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Boakye DS, Amoah VMK, Amoah C, Boateng AA, Aduomi-Botchwey CO, Bamfo F, Boampong J. Eclampsia or epilepsy? The intriguing experiences of pregnant women diagnosed with preeclampsia and eclampsia: A descriptive exploratory study. SAGE Open Med 2024; 12:20503121241271768. [PMID: 39139267 PMCID: PMC11320684 DOI: 10.1177/20503121241271768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 06/27/2024] [Indexed: 08/15/2024] Open
Abstract
Aim The purpose of this study was to explore the experiences of pregnant women who suffer the stressful effects of preeclampsia and eclampsia through pregnancy, delivery, and postpartum. Methods A descriptive exploratory approach was adopted to gather in-depth data from women diagnosed with preeclampsia and eclampsia during pregnancy from February to March 2022. Purposive sampling was used to enlist 12 participants from a Municipal Hospital in the Ahafo region of Ghana. Data were analyzed thematically following Braun and Clark approach. Results The study found that women had strong negative emotional reactions after being diagnosed with preeclampsia or eclampsia. They frequently felt guilty, angry, scared, in denial, or disbelief about their condition. Many women held mistaken beliefs about the diseases (they misconstrued eclampsia to be epilepsy) and isolated themselves, mainly because of false perceptions and stigma around their illness in the community. Participants expressed unfulfilled needs for informational and emotional support. The information they received about their condition was insufficient, contradictory, and confusing. Some women also felt pressured into having cesarean deliveries without enough discussion or say in the decision-making process. Conclusion These findings reveal important psychosocial impacts of preeclampsia/eclampsia and gaps in condition-specific education and empathetic, patient-centered communication. Improving provider knowledge and counseling skills along with community awareness may help address these unmet needs among Ghanaian women facing this threat to maternal health.
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Affiliation(s)
- Dorothy Serwaa Boakye
- Department of Health Administration and Education, University of Education, Winneba, Winneba, Ghana
| | - Vida Maame Kissiwaa Amoah
- Department of Nursing, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Christian Amoah
- Department of Behavioral Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Agartha Afful Boateng
- Department of Health Administration and Education, University of Education, Winneba, Winneba, Ghana
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Nyakio O, Cakwira H, Masimango G, Kena L, Narayan G, Naaz F, Mugenyi N, Cyubahiro VK, Amani T, Balagizi F, Suvvari TK, Oduoye MO, Akilimali A. The silent threat: investigating the incidence and clinical characteristics of pre-eclampsia and eclampsia in women from tertiary care hospitals of the Democratic Republic of Congo. Ann Med Surg (Lond) 2024; 86:3267-3272. [PMID: 38846848 PMCID: PMC11152814 DOI: 10.1097/ms9.0000000000002087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 03/22/2024] [Indexed: 06/09/2024] Open
Abstract
Background Pre-eclampsia and eclampsia are medical conditions that can cause severe complications, such as maternal and foetal morbidity and mortality. This study aimed to assess the incidence and characteristics of pre-eclampsia and eclampsia. Methods From July 2021 to July 2022, the authors conducted a retrospective, cross-sectional, descriptive study in the Department of Obstetrics and Gynaecology of a tertiary care hospital in the Democratic Republic of the Congo (DR Congo). Out of 1236 total deliveries, 40 patients aged 18-35 years with pre-eclampsia and/or eclampsia with complete data in medical records were studied. Results In the studied group, 3.23% of women (40 cases) experienced pre-eclampsia or eclampsia, with the majority (75%, 30 cases) occurring before childbirth. Among these, 62.5% (25 cases) were first-time mothers. The main complications observed in the mothers included HELLP syndrome and placental abruption, whereas their newborns frequently exhibited delayed in-utero growth. Caesarean delivery was the prevalent birthing method, and the treatments most often used for effective management were magnesium sulfate and nicardipine. Conclusion The research highlights the common occurrence of eclampsia among patients in the DRC and stresses the critical need for prompt detection of hypertensive complications during pregnancy, aiming to reduce negative health impacts on both mothers and their children.
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Affiliation(s)
- Olivier Nyakio
- Faculty of Medicine, Evangelic University in Africa
- Faculty of Medicine, Official University of Bukavu
| | - Hugues Cakwira
- Faculty of Medicine, Catholic University of Bukavu
- Department of research, Medical Research Circle (MedReC), Bukavu
| | - Gaston Masimango
- Faculty of Medicine, Official University of Bukavu
- Department of research, Medical Research Circle (MedReC), Bukavu
| | - Louison Kena
- Department of research, Medical Research Circle (MedReC), Bukavu
- Faculty of Medicine, Université Libre des Pays des Grands Lacs, Goma, DR Congo
| | - Gaurang Narayan
- Department of Obstetrics and Gynecology, Indira Gandhi Government Medical College, Nagpur
| | - Farheen Naaz
- Medical college, Deccan College of Medical Sciences, Hyderabad
| | - Nathan Mugenyi
- Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | | | - Toussaint Amani
- Department of research, Medical Research Circle (MedReC), Bukavu
- Faculty of Medicine, Université Libre des Pays des Grands Lacs, Goma, DR Congo
| | - Fabien Balagizi
- Department of research, Medical Research Circle (MedReC), Bukavu
| | - Tarun Kumar Suvvari
- Department of Surgery, Rangaraya Medical College, Kakinada, Andhra Pradesh, India
| | | | - Aymar Akilimali
- Department of research, Medical Research Circle (MedReC), Bukavu
- Society for Maternal-Fetal Medicine (SMFM), SW, Washington, DC
- Department of research, East Africa Medical Students Association, Nairobi, Kenya
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Okonofua F, Ekezue BF, Ntoimo LF, Ohenhen V, Agholor K, Imongan W, Ogu R, Galadanci H. Outcomes of a multifaceted intervention to prevent eclampsia and eclampsia-related deaths in Nigerian referral facilities. Int Health 2024; 16:293-301. [PMID: 37386659 PMCID: PMC11062200 DOI: 10.1093/inthealth/ihad044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 05/01/2023] [Accepted: 06/07/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND Eclampsia causes maternal mortality in Nigeria. This study presents the effectiveness of multifaceted interventions that addressed institutional barriers in reducing the incidence and case fatality rates associated with eclampsia. METHODS The design was quasi-experimental and the activities implemented at intervention hospitals included a new strategic plan, retraining health providers on eclampsia management protocols, clinical reviews of delivery care and educating pregnant women and their partners. Prospective data were collected monthly on eclampsia and related indicators from study sites over 2 y. The results were analysed by univariate, bivariate and multivariable logistic regression. RESULTS The results show a higher eclampsia rate (5.88% vs 2.45%) and a lower use of partograph and antenatal care (ANC; 17.99% vs 23.42%) in control compared with intervention hospitals, but similar case fatality rates of <1%. Overall, adjusted analysis shows a 63% decrease in the odds of eclampsia at intervention compared with control hospitals. Factors associated with eclampsia were ANC, referral for care from other facilities and older maternal age. CONCLUSION We conclude that multifaceted interventions that address challenges associated with managing pre-eclampsia and eclampsia in health facilities can reduce eclampsia occurrence in referral facilities in Nigeria and potential eclampsia death in resource-poor African countries.
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Affiliation(s)
- Friday Okonofua
- Centre of Excellence in Reproductive Health Innovation, University of Benin, Benin City, Nigeria
- Department of Obstetrics and Gynaecology, University of Benin and University of Benin Teaching Hospital, Benin City, Nigeria
- Women's Health and Action Research Centre, Benin City, Nigeria
| | - Bola F Ekezue
- Broadwell College of Business and Economics, Fayetteville State University, Fayetteville, NC, USA
| | - Lorretta Favour Ntoimo
- Women's Health and Action Research Centre, Benin City, Nigeria
- Department of Demography and Social Statistics, Federal University Oye-Ekiti, Nigeria
| | - Victor Ohenhen
- Department of Obstetrics and Gynaecology, Central Hospital Benin City, Benin City, Nigeria
| | - Kingsley Agholor
- Department of Obstetrics and Gynaecology/Anti-Retroviral Therapy Centre, Central Hospital, Warri, Delta State, Nigeria
| | - Wilson Imongan
- Women's Health and Action Research Centre, Benin City, Nigeria
| | - Rosemary Ogu
- Department of Obstetrics and Gynaecology, University of Port Harcourt, Rivers State, Nigeria
| | - Hadiza Galadanci
- Department of Obstetrics and Gynaecology, Bayero University, Kano, Nigeria
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Tawfiq E, Azimi MD, Feroz A, Hadad AS, Soroush MS, Jafari M, Yaftali MS, Saeedzai SA. Predicting maternal healthcare seeking behaviour in Afghanistan: exploring sociodemographic factors and women's knowledge of severity of illness. BMC Pregnancy Childbirth 2023; 23:561. [PMID: 37533023 PMCID: PMC10398983 DOI: 10.1186/s12884-023-05750-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 05/31/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND Little is known whether women's knowledge of perceived severity of illness and sociodemographic characteristics of women influence healthcare seeking behavior for maternal health services in Afghanistan. The aim of this study was to address this knowledge gap. METHODS Data were used from the Afghanistan Health Survey 2018. Women's knowledge in terms of danger signs or symptoms during pregnancy was assessed. The signs or symptoms were bleeding, swelling of the body, headache, fever, or any other danger sign or symptom (e.g., high blood pressure). A categorical variable of knowledge score was created. The outcome variables were defined as ≥ 4 ANC vs. 0-3 ANC; ≥ 4 PNC vs. 0-3 PNC visits; institutional vs. non-institutional deliveries. A multivariable generalized linear model (GLM) was used. RESULTS Data were used from 9,190 ever-married women, aged 13-49 years, who gave birth in the past two years. It was found that 56%, 22% and 2% of women sought healthcare for institutional delivery, ≥ 4 ANC, ≥ 4 PNC visits, respectively, and that women's knowledge is a strong predictor of healthcare seeking [odds ratio (OR)1.77(1.54-2.05), 2.28(1.99-2.61), and 2.78 (2.34-3.32) on knowledge of 1, 2, and 3-5 signs or symptoms, respectively, in women with ≥ 4 ANC visits when compared with women who knew none of the signs or symptoms. In women with ≥ 4 PNC visits, it was 1.80(1.12-2.90), 2.22(1.42-3.48), and 3.33(2.00-5.54), respectively. In women with institutional deliveries, it was 1.49(1.32-1.68), 2.02(1.78-2.28), and 2.34(1.95-2.79), respectively. Other strong predictors were women's education level, multiparity, residential areas (urban vs. rural), socioeconomic status, access to mass media (radio, TV, the internet), access of women to health workers for birth, and decision-making for women where to deliver. However, age of women was not a strong predictor. CONCLUSION Our findings suggest that pregnant women's healthcare seeking behaviour is influenced by women's knowledge of danger signs and symptoms during pregnancy, women's education, socioeconomic status, access to media, husband's, in-laws' and relatives' decisions, residential area, multiparity, and access to health workers. The findings have implications for promoting safe motherhood and childbirth practices through improving women's knowledge, education, and social status.
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Affiliation(s)
- Essa Tawfiq
- The Kirby Institute, UNSW Sydney, Sydney, Australia.
| | | | - Aeraj Feroz
- Formerly the Ministry of Public Health, Kabul, Afghanistan
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Makombe D, Thombozi E, Chilemba W, Mboma A, Banda KJ, Mwakilama E. Herbal medicine use during pregnancy and childbirth: perceptions of women living in Lilongwe rural, Malawi - a qualitative study. BMC Womens Health 2023; 23:228. [PMID: 37143030 PMCID: PMC10158248 DOI: 10.1186/s12905-023-02387-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 04/22/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND Globally, use of herbal medicine during pregnancy and labour is often associated with adverse obstetric outcomes such as uterine rupture and fetal distress. However, in rural Malawi, information on the perceptions of women about the use of herbal medicine during pregnancy and labour is underreported despite the practice. Understanding women's views and perceptions on use of herbal medicine during pregnancy and labour is therefore critical for understanding the basis of their practice and for setting up maternal and neonatal health care interventions to alleviate any possible pregnancy and labour complications. AIMS To explore the perceptions of women on the use of herbal medicine during pregnancy and labour in rural Malawi. METHODS We employed a qualitative descriptive (QD) study on the purposively identified participants (women with parity [Formula: see text]), residing in four villages (Kagona, Champsinja, Mthupi and Manja) of Traditional Authority Malili, in Lilongwe rural district, Malawi. Qualitative data was collected through four Focus Groups of 6-8 women in each group that were conducted in each village. Data analysis was performed inductively, using reflexive thematic analysis approach. RESULTS A total of 28 women of reproductive age 20 and above; 20-24 (32.14%), married (75%), average of 3 deliveries (57.14%), primary school education (75.0%), and Christians (92.86%) were recruited and interviewed. Two main themes emerged from the narratives: (1) perceived benefits of using herbal medicine: (i) hastens labour, (ii) prevents pregnancy complications and (iii) prevents and treats illnesses, and (2) perceived risks of using herbal medicine: (i) perceived maternal risks, (ii) perceived fetal risks. CONCLUSION In rural Malawi, the practice of using herbal medicine during pregnancy and labour is perceived as both risky and beneficial to women. These perceptions are shaped by the exposure to either personal or other people's experiences, hence the continued practice. Therefore, inclusion of health education topics on maternal complications due to use of herbal medicine among women can help reduce maternal and neonatal mortality rates in rural Malawi. Further research is also warranted to explore accessibility and community pathway systems for herbal medicine use during pregnancy and labour among the pregnant women.
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Affiliation(s)
- Dziwenji Makombe
- Department of Community Health Nursing, Kamuzu University of Health Sciences, Lilongwe, Malawi.
| | - Enalla Thombozi
- Department of Community Health Nursing, Kamuzu University of Health Sciences, Lilongwe, Malawi
| | - Winnie Chilemba
- Department of Community Health Nursing, Kamuzu University of Health Sciences, Lilongwe, Malawi
| | - Alexander Mboma
- Department of Midwifery, Kamuzu University of Health Sciences, Lilongwe, Malawi
| | - Kondwani Joseph Banda
- College of Nursing, School of Nursing, Taipei Medical University, Taipei, Taiwan
- Endoscopy Unit, Department of Surgery, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Elias Mwakilama
- Department of Mathematical Sciences, University of Malawi, Zomba, Malawi
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Alemayehu M, Yakob B, Khuzwayo N. Barriers and enablers to emergency obstetric and newborn care services use in Wolaita Zone, Southern Ethiopia: a qualitative case study. BMC Public Health 2022; 22:2087. [PMID: 36384508 PMCID: PMC9667656 DOI: 10.1186/s12889-022-14504-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 10/31/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Globally, 11.4 million untreated obstetric complications did not receive Emergency Obstetric and Newborn Care (EmONC) services yearly, with the highest burden in low and middle-income countries. Half of the Ethiopian women with obstetric complications did not receive EmONC services. However, essential aspects of the problem have not been assessed in depth. This study, therefore, explored the various aspects of barriers and enablers to women's EmONC services utilization in southern Ethiopia. METHODOLOGY A qualitative case study research design was used in nine districts of the Wolaita Zone. A total of 37 study participants were selected using a purposive stratified sampling technique and interviewed till data saturation. Twenty-two key informant interviews were conducted among front-line EmONC service providers, managers, community leaders, and traditional birth attendants (TBAs). Individual in-depth interviews were conducted among 15 women with obstetric complications. The trustworthiness of the research was assured by establishing credibility, transferability, conformability, and dependability. NVivo 12 was used to assist with the thematic data analysis. RESULT Five themes emerged from the analysis: service users' perception and experience (knowledge, perceived quality, reputation, respectful care, and gender); community-related factors (misconceptions, traditional practices, family and peer influence, and traditional birth attendants' role); access and availability of services (infrastructure and transportation); healthcare financing (drugs and supplies, out-of-pocket expenses, and fee exemption); and health facility-related factors (competency, referral system, waiting time, and leadership). CONCLUSION Many women and their newborns in the study area suffered severe and life-threatening complications because of the non-utilization or delayed utilization of EmONC services. A key policy priority should be given to enhancing women's awareness, eliminating misconceptions, improving women's autonomy, and ensuring traditional practices' role in EmONC service utilization. Community awareness interventions are required to enhance service uptake. Furthermore, the health systems must emphasize improving the quality of care, inequitable distribution of EmONC facilities, and essential drugs. The financial constraints need to be addressed to motivate women from low socioeconomic status. Furthermore, intersectoral collaboration is required to maintain a legal framework to control and prohibit home deliveries and empower women.
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Affiliation(s)
- Mihiretu Alemayehu
- School of Public Health, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
- School of Nursing and Public Health, Discipline of Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Bereket Yakob
- School of Public Health, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
- School of Population and Public Health, the University of British Columbia, Vancouver, BC Canada
| | - Nelisiwe Khuzwayo
- School of Nursing and Public Health, Discipline of Public Health, University of KwaZulu-Natal, Durban, South Africa
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Imo CK, De Wet-Billings N, Isiugo-Abanihe UC. The impact of maternal health insurance coverage and adequate healthcare services utilisation on the risk of under-five mortality in Nigeria: a cross-sectional study. Arch Public Health 2022; 80:206. [PMID: 36100949 PMCID: PMC9472384 DOI: 10.1186/s13690-022-00968-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 09/07/2022] [Indexed: 11/28/2022] Open
Abstract
Background Despite the progress in reducing under-five mortality (U-5 M) in recent years, these deaths remain considerably high in Nigeria. This could be attributed to poor health policies including inequality of health insurance coverage and access to adequate healthcare services utilisations which has remained inimical to achieving sustainable development goals (SDGs). Therefore, this study examined the impact of maternal health insurance coverage and adequate healthcare services utilisation on the risk of U-5 M in Nigeria. Methods The data for the study were derived from the 2018 Nigeria Demographic and Health Survey and comprised a weighted sample of 127,545 birth histories of childbearing women. Descriptive and analytical analyses were carried out, including frequency tables and multivariate using Cox proportional regression. The results were presented as hazard ratios (HR) with 95% confidence intervals (CIs). Data were analyzed using Stata software version 15.1. Results The results showed that 14.3% of the sampled birth histories of the childbearing women were children who died before age 5. The results further showed that 97.7% of the children were of mothers who have health insurance and over one-half (56.5%) were children whose mothers had adequate healthcare services utilisation. The risk of under-five death was significantly lower among the children of mothers who were covered by health insurance (HR: 0.66, CI: 0.42–1.02) and those whose mothers utilised adequate healthcare services (HR: 0.78, CI: 0.68–0.90). A similar result was observed among children whose mothers reported that distance to the health facility was not a problem (HR: 0.81, CI: 0.72–0.86). Some mothers’ characteristics including educational attainment, wealth quintile and region of residence significantly influenced the risk of U-5 M. Conclusions The study established that maternal health insurance coverage and adequate healthcare services utilisation were found to be protective factors against the risk of U-5 M. Also, the revealed low health insurance coverage of mothers calls for more pragmatic policy and intervention programmes through health insurance to achieve SDGs targets of ending preventable deaths of children under 5 years of age and ensuring quality, as well as universal access to maternal and child healthcare services.
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Adeosun F, Folayan O, Ojo T. Choosing cesarean section over natural birth: Challenges of decision making among pregnant women with pre-eclampsia in Ado-Ekiti. Pregnancy Hypertens 2022; 30:97-102. [PMID: 36130417 DOI: 10.1016/j.preghy.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 08/28/2022] [Accepted: 09/04/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Although Caesarean section has greatly improved obstetric care throughout the world, there is a great aversion to caesarean section in developing countries. This study was carried out to examine the rate at which pregnant women with Pre-eclampsia decide to choose caesarean section over natural birth. STUDY DESIGN A descriptive study was conducted among a sample of 112 pregnant women with Pre-eclampsia, aged 18-40 years, whose gestation period has exceeded 20 weeks and are registered in the hospitals. The sample selection was purposive. MAIN OUTCOME MEASURES Data collection was done through self-administered structured questionnaire. Data analysis was presented using simple percentages. RESULTS 94% of respondents had no prior information about Pre-eclampsia and its associated complications. Pre-eclampsia has a prevalence rate of 12.3% among respondents in Ado-Ekiti as at the time this study was conducted. 38% of respondent favored caesarean section because they believed it is safer, less painful with little or no complications. If caesarean section is given as an only medical option for safe childbirth to respondents who preferred natural birth, 46.4% would opt for religious interventions while 10.7% would opt for traditional healthcare. CONCLUSIONS Respondents who preferred natural birth would not choose caesarean section because of fear, cultural belief, religious beliefs and the cost. Level of education, religion and employment status were found to influence respondents' decision to choose. Hence the need to encourage research in awareness creation, patient education and best ways to assist patients decide on mode of delivery and plan on how to finance treatment.
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Affiliation(s)
- Foluke Adeosun
- Department of Sociology, College of SMS, Afe Babalola University, Km 8.5 Afe Babalola Way, Ado Ekiti, Ekiti State, Nigeria.
| | - OpeOluwa Folayan
- Department of Sociology, College of SMS, Afe Babalola University, Km 8.5 Afe Babalola Way, Ado Ekiti, Ekiti State, Nigeria
| | - Tolulope Ojo
- Department of Sociology, College of SMS, Afe Babalola University, Km 8.5 Afe Babalola Way, Ado Ekiti, Ekiti State, Nigeria
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Sakurai S, Shishido E, Horiuchi S. Experiences of women with hypertensive disorders of pregnancy: a scoping review. BMC Pregnancy Childbirth 2022; 22:146. [PMID: 35193516 PMCID: PMC8864783 DOI: 10.1186/s12884-022-04463-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 02/08/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Hypertensive disorders of pregnancy (HDP) constitute one of the leading causes of maternal and perinatal mortality worldwide, and are associated with an increased risk of recurrence and future cardiovascular disease. HDP affect women's health condition, mode of birth and timing, length of hospital stay, and relationship with their newborn and family, with future life repercussions. AIMS To explore the experiences of women with HDP from pregnancy to postpartum, and to identify (a) their perceptions and understanding of HDP, (b) their understanding of future health risks, and (c) the possible interventions by healthcare providers. METHODS A scoping review was conducted following the Joanna Briggs Institute method and in accordance with the PRISMA-ScR checklist. The following databases were searched from 1990 to 2020 (October): MEDLINE (PubMed), EMBASE, Cochrane Library, CINAHL, PsycINFO, and Google Scholar database. The Critical Appraisal Skills Programme (CASP) checklist was used as a guide for the qualitative analysis. Content analysis and synthesis of findings were conducted using Nvivo12. RESULTS Of the 1971 articles identified through database searching, 16 articles met the inclusion criteria. After data extraction, content analysis yielded six categories: 'Life-threatening disorder', 'Coping with HDP', 'Concerns for baby and challenges of motherhood', 'Fear of recurrence and health problems', 'Necessity of social and spiritual support', and 'Positive and negative experiences in the healthcare context'. Women faced complex difficulties from the long treatment process while transitioning to motherhood. CONCLUSION Our findings revealed the perceptions and understanding of women regarding HDP as a life-threatening disorder to both mothers and their babies which mothers need to cope with. Recovery of physical condition and the long-term psychological effects of HDP on women should be given attention by mothers and HCP to reduce future health risks. Importantly, a lifelong follow-up system is recommended for women with HDP.
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Affiliation(s)
- Sachiko Sakurai
- Department of Midwifery, Graduate School of Nursing Science, St Luke’s International University, 10-1 Akashi-cho, Chuo-ku, Tokyo, 1040044 Japan
| | - Eri Shishido
- Department of Midwifery, Graduate School of Nursing Science, St Luke’s International University, 10-1 Akashi-cho, Chuo-ku, Tokyo, 1040044 Japan
| | - Shigeko Horiuchi
- Department of Midwifery, Graduate School of Nursing Science, St Luke’s International University, 10-1 Akashi-cho, Chuo-ku, Tokyo, 1040044 Japan
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“It was a no-brainer”: A Qualitative Study of Factors Driving Previvors’ Decision-Making when Considering Risk-Reducing Salpingectomy with Delayed Oophorectomy. Gynecol Oncol Rep 2022; 40:100948. [PMID: 35265744 PMCID: PMC8898920 DOI: 10.1016/j.gore.2022.100948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 02/21/2022] [Accepted: 02/23/2022] [Indexed: 11/30/2022] Open
Abstract
Self-advocacy and building rapport with providers facilitated decision-making for RRS-DO-focused previvors. Avoiding menopause through RRS was a key motivator for RRS-DO-focused previvors. RRS-DO-focused previvors viewed RRS as a stepwise approach to risk reduction. Understanding previvor priorities and experiences can help optimize shared decision-making.
Objective Previvors are becoming more aware of the option of risk-reducing salpingectomy with delayed oophorectomy (RRS-DO) to mitigate their risk of ovarian cancer. In this qualitative study, we explored the clinical and non-clinical factors that impacted previvors’ decision-making to pursue RRS-DO as a risk reduction strategy. Methods Semi-structured telephone interviews were conducted with previvors and transcribed verbatim. Using ATLAS.ti® software, two primary investigators interpreted data through thematic analysis. After coding four interviews, the investigators discussed discrepancies between codes with a moderator and resolved and refined code. The investigators applied the universal codebook to all interviews and revised the codebook using an iterative approach. Examining codes within and across interviews allowed for major themes and patterns to emerge. Results Interviews were conducted with seventeen previvors (ages 31–46). 6 (25%) previvors had a BRCA1 mutation, 7 (41%), a BRCA2 mutation, 3 (13%), a Lynch-related mutation, and 1 (6%), other (MUTYH mutation). At the time of interview, 12 previvors (71%) were planning (6) or had undergone (6) RRS-DO, 4 (23%) were planning (1) or had undergone (3) risk reducing salpingo-oophorectomy (RRSO), and 1 (6%) was undecided. Three major themes emerged: motivating factors for selecting surgical risk reduction option, barriers complicating surgical decision-making, and facilitating factors for surgical decision-making. RRS-DO-focused previvors prioritized avoiding menopause, and they also emphasized that self-advocacy and building rapport with providers facilitated their decision-making. Conclusion By understanding previvors’ priorities and experiences, physicians can better partner with previvors as they navigate their ovarian cancer risk reduction journey. This will ultimately optimize shared decision-making.
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Joshi A, Beyuo TK, Oppong SA, Moyer CA, Lawrence ER. 'I don't really understand this BP': Women's knowledge, attitudes, and experiences with preeclampsia in Ghana. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000121. [PMID: 36962267 PMCID: PMC10022332 DOI: 10.1371/journal.pgph.0000121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 06/13/2022] [Indexed: 11/18/2022]
Abstract
Preeclampsia and eclampsia are common and serious complications of pregnancies, often presenting as obstetric emergencies. In low- and middle-income countries, limited numbers of healthcare providers and a high volume of critically ill patients can negatively impact provider communication and counseling. Lack of knowledge or awareness of preeclampsia and eclampsia among pregnant women can lead to delays in health seeking behavior. Our study uses grounded theory to explore patients' experience of preeclampsia and eclampsia in a low-resource setting. Participants were postpartum women diagnosed with preeclampsia or eclampsia at Korle Bu Teaching Hospital in Ghana. Interviews consisted of semi-structured, open-ended questions regarding participant understanding of their diagnosis of preeclampsia and eclampsia; counseling from their healthcare providers; and experiences with their delivery, monitoring, and treatment. Qualitative thematic analysis was performed according to the Attride-Sterling analytical framework, using NVivo 12. A total of 45 women were interviewed, 88.9% with preeclampsia and 11.1% with eclampsia. Major themes identified include participants' low general knowledge of their diagnosis, inadequate counseling from healthcare providers, and resulting emotional distress. Women desire more information regarding their diagnosis and associate their health-seeking behaviors with counseling they receive from healthcare providers. Women also acknowledge the systemic barriers that make patient care and counseling challenging for providers, especially in low- and middle-income countries. These findings highlight the need for improved models of counseling and health education for women with pregnancies complicated by preeclampsia and eclampsia.
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Affiliation(s)
- Avina Joshi
- University of Massachusetts Medical School, Worcester, Massachusetts, United States of America
| | - Titus K Beyuo
- University of Ghana School of Medicine and Dentistry, Accra, Ghana
- Department of Obstetrics & Gynaecology, Korle Bu Teaching Hospital, Accra, Ghana
| | - Samuel A Oppong
- University of Ghana School of Medicine and Dentistry, Accra, Ghana
- Department of Obstetrics & Gynaecology, Korle Bu Teaching Hospital, Accra, Ghana
| | - Cheryl A Moyer
- Global REACH, University of Michigan Medical School, Ann Arbor, Michigan, United States of America
- Department of Obstetrics & Gynecology, University of Michigan Medical School, Ann Arbor, Michigan, United States of America
| | - Emma R Lawrence
- Department of Obstetrics & Gynecology, University of Michigan Medical School, Ann Arbor, Michigan, United States of America
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Robbins T, Hanlon C, Kelly AH, Gidiri MF, Musiyiwa M, Silverio SA, Shennan AH, Sandall J. Pills and prayers: a comparative qualitative study of community conceptualisations of pre-eclampsia and pluralistic care in Ethiopia, Haiti and Zimbabwe. BMC Pregnancy Childbirth 2021; 21:716. [PMID: 34702209 PMCID: PMC8547033 DOI: 10.1186/s12884-021-04186-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 09/24/2021] [Indexed: 11/11/2022] Open
Abstract
Background Pre-eclampsia is a leading cause of preventable maternal and perinatal deaths globally. While health inequities remain stark, removing financial or structural barriers to care does not necessarily improve uptake of life-saving treatment. Building on existing literature elaborating the sociocultural contexts that shape behaviours around pregnancy and childbirth can identify nuanced influences relating to pre-eclampsia care. Methods We conducted a cross-cultural comparative study exploring lived experiences and understanding of pre-eclampsia in Ethiopia, Haiti and Zimbabwe. Our primary objective was to examine what local understandings of pre-eclampsia might be shared between these three under-resourced settings despite their considerable sociocultural differences. Between August 2018 and January 2020, we conducted 89 in-depth interviews with individuals and 17 focus group discussions (n = 106). We purposively sampled perinatal women, survivors of pre-eclampsia, families of deceased women, partners, older male and female decision-makers, traditional birth attendants, religious and traditional healers, community health workers and facility-based health professionals. Template analysis was conducted to facilitate cross-country comparison drawing on Social Learning Theory and the Health Belief Model. Results Survivors of pre-eclampsia spoke of their uncertainty regarding symptoms and diagnosis. A lack of shared language challenged coherence in interpretations of illness related to pre-eclampsia. Across settings, raised blood pressure in pregnancy was often attributed to psychosocial distress and dietary factors, and eclampsia linked to spiritual manifestations. Pluralistic care was driven by attribution of causes, social norms and expectations relating to alternative care and trust in biomedicine across all three settings. Divergence across the contexts centred around nuances in religious or traditional practices relating to maternal health and pregnancy. Conclusions Engaging faith and traditional caregivers and the wider community offers opportunities to move towards coherent conceptualisations of pre-eclampsia, and hence greater access to potentially life-saving care. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-04186-6.
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Affiliation(s)
- Tanya Robbins
- Department of Women & Children's Health, School of Life Course Sciences, King's College London, St Thomas' Hospital, 10th Floor, North Wing, Westminster Bridge Road, London, SE1 7EH, UK.
| | - Charlotte Hanlon
- Centre for Global Mental Health, Health Service and Population Research Department, and WHO Collaborating Centre for Mental Health Research and Training, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Department of Psychiatry, WHO Collaborating Centre for Mental Health Research and Capacity-Building, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.,Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Ann H Kelly
- Department of Global Health and Social Medicine, King's College London, London, UK
| | - Muchabayiwa Francis Gidiri
- Department of Obstetrics and Gynaecology, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Mickias Musiyiwa
- Department of History, Heritage and Knowledge Systems, Faculty of Arts and Humanities, University of Zimbabwe, Harare, Zimbabwe
| | - Sergio A Silverio
- Department of Women & Children's Health, School of Life Course Sciences, King's College London, St Thomas' Hospital, 10th Floor, North Wing, Westminster Bridge Road, London, SE1 7EH, UK
| | - Andrew H Shennan
- Department of Women & Children's Health, School of Life Course Sciences, King's College London, St Thomas' Hospital, 10th Floor, North Wing, Westminster Bridge Road, London, SE1 7EH, UK
| | - Jane Sandall
- Department of Women & Children's Health, School of Life Course Sciences, King's College London, St Thomas' Hospital, 10th Floor, North Wing, Westminster Bridge Road, London, SE1 7EH, UK
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Nabulo H, Ruzaaza G, Mugabi F, Bajunirwe F. Perceptions on preeclampsia and eclampsia among senior, older women, in rural Southwestern Uganda. JOURNAL OF GLOBAL HEALTH REPORTS 2021; 5. [PMID: 34541336 PMCID: PMC8445047 DOI: 10.29392/001c.19464] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background Eclampsia is among the leading causes of maternal mortality. It is a serious hypertensive complication of pregnancy and increases the risk of cardiovascular disease in later life. Pregnancy-related hypertension complications predispose to chronic hypertension and premature heart attacks. A significant proportion of women with preeclampsia/eclampsia does not reach the formal healthcare system or arrive too late because of certain traditional or cultural beliefs about the condition. The older, senior women in the community are knowledgeable and play a significant role in decision making regarding where mothers should seek maternal health care. Therefore, the purpose of this study was to explore the perceptions of older and senior women regarding the manifestation of, risk factors and possible causes of preeclampsia/eclampsia. Methods We conducted a qualitative study in rural Southwestern Uganda. The key informants were senior, older women including community elders, village health team members and traditional birth attendants who were believed to hold local knowledge and influence on birth and delivery. We purposively selected key informants and data were collected till we reached saturation point. We analyzed data using an inductive thematic approach to identify themes. Results We interviewed 20 key informants with four themes identified. The 'causes' theme emerged from the subthemes of confusion with other conditions, spiritual beliefs and high blood pressure. The 'risk factors' theme emerged from the subthemes of oedema-related illnesses, poverty-induced malnutrition, and strained relationships. The 'remedies' theme emerged from the consistent mention of traditional herbal treatment, seek medical help, spiritual healing, emotional healing and corrective nutrition as potential solutions. The theme 'effects of preeclampsia/eclampsia' emerged from the mention of pregnancy complications like premature delivery, child loss, operative delivery like caesarian section delivery as well as death. There was no identifiable local name from the interviews. Women carried several myths regarding the cause and these included little blood, witchcraft, ghost attacks and stress from strained relationships including marital tension. Women were generally aware of the outcomes of eclampsia, mainly that it kills. Conclusions Eclampsia is associated with significant myths and misconceptions in this rural community. We recommend interventions to increase awareness and dispel these myths and misconceptions, increase access to antenatal preeclampsia surveillance, and facilitate timely referral for basic maternity care as means for early detection and management of preeclampsia.
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Affiliation(s)
- Harriet Nabulo
- Department of Nursing, Mbarara University of Science and Technology, Department of Nursing, Mbarara, Uganda
| | - Gad Ruzaaza
- Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Francis Mugabi
- Department of Community Health, Mbarara Regional Referral Hospital, Mbarara, Uganda
| | - Francis Bajunirwe
- Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda
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Ravaoarisoa L, Razafimahatratra MJJ, Rakotondratsara MA, Gaspard N, Ratsimbazafy MR, Rafamantanantsoa JF, Ramanantsoa V, Schaaf M, Midy AC, Casey SE. Slowing progress: the US Global Gag Rule undermines access to contraception in Madagascar. Sex Reprod Health Matters 2021; 28:1838053. [PMID: 33054631 PMCID: PMC7887949 DOI: 10.1080/26410397.2020.1838053] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Madagascar's health system is highly dependent on donor funding, especially from the United States (US), and relies on a few nongovernmental organisations (NGOs) to provide contraceptive services in remote areas of the country. The Trump administration reinstated and expanded the Global Gag Rule (GGR) in 2017; this policy requires non-US NGOs receiving US global health funding to certify that neither they nor their sub-grantees will provide, counsel or refer for abortion as a method of family planning. Evidence of the impact of the GGR in a country with restrictive abortion laws, like Madagascar - which has no explicit exception to save the woman's life - is limited. Researchers conducted semi-structured interviews with 259 representatives of the Ministry of Health and NGOs, public and private health providers, community health workers and contraceptive clients in Antananarivo and eight districts between May 2019 and March 2020. Interviews highlighted the impact of the GGR on NGOs that did not certify the policy and lost their US funding. This reduction in funding led to fewer contraceptive service delivery points, including mobile outreach services, a critical component of care in rural areas. Public and private health providers reported increased contraceptive stockouts and fees charged to clients. Although the GGR is ostensibly about abortion, it has reduced access to contraception for the Malagasy population. This is one of few studies to directly document the impact on women who themselves described their increased difficulties obtaining contraception ultimately resulting in discontinuation of contraceptive use, unintended pregnancies and unsafe abortions.
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Affiliation(s)
| | | | | | - Naomi Gaspard
- Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, USA
| | | | | | | | | | - Anne-Caroline Midy
- Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Sara E Casey
- Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, USA
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Stitterich N, Shepherd J, Koroma MM, Theuring S. Risk factors for preeclampsia and eclampsia at a main referral maternity hospital in Freetown, Sierra Leone: a case-control study. BMC Pregnancy Childbirth 2021; 21:413. [PMID: 34078312 PMCID: PMC8173903 DOI: 10.1186/s12884-021-03874-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 05/13/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In the African region, 5.6% of pregnancies are estimated to be complicated by preeclampsia and 2.9% by eclampsia, with almost one in ten maternal deaths being associated with hypertensive disorders. In Sierra Leone, representing one of the countries with the highest maternal mortality rates in the world, 16% of maternal deaths were caused by pregnancy-induced hypertension in 2016. In the light of the high burden of preeclampsia and eclampsia (PrE/E) in Sierra Leone, we aimed at assessing population-based risk factors for PrE/E to offer improved management for women at risk. METHODS A facility-based, unmatched observational case-control study was conducted in Princess Christian Maternity Hospital (PCMH). PCMH is situated in Freetown and is the only health care facility providing 'Comprehensive Emergency Obstetric and Neonatal Care services' throughout the entire country. Cases were defined as pregnant or postpartum women diagnosed with PrE/E, and controls as normotensive postpartum women. Data collection was performed with a questionnaire assessing a wide spectrum of factors influencing pregnant women's health. Statistical analysis was performed by estimating a binary logistic regression model. RESULTS We analyzed data of 672 women, 214 cases and 458 controls. The analysis yielded several independent predictors for PrE/E, including family predisposition for PrE/E (AOR = 2.72, 95% CI: 1.46-5.07), preexisting hypertension (AOR = 3.64, 95% CI: 1.32-10.06), a high mid-upper arm circumflex (AOR = 3.09, 95% CI: 1.83-5.22), presence of urinary tract infection during pregnancy (AOR = 2.02, 95% CI: 1.28-3.19), presence of prolonged diarrhoea during pregnancy (AOR = 2.81, 95% CI: 1.63-4.86), low maternal assets (AOR = 2.56, 95% CI: 1.63-4.02), inadequate fruit intake (AOR = 2.58, 95% CI: 1.64-4.06), well or borehole water as the main source of drinking water (AOR = 2.05, 95% CI: 1.31-3.23) and living close to a waste deposit (AOR = 1.94, 95% CI: 1.15-3.25). CONCLUSION Our findings suggest that systematic assessment of identified PrE/E risk factors, including a family predisposition for PrE/E, preexisting hypertension, or obesity, should be performed early on in ANC, followed by continued close monitoring of first signs and symptoms of PrE/E. Additionally, counseling on nutrition, exercise, and water safety is needed throughout pregnancy as well as education on improved hygiene behavior. Further research on sources of environmental pollution in Freetown is urgently required.
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Affiliation(s)
- N Stitterich
- Institute of Tropical Medicine and International Health, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353 Berlin, Germany.
| | - J Shepherd
- National School of Midwifery, Freetown, Sierra Leone
| | - M M Koroma
- Princess Christian Maternity Hospital, Freetown, Sierra Leone
| | - S Theuring
- Institute of Tropical Medicine and International Health, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353 Berlin, Germany
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16
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Dempsey A, Sripad P, Sultana K, Kirk K, Hossain SMI, Warren C. Pathways to service access for pre-eclampsia and eclampsia in rural Bangladesh: Exploring women's care-seeking. PLoS One 2021; 16:e0245371. [PMID: 33539410 PMCID: PMC7861535 DOI: 10.1371/journal.pone.0245371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Accepted: 12/29/2020] [Indexed: 11/15/2022] Open
Abstract
Background While women in low- and middle-income countries face a range of barriers to accessing care for hypertensive disorders of pregnancy, there is little understanding of the pathways taken to overcome these constraints and reach the services they need. This study explores the perspectives of women and communities on the influences that impact care-seeking decisions and pathways to health services. Methods To understand individual perspectives, we conducted 22 in-depth interviews (IDIs) with pre-eclampsia and eclampsia survivors (PE/E) in a tertiary hospital, where they received care after initiating PE/E services in different parts of the country. In four districts, we conducted one male and one female focus group discussion (FGD) to unearth care-seeking pathways and explore normative perspectives and the range of internal and external influences. Careful thematic analysis using Atlas-ti was applied. Results Prevailing views of women and communities across settings in Bangladesh indicate varied pathways to care throughout their pregnancy, during childbirth, and in the postnatal period influenced by internal and external factors at the individual, familial, social, and health systems levels. Internal influences draw on women’s own awareness of hypertension complications and options, and their ability to decide to seek care. External factors include social influences like family and community norms, culturally-accepted alternatives, and community perceptions of the health system’s capacity to provide quality care. The interaction of these factors often delay care seeking and can lead to complex pathways to care. Conclusion Women’s individual pathways to care were diverse, despite the homogenous community perceptions of the influences on women’s care-seeking behaviors. This finding supports the need for improving quality of care in primary healthcare facilities and strengthening gender equity and community-based promotion activities through targeted policy and programming.
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Affiliation(s)
- Amy Dempsey
- Population Council, Washington, DC, United States of America
- * E-mail:
| | - Pooja Sripad
- Population Council, Washington, DC, United States of America
| | | | - Karen Kirk
- Population Council, Washington, DC, United States of America
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