications is pre-eclampsia, which is one of the major causes of maternal death and disability in Nigeria. To improve maternal health, barriers that limit access to quality maternal health services must be identified and addressed for any intervention program to be effective. The objective of the study was to investigate the factors associated factors regarding pre-eclampsia among pregnant women attending antenatal centres in Sagamu, Ogun State, Nigeria.

The study design was cross-sectional, utilizing a pre-tested 42-item questionnaire (Cronbach’s alpha of 0.81) to collect information about knowledge regarding pre-eclampsia, perceived susceptibility, seriousness, and perceived benefits of good health care-seeking behaviour among pregnant women attending maternity centres in Sagamu, Ogun State, Nigeria. Four hundred participants recruited from eight antenatal centres in randomly selected eight communities in Sagamu, participated in the study. Pearson’s bivariate correlation was used to examine relationships between independent and dependent variables while multiple regression was adopted to test for the hypothesis.

Results showed that Knowledge about pre-eclampsia as an important pregnancy complication measured on a 16-point scale recorded a mean score of 6.82 (±3.53) and perception of pre-eclampsia considered in three sub-domains of susceptibility, seriousness and benefit, measured on a 30-point scale, similarly recorded a mean score of 13.41 (±5.39); while health care-seeking behavior, measured on a 30-point scale, showed that participants in the study recorded a mean scored of 9.96 (±8.11). Knowledge about pre-eclampsia was below average (42.6%), perceived susceptibility, seriousness and benefit measured was 39.3%, 50.7%, and 49% respectively, as well as their health care-seeking behaviour (33.2%). There is a significant relationship between the variables and health care-seeking behaviour regarding pre-eclampsia (P=0.0001). However, perception domain regarding pre-eclampsia predicts health care-seeking behaviour more significantly (R – 0.57 = 57%; R² = 0.33; F-value = 194.44; β = 0.86; P-value = 0.0001 < 0.0005)

In conclusion, there is poor health care-seeking behaviour among respondents regarding pre-eclampsia in the study area which according to the finding, is as a result of low level of knowledge about the disease with low perception level about the condition. Therefore, in order to correct this, there should be an aggressive health promotion intervention designed to empower women with the required knowledge and thereby, increasing their perception level regarding pre-eclampsia, especially perceived susceptibility to pre-eclampsia, that will prompt good health care-seeking behaviour. This will in turn make future interventions effective.

 

CHAPTER ONE

 INTRODUCTION

1.1       Background to the Study

Pregnancy and delivery for most women, include physiological and psychosocial changes in the body constituting a major life event. Pregnancy throughout the world is regarded as a perfect normal stage, mile stone to motherhood, and a moment of celebration. However to many, especially in the developing Countries, it is a moment of sadness, pain, disability, and death (Zhianian, Zareban, Ansari, & Rahimi, 2015).

Globally, approximately 830 women die from pregnancy or childbirth-related complications around the world every day and about 99% occur in developing countries (World Health Organization [WHO], 2015).Nearly 80% of the maternal deaths are caused by the five direct obstetric causes namely haemorrhage, hypertension, sepsis, obstructed labour and complications of abortion (WHO, 2015). Hypertensive diseases of pregnancy (pre-eclampsia and eclampsia) are considered to be common causes of maternal deaths world-wide, contributing to 18% of the deaths, being the second after haemorrhage as the most common cause of maternal deaths (WHO, 2015).Pre-eclampsia is one of the leading causes of maternal mortality and morbidity worldwide (WHO, 2014).

In both developed and developing countries, preeclampsia continued to be a significant public health issue contributing to maternal and perinatal mortality and morbidity. However, the effect of the disease is felt more severely in developing countries where, unlike hemorrhage and sepsis, medical interventions may be ineffective due to late presentation of pre-eclampsia cases (Osungbade & Ige, 2011).

In Nigeria, pre-eclampsia is one of the leading causes of maternal mortality and morbidity due to late presentation of women at hospital (Onakewhor & Gharoro, 2008). Furthermore, there are frequent severe cases of pre-eclampsia, following delays in identification/management at the community level and further delays in referral and transportation of women to higher facilities when necessary (Onakewhor & Gharoro, 2008).

 

 

The opinion pregnant women have toward the cause of their health problems varies, while some view it as a result of traditional black magic or spiritual attack, others have no clue of the cause of their health problem in their pregnant state. These opinion of theirs therefore have effect on their health care-seeking behaviour (Egbuniwe, Egboka, & Nwankwo, 2016). Furthermore, Martina and Franklin (2015), contributed that maternal and perinatal mortality and morbidity constitutes a major challenge around the world especially in the developing countries. These are associated with inappropriate health seeking behaviour during pregnancy (Martina & Franklin, 2015).

The Millennium Development Goals (MDGs) which was adopted by the international community in 2000, had ‘improving maternal health’, as one of the eight MDGs. Under MDG five, there have been compliance in reducing maternal mortality by 3 quarters between 1990 and 2015 globally. However, in 2015, despite the significant gains in reduction, an estimated 303,000 maternal deaths occur globally, representing a decline of only 43 % since 1990 (estimated 535,000 maternal deaths) and a similar reduction since the adoption of the MDGs in 2000,(estimated 529,000 deaths) which is still far from the target of 75 % reduction (WHO, 2015).In the Sustainable Development Goals, the achievement of the new targets which is to end preventable maternal and new-born mortality, will require universal access to improved delivery of evidence-based solutions for preventable maternal conditions, such as hypertensive disorders of pregnancy (Bhutta et al., 2014).

Utilization of health care facility by pregnant women include antenatal care (ANC), which is the care a pregnant woman receives during her pregnancy through a series of consultations with trained health care workers such as midwives, nurses, and sometimes a doctor who specializes in pregnancy and birth (Nigeria Demographic and Health Survey [NDHS], 2013). However, an analytical review of recent world health statistics showed that ANC coverage in Nigeria is low and is indirectly correlated with the high maternal mortality ratio recorded. The poor maternal health outcome in Nigeria could be a result of poor utilization of maternal health care services (WHO, 2014).

Most studies of pre-eclampsia (McClure, Saleem, Pasha, & Goldenberg, 2009; Osungbade & Ige, 2011; Shah, 2009) focus on management and treatment of preeclampsia, while few others focus generally on determinants of health care seeking behaviour in pregnancy (Akeju, et al., 2016; Furuta & Salway, 2006; Titaley & Dibley, 2010). However, understanding the individual perceptions, and modifying factors associated with health care-seeking behaviour of women regarding pre-eclampsia is critical in addressing this problembecause even though efforts to minimize and cure the complication of pre-eclampsia have been recorded, additional steps are need to be taken to achieve the preventive goal.

1.2       Statement of the Problem

Illness and death related to pregnancy and childbirth are significant health problems in the world especially in developing countries. Nigeria is among the countries with the greatest burden of maternal mortality in the world with 15% (45, 000) of global maternal deaths (Singh, Ahmed, Egondu, & Ikechukwu, 2015), and a high maternal mortality ratio of 814/100,000 live births was recorded for Nigeria (WHO, 2015).According to the United Nations Population Fund (UNFPA, 2016) this is equivalent to about one woman every two minutes and for every woman who dies 20 or 30 encounter complications with serious or long-lasting consequences.

Pre-eclampsia is a problem in Nigeria. A recent statistics carried out in Nigeria shows that, approximately 37, 000 women die annually due to pre-eclampsia and its complications (Adeosun, Ayebatonyo, Ogundahunsi, & Ogunlewe, 2015). In Sagamu, Ogun State, a high maternal mortality ratio of 7, 480/100,000 live births was recorded and pre-eclampsia contributed to about 60% of these deaths. (Olukoya & Sodipo, 2015)

Pre-eclampsia is associated with high risks of maternal complications such as abruption placenta, premature delivery, disseminated coagulopathy, pulmonary oedema, acute renal failure, eclampsia, liver failure, haemorrhage, and maternal death. It is also associated with higher risks of adverse perinatal outcomes such as low birth weight, intrauterine foetal growth restriction, hypoxia-neurologic injury and foetal death. Pre-eclampsia also impacts the social and economic life of a pregnant woman. In addition, infants who are born after a pregnancy complicated by preeclampsia are at increased risk of metabolic syndrome, stroke and cardiovascular disease later in life (Brown, et al., 2013; Raymond & Peterson, 2011).

The recognition of pre-eclampsia today is largely healthcare provider dependent, which as a result, the disease still remains essentially unpreventable. Low pre-eclampsia knowledge and lack of information on pre-eclampsia signs and symptoms are closely linked to delay in decision to seek care and ultimately compromises the survival of the mother and expected new-born because they have not understood the need to utilize health care facility for quality care (Adekanle, Adeyemi, Olowookere, & Akinleye, 2015).To improve maternal health, barriers that limit access to quality maternal health services must be identified and addressed at all levels of health system.

Therefore, the purpose of this study is to investigate individual perceptions, and modifying factors associated with health care-seeking behaviour regarding pre-eclampsia among pregnant women attending ANC in Sagamu, Ogun State, Nigeria, and to determine the extent to which their knowledge, perception of seriousness and susceptibility to pre-eclampsia may contribute to present situation of health care-seeking behaviour.

1.3       Objective of the Study

The main objective of this study is to investigate the factors associated factors regarding pre-eclampsia among pregnant women attending antenatal centres in Sagamu, Ogun State, Nigeria. The specific objectives are to;

1. Assess the level of knowledge of pregnant women in the study area about pre-eclampsia.
2. Determine the perceptions of pregnant women attending maternity centres in Sagamu Ogun State about pre-eclampsia.
3. Identify the factor regarding pre-eclampsia among pregnant women attending maternity centres in Sagamu, Ogun State.
4. Examine the relationship between knowledge of pre-eclampsia and health care-seeking behaviours for perceived pre-eclampsia among pregnant women attending maternity centres in Sagamu, Ogun State.
5. Examine the relationship between perceptions of pre-eclampsia and health care-seeking behaviours for perceived pre-eclampsia among pregnant women attending maternity centres in Sagamu, Ogun State.
6. Determine the variables that will predict the health care-seeking behaviour of pregnant women more significantly.

1.4       Research Questions

1. What is the level of knowledge about pre-eclampsia among pregnant women attending maternity centres in Sagamu Ogun State?
2. What is the perceptions of pre-eclampsia and its warning signs and symptoms among pregnant women attending maternity centres in Sagamu Ogun state?
3. What are the factor regarding pre-eclampsia among pregnant women attending maternity centres in Sagamu, Ogun State?
4. Is there a relationship between knowledge of pre-eclampsia and health care-seeking behaviours for perceived pre-eclampsia among pregnant women attending maternity centres in Sagamu, Ogun State?
5. Is there a relationship between perceptions of pre-eclampsia and health care-seeking behaviours for perceived pre-eclampsia among pregnant women attending maternity centres in Sagamu, Ogun State?
6. Which of the variables will predict the health care-seeking behaviour more significantly?