Abstract
The purpose of this study was to
determine the prevalence of hypertension among pregnant women in Nsukka Urban
from 2007-2011.To achieve the purpose of the study, five objectives were
formulated with corresponding research questions and four hypotheses were formulated.
The descriptive survey research method utilizing the expost-facto design was
used for the study. The instrument for data collection was a researcher
designed hypertension in pregnancy inventory Proforma (HIPI). Five experts in
the Department of Health and Physical Education and Department of Science
Education validated the proforma. The population for the study consisted of all
registered pregnant women in the twenty –three health facilities in Nsukka
urban of Nsukka L.G.A in Enugu State from 2007-2011. This gave an estimated
population of 23,520 pregnant women, while the sample for the study consisted
of 706 cases. Data collected from the health facilities were used for analysis.
In analyzing the data, frequencies and percentages were used to answer the
research questions while chi-square statistic was used to test all the null
hypotheses at .05 level of significance. The result of the study showed that
the highest prevalence cases (26.3%) and (25.1%) were recorded in 2007 and 2009
respectively while the lowest prevalence cases occurred in 2010 (14.5%).
Pregnant women aged 30-49 years recorded the highest prevalence of (90.7%)
while the lowest prevalence was recorded in pregnant women aged 15-29 years
(9.5%). Prevalence of hypertension was also higher in pregnant women who have
up to 6-9 children and above (66.9%) while lowest prevalence occurred in
pregnant women who have 0-5 pregnancies. The highest cases of prevalence of
hypertension among pregnant women were recorded among the uneducated pregnant
women (65.4%) while the educated pregnant women recorded the lowest. Pregnant
women who are civil servants and traders recorded the highest prevalence of
(75.7%) cases of hypertension while those who are house wives and farmers
recorded the lowest. From the findings of the study, it was therefore
recommended that there should be continual increase in creation of awareness on
possible factors that can predispose pregnant women to hypertension as this has
been shown to be responsible in the reduction of hypertension, awareness should be created for women on the
dangers of late pregnancy cases, so as to enable them control their chances of
getting pregnant as they get older, adequate birth control measures should be
put in place and adopted by women so as to check the number of children a woman
will have thereby reducing their chances of hypertension cases during pregnancy,
poor level of education has been implicated in the high prevalence of
hypertension, therefore adequate awareness and education should be provided for
pregnant women with primary education on the factors associated with
hypertension, It is also recommended that appropriate policies should be put in
place by the government to reduce work load on women during pregnancy, such
policies may include among others pregnancy leave or break.
CHAPTER ONE
Introduction
Background to the Study
Globally, pregnant mothers face different complications that may endanger their lives and their foetuses. Such complications include haemorrhage, obstructed labour, sepsis, abortion and hypertension. Among these complications, hypertension contributes directly or indirectly to millions of material deaths each year around the world. Lucas and Gilles (2003) opined that in many developing countries, complications of pregnancy and child birth are the leading causes of death among women of reproductive age. Hypertension in pregnancy has been a disease of great concern. UNICEF (2001) and WHO (2002) estimated that in Nigeria, there is a raising prevalence of pregnancy induced-hypertension ranging from 10-15 per cent of direct medical causes of maternal mortality. Worldwide, it is far greater problem with an estimated 72, 000 deaths annually due to lack of awareness of the health problem (Baker, 2006). Similarly, this disease is at a high prevalence in Nigeria which is a developing country where health services and facilities are not yet adequately made available to the population. James and Piercy (2004) observed that hypertension is the most common medical problem encountered in pregnancy and remains an important cause of maternal and fetal morbidity and mortality. Hypertensive disorders in pregnancy are among the leading causes of maternal mortality, along with thromboemboilsm, haemorrhage and nonobstetric injuries. They further stated that hypertension in pregnancy is one of the most serious morbidity conditions of the expectant mother, which the cause remains unknown.
Anthony and Glaser (2010) indicated that with high blood pressure in pregnancy, there is an increase in the resistance of blood vessels. They further stressed that this may hinder blood flow in many different organ systems in the expectant mother including the liver, brain, uterus and placenta. Other problems include placental abruption i.e. premature detachment of the placenta from the uterus, poor fetal growth and stillbirth.
Hyman and Parlik (2003) defined hypertension as the persistent raised level of blood pressure in which systolic pressure is 140mm Hg and diastolic pressure above 90mm Hg. However, Gordon (1989) viewed that pregnancy-induced hypertension is characterized by high blood pressure with a diastolic of 90mm Hg or more and a systolic of 140mm Hg or greater. The types of hypertension in pregnancy differ primarily in the incidence and not the nature of maternal and prenatal complications. Hence, Gibson (2009) classified hypertensive disorders of pregnancy into four categories: chronic hypertension, gestational hypertension, preeclampsia and eclampsia. He further explained that chronic hypertension is a known hypertension before pregnancy or a rise in blood pressure > 140/90mm Hg before 20 weeks gestation and persistently 6 weeks after delivery; gestational hypertension is the development of hypertension without other signs of preeclampsia. It is also hypertension that is diagnosed for the first time in pregnancy and that does not resolve postpartum. Preeclampsia is diagnosed on the basis of hypertension with proteinuria. In the absence of proteinuria, preeclampsia is suspected when hypertension is accomplished by symptoms including headache, blurred vision, abdominal/epigastric pain, or altered biochemistry, specifically low platelet counts and abdominal liver enzyme levels. Eclampsia is defined as the new onset of convulsions during pregnancy or postpartum, unrelated to other cerebral pathological conditions in a woman with preclampsia. In the context of the present study therefore, all the four categories of hypertension will be considered.
The occurrence of hypertension cannot be determined without the concept of prevalence. Onwasigwe (2002) defined prevalence of a disease as the number of people in a population that have a disease at a given period (old and new cases). Similarly, Millidot (2009) conceptualized prevalence as the number of people with a disease or condition in a given population at a specified time (point prevalence). Also, Onwasigwe (2002) further indicated that there are two types of prevalence rates: the point prevalence and the period prevalence. Point prevalence measures the probability of people having a disease at a specific point of time. That specific point of time may be an hour, day or week while period prevalence is the prevalence during a given time interval. This time interval is usually in months or years. Hence, period prevalence will be appropriate measure for the present study as it aims to determine the prevalence of hypertension among pregnant women in Nsukka urban from 2007-2011. In this study therefore, prevalence is the number of all new and old cases of hypertension among pregnant women between 2007 and 2011. Prevalence is expressed as a ratio in which the number of events is the numerator and the population at risk is the denominator (Mosby, 2009). Prevalence rate is represented mathematically thus:
Prevalence Rate (PR) = Number of existing cases of a disease (old and new at a point in time or during a period) x 100
Total population 1
The above formular is used in calculating the prevalence rate of hypertension during pregnancy among women in the present study.
Pregnancy, according to Shiela (2000), is a condition of supporting a fetus from conception till birth. In the same vein, Shriver (2012) defined pregnancy as when a woman has a growing fetus inside of her. Roberts (1994) explained that pregnancy is associated with many signs and symptoms which include: vomiting, headache, fever, dizziness, nausea and loss of appetite at the first trimester which can trigger hypertension. In the present study, pregnant women are the women carrying developing offspring within the body.
However, to ensure positive result in pregnancy, pregnant women are introduced to antenatal care. Antenatal care known as prenatal care, according to WHO (2003) is the complex of interventions that a pregnant woman receives from organized health care services. Similarly, Lucas and Gilles (2003) defined the term antenatal clinic as a place where special services are offered to pregnant women especially those of high-risk pregnancies including closer supervision during delivery. The purpose of antenatal care is to prevent or identify and treat conditions that may threaten the health of the fetus or the mother and to help a woman approach pregnancy and birth as positive experiences. In the context of the present study, therefore, antenatal clinic refers to the regular medical and nursing care given to women during pregnancy. This includes the screening for the management of hypertension during pregnancy.
It is expected that pregnant mothers in Nsukka Urban, like others reported in literature (UNICEF, 2001, Shemman, 2007), might have experienced any or all of the categories of hypertension indicated above. The need to ascertain this prompted the present study on prevalence of hypertension among pregnant women in Nsukka Urban between 2007 and 2011. Nsukka Urban is in Nsukka LGA in Enugu State. The town is made up of the following communities: Nru, Ihe-Owerre and Nguru. Others include Ugwu-nkwo, Ugwuoye, Amaze, Market area, University of Nigeria Community and Onuiyi. However, the extent Nigerian pregnant women know about this health problem does not appear to have received adequate research attention, hence, the need for the study.
There may be, however, some demographic factors that can be associated with prevalence of hypertension among pregnant women. They include age, educational status, parity status and maternal occupation.
An important measurement of risk to maternal and child health especially those associated with pregnancy and child health is maternal age. Abanobi (2003) reported a consistent association between maternal age and pregnancy complications. He further indicated that the childbearing age that is often associated with most favourable outcome of pregnancy is 20-30 years of age. However, Jones (2002) had earlier stated that after the age of 35 years, a maternal morbidity and mortality increase significantly and there is a high incidence of congenital malformations. WHO (1992) and Gaudemaris (2002) reported that morbidity and mortality rates of hypertension in pregnancy increase steadily with advancing age and that the older a person is, the likely she is to develop high blood pressure. Five to ten per cent out of one hundred women with their first pregnancy who are under 17 or over 35 years would probably develop high blood pressure (Duley, 2002). This however, is a major factor to pregnancy induced hypertension and other pregnancy complications. This is to determine maternal age in relation to hypertension in pregnancy.
Another variable that can predispose pregnant women to hypertension is low literacy level especially in a developing country like Nigeria. Ohonsi and Ashimi (2008) found that some pregnant mothers lack the knowledge of health values and health problems because of poor educational status. Most of the Nigerian women are unaware of this health problem. It was found that the values they attach to health and opinion they hold on health care services often differ significantly from those at rich and educationally advantaged country. Hence, where level of education including family life education are low, less healthy family lives practices are likely to prevail. WHO (1989), reported that the educationally disadvantage people lack the practical skill that might favour health. Ohonsi and Ashimi (2008) further indicated that low literacy level could have accounted for why these women could not appreciate the importance of proper antenatal care and avail themselves of the services. This also makes them to keep on producing as many children as possible. This study however, will examine the knowledge of pregnancy induced hypertension and the effect of a simple educational intervention measure.
Also, an African woman’s chance of dying from pregnancy related causes, obstructed labour, unsafe abortion and pregnancy-induced hypertension is high. This may be as a result of high parity status which is another major factor that influences hypertension in pregnancy. The term ‘Parity’ refers to the number of children a woman has delivered, for example, a woman giving birth to up to 4-5 children and above six children. Essien (2000) revealed that high parity level is associated with serious complications of pregnancy. Similarly, American College of Obstetricians and Gynecologist (2001) found that high parity level have an association with pregnancy-induced hypertension. The report further stated that any woman with family history of hypertension who does not develop in first is prone to develop in subsequent pregnancies. In the same vein, Fraser and Cooper (2003) revealed that high parity level influences hypertension in pregnancy. They further stated that between 5 per cent and 80 per cent of all pregnancies are complicated by hypertension especially in the first pregnancy and among women with more than four pregnancies. Because of high fertility rate in Nigeria, there is every tendency that pregnant women with more than four to five pregnancies may experience one pregnancy complication or the other. This of course predisposes them to hypertension, which when properly handled will ensure safe motherhood.
Another predisposing factor to the occurrence of hypertension morbidity and mortality among pregnant women is maternal occupation. Pregnant women are most often exposed to stress as a result of the type of occupation they engage in. Onuzulike (2003) found that maternal occupation which is the type of daily or routine activities undertaken by the pregnant women affect them especially during pregnancy. Adredi (2004) surveyed that during stress or emotional disturbances, the body system produces chemical substances called catecholamine and renalin and non-adrenalin. He further revealed that when such substances are released, it causes generalized vasoconstriction (contraction) and narrowing of the blood vessels which can produce transient hypertensive state. However, Achalu (2002) found that any worker who is not in harmony with her work or the work is stressful is likely to develop illness. Any woman with essential hypertension is liable to develop hypertension in pregnancy (Myles, 1999). Achalu (2002) further indicated that high stress occupation triples the risk of pregnancy-induced hypertension and that high levels of personal stress in pregnant women double the risk of premature birth. Hence, Landisbergis and Hatch (2011) concluded that women who had one or more highly stressful life events have the risk of preterm delivery 1.76 times greater than those without stressful events. This study is to explore possible mechanisms underlying poor working environment which may lead to stress and pregnancy outcomes. Such information might be necessary to help the pregnant women adjust in their working places so as to help improve maternal and fetal health.
The study was anchored on two theories. These are the hierarchy of needs and the self care theory. The hierarchy of need is a psychological model propounded by Abraham Maslow (1970). The theory attempts to explain the basic needs of life. The hierarchy of needs is based on core assumptions that the presence of basic needs of life provides an environment in which health manifests. The hierarchy of needs is necessary because, it creates awareness based on modifiable and non-modifiable risk factors by periodic checking of blood pressure, eating right type of food, regular antenatal care, exercise and adjustment in work place so as to ensure positive result in pregnancy. The theory of self care propounded by Orem (1971) is another theory related to this study. The theory was divided into three namely: universal self care needs, developmental self care needs and health deviation self care needs. The researcher then focused attention on health deviation self care needs which identified six requisites for individuals with health deviation which include: seeking and securing appropriate medical assistance, recognizing and taking care of the condition, implementing prescribed therapeutic and diagnostic measures, recognizing and regulating the effect of treatment, modifying the self concept and the acceptance of the condition and learning to live with the condition in a lifestyle that promotes continued personal development.
