Knowledge Of Hypertensive Disorders Of Pregnancy Among Pregnant Women Attending Antenatal Clinic

Project and Seminar Material for Nursing (Science)

Abstract

This study was carried out to assess the knowledge of hypertensive disorders of pregnancy among pregnant women attending antenatal clinic. The survey design was adopted and the simple random sampling techniques were employed in this study. The population size comprise of mothers and pregnant women in Maiduguri. In determining the sample size, the researcher conveniently selected 70 respondents and all were validated. Self-constructed and validated questionnaire was used for data collection. The collected and validated questionnaires were analyzed using frequency tables, and mean scores. The result of the findings reveals that the rate at which hypertension is prevalent in pregnant women is very high. The study also revealed that the factors that leads to hypertension in pregnant women include; obesity, a family history of hypertensive disorders, alcohol intake, heart failure, stroke and left ventricular hypertrophy and smoking. It was further discovered that the effects of hypertensive disorders in pregnancy include; decreased blood flow to the placenta, low birth weight, premature birth, and Pre-eclampsia. To mention but a few. Therefore, it is recommended that primary care physicians should effectively assume their role so as ensure the early identification and management of hypertensive disorders during early antenatal care. And pregnant women should endeavour to seek for the services of a physician when having hypertensive disorders, and not rely on self medication and traditional treatments.

Table of Content

Title Page
Certification
Dedication
Acknowledgement
Table of Content
List of Tables
Abstract

Chapter One:

Introduction

1.1 Background of the Study
1.2 Statement of the Problem
1.3 Objective of the Study
1.4 Research Questions
1.5 Research Hypothesis
1.6 Significance of the Study
1.7 Scope of the Study
1.8 Limitation of the Study
1.9 Definition of Terms
1.10 Organisations of the Study

Chapter Two:

Review of Literature

2.1 Conceptual Framework
2.2 Theoretical Framework
2.3 Empirical Review

Chapter Three:

Research Methodology

3.1 Research Design
3.2 Population of the Study
3.3 Sample Size Determination
3.4 Sample Size Selection Technique and Procedure
3.5 Research Instrument and Administration
3.6 Method of Data Collection
3.7 Method of Data Analysis
3.8 Validity of the Study
3.9 Reliability of the Study
3.10 Ethical Consideration

Chapter Four:

Data Presentation and Analysis

4.1 Data Presentation
4.2 Analysis of Data
4.3 Answering Research Questions
4.4 Test of Hypotheses

Chapter Five:

Summary, Conclusion and Recommendation

5.1 Summary
5.2 Conclusion
5.3 Recommendation
References
APPENDIX
QUESTIONNAIRE

Chapter One

Introduction

1.1 Background of the Study

In 2013 almost 300,000 maternal deaths occurred worldwide of which majority (62%) were from Sub-Saharan Africa (Duckitt et al., 2017). HDP refers to group of Hypertensive disorders of pregnancy represent group of disorders related to high blood pressure they include preeclampsia, eclampsia, gestational hypertension, and chronic hypertension. Globally this condition account for 10 % of all pregnancies. According to the studies done in Africa maternal death due to HDP was around 9.1 %. In Ethiopia 19% of deaths were linked to Hypertensive disorder of pregnancy., making it a major public health (Sibai et al., 2014).

The most serious consequences for the mother and the baby results from preeclampsia and eclampsia (Gaugler et al., 2014). Several studies estimated that that 9.1 % of maternal deaths in Africa are due to HDP (Steegers et al., 2010). HDP has remain main cause for maternal mortality and morbidity for last several decades. In addition, the exact cause of the condition is still unknown (Berg et al., 2014). The problems associated with HDP are still affecting the health of the mother and the foetus as well. The course of the medical condition of mother with HDP is depend on the seriousness of the disease process (Saucedo et al., 2013).

Preeclampsia is the commonest cause of maternal mortality in developing country which ranges from 1.8% to 16.7% (Asamoah et al., 2011). According to study carried out in South Africa the occurrence of HDP approximated 9.8%. (Gaym et al., 2011). Among all maternal deaths in developing country preeclampsia accounts 40%-60 % (Duckitt et al., 2017). In the globe HDP is the leading cause of maternal mortality especially in poor countries (Nilsson et al., 2015)

According to various study conducted there are different risk factors of HDP. Among them population growth is the main factor, also null-parity, extreme ages and behavioural risk factors like: unhealthy diet, hurtful use of alcohol, deficiency of physical exercise, overweight and sustained stress (Xiang et al., 2012). Even though there is reduction in the rate HDP in the country, it remains a common pregnancy related cause of maternal death in Ethiopia (Dawson et al., 2013). Hypertensive disorder of pregnancy is related with maternal mortality and morbidly in Ethiopia (Otieno, 2013).

Hypertensive disorder in pregnancy is a condition in which the pregnant woman presents an elevated blood pressure during pregnancy or puerperium as defined in 1986 by the American College of Obstetricians and Gynecologists and adopted by the World Health Organization (WHO) (Malik, Yoshida, Erkin, Salim, & Hamajima, 2016). Previous reports defined hypertension in pregnancy as a condition presented with a diastolic blood pressure of at least 90 mmHg or a systolic blood pressure of at least 140 mmHg, or a rise in diastolic blood pressure of at least 15 mmHg or a rise of 30 mmHg in systolic blood pressure. In the obstetric condition, the Working Group recently defined hypertension in pregnancy as a condition in which, the diastolic blood pressure is at 90 mmHg or above, or a systolic blood pressure is at 140 mmHg or above. Moreover, WHO considers only an elevated value of diastolic blood pressure as a criterion for defining the disorder. The disorder complicates 4-10% of pregnancies(Malik, Yoshida, Erkin, Salim, & Hamajima, 2016). The American College of Obstetricians and Gynecologists and the United Nations Organization recognize four categories of hypertension in pregnancy. These include chronic hypertension, gestational hypertension, preeclampsia/eclampsia, and super-imposed preeclampsia/eclampsia, a condition defined as chronic hypertension complicated by pre-eclampsia/eclampsia.

1.2 Statement of the Problem

HDP is a public health problem globally (Cunningham et al., 2014). Maternal mortality rate related to pregnancy is one in four thousand and one in ten thousand in developed country, whereas one in fifteen and one in fifty in low come country. (Gandhi et al., 2014). The study conducted in 2015 shows that, MMR was 546/ 100,000 live birth in most SSA (Dekker et al., 2016). Globally HDP accounts 10% of all pregnancies (Khan et al., 2006). Among this around 40,000 women, mostly from developing.

HDP accounts for 19% of maternal death in Ethiopia (Sibai et al., 2014). Study done in Ethiopia on 112 hospitals and 685 health centres showed that 1.2 percent of all institutional deliveries were complicated by preeclampsia or eclampsia (Wolde et al., 2011). The cause-specific case fatality rate is 3.6 percent. Current EDHS 2016 reports maternal mortality ratio is 412; preeclampsia or eclampsia contributes about 19% of maternal deaths (Campbell et al., 2014).

High blood pressure during pregnancy can impact the body in different ways than it normally would. Mothers with high blood pressure during pregnancy are at a higher risk of complications before, during and after the birth. Not only is the mother’s health in danger, but the baby can be impacted by high blood pressure during pregnancy (Dawson 2018).

High blood pressure during pregnancy can affect the development of the placenta, causing the nutrient and oxygen supply to the baby to be limited. This can lead to an early delivery, low birth weight, placental separation (abruption) and other complications for the baby.

1.3 Objectives of the Study

The primary objective of this study is to examine the knowledge of hypertensive disorders of pregnancy among pregnant women attending antenatal clinic.

Specifically, other objectives of this study are:

To determine the rate at which hypertensive disorders is prevalent in pregnant women.
To examine if pregnant women have knowledge on the management of hypertensive disorders.
To determine the factors that leads to hypertensive disorders in pregnant women.
To examine the effects of hypertensive disorders in pregnancy.
To proffer ways in which hypertensive disorders in pregnant women can be prevented.

1.4 Research Questions

The following research questions will be answered in this study:

What is the the rate at which hypertensive disorders is prevalent in pregnant women
Do pregnant women have knowledge on the management of hypertensive disorders?
What are the factors that leads to hypertensive disorders in pregnant women?
What are the effects of hypertensive disorders in pregnancy?
What are the ways in which hypertensive disorders in pregnant women can be prevented?

1.5 Significance of the Study

The study will be significant to ministry of health as this will expose them to the need of creating awareness on hypertensive disorders and also training health care personnel on knowledge, practice and attitude of patients and how to treat and handle patients especially pregnant women with hypertensive disorders.

This study will be significant to the academic community as it will contribute to the existing literature.

1.6 Scope of the Study

This study focuses on the knowledge of hypertensive disorders of pregnancy among pregnant women attending antenatal clinic. Specifically, this study focuses on determining the rate at which hypertensive disorders is prevalent in pregnant women, examining if pregnant women have knowledge on the management of hypertensive disorders, determining the factors that leads to hypertensive disorders in pregnant women, examining the effects of hypertensive disorders in pregnancy and proffering ways in which hypertensive disorders in pregnant women can be prevented. Selected pregnant women in Maiduguri in Borno State will serve as the respondents for the survey of this study.

1.7 Limitations of the Study

In the course of carrying out this study, the researcher experienced some constraints, which included time constraints, financial constraints, language barriers, and the attitude of the respondents. However, the researcher were able to manage these just to ensure the success of this study.

Moreover, the case study method utilized in the study posed some challenges to the investigator including the possibility of biases and poor judgment of issues. However, the investigator relied on respect for the general principles of procedures, justice, fairness, objectivity in observation and recording, and weighing of evidence to overcome the challenges.

1.8 Definition of Terms

Prevalence:

In epidemiology, prevalence is the proportion of a particular population found to be affected by a medical condition at a specific time.

Hypertensive Disorders:

A condition in which the force of the blood against the artery walls is too high. Usually hypertensive disorders is defined as blood pressure above 140/90, and is considered severe if the pressure is above 180/120. High blood pressure often has no symptoms. Over time, if untreated, it can cause health conditions, such as heart disease and stroke. Eating a healthier diet with less salt, exercising regularly and taking medication can help lower blood pressure.

Pregnant Women:

Pregnant woman means a woman determined to have one or more embryos or fetuses in utero.

1.9 Organizations of the Study

The chapter one consist of the introductory part of the study which includes the study background, the statement of the research problem, the study objective and scope of the study. The second chapter is a critical review of other literatures relevant to the study and its objectives including the theoretical framework for the study. While the third chapter is methods of data collection, sampling and data analysis used in conducting the study. The fourth chapter centres around the research findings including an analysis of how it relates to previous findings. The fifth chapter consists of the summary of findings, conclusion and recommendations base on the study objectives.

Chapter Five

Summary, Conclusions and Recommendations:

5.1 Introduction

This chapter summarizes the findings on the knowledge of hypertensive disorders of pregnancy among pregnant women attending antenatal clinic. The chapter consists of summary of the study, conclusions, and recommendations.

5.2 Summary of the Study

In this study, our focus was on the knowledge of hypertensive disorders of pregnancy among pregnant women attending antenatal clinic.

The study is was specifically set to determine the rate at which hypertension is prevalent in pregnant women; examine if pregnant women have knowledge on the management of hypertension; determine the factors that leads to hypertension in pregnant women; examine the effects of hypertension in pregnancy; and proffer ways in which hypertension in pregnant women can be prevented.

The study adopted the survey research design and randomly enrolled participants in the study. A total of 100 responses were validated from the enrolled participants where all respondent are mothers and pregnant women in Maiduguri.

5.3 Conclusions

In the light of the analysis carried out, the following conclusions were drawn.

The rate at which hypertension is prevalent in pregnant women is very high.
Pregnant women have knowledge on the management of hypertension.
The factors that leads to hypertension in pregnant women include; obesity, a family history of hypertension, alcohol intake, heart failure, stroke and left ventricular hypertrophy and smoking.
The effects of hypertension in pregnancy include; decreased blood flow to the placenta, low birth weight, premature birth, and Pre-eclampsia.
The ways in which hypertension in pregnant women can be prevented are the use of salt as needed for taste, drinking at least 8 glasses of water a day, increasing the amount of protein you take in, and decrease the number of fried foods and junk food you eat, getting enough rest, exercising regularly, and elevating your feet several times during the day.

5.3 Recommendation

With respect to the findings and the aim of this study, the researchers therefore recommend that;

Primary care physicians should effectively assume their role so as ensure the early identification and management of hypertension during early antenatal care.
Pregnant women should endeavour to seek for the services of a physician when having hypertension, and not rely on self medication and traditional treatments.
The strategies outlined above on how hypertension can be managed should be effectively put into practice.