PE/E show a significantly higher mortality rate in comparison to other hypertension illnesses that occur during pregnancy [10, 44]. Therefore, in addition to diagnosing and treating patients who seek medical care, it is important to have insights into the extent to which pregnant women understand PE/E. This can inform the development of suitable intervention strategies.
Knowledge of preeclampsia/eclampsia (PE/E)
In this study, the study participants' knowledge of PE/E varied. Many of the women were aware of the risk factors and symptoms, but not when the condition developed. This trend is not uncommon among pregnant women [45-48], and may be associated with the fact that PE/E has no obvious symptoms and most women with the condition feel well. While a majority recognized its severity, a substantial number did not. This difference in awareness could impact the timely identification of symptoms and risk factors, potentially affecting early diagnosis, prompt healthcare seeking, and condition management. While the participants' identification of key risk factors like family history and previous occurrences was admirable, there was room for improvement in recognizing less emphasised factors such as substance abuse and sedentary lifestyle. The severity of PE/E was highlighted by reported complications, which included foetal and maternal deaths, heart-related diseases, and placental separation. The inadequate knowledge of PE/E among the participants can be linked to the information gap in ANC education [18-21]; as most participants who were aware of PE/E had general knowledge about pregnancy care and not specific to preeclampsia/eclampsia prevention.
Adequate knowledge of PE/E and its risk factors, symptoms, and complications, empowers patients and supports better healthcare decisions such as preventive measures and health seeking behaviour [18, 49, 50, 51]. To understand participants' knowledge of PE/E, they were asked about their understanding and prior encounters. Responses varied, revealing diverse perspectives. Many women cited symptoms like severe headaches, edema, sleep disturbances, and blurry vision. One shared a tragic incident involving a neighbour's fatal experience with pre-eclampsia during childbirth. The woman explained that her neighbour frequently complained of severe headaches, and despite efforts to undergo a caesarean section (CS), she passed away along with her unborn child. An account from a participant from one of the health facilities in Kumbotso LGA stated,
“I had one of my neighbours that had [pre-eclampsia] ...She started with a headache, and she died as a result of the headache. She couldn't put to birth until she passed away with the unborn child."
Another participant discussed experiencing post-delivery symptoms, particularly persistent headaches. Despite medical tests showing no abnormalities, the participant continued to face health concerns, emphasising the complexity of identifying and addressing such conditions.
"Presently I'm feeling some kind of condition in my body... I delivered, and am having a headache from one side up to now. I was tested differently but they said there's nothing, no high BP, nothing is wrong." - A participant from a health facility in Ungogo LGA
A participant recounted a case where a pregnant woman with preeclampsia developed complications, including oedema and eventually madness. The woman delivered at home, and despite later being taken to the hospital, her mental health deteriorated significantly.
"I had a neighbour with this condition who has gone mad as a result of it. She started with oedema and later became mad. Up to now she didn't get herself." - A participant from a health facility in Ungogo LGA
The study also inquired about the channels from which the women gained knowledge about PE/E and the associated health conditions. The responses indicate that individuals became aware of these conditions through various channels. In the hospital, counselling sessions and lectures were mentioned as sources of information.
“Yes, they were been counselling in the hospital and also lecturing us about the condition” - A participant from a health facility in Kumbotso LGA
Additionally, seeing individuals with the condition during hospital visits contributed to awareness. Family and friends were also cited as important sources of information, suggesting that informal networks play a role in disseminating knowledge about health conditions. One participant highlighted a specific case of a woman who developed the condition during pregnancy, emphasising the real-life impact observed in the community.
“There's a woman who still has the condition after she has put to birth and the BP is still high. She got the condition during the pregnancy.” - A participant from a health facility in Ungogo LGA
The study also inquired into whether the participants received counselling about PE/E from healthcare providers. Participants in different healthcare centres acknowledged the significance of counselling in their understanding and management of these conditions. In one of the PHC in Ungogo LGA, a participant ascertained that healthcare providers inform them about the causes of PE/E, emphasising the importance of avoiding certain practices.
"They are telling us the causes of the condition and the things we are to avoid."
Similarly, a participant from a health facility in Ungogo LGA, participants reported being gathered in groups for counselling sessions on preventive measures. A participant mentioned,
"They are gathering us in a group and counselling us on how to prevent ourselves from the condition in the hospital."
In one of the health facilities in Kumbotso LGA, participants highlighted the role of doctors in counselling and guiding them during hospital visits. A participant stated,
"Is the Doctors that are telling us whenever we come to the hospital because of how they are taking good care of us."
Another participant emphasised,
"They are counselling us and also telling us the way forward. If it's for drugs then they will place you. And we heard all this counselling in the hospital."
These firsthand accounts highlight the severity of the condition and the challenges it poses during childbirth. Another key takeaway from the excerpts is that healthcare providers play a crucial role in educating pregnant individuals about pre-eclampsia and eclampsia. Counselling sessions include information on the causes, preventive measures, and guidance on managing the conditions.
Attitude towards preventing PE/E
Concerning attitudes towards PE/E preventive measures, a majority expressed belief in prevention and showed positive attitudes towards various preventive measures, which is common from previous studies [52, 43]. This positive perspective offers an opportunity for implementing strategies to reinforce positive attitudes towards prevention through health education. There was a consensus on the role of antenatal care, stress reduction, and dietary habits in preventing PE/E. The present study also revealed significant associations between pregnant women's attitudes and various demographic factors. The rural/urban divide, trimester, religion, and source of income were found to be associated with attitudes towards preventive measures for PE/E. For instance, pregnant women in Ungogo LGA (more urban) were twice as likely to show a positive attitude compared to those in Kumbotso LGA. Additionally, women in the third trimester and those without a source of income were more likely to hold negative attitudes. The findings present a diverse disposition of pregnant women towards managing their health during pregnancy. Recent studies found that pregnant women who had inadequate knowledge of the symptoms of PE/E also had poor attitude toward preventing PE/E [18, 19, 22, 21], which was associated with no formal education [18], irregular ANC visits [24, 52, 25].
All the participants of the focus group discussions showed agreement on the significant importance of preventing PE/E in pregnant women. This sentiment was consistently shared across different focus group discussions in various primary healthcare centres. From the discussions with participants in one of the health facilities in Kumbotso LGA, participants stressed the importance of preventing maternal conditions. One participant stated:
"It's very important for a pregnant woman to prevent herself and the unborn child from eclampsia and any other maternal condition."
Additionally, the potential severity of eclampsia was highlighted with a comment like, "some of the eclampsia patients cannot survive, because the one we give birth at the same time has passed away both the mother and the child. But when you come to the hospital for them to place you on drugs Allah will make it easy for you."
In one of the health facilities in Ungogo LGA stated, one participant stressed the significance of adhering to healthcare provider counselling to prevent the conditions. She stated that:
“Because if a person abides by the counselling of the health care provider, she will be liable to prevent herself from this condition."
In finding out whether the women had positive attitudes towards preventing PE/E, the women generally exhibit positive attitudes towards preventive measures against ill-health, particularly during pregnancy. There is a consensus on the importance of reducing the intake of certain substances to prevent high blood pressure during pregnancy. One participant emphasises the need to reduce the intake of maggie, salts, and potassium during pregnancy, attributing them to causing high blood pressure.
“Yes, sincerely if you are pregnant you need to reduce the level of Maggie, salts and potassium intake because all things are causing high blood pressure.” - A participant from a health facility in Kumbotso LGA
This sentiment is echoed by another participant who connects the advice to reduce “maggie and salt” intake to the presence of salt in kalaba, a local food item. This reflects an awareness of the impact of dietary choices on health, especially during pregnancy. Furthermore, participants express a commitment to regularly taking their routine drug, highlighting a proactive approach to preventive healthcare. One participant stresses the importance of timely hospital visits, suggesting a recognition of the significance of early medical intervention. Additionally, there is an acknowledgement of the role of counselling in shaping positive attitudes towards preventive measures. One participant noted that adherence to drug intake and prompt hospital visits is a result of counselling.
“Because as you stop bothering yourself, keep on taking your drugs and any slight thing you will rush to the hospital you see all this are as a result of the counselling.”- A participant from a health facility in Kumbotso LGA
Practice of preventive measures against PE/E
The women exhibited divergent health practices during pregnancy, including utilisation of traditional healers and inconsistent attendance at antenatal care, use of over-the-counter medicine, irregular sleeping patterns. The practice of preventive measures against PE/E was notably equally divided between good and bad practice. Studies had noted that pregnant women typically take less measures to prevent PE/E [53]. The study identified significant associations between pregnant women's practices and demographic factors such as location (rural-urban divide), educational level, religion, and source of income. Multivariate analysis revealed that LGA, trimester, education level, and income source served as predictors of preventive measures practices. Pregnant women in the more urban area (Ungogo LGA) were less likely to adopt preventive measures compared to those in Kumbotso LGA. Additionally, women in the third trimester, those with tertiary education, and those without a source of income were less likely to engage in preventive measures. Conversely, Janakiraman et al. [26], reported that participants with education were more likely to have good preventive measures. Measures such as adequate antenatal care, screening, use of supplements, and management of risk factors have been shown to reduce the incidence and severity of PE/E. However, the uptake of these preventive measures among pregnant women remains low [54-56]. Only 14.5% pregnant women attending ANC in Kano State, practised all the recommended preventive measures for PE/E. Yakasai and Morhason-Bello [56] highlighted the importance of sufficient antenatal care, early identification, and reducing stressful home situations as essential preventive measures against early-onset severe preeclampsia in pregnant women.Ojukwu et al. [57] discovered that 52.36% of participants possessed knowledge regarding antenatal workouts as a preventive intervention against preeclampsia and eclampsia.Okonofua et al. [58] showed that multiple interventions effectively addressed institutional barriers, leading to a decrease in both the occurrence and death rates related to preeclampsia and eclampsia.
However, from the focus group discussions, when the participants were asked to share insights into preventive measures they personally practised during pregnancy or past pregnancies. The predominant theme revolved around the guidance and counselling received, with a strong emphasis on information obtained from healthcare professionals at hospitals. A first hand account from a participant in one of the health facilities in Kumbotso LGA stated:
“Once we were told not to do things sincerely speaking, I'm not doing it."
Another account from another facility in the same LGA mentioned that,
“It’s when you come to the hospital that you will learn things you didn’t know and it is possible that people did not know anything at home while in the hospital, we have many people like doctors who have different knowledge that Allah has blessed them with.”
A participant from a facility in Ungogo LGA mentioned that they do practise the counselling given to them by the healthcare workers. She stated:
“We are going to practise the counselling given to us.”
These responses revealed the challenges faced and might influence the approach of pregnant women towards preventive measures for PE/E. The findings from this analysis suggests that while knowledge influences attitudes, other factors may also influence their practice. The insights from the FGDs highlight a disconnect between knowledge they have about PE/E, their attitude towards preventing PE/E, and their practice of preventive measures. A good starting point is to develop targeted patient education on signs, symptoms, and risk factors, PE/E prevention strategies to reduce adverse complications [52]. Some of the delivery strategies could include leaflets, educational videos, one-on-one counselling sessions, and group education sessions [50, 51].