CHAPTER ONE

INTRODUCTION

1.1 Background 

Pre-eclampsia is a complication which may occur during Pregnancy characterized by Blood

Pressure (BP) of 140/90mmHg (Systolic blood pressure (SBP) ≥140 mmHg and or diastolic blood pressure (DBP)≥ 90mmHg and typically occurs ofter20 weeks of gestation, and cause damages to organs such as the liver, kidneys, brain, and eyes. Pre-eclampsia also Known as Hypertensive disorders of pregnancy (HDP) are a major cause of maternal morbidity and mortality. According to the World Health Organization (WHO), Maternal mortality referred to as the death of a woman during pregnancy, delivery, or within 48 days of Child birth. Accounts for about 830 deaths every day worldwide. This indicates that maternal mortality is unacceptably high, and it Claim the lives of many women in Sub-Sahara Africa.  A study in Yaounde Central Hospital found that pre-eclampsia was leading cause of maternal mortality, according for 23.1% of all maternal deaths (Tchente et al., 2017). Maternal mortality is often from factors that could have been prevented but was not prevented due to the poor health System. Generally, Hypertensive disorder of Pregnancy (HDP) are said to complicate 5-10% of pregnancies and account for 10-15% of maternal death globally. Majority of these maternal deaths are found to occur in low and middle- income Countries (LMICs). The elevation of blood Pressure before the pregnancy or during the first 20 weeks of pregnancy is classified as chronic hypertension while the elevation of blood pressure after 20 weeks of pregnancy and in postpartum Period is classified as Pregnancy induced hypertension, which can be associated with proteinuria and it is therefore classified as preeclampsia. If the pregnancy induced hypertension is not associated with proteinuria it is classified as gestational hypertension. It has been indicated that in 2015, roughly 303,000 women died during the following pregnancy and child birth. Almost all these deaths occurred in low-resource, settings, and most could have been prevented.

A study in northern Cameroon found teenage status, illiteracy, nulliparity and family or personal history or hypertension as a risk factor for Hypertensive disorder of Pregnancy (HDP). Moreover, in women with Pre-eclampsia dysfunction of many organs, such as kidney and liver, may be diagnosed, and in some cases, fetal growth restriction is observed. Preeclampsia when left untreated can lead to death. Pre-eclampsia has increase in both the youngest and the oldest women of reproductive stage. An Outdated term for Pre-eclampsia is Toxemia, a term originated in a mistaken belief that the condition was caused by toxins (Encyclopedia Britannica, 1998). Rarely, pre-eclampsia develops after the delivery of a baby, a condition known as Postpartum Pre-eclampsia. Furthermore, it has been reported that each day in Cameroon, there are 12-13 Cases of maternal mortality. 

This shows that Cameroon is among the countries with high maternal mortality levels in sub- Saharan Africa with the prevalence of 4.4% among pregnant women attending antenatal care in a tertiary hospital (Njim et al., 2018), representing on enormous burden for the health of conception till the onset of labor. Thus, it is particularly important that the mother should give birth safely to a healthy baby at full term. Several theories exist on the pathogenesis of pre-eclampsia but at present, it is suggested that the placenta is the primary agent in the development of pre-eclampsia hence, removal of the placenta by termination of the pregnancy is the sole method of treating the Condition. ANC Coverage is an indicator of access and use of health Care services during pregnancy. The antenatal Period presents opportunities. for reaching pregnant women with interventions that are vital to their health and wellbeing and that of their fetuses and neonates. 

ANC is very important in monitoring and detecting early warning signs of pre-eclampsia from nausea, upper belly pain, vomiting, and blood pressure and urine tests for proteins. Preeclampsia and eclampsia are serious obstetric complications, particularly in developing countries. When Convulsion occurs in the presence of these features, the condition is known as eclampsia. The Prevalence of eclampsia varies from 0.15 to 3.23 per 100 deliveries with high frequency in developing countries. Eclampsia has its own complications, as abruption placenta (11.6%), pneumonia in the same proportion, intravascular coagulated dissemination (4.4%) cerebra-vascular accident (2.94%), and acute tubular necrosis (2.94%). Majority of these complications will lead to death, and, hypertensive disorders in pregnancy among the three leading causes of maternal mortality and contribute for 15-20% in worldwide maternal mortality ratio.

1.2 Problem Statement 

According to WHO Pre-eclampsia is a major cause of maternal and neonatal morbidity and mortality in the world (14%) and especially in developing countries (Say et al., 2014). It is the third leading Cause of material mortality after postpartum hemorrhage and infections in Cameroon (Epsom et al., 2020).   Many Studies have shown that many women lack knowledge on the prevention of pre-eclampsia and they end up developing the condition and its associated consequences such as placenta abruption, preterm birth, still birth, stroke, eclampsia, hypoxic-ischemic encephalopathy, mental retardation on babies, diabetes. This study was to asses and Improve women’s knowledge and practices on the prevention of preeclampsia in a bid to better manage its morbidity, and reduce Pre-eclampsia related maternal mortality in the Buea Town Integrated Health Area.

1.3 Rational 

Pre-eclampsia is a major public health concern in Cameroon, causing significant maternal and fetal complications. However, there’s a lack of recent data on its prevalence and factors in the Buea Town Integrated Health Center. This study aims to investigate the prevalence and associated risk factors of Pre-eclampsia among pregnant woman attending ANC at the Buea Town Integrated Health Center. The finding will inform targeted interventions to reduce the incidence and improve outcomes for women with pre-eclampsia, ultimately contributing to improve maternal and fetal health outcomes in Cameroon.

1.4 Research Questions 

1. What is the prevalence of awareness that pregnant women attending ANC at the Buea

Town Integrated Health Center have about pre-eclampsia pregnancy? 

2. What knowledge do pregnant women attending ANC At the Buea Town Integrated

Health Center about Pre-eclampsia in Pregnancy? 

3. 3) What are the predictors of pre-eclampsia pregnant women attending ANC at the Buea

Town Integrated Health Center have?

1.5 Objectives  

1.5.1 General Objectives

 The aim of this study is to assess the prevalence and associated factors of Preeclampsia among pregnant women attending ANC at the Buea Town Integrated Health Center.

1.5.2 Specific Objectives

• To determine the prevalence of Pre-eclampsia among pregnant women attending ANC at the Buea Town Integrated Health Center.
• To assess pregnant women’s knowledge on the factors associated with Pre-eclampsia attending ANC at the Buea Town Integrated Health Center.
• To determine the predictors of Pre-eclampsia among pregnant women attending

ANC at the Buea Town Integrated Health Center.