KNOWLEDGE, ATTITUDE AND PRACTICES IN LINE WITH THE PREVENTION OF HYPERTENSION IN PREGNANCY AMONG PREGNANT WOMEN AT THE LIMBE REGIONAL HOSPITAL

Abstract

Hypertension in pregnancy or pregnancy-induced hypertension (PIH) is a gestational hypertensive disorder. It is the commonest medical complication encountered in pregnancy. An estimate shows that globally 6-8% of pregnancies are complicated by hypertension and this disorders account for 10-15% of all maternal deaths.

The main objective of this study was to assess knowledge, attitude and practices in line with prevention of hypertension in pregnancy amongst pregnant women at the Limbe Regional Hospital. The study adopted Orem’s self-care model as the theoretical framework.

A descriptive cross-sectional survey design and the convenience sampling technique were adopted. The sample size was 80 from a population of 95, determined following the Cochran formula. A self-administered structured questionnaire was used as the main instrument for data collection with a return rate 100%.

The data was processed with Microsoft excel 2010 and SPSS 25.0 and presented in tables and figures. The major findings on the causes showed that majority (72.5%) of the respondents believe that stress is the main cause of PIH. The mean knowledge score of the pregnant women on pregnancy induced hypertension was 5.11 on 12.

Of the 80 pregnant women sampled, 34 (42.5%) had adequate knowledge  35 (43.8%) had a positive attitude,and97.5% were for the fact that stress avoidance is the best prevention for hypertension in pregnancy.

The above result shows that the respondents have inadequate knowledge and attitudes towards PIH. The main practices in line with prevention of PIH were avoiding stress and regular ANC visit.  Recommendations were made to health workers in health centers and hospitals to educate pregnant women on PIH during ANC and to the Ministry of Health to organize seminars to educate health workers.

CHAPTER ONE

INTRODUCTION 

This chapter presents the background of the study, problem statement, objectives, research questions, significance of the study, the scope of study and operational and contextual definitions of terms.

1.1 Background

The most delicate period in the lives of women in child bearing age which is when they are pregnant. During pregnancy, women face a lot of complications that are threats to their lives and their unborn babies. One such medical condition that poses a serious threat to the life and health of pregnant women is pregnancy-induced hypertension (Adeloye et al., 2016). This complication is made worst especially when many of these women have little or no knowledge about the complication, and how to prevent or manage it, leading to an increase in the mortality rate among pregnant women.

According to the American college of obstetricians and gynaecologists in 1986, hypertensive disorders in pregnancy is a condition in which the pregnant woman presents elevated blood pressure during pregnancy or puerperium. This definition was also adopted by the World Health Organization (WHO,2016).  Previous reports defined hypertension in pregnancy as a condition presented with a diastolic blood pressure of at least 90 mmhg, or a rise in systolic blood pressure of at least 140 mmhg, or a rise in diastolic blood pressure of at least 15mmhg or a rise in systolic blood pressure of at least 30 mmhg

Hypertension in pregnancy or pregnancy induced hypertension (PIH) is a complication that results in the development of hypertension after about twenty weeks of gestation in a woman who had previously been normotensive (Oyeyemi et al., 2015). It often manifests through blood pressure readings higher than 140/90 mm Hg, edema, protein in the urine, severe headaches, blurry vision, spots in the eyes, severe pain over the stomach, under the ribs and decrease in the amount of urine (James et al., 2000  Oyeyemi et al., 2015).This health complication (hypertension in pregnancy) can either be gestational hypertension, pre-eclampsia and eclampsia and can be diagnosed when, after resting, the woman’s diastolic blood pressure rises 25mmHg above the basal blood pressure recorded early in pregnancy or when the blood pressure rises above 140/90mmHg, on at least two occasions, four hours or more apart after the 20th week of pregnancy in a woman known to be normotensive (Fraser, et al., 2003).

With regards to the factors that triggers hypertension in pregnancy, several studies such as (Oyeyemi et al., 2015,Adeloye et al., 2016) have identified obesity, a family history of hypertension (genetic), alcohol intake, heart failure and smoking, not having adequate knowledge of the condition, carrying multiple pregnancy, having kidney disease before pregnancy, being a teenager and being over 40 years to be the factors triggering pregnancy induced hypertension. This complication has severe effects such as chronic hypertension, kidney failure, nervous system disorders that can eventually lead to death, cause premature delivery, fetal growth retardation, abruption placenta and fetal death, maternal mortality, morbidity and disability.

The World Health Organization (WHO 2016) estimates that at least one woman dies every seven minutes from complications of hypertensive disorders of pregnancy (Dadelszen et al., 2008 Bouthoorn et al., 2012; ). It is estimated that globally 6-8% of pregnancies are complicated by hypertension and this disorders accounts for 10-15% of all maternal death in developing as well as some developed countries, namely18% in United States (Bennet et al., 2006; Rathet al., 2009). In addition, between 2012 and 2018, complications of HPD (preeclampsia and eclampsia) account for 18.4% (9 out of 49) of direct maternal death in Australia (Ouasmani et al., 2018).

Furthermore, the risk of women in developing countries dying from a maternal related complication such as pregnancy induced hypertension during their life time is about 33 times higher compared to women in the developed country (Say et al., 2014). This is because women in the developing countries have inadequate knowledge on their health status. Recent evidence suggests that the high maternal mortality rate in developing countries is as a result of inadequate knowledge, negative attitude and lack of preventive practice on the part of the pregnant women who have strong traditional beliefs (Olusanya et al., 2012). This can be backed by a recent study carried out at the Maroua regional  Hospital that revealed that hypertension in pregnancy was the first cause of maternal death recorded between 2003 and 2005 (Oyeyemi et al., 2015).

Taking into consideration the fact that Mile 16 (Buea) is found in the South-West Region of Cameroon, one of the developing countries in the world where pregnant women are generally considered to have inadequate knowledge on pregnancy-induced hypertension and other health complications which makes it a call for concern, it is our duty as health workers and researchers to breach this gap. As such, this study seeks to assess knowledge causes, attitudes, complications and practice in line with the prevention of hypertension in pregnancy among pregnant women in the mile 16 community area health a Buea.

1.2 Problem Statement

Early initiation of antenatal care visits is an essential component of services to improving maternal new born health. The Cameroonian Demographic and health survey conducted in 2011 indicated that, only 34% of pregnant women start ANC in the first trimester.

Pregnancy-induced hypertension is one of the many complications that makes the pregnancy period in women delicate. Deaths in 2015, globally, the maternal mortality rate (MMR) fell by nearly 44% over the past 25years, to an estimated 216 maternal deaths per 100,000 live births in 2015. Developing regions accounted for approximately 99% of this estimated global maternal deaths, with sub-Saharan Africa, alone accounting for roughly 66%.

This report estimates MMR in Cameroon at 596 maternal deaths per 100,000 live births (WHO et al, 2016) This is a complication that has been recognized by renowned health organizations such as the World Health Organization (WHO), the Center for Disease Control and Prevention (CDC) amongst many other researchers who have all portrayed hypertension in pregnancy as a major cause of maternal mortality across the globe.

However, the mortality rate differs across the globe with lower rates in the developed world and higher rates in developing countries where Cameroon (Buea) is found. This disparity in the prevalence is largely blamed on the level of awareness among women on such complications where women in developing countries (Cameroon, Buea) inclusive are considered to have inadequate knowledge, poor attitudes and preventive strategies of PIH.

Based on the above facts, it is our duty as health workers and researchers to breach this gap by improving the awareness on the knowledge of hypertension in pregnancy among pregnant women and women in the child bearing age in mile16 community buea . As such, this study seeks to assess theknowledge, causes, altitude, complications and practice in line with prevention of hypertension in pregnancy at the mile16 community Buea.

I.3 Rationale (Justification of the Study)

This study examines basically the knowledge, causes, altitudes, complications and practice in line with prevention of hypertension in pregnancy among pregnant women in the mile16 community health area Buea.

This is an ideal topic because a pregnant woman die every 7minutes due to hypertension, 6 – 8% of pregnancies are affected by it 10 – 15% of maternal deaths is due to PIH (Brown et al., 2001  Bennet et al., 2006; Rath et al., 2009; Dadelszen et al., 2008). As such, it is our duty as health workers to assist the public and pregnant women on this issue so as to reduce the infant and maternal mortality rates in our communities.

1.6 Objectives

1.6.1 General objective

The main objective of this project is to assess the knowledge, causes, attitude complications and practice in line with the prevention of hypertension in pregnancy among Pregnant Women in the mile16 community health area Buea.

1.6.2. Specific Objectives

1. To assess the level of knowledge regarding hypertension in pregnancy amongst pregnant women in mile16 community health area Buea have on hypertension in Pregnancy.
2. To determine the attitude of pregnant women in the mile16 community health area Buea have regarding hypertension in pregnancy.
3. To identify the causes, complications and practices in line with the prevention of hypertension in pregnancy among pregnant women in the mile16 community of Buea.