ISSN: 2456-9992 Pregnancy Induced Hypertension (Pih): Expectant . - IJARP
International Journal of Advanced Research and PublicationsISSN: 2456-9992Pregnancy Induced Hypertension (Pih): ExpectantMothers‟ Care Seeking Behavior In Ekiti-StateNigeria.Adeosun Foluke O., Ayorinde Margaret A., Ogundele Samuel B., Adewole Josephine O.Afe Babalola University Ado – Ekiti, College of Social and Management Sciences, Department of Sociology, Nigeria, PH 2348039438880Adeosunf@abuad.edu.ngCollege of Medicine and Health Sciences, Afe Babalola University, Department of Nursing Science, Nigeria, PH- 2348075213798apekeola@gmail.comCollege of Medicine and Health Sciences, Afe Babalola University, Department of Nursing Science, Nigeria, PH- 2348029224659Tosley2000@gmail.comCollege of Medicine and Health Sciences, Afe Babalola University, Department of Nursing Science, Nigeria, PH- 2348029224659e-mail: ibikunlejosphn@yahoo.comAbstract: In Nigeria, women frequently suffer the outcomes of serious hypertensive disorders in pregnancy that may lead to death. Delayin seeking care is a key contributor to worsening the complications of Pregnancy induced hypertension (PIH). This study therefore aimed atcontributing to the available body of research on the knowledge and Health seeking behaviour among pregnant women (18 to 40 years)diagnosed with PIH in Ekiti-state, Nigeria. Data was collected through the use of questionnaire from pregnant women who have beendiagnosed with PIH. Research findings show that the level of knowledge of pregnancy induced hypertension among expectant mothers aged18 to 40 years with PIH complications in Ekiti-state Nigeria is so low (15%). Again, the rate at which they seek healthcare (15.8%), calls forurgent attention. In order to checkmate early complications of unmanaged PIH, maternal, foetal and neonatal mortality and morbidity; it istherefore recommended that appropriate health interventions and education programmes for the pregnant women with PIH should bedesigned by the government of Ekiti-State, Nigeria. For interventions to work, the knowledge gained via this study would sensitizemidwives on knowledge needs of pregnant women with PIH previously unrealized thereby strengthening the quality of antenatal careeducation. In conclusion, there is a significant relationship between the level of knowledge of expectant mothers and the frequency at whichthey seek health care, the point at which they seek healthcare; as well as the alternative choices available to them.Keywords: Care seeking behavior, Expectant mothers, Knowledge, Pregnancy Induced Hypertension (PIH).1. INTRODUCTIONPregnancy induced hypertension (PIH) is a global problem[1] which Hypertension in pregnancy affects about 5-22%of pregnancies worldwide [2]. PHI is an emerging clinicaland public health problem in Nigeria. However, there havebeen very few researches on PIH in Nigeria and the fewresearches have focused more on the reduction,management and treatment of PIH.In 2009, theprevalence of PIH ranges between 2% to 16.7% [3]. Innorthern Nigeria Pre-eclampsia/eclampsia accounts for upto 40 percent of maternal deaths [3]. In 2011, Enugu townhad 3.3%/77 cases of PIH out of 2337 cases [4]. In 2014,according to [5] the prevalence of hypertensive disorderswas estimated to be higher than 17% in Nigeria. Thiscalls for urgent attention. Health seeking behaviour isdefined as an activity undertaken by individuals whoperceive themselves to have a health problem, or are ill forthe purpose of finding an appropriate remedy [6].Research evidence suggests that women have healthseeking behaviours which range from buying over thecounter drugs to relieve headache, consulting relatives onwhat to do with odema, epigastric pain and blurred vision,consulting a spiritual or traditional healer on convulsingand coming to hospital. All these health-seekingbehaviours may delay coming to hospital, worsening thePIH complications [7]. This study therefore aims atcontributing to the available body of research on theknowledge and Health seeking behaviour among pregnant women (18 to 40 years) diagnosed with PIH complicationsin Ekiti-state Nigeria.2. RESEARCH QUESTIONS1.2.3.How knowledgeable are pregnant women age 18 -40years in Ekiti State about induced hypertension(PIH)?What are the health seeking behaviours of pregnantwomen with pregnancy induced hypertension aged 18to 40 years in Ekiti - State?What is the relationship between knowledge ofcomplications of PIH and health seeking behavioursamong pregnant women (aged 18 to 40 years)diagnosed with pregnancy induced hypertension inEkiti - State?3. OBJECTIVES OF THE STUDY1.2.To determine knowledge about complications of PIHamong pregnant women aged 18 to 40 years Ekiti –State.To identify the health seeking behaviours of pregnantwomen aged 18 to 40 years who have been diagnosedof PIH in Ekiti – State.4. VARIABLESIn this study the variables are Health Seeking Behaviour(dependent variable) and knowledge of complications(independent variable).Volume 1 Issue 4, Oct 2017www.ijarp.org88
International Journal of Advanced Research and PublicationsISSN: 2456-99927.1 Classification of PHICanadian Hypertension Society posits that PIH refers toone of four conditions [10] :4.1 DEMOGRAPHIC VARIABLESDemographic variables address expectant mothers‟ age,religion, marital status, level of education, andemployment status.7.1.2 Gestational hypertension (GH) is diagnosed inwomen whose blood pressure reaches 140/90 mmHg forthe first time during pregnancy (after 20 weeks gestation),but without proteinuria. Blood pressure normalizes by 12weeks postpartum [9], [10].5. HYPOTHESIS 1Hi: There is a significant relationship between knowledgeof PIH complications and care- seeking among pregnantwomen aged 18 to 40 who have been diagnosed of PIH inEkiti – StateHo: There is no significant relationship betweenknowledge of PIH complications and care- seeking amongpregnant women aged 18 to 40 who have been diagnosedof PIH in Ekiti – State.7.1.3 Preeclampsia (PE)Hypertension (blood pressure 140 / 90 mmHg)accompanied with proteinuria exceeding 300 mg/24 hoursemerges for the first time after 20 weeks gestation, butboth symptoms normalize by 12 weeks postpartum [9].7.1.4 Superimposed preeclampsia (S-PE)Superimposed preeclampsia is diagnosed in the followingthree cases. (1) New onset proteinuria ( 300 mg/24hours) in hypertensive women who exhibit no proteinuriabefore 20 weeks gestation. (2) Hypertension andproteinuria documented antecedent to pregnancy and/ordetected before 20 weeks gestation, one or both of whichprogressing after 20 weeks gestation. (3) Renal diseasewith proteinuria documented antecedent to pregnancyand/or detected before 20 weeks gestation, which isaccompanied with new onset hypertension after 20 weeksgestation [9], [11].5.1HYPOTHESIS 2Hi: There is a significant relationship between knowledgeof PIH complications and the point when expectantmothers aged 18 to 40 who have been diagnosed of PIH inEkiti – State seek care after diagnosisHo: There is no significant relationship betweenknowledge of PIH complications and the point whenexpectant mothers aged 18 to 40 who have been diagnosedof PIH in Ekiti – State seek care after diagnosis.5.2HYPOTHESIS 3Hi: There is a significant relationship between knowledgeof PIH complications and alternative choices of expectantmothers aged 18 to 40 who have been diagnosed of PIH inEkiti – State.Ho: There is no significant relationship betweenknowledge of PIH complications and alternative choicesof expectant mothers aged 18 to 40 who have beendiagnosed of PIH in Ekiti – State.7.1.5 Eclampsia (E)Eclampsia is defined as the onset of convulsions in awoman with PIH that cannot be attributed to other causes.The seizures are generalized and may appear before,during, or labor [9], [11].The knowledge gained through this study would sensitizemidwives on knowledge needs of pregnant women withPIH previously unrealized thereby strengthening thequality of antenatal care education.7.2 Risk factorsHypertension, collagen vascular disease, obesity, blackrace, insulin resistance, diabetes mellitus, gestationaldiabetes, increased serum testosterone concentrations andthrombophilia, clotting disorders, and HELLP syndromeare considered risk factors for PIH [12]–[14].7. LITERATURE REVIEW8. METHOD OF STUDY6. SIGNIFICANCE OF THE STUDYPregnancy induced hypertension (PIH) is the mostcommon medical dilemma of unknown causes duringpregnancy and linked with very high risk globally;especially in developing countries [1]. According to theAmerican College of Obstetricians and Gynecologists [8],Hypertensive disorders of pregnancy includingpreeclampsia, complicate about 10-17% of pregnanciesworldwide, constituting one of the greatest causes ofmaternal and perinatal morbidity and mortality worldwide[1]. Pregnancy induced hypertension (PIH) is a genericterm used to define a significant rise in blood pressureduring pregnancy, occurring after 20 weeks. Pregnancyinduced hypertension (PIH) is defined as hypertension(blood pressure 140/90 mmHg) with or withoutproteinuria ( 300 mg/24 hours) emerging after 20 weeksgestation, but resolving up to 12 weeks postpartum.1–10)PIH is also defined as new onset proteinuria ( 300mg/24 hours) in hypertensive women who exhibit noproteinuria before 20 weeks gestation [9]. The study adopted the qualitative/ descriptive correlationalstudy as the investigator sought to describe therelationship between knowledge of PIH complications andcare-seeking among pregnant women aged 18 to 40 yearswho have been diagnosed of PIH in Ekiti – State. Thestudy population of this study consists of 120 pregnantwomen aged 18 to 40years, attending antenatal clinic andemergency; whose gestation period has exceeded 20weeks and diagnosed with PIH. Purposive samplingtechnique was used in this study because only the peopleaffected were considered. Structured questionnaire wasused for the study and consisted of both open and closedended questions; with carefully constructed researchquestions titled „pregnancy induced hypertension:expectant mothers‟ perceptions and care seekingbehaviour in Ekiti-State Nigeria. Section A of the researchquestions is made up of demographic information andsection B is made up of five (5) questions on knowledgeof expectant mothers about PIH; their perceptions and careseeking behaviour. The data generated from therespondents were addressed by answering the researchVolume 1 Issue 4, Oct 2017www.ijarp.org89
International Journal of Advanced Research and PublicationsISSN: 2456-9992questions formulated for the study. The statistical methodemployed is descriptive in nature using simple percentage.The informed consent of the hospital administrators wereobtained in writing while those of other health workersand the respondents were obtained orally. CompletedQuestionnaires were collected at the spot by theresearchers. Correlation coefficient model was used toidentify significant predictors with Level of significancetaken at 0.01.9. RESULTS.Table 1: SOCIO-DEMOGRAPHIC CHARACTERISTICSAgeMarital status18– 29 yrs30 – 40 yrsNo ryTertiaryNo el of EducationEmploymentStatusIn figure 1, data gathered shows that an alarming number(61%) of respondents have no prior knowledge aboutcomplications of PIH in Ekiti – State. 22% of expectantmothers in this study are uncertain about their knowledgeof PIH while only a very little number (15%) ofrespondents have an understanding of complications ofPIH.Source: field survey 2017.The table above shows the age distribution of respondentswith 52.5% falling below 30 years of age. 80% of therespondents are married while 20% are single. Majority(45%) of the respondents had tertiary education while26.7%, 18.3%and 10% had secondary, primary and noeducation respectively. 55.8% of the respondents areunemployed while 44.2% are employed. Religiousaffiliations of respondents include Islam (27.5%),Christianity (55%), Traditional belief (5%) and others(12.5%).Very oftenOftenNot often Not at allFigure 2: Percentage distribution showing how oftenexpectant mothers aged 18 to 40 years who have beendiagnosed of PIH in Ekiti – State seek care afterdiagnosis.Results from figure 2 show that only a total of 6.7%ofexpectant mothers who have been diagnosed with PIH inEkiti – State seek healthcare very often, 15.8% seekhealthcare often while a large number (75.8%) do not seekhealthcare often. Only 1.7% of these women do not seekhealthcare at all. Even though all of the expectant mothersseek help in one way or the other, research shows thatmore women do not seek help as often as the others.Table 2: Percentage distribution showing alternativechoices of expectant mothers, instead of going to thehospital.ResponseFreq%Buy over the counter drugs5445Consult experienced relative3327.5Consult a spiritual or traditional healer2823.3Consult internet sources54.2Total120100Source: field survey 2017.NoYesresponse 15%2%Uncertain22%No61%Table 2 shows that 45% of expectant mothers practice selfmedication by buying over the counter drugs, 27.5%consult some of their experienced relatives to seek adviceon the actions to take, 23.3% consult theirspiritual/traditional healers while only a little fraction ofexpectant mothers consult internet sources for help.Table 3: percentage distribution showing the point whenexpectant mothers aged 18 to 40 years who have beendiagnosed of PIH in Ekiti – State seek care afterdiagnosis.Figure 1: Percentage distribution showing the Level ofknowledge of expectant mothers aged 18 to 40 years whohave been diagnosed of PIH in Ekiti – State , on PIH. ResponseWhenever I fall illWhenever I have an appointment at the clinicWhenever I am less busyWhen other options failVolume 1 Issue 4, Oct 2017www.ijarp.orgFreq17332644%14.127.521.636.690
International Journal of Advanced Research and PublicationsISSN: 2456-9992Total120100Source: field survey 2017.Table 3 shows that 14.1% of expectant mothers seekhealthcare only when they fall ill while 27.5% seekhealthcare whenever they have appointment with thedoctor. Expectant women who seek help only when theyhave the time to do so and when other options fail are21.6% and 36.6% respectively.10. TEST OF HYPOTHESISTABLE 4: TABLE 6: Relationship between knowledge of expectant mothers on PIH on the point of seeking healthcare.CorrelationsLevel ofknowledge ofexpectantmothers on PIH.Level of knowledge ofexpectant mothers on PIH.Kendall's tau bThe point when expectant seekcare after diagnosis.The point when expectant mothersseek care after diagnosis.Correlation Coefficient1.000.752**Sig. (2-tailed)NCorrelation CoefficientSig. (2-tailed)N.120.752**.000120.0001201.000.120**. Correlation is significant at the 0.01 level (2-tailed).TABLE 5: TABLE 6: Relationship between knowledge of expectant mothers on PIH and alternative choices.CorrelationsLevel ofknowledge ofexpectant on PIH.Level of knowledge of expectanton PIH.Kendall's tau bAlternative choices of expectantmothersAlternative choices of expectantmothersCorrelation Coefficient1.000.701**Sig. (2-tailed)NCorrelation CoefficientSig. (2-tailed)N.120.701**.000120.0001201.000.120**. Correlation is significant at the 0.01 level (2-tailed).TABLE 6: Relationship between knowledge of expectant mothers on PIH and healthcare seeking Level of knowledgeVolume 1 Issue4, Oct 2017of expectantmotherswww.ijarp.orgHow often expectant mothersseek care after diagnosis.on PIHCorrelation1.000.584**91
International Journal of Advanced Research and PublicationsISSN: 2456-9992This study established the fact that of the level ofknowledge of pregnancy induced hypertension(PIH)among expectant mothers aged 18 to 40 years with PIHcomplications in Ekiti-state, Nigeria is so poor(15%).Again, the rate at which they seek healthcare(15.8%) callsfor urgent action because this study reveals that a largenumber of these expectant women do not seek healthcareregularly or at the right place (Hospital) thereby leading toearly complications of unmanaged PIH and maternal,foetal and neonatal mortality and morbidity. Inconclusion, there is a significant relationship between thelevel of knowledge of expectant mothers and thefrequency at which they seek health care, the point atwhich they seek healthcare; as well as the alternativechoices available to them.11.1[3] A. Abubakar, R.A. Abdullahi, H.Z. Jibril, M.H.Dauda, M.A. Poopola, “Maternal Ethnicity andSeverity of Pre-Eclampsia in Northern Nigeria,”Asian Journal of Medical Sciences 1(3), pp.104-107,2009.[4] E.O. Ugwu, C. Dim, C.D. Okonkwo, T. Nwankwo,“Maternal and perinatal outcome of severe preeclampsia in Enugu, Nigeria after introduction ofMagnesium sulphate” Nigerian Journal of ClinicalPractice, Vol 14 Issue 4,pp.418-421 ,2011.[5] S. Singh, E.B. Ahmed, S.C. Egondu, N.E. Ikechukwu,“Hypertensive disorders in pregnancy amongpregnant women in a Nigerian Teaching Hospital”,Niger Med 55 (5), pp. 384-388, 2014.RECOMMENDATIONIt is therefore recommended that appropriate healthinterventions and education programmes for the pregnantwomen with PIH should be designed by the governmentof Ekiti-State. For interventions to work, the knowledgegained via this study would sensitize midwives onknowledge needs of pregnant women with PIH previouslyunrealized thereby strengthening the quality of antenatalcare education. Gaining insight into the knowledge needsof pregnant women with PIH complications will make animportant contribution to the midwifery body ofknowledge with the potential to improve quality ofmidwifery education. This study will create an opportunityfor updating Maternal Child Health (MCH) knowledge onPIH complications and improve the quality of care givento these women. The knowledge expectant pregnantwomen have on complications of PIH and theirpreferences of care will be developed through thisresearch. These would guide the midwives to designindividualized care for pregnant women, therebyenhancing their use of health care facilities.[6] I.M. Rosenstock, “The Past, Present, and Future ofHealth Education.” In K. Glanz, F. M. Lewis, and B.K. Rimer (eds.), San Francisco: Jossey-Bass, 1990.11.1[10] E. Kintiraki, S. Papakatsika, G. Kotronis, D. Goulis,V. Kotsis, “Pregnancy-Induced hypertension”,HORMONES, 14(2), pp.211-223, 2015.[7] D. O. Akeju et al,” Determinants of health careseeking behaviour during pregnancy in Ogun State,Nigeria,” Reproductive Health, 13(Suppl 1):32 DOI10.1186/s12978-016-0139-7,pp.68-97,2016.[8] The American College of Obstetricians shington DC 20090 – 6920, ISBN 978-1-93498428-4,2013.[9] K. Watanabe, K. Naruse, K.Tanaka, H. Metoki, Y.Suzuki, “Outline of Definition and Classification ion Research in Pregnancy” Japan Societyfor the Study of Hypertension in Pregnancy, pp. 11,2013.REFERENCES[1] S. Anjana, M. Poonam, B. Shradha, “Management ofpregnancy induced hypertension”, InternationalJournal of research in Ayurveda and Pharmacy, 1 (2),pp.390-398.2010.[2] S. Azubuike, I. Danjuma, “Hypertension inPregnancy among Rural Women in Katsina State,Nigeria”, Journal of Basic and Clinical ReproductiveScience doi: 10.4103/2278-960X.194500,pp.140-146,2017. [11] www.elsevier.com, “Pregnancy Hypertension: Theclassification, diagnosis and management of thehypertensive disorders of pregnancy”, InternationalJournal of Women‟s Cardiovascular Health”,pp. 97–104,2014.[12] J.M. Roberts, G. Pearson, J. Cutler, M. Lindheimer,“hypertension during pregnancy”, Summary of theVolume 1 Issue 4, Oct 2017www.ijarp.org92
International Journal of Advanced Research and PublicationsISSN: 2456-9992NHLBI working group on research on Hypertension,pp. 437-445, 2003.[13] M. Koual, H. Abbou, M. Carbonnel, O. Picone, J.M.Ayoubi, “Short-term outcome of patients withpreeclampsia”, Vasc Health Risk Manag 9, pp. 143148, 2013.[14] R. Anujeet, A. Singh, S. Kapoor, “Pregnancy inducedhypertension: A retrospective study of 200 cases ofpregnant women”, Journal of Dental and MedicalSciences (IOSR-JDMS), Volume 15, Issue 6, pp.3643, 2016. Volume 1 Issue 4, Oct 2017www.ijarp.org93
Pregnancy induced hypertension (PIH) is a generic term used to define a significant rise in blood pressure during pregnancy, occurring after 20 weeks. Pregnancy induced hypertension (PIH) is defined as hypertension (blood pressure 140/90 mmHg) with or without proteinuria ( 300 mg/24 hours) emerging after 20 weeks .
US intrauterine pregnancy: reproducible loss heart activity, failure increase CRL over 1 w or persisting empty sac at 12 w Ectopic pregnancy blood/urine hCG, gestational sac outside uterus Heterotopic pregnancy Intrauterine ectopic pregnancy Pregnancy of unknown location (PUL) No identifiable pregnancy on US with blood/urine hCG
Discuss prevalence of teenage pregnancy. 2. Discuss pregnancy screening in teen population. 3. Identify pregnancy risks associated with teenage pregnancy for the mother. 4. Discuss medical impacts associated with teenage pregnancy for the fetus/infant. 5. Discuss social implications of teenage pregnancy. 6. Discuss risk for repeat unintended .
Pregnancy-induced rhinitis* Summary Background: Pregnancy-induced rhinitis (PIR) is often misclassified and under-diagnosed. There is currently no cure or opti- . to pregnancy) determined the incidence of PIR to be 22% (11). When assessing the symptom of 'nasal stuffiness' , one Swedish . maternal hypertension, preeclampsia and .
Ectopic pregnancy-Right Tubal Pregnancy Blastocyst implants at abnormal site outside uterus Sites: Uterine tubes (tubal pregnancy) Ovary (ovarian pregnancy) Abdominal cavity (abdominal pregnancy) Intrauterine portion of uterine tubes (cornual pregnancy)
Wellness in Pregnancy Medications in Pregnancy Good nutrition in pregnancy Building blocks for a healthy pregnancy Weight gain in pregnancy . Laxatives (Peri-Colace, Dulcolax) Hemorrhoid relief: Tucks Preparation H with hyd
4. Pre-pregnancy Obese Weight Range Weight Gain Grids for Twin Pregnancy (Rev. 1/13) 5. Pre-pregnancy Normal Weight Range (Twins) 6. Pre-pregnancy Overweight Range (Twins) 7. Pre-pregnancy Obese Weight Range (Twins) Source: IOM (Institute of Medicine) and NRC (National Research Council). 2009. Weight Gain During Pregnancy: Reexamining the .
5.1 Causes of Teenage Pregnancy 7 5.2 Prevention of Teenage Pregnancy 10 5.3 HIV/AIDS and Teenage Pregnancy 12 5.4 Level of Awareness Regarding Teenage Pregnancy and HIV/AIDS 12 5.5 Guidance and Counselling Support 14 5.6 Support Services available for schoolgirl mothers during pregnancy and afterwards 16 6.0 CONCLUSION AND RECOMMENDATIONS .
National factors – political issues, level and type of government support for business, taxation, the economy, e.g. level of employment, inflation, exchange rates, cost of loans Local factors – location of business, requirements for resources, e.g. premises, staff, equipment, location of suppliers, competitors and customers
