Socio-demographic characteristics of participants
For the retrospective study, 4,707 female participants were sampled from the hospital registers with 234 participants selected as they met the desired characteristics of the study i.e., Preeclampsia. The highest participants were within age groups of 28–32 years, with 82(35.0%) participants while the age group with lowest participants was ≤ 22 years with 30 (12.8%). Married women constituted the majority of the retrospective study with 155 (66.2%) of the total participants, while cohabitating participants were the lowest with 10 (4.3%) of the participants as indicated by marital status. A summary of this retrospective demographic data is represented accordingly, (Table 2).
Table 2
Socio-demographic characteristics of the retrospective cross-sectional study participants
Variable | Characteristics | Number examined N (%) |
Age groups (Years) Total | ≤ 22 23–27 28–32 ≥ 33 4 | 30(12.8) 70(29.9) 82(35.0) 52(22.2) 234(100) |
Marital status Total | Single Married Cohabitation 3 | 69(29.5) 155(66.2) 10(4.3) 234(100) |
Socio-demographic characteristics of cross-sectional study participants
With regards to the data collected from respondents’ questionnaires in the cross-sectional study, there was a 100% response rate from the 200 women sampled. Data revealed that the age group with the highest participants was 23–27 years with 73(36.5%) of the total participants while the age group with the lowest number of participants was ≤ 22 with 35 participants, representing 17.5% of the sample population. Most participants were Christians 184(92.0%) while 4(2.0%) indicated they belonged to other non-conventional religious groups. Of the 200 participants, more than half, 106(53.0%) participants were married while 13(6.5%) participants were cohabitating. For the educational level, 88(44.0%) of the participants were persons with university level of education while 3(1.5%) had no formal educational background. Tole health area had the least participants in the study represented by 1(0.5%) while Buea Town health area had 45(22.5%) of the participants, representing the highest portion of women in the study. Regarding occupation 72(36.0%) participants were business owners while the least group 10(5%) was made of farmers. Among the study participants, majority 124(62.0%) had ≤ 1 children while those with ≥ 4 represented the least number 11(5.5%) of the participants. More than half 122(61.0%) of the participants have incomes between 20.000 and 90.000 while only 17(8.5%) of the participants have salaries ≥ 200.000, (Table 3).
Table 3
Socio-demographic characteristics for cross-sectional study participants (n = 200)
Variable | Characteristics | Frequency N (%) |
Age Group (Years) | ≤ 22 23–27 28–32 ≥ 33 | 35(17.5) 73(36.5) 55(27.5) 37(18.5) |
Religion | Christian Muslim African Traditional Beliefs Others | 184(92.0) 6(3.0) 6(3.0) 4(2.0) |
Marital status | Single Married Cohabitation | 81(40.5) 106(53.0) 13(6.5) |
Educational level | No formal education Primary Secondary High School University Education | 3(1.5) 19(9.5) 43(21.5) 47(23.5) 88(44.0) |
Location | Buea Town Bokwoango Bova Molyko Muea Tole Buea Road Others | 45(22.5) 23(11.5) 16(8.0) 44(22.0) 19(9.5) 1(0.5) 25(12.5) 27(13.5) |
Occupation | Civil Servant Farmer Private sector Business person Others | 29(14.5) 10(5.0) 52(26.0) 72(36.0) 37(18.5) |
Transportation to Health facility | Walking Car Motorcycle | 10(5.0) 186(93.) 4(2.0) |
Monthly Income | ≤ 10.000 20.000–90.000 100.000-190.000 ≥ 200.000 | 18(9.0) 122(61.0) 43(21.5) 17(8.5) |
Number of children | ≤ 1 2–3 ≥ 4 | 124(62.0) 65(32.5) 11(5.5) |
Prevalence of Preeclampsia amongst pregnant women in the Buea Health District (2017–2021)
In this study, of the 5year range of files examined for a total of 4,707 women, the prevalence of preeclampsia was 4.97% that is 234 women, (Fig. 2). For the educational level, 88(44.0%) of the participants were persons with university level of education while 3(1.5%) had no formal educational background.Tole health area had the least participants in the study represented by 1(0.5%) while Buea Town health area had 45(22.5%) of the participants, representing the highest portion of women in the study.
Records collected from the 3 facilities involved indicated that the trends in prevalence of preeclampsia were not directly proportional to size though some institutions with large populations actually had high incidences of preeclampsia. The case of PMI with 1,206(25.62%) participants observed had 14.3% (173participants) prevalence vs. Mount Mary with 3,106(65.98%) participants had 58(18.7%) participants who turned out positive with preeclampsia (Table 4). The yearly trends amongst facilities involved were irregular (Fig. 3) with a great increase observed across all facilities in 2021. Considering the observed trend, it was noticed that there is a general increase across the years on the incidence of preeclampsia across all facilities involved in the study (Fig. 4, 5, 6).
Knowledge of pregnant women on the importance of ANC
From a Likert scale of 3 responses; Yes, No and No idea, a tally of 33points was generated with a minimum score of 24 considered as the threshold for adequate knowledge. As such participants with scores < 24 was considered to have inadequate knowledge while those with scores of ≥ 24 was considered to have adequate knowledge on ANC. Findings showed most; 189(94.5%) of the participants had adequate knowledge on ANC, (Fig. 7 ).
Knowledge of participants with respect to sociodemographic factors
Age group was seen to be significantly associated (X2 = 15.306, p = 0.018) with knowledge on ANC. Religion (X2 = 47.521, p < 0.001), marital status (X2 = 11.663, p = 0.020), educational level (X2 = 32.148, p < 0.001), location (X2 = 24.287, p = 0.042), and number of children (X2 = 25.799, p < 0.001) were all significantly associated with knowledge on ANC while the other socio- demographic factors had no significant association with women’s’ knowledge on ANC, (Table 4).
Knowledge on importance of ANC
A 5 response Likert scale was used to test for the level of knowledge on the importance of ANC by pregnant women and responses gotten were graded as such from the 5 questions asked: <18; inadequate knowledge, ≥ 18; adequate knowledge. It was observed (Fig. 8) that 169(84.5%) participants had adequate knowledge while 31(15.5%) had inadequate knowledge on the importance of ANC. This was tested with questions like “Antenatal care schools you on complications (danger signs) that should warn you of problems with the pregnancy”, And others like “Early antenatal booking reduces the risk of preeclampsia”.
Table 4
a: Association of demographic factors with participant’s knowledge on ANC (n = 200).
Variable | Characteristics | Frequency (n) | Adequate knowledge (%) | Inadequate knowledge (%) | X2 Value | P value at 95% CI |
Age Group (Years) | ≤ 22 | 35 | 30(85.7) | 5(14.3) | 15.306 | 0.018 |
23–27 | 73 | 72(98.6) | 1(1.4) | | |
| 28–32 | 55 | 51(92.7) | 4(7.3) | | |
| ≥ 33 | 37 | 34(91.9) | 3(8.1) | | |
Religion | Christian | 184 | 174(94.6) | 10(5.4) | 47.521 | < 0.001 |
| Muslim | 6 | 6(100.0) | 0 | | |
| African Traditional Beliefs | 6 | 3(50.0) | 3(50.0) | | |
| Others | 4 | 4(100.0) | 0 | | |
Marital status | Single | 81 | 72(88.9) | 9(11.1) | 11.663 | 0.020 |
| Married | 106 | 103(97.2) | 3(2.8) | | |
| Cohabitation | 13 | 12(92.3) | 1(7.7) | | |
Educational level | No formal education | 3 | 3(100) | 0 | 32.148 | < 0.001 |
| Primary | 19 | 13(68.4) | 6(31.6) | | |
| Secondary | 43 | 40(93.0) | 3(7.0) | | |
| High School | 47 | 44(93.6) | 3(6.4) | | |
| University Education | 88 | 87(98.9) | 1(1.1) | | |
Table 4
b: Association of demographic factors with participant’s knowledge on ANC (n = 200)
Variable | Characteristics | Frequency (n) | Adequate knowledge (%) | Inadequate knowledge (%) | X2 Value | P value at 95% CI |
Location | Buea Town | 45 | 44(97.8) | 1(2.2) | 24.287 | 0.042 |
| Bokwoango | 23 | 22(95.7) | 1(4.3) | | |
| Bova | 16 | 14(87.5) | 2(12.5) | | |
| Molyko | 44 | 43(97.7) | 1(2.3) | | |
| Muea | 19 | 16(84.2) | 3(15.8) | | |
| Tole | 1 | 1(100.0) | 0 | | |
| Buea Road | 25 | 21(84.0) | 4(16.0) | | |
| Others | 27 | 26(96.3) | 1(3.7) | | |
Occupation | Civil Servant | 29 | 29(100.0) | 0 | 9.292 | 0.318 |
| Farmer | 10 | 10(100.0) | 0 | | |
| Private sector | 52 | 50(96.2) | 2(3.8) | | |
| Business person | 72 | 63(87.5) | 9(12.5) | | |
| Others | 37 | 35(94.6) | 2(5.4) | | |
Monthly Income | ≤ 10.000 | 18 | 15(83.3) | 3(16.7) | 8.394 | 0.211 |
20.000–90.000 | 122 | 112(91.8) | 10(8.2) | | |
| 100.000-190.000 | 43 | 43(100.0) | 0 | | |
| ≥ 200.000 | 17 | 17(100.0) | 0 | | |
Number of children | ≤ 1 | 124 | 117(94.4) | 7(5.6) | 25.799 | < 0.001 |
2–3 | 65 | 63(96.9) | 2(3.1) | | |
| ≥ 4 | 11 | 7(63.6) | 4(36.4) | | |
Knowledge on importance with respect to Socio-demographic factors.
Religion was significantly associated with knowledge on the importance of ANC, having a chi-square(X2) value of 12.029 and a p-value of 0.007, together with educational level (X 2 = 10.641 p = 0.031), and income (X 2 = 8.061, p = 0.045) while the other socio-demographic had no significant association (p > 0.05) with women’s’ knowledge on the importance of ANC, (Table 5).
Effectiveness of ANC in the prevention and management of preeclampsia during pregnancy.
A total of 223 (95.3%) of the 234 diagnosed cases of preeclampsia were observed to have been properly managed at the 3 health institutions over the time of the study (2017–2021), leaving a total of 11(4.7%) cases that resulted in eclampsia (Table 6).
Table 5
a: Association of demographic factors with participant’s knowledge on importance of ANC (n = 200)
Variable | Characteristics | Frequency (n) | Adequate knowledge (%) | Inadequate knowledge (%) | X2 Value | P value at 95% CI |
Age Group (Years) | ≤ 22 | 35 | 28(80.0) | 7(20.0) | 1.147 | 0.766 |
23–27 | 73 | 64(87.7) | 9(12.3) | | |
| 28–32 | 55 | 46(83.6) | 9(16.4) | | |
| ≥ 33 | 37 | 31(83.8) | 6(16.2) | | |
Religion | Christian | 184 | 160(87.0) | 24(13.0) | 12.029 | 0.007 |
| Muslim | 6 | 3(50.0) | 3(50.0) | | |
| African Traditional Beliefs | 6 | 3(50.0) | 3(50.0) | | |
| Others | 4 | 3(75.0) | 1(25.0) | | |
Marital status | Single | 81 | 66(81.5) | 15(18.5) | 0.989 | 0.610 |
| Married | 106 | 92(86.8) | 14(13.20 | | |
| Cohabitation | 13 | 11(84.6) | 2(15.4) | | |
Educational level | No formal education | 3 | 3(100) | 0 | 10.641 | 0.031 |
Primary | 19 | 15(78.9) | 4(21.1) | | |
| Secondary | 43 | 34(79.1) | 9(20.9) | | |
| High School | 47 | 35(74.5) | 12(25.5) | | |
| University Education | 88 | 82(93.2) | 6(6.8) | | |
Location | Buea Town | 45 | 41(91.1) | 4(8.9) | 5.666 | 0.579 |
| Bokwoango | 23 | 17(73.9) | 6(26.1) | | |
| Bova | 16 | 14(87.5) | 2(12.5) | | |
| Molyko | 44 | 35(79.5) | 9(20.5) | | |
| Muea | 19 | 15(78.9) | 4(21.1) | | |
| Tole | 1 | 1(100) | 0 | | |
| Buea Road | 25 | 22(88.0) | 3(12.0) | | |
| Others | 27 | 24(88.9) | 3(11.1) | | |
Table 5
b: Association of demographic factors with participant’s knowledge on importance of ANC (n = 200)
Variable | Characteristics | Frequency (n) | Adequate Knowledge (%) | Inadequate Knowledge (%) | X2 Value | P value at 95% CI |
Occupation | Civil Servant | 29 | 26(89.7) | 3(10.3) | 7.624 | 0.106 |
| Farmer | 10 | 10(100) | 0 | | |
| Private sector | 52 | 39(75.0) | 13(25.0) | | |
| Business person | 72 | 60(83.3) | 12(16.7) | | |
| Others | 37 | 34(91.9) | 3(8.1) | | |
Transportation to Health facility | Walking | 10 | 9(90) | 1(10) | 1.021 | 0.600 |
Car | 186 | 156(83.9) | 30(16.1) | | |
Motorcycle | 4 | 4(100) | 0 | | |
Monthly Income | ≤ 10.000 | 18 | 18(100) | 0 | 8.061 | 0.045 |
20.000–90.000 | 122 | 98(80.3) | 24(19.7) | | |
| 100.000-190.000 | 43 | 36(83.7) | 7(16.3) | | |
| ≥ 200.000 | 17 | 17(100) | 0 | | |
Number of children | ≤ 1 | 124 | 105(84.7) | 19(15.3) | 1.303 | 0.521 |
2–3 | 65 | 56(86.2) | 9(13.8) | | |
| ≥ 4 | 11 | 8(72.7) | 3(27.3) | | |
Table 6
Management of Preeclampsia at ANC facilities
Variable | Number examined (N) | Preeclampsia N (%) | ManagedN (%) | Resulted in Eclampsia N (%) |
Examined (N) | 4,707 | 234(4.97) | 223(95.3) | 11(4.7) |
Results indicate that most cases of preeclampsia were seen from women who started ANC during the 2nd trimester, 166(70.9%) cases in total of the 234 observed. This also indicated that women who started ANC early (1st trimester) had fewer cases of preeclampsia [51(21.8%)]. Pregnancy outcome was also monitored to ascertain what became of the women with or without preeclampsia and it was noticed 204(87.2%) of the women were lost to follow-up with just a single case (0.4%) referred (Table 7).
Each facility had varying degrees of management across the years with PMI having the most managed cases: 170 representing 98.3% of their total diagnosed cases and Mount Mary having the most cases that progressed to eclampsia; 8 representing 13.8% of their total diagnosed cases, (Table 8). Graphical representation shown in Fig. 10.
Table 7
General observation of Preeclampsia during 1st to 3rd trimesters and their outcomes (n = 234)
Variable | Characteristics | Number examined N (%) |
Gestational Age at first ANC (Trimesters) | 1st | 51(21.8) |
2nd | 166(70.9) |
| 3rd. | 17(7.3) |
Pregnancy Outcome | Completed pregnancy | 29(12.4) |
| Loss to follow up | 204(87.2) |
| Referred | 1(0.4) |
Table 8
Management Results of Preeclampsia per health institution (2017–2021) in BHD
Health institution | Number examined N (%) | Preeclampsia N (%) | Successfully managed N (%) | Resulted in Eclampsia N (%) |
PMI | 1,206 | 173(14.2) | 170(98.3) | 3(1.7) |
Mount Mary | 3,106 | 58(1.9) | 50(86.2) | 8(13.8) |
Bebetta | 395 | 3(0.8) | 3(100.0) | 0 |
| 4,707 | 234(4.97) | 223(95.3) | 11(4.7) |
Factors limiting ANC attendance
Considering the various factors laid down as challenges that limit access to ANC care, long distance to the facility was seen to be significantly associated with ANC attendance (p = 0.032), together with financial limitations (p = 0.002), biased treatment from hospital staff (p0.05) with ANC attendance, (Table 9).
Reasons why women choose particular ANC centers
Among the study participants, almost half indicated that they preferred the particular ANC sites they visited because of the trust they had in the services provided 49.5%( p0.05). These reasons were listed in Table 10.
Table 9
Association of Factors limiting ANC attendance with use of ANC in the BHD (n = 200)
FACTOR | RESPONSE | FREQUENCY N (%) | P value at 95% CI | Confidence Interval |
| | Lower Bound | Upper Bound |
Long Distance from facility | No | 120(60.0) | 0.032 | 0.007 | 0.165 |
Yes | 80(40.0) | | | |
Financial limitations | No | 127(63.5) | 0.002 | 0.046 | 0.201 |
| Yes | 73(36.5) | | | |
Biased treatment from hospital staff | No | 170(85.0) | < 0.001 | 0.203 | 0.424 |
| Yes | 30(15.0) | | | |
No time to come to the hospital | No | 164(82.0) | 0.120 | -0.017 | 0.143 |
Yes | 36(18.0) | | | |
Long waiting time at the hospital | No | 125(62.5) | 0.002 | 0.059 | 0.247 |
| Yes | 75(37.5) | | | |
No privacy | No | 176(88.0) | < 0.001 | 0.146 | 0.383 |
| Yes | 24(12.0) | | | |
No Security | No | 187(93.5) | 0.074 | -0.015 | 0.323 |
| Yes | 13(6.5) | | | |
Limited female staff | No | 193(96.5) | 0.261 | -0.104 | 0.382 |
| Yes | 7(3.5) | | | |
Little or no knowledge on the need for ANC | No | 169(84.5) | 0.780 | -0.086 | 0.114 |
Yes | 31(15.5) | | | |
Family resistance | No | 185(92.5) | 0.195 | -0.053 | 0.258 |
| Yes | 15(7.5) | | | |
Community restrictions | No | 194(97.0) | 0.439 | -0.321 | 0.140 |
| Yes | 6(3.0) | | | |
No specialized staff Gynecologist | No | 181(90.5) | 0.005 | 0.069 | 0.375 |
Yes | 19(9.5) | | | |
Table 10
Reason why women choose particular ANC centers (n = 200)
FACTOR | RESPONSE | FREQUENCY N (%) | P value at 95% CI |
Location close to home | No | 153(76.5) | 0.007 |
| Yes | 47(23.5) | |
Low cost | No | 128(64.0) | 0.005 |
| Yes | 72(36.0) | |
Trust in providers/ High quality care | No | 101(50.5) | < 0.001 |
Yes | 99(49.5) | |
Availability of drugs | No | 183(91.5) | 0.192 |
| Yes | 17(8.5) | |
Availability of female staff | No | 179(89.5) | 0.462 |
Yes | 21(10.5) | |
Recommendation/ Referral | No | 138(69.0) | 0.051 |
Yes | 62(31.0) | |
Availability of specialized staff | No | 164(82.0) | 0.782 |
Yes | 36(18.0) | |