CHAPTER ONE

INTRODUCTION

1.1 Background

 The most delicate period in the lives of women, is child bearing 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 of such medical conditions that pose serious threat to the life and health of pregnant women, is pregnancy induced hypertension (Adeloye et al., 2016). When many of these women have little or no knowledge about the complication, how to prevent or manage it, may lead to an increase in the mortality rate among pregnant women. According to the American college of obstetricians and gynecologists in 1986, hypertensive disorders in pregnancy is a condition in which the pregnant woman presents an 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 twenty weeks of gestation in a woman who had previously been normotensive (Oyeyemi et al., 2015). It often manifests through blood pressure reading 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;Oyeyemiet 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 inability.

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; Rath et 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 in Cameroon carried out at the Maroua Regional  Hospital that revealed that hypertension in pregnancy was the first cause of maternal death recorded 17.5% between 2003 and 2005 (Tebeu  et al., 2011). Taking into consideration the fact that Regional hospital (Buea) is found in the South-West Region of Cameroon, a resource limited; developing country 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 assessment knowledge and attitudes towards hypertension in pregnancy among pregnant women at the Buea Regional Hospital

1.2 Problem Statement

This study examines basically the knowledge and attitude towards hypertension in pregnancy among pregnant women attending Buea Regional Hospitals.  Clinical experience shows pregnant women die every 7minutes due to hypertension, 6 – 8% of pregnancies are affected by hypertension, this accounts for 10 – 15% of maternal death (Brown et al., 2001Bennetet 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 infant and maternal mortality rate in our communities.

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. 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 at the Buea Regional Hospital. As such, this study seeks to assessment of knowledge and attitude toward hypertension in pregnancy among pregnant women attending   at the Buea Regional Hospital

I.3 Rationale

Hypertension in pregnancy, the mortality and morbidity is high in Cameroon due to the fact that, most pregnant women initiate antenatal care late into their pregnancy when most have already developed the condition. 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. (Brown et al., 2001Bennetet al., 2006; Rath et al., 2009; Dadelszen et al., 2008). As such, it is our duty as health workers to assist the public (Brown et al., 2001Bennetet 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 infant and maternal mortality rate in our communities.

1.4 Research Questions

The research questions are,

• What level of knowledge do pregnant women attending antenatal care at the Buea Regional Hospital have regarding hypertension in pregnancy?
• What attitude do pregnant women attending antenatal care at the Buea Regional Hospital have regarding hypertension in pregnancy?
• What are the practices related to prevention of pregnant women towards hypertension in pregnancy among pregnant women attending Buea Regional Hospital?

1.5 Objectives

1.5.1 General objective

The main objective of this study was to assess the   knowledge and attitude towards hypertension in pregnancy among pregnant women attending the Buea Regional Hospital.

1.6.2. Specific Objectives

This study seeks;

• To assess the level of knowledge regarding hypertension in pregnancy amongst pregnant women attending the Buea Regional Hospital.
• To determine the attitude of pregnant women in the Buea Regional Hospital regarding hypertension.
• To identify the practices related to prevention towards hypertension in pregnancy at the Buea Regional Hospital.