Abstract

Background: Pre-eclampsia is a systematic syndrome that occurs in 2 to 8% of pregnant women and remains a leading cause of maternal and perinatal morbidity and mortality worldwide. Diagnosis is classically based on new-onset hypertension and proteinuria after 20 weeks of gestation and prior to 48 hours postpartum.

Objectives: The aim of this study is to determine the knowledge of preeclampsia and its Associated Risk Factors amongst Pregnant women in the Limbe Health District.

Methods: This was a hospital-based cross-sectional study using a Descriptive quantitative method. A Simple Random probability sampling method was used. Data was collected using questionnaires. Data were obtained from pregnant women who attended ANC visits at the Regional hospital Limbe, Bota District Hospital, and the integrated health Center (PMI) Down beach Limbe from May 1st, 2021 to June 1st, 2021.  Data was kept and analyzed by the use of SPSS version 23.0.

Results: 100 pregnant women attending ANC in 3 selected hospitals in the Limbe Health District. Of the 100 pregnant women sampled, 35 (35.0%) were aged 25 – 30 years old, 48 (48.0%) were businesswomen and 60 (60.0%) had attended secondary school. The majority of the pregnant women were either married (67.0%) or were Christians (94.0%).

The signs and symptoms of preeclampsia were protein in the urine (51.0%), persistent headache (35.0%), blurred vision (34.0%), and edema (25.0%).

The reported complications of preeclampsia were maternal death (69.0%), fetal death (56.0%),  heart disease (45.0%), and premature birth (22.0%). The ways of preventing preeclampsia were regular exercise (37.0%), routine blood pressure check (29.0%), and healthy dieting (20.0%). The mean knowledge score of the pregnant women on preeclampsia was 4.42 (SD=0.23) on a scale of 17. Of the 100 pregnant women, 26 (26.0%) had adequate knowledge on preeclampsia.

The main factors associated with preeclampsia were underlying conditions like diabetes (36.0%), first pregnancy (35.0%), maternal age (30.0%), ethnicity (30.0%), and multiple births (25.0%). Educational level and profession were significantly associated with adequate knowledge of pregnant women on preeclampsia. The pregnant women who had attended university (56.3%) were significantly (p = 0.011) more knowledgeable on preeclampsia. Employed pregnant women (71.4%) were significantly (p = 0.025) more knowledgeable on preeclampsia compared to their unemployed counterparts (10.5%).

Conclusion: The knowledge of pregnant women on preeclampsia in the Limbe Health District was poor or inadequate. The knowledge of pregnant women on the risk factors associated with preeclampsia in the Limbe Health District was poor or inadequate. Being educated and employed were significantly associated with adequate knowledge on preeclampsia among pregnant women in the Limbe Health District.

CHAPTER ONE

INTRODUCTION

1.1 Background

Pre-eclampsia is a systematic syndrome that occurs in 2 to 8% of pregnant women and remains a leading cause of maternal and perinatal morbidity and mortality worldwide. Diagnosis is classically based on new-onset hypertension and proteinuria after 20 weeks of gestation and prior to 48 hours post-partum.

Preeclampsia(PE) is a pregnancy-associated multisystem disorder with no definite etiology. Preeclampsia is a human pregnancy-specific disease defined as the occurrence of hypertension and significant proteinuria in a previously healthy woman or after the 20th week of gestation. It is the most common medical complication of pregnancy[1,2].

The hypertensive disorders of pregnancy include; hypertension that antedates pregnancy, chronic hypertension, and gestational hypertension occurring uniquely during pregnancy. When gestational hypertension is accompanied by new-onset proteinuria, the disorder is termed preeclampsia and when not associated with proteinuria, transient hypertension of pregnancy.

If the woman with chronic hypertension also manifests evidence of preeclampsia, this is classified as chronic hypertension with superimposed preeclampsia. Eclampsia is the occurrence of seizures in women with preeclampsia [2,3]

Preeclampsia is thought to occur in two stages: The first stage encompasses the impairment of fetal trophoblastic invasion of the deciduous and local placenta. The second stage is the release of placental blood-related factors into the maternal circulation and aberrant expression of pro-inflammatory, antiangiogenic, and angiogenic factors[4].

Understanding the mechanism of disease responsible for the syndrome of preeclampsia as well as early risk assessment is still a major challenge. Risk factors for PE are; nulliparity, a family history of PE, pre-existing diabetes or increased body mass index, multiple pregnancies, maternal age, renal disease, hypertension or raised blood pressure at booking, and chronic autoimmune disease.

Other factors are thrombophilia and insulin resistance together with obesity [3].

Women treated for pre-eclampsia also have an increased risk for cardiovascular and renal disease due to residual and or progressive effects of endothelial damage from preeclampsia and cardiac disease [2]. The disorder is diagnosed by gestational hypertension and proteinuria but is far more than pregnancy-induced hypertension. The disorder affects both mothers and their families.

Preeclampsia/Eclampsia is one of the most common causes of maternal and perinatal morbidity and mortality in low and middle-income countries. Globally preeclampsia is responsible for approximately 50,000 maternal deaths worldwide annually out of which 25% of cases are due to intrauterine growth restrictions (IUGR) and 15% are outcomes of preterm birth in developed countries [6].

In developing countries, where inadequate prenatal care limits preeclampsia surveillance, maternal mortality is common [3]. In Africa, more than 270,000 women die from maternal deaths. Preeclampsia occurs in 10% of pregnancies which is significantly higher than the global average of approximately 2%[6]. In Cameroon, hypertension in pregnancy occurs in 7.7 to 8.2%, and in the southwest region, the prevalence of hypertension in pregnancy was 5.02% and maternal Mortality was estimated at 1887/100,000 live births [7].

For the purpose of clinical management, any woman with an acute rise in blood pressure in the latter half of pregnancy must be regarded as having preeclampsia with the possibility of progression to eclampsia and pregnant women with a diastolic blood pressure of 105 to 110mmHg or higher should receive antihypertensive medication[5].

Rationale of the study

This study aims at bringing out the knowledge level of preeclampsia and the factors associated with knowledge adequacy amongst pregnant women at the Limbe Health District.

1.2 Statement Problem

Despite the increasing prevalence of PE in Cameroon, the proportion of women with adequate knowledge on the signs and symptoms, risk factors complications, and prevention is not known in the Limbe Health District.

1.3 Justification

Adequate knowledge about a disorder contributes greatly to its prevention, control, and management. Reports indicate that patient’s knowledge about a disease has significant benefits on compliance to treatment and helps to abate complications associated with the disease (6).

While knowledge of preeclampsia and its associated factors has been studied worldwide, in Africa,  and in Cameroon, It has not been widely studied in the South West Region of Cameroon most especially in the Municipality of Limbe[7].

One major hurdle in combating PE is the late reporting of women to healthcare centers following an experience of a sign or symptom. PE is a disease of signs and symptoms which requires prompt attention. Equipped with knowledge, women experiencing PE would report early to the hospital, receive timely medical intervention and have fewer adverse outcomes. This emphasizes the need for women to have adequate knowledge of the disease.

1.4 Research Questions

1. What is the knowledge level of preeclampsia of pregnant women in the Limbe Health District?
2. What are the symptoms, complications, and risk factors of preeclampsia among Pregnant in the Limbe Health District?
3. What are the factors associated with knowledge adequacy amongst pregnant women in the Limbe Health District?