Management of Hypertension in Pregnancy as a Quality Indicator of Antenatal Care in Rural Tanzania

Abstract

To assess the ability of antenatal care to manage hypertension in pregnancy, a cross-sectional study involving 379 pregnant women was conducted in 16 randomly selected antenatal clinics in Rufiji district of Tanzania. We observed necessary structural availability, provider client interaction, interviewed women attending antenatal clinics, and measured their blood pressure. Measurements made by observers and health workers were compared. One third of the women were not checked for hypertension and health workers detected only four out of twelve women with elevated blood pressure. There was disagreement in diagnosis of blood pressure as measured by health workers and observers. Only one woman with elevated blood pressure was managed appropriately. The low quality of screening and management of hypertension in pregnancy makes it less realistic to expect any impact of antenatal care programme in reducing morbidity or mortality due to hypertension in pregnancy. (Afr J Reprod Health 2003; 7[3]: 69-76) RÉSUMÉTraitement de l'hypertension pendant la grossesse comme un indice de qualité de soin prénatal en Tanzanie rurale. Pour évaluer la capacité de soin prénatal de traiter l'hypertension pendant la grossesse, nous avons mené une étude transversale qui a fait intervenir 379 femmes enceintes, dans 16 services de consultation prénatale selectionnés au hasard dans le district de Rufiji en Tanzanie. Nous avons remarqué la disponibilité structurale, l'interaction entre dispensateur et client, intérrogé les femmes qui allaient à la consultation prénatale et nous avons mésuré la pression artérielle. Les mesures faites par les observateurs et le personnel soignant ont été comparées. Un tiers des femmes n'ont pas été contrôlé pour l'hypertension et la personnel soignant n'ont dépisté que quatre femmes sur douze dont la pression artérielle était élévée. Il y avait une disparité entre le diagnostique de la pression artérielle faite par le personnel soignant et celui fait par les observateurs. Il n' y avait qu'une seule femme dont la pression artérielle était élevé que suivait un traitement approprié. Le bas niveau du dépistage et du traitement de l'hypertension dans la grossesse le rendent moins pratique de s'attendre à un impact quiconque de programme de service de consultation prénatale sur la reduction de la morbidité ou de la mortalité occasionnée par l'hypertension pendant la grossesse. (Rev Afr Santé Reprod 2003; 7[3]: 69-76)

High blood pressure and associated risk factors among women attending antenatal clinics in Tanzania

“…The overall prevalence of HDP (6.9%) was comparable to worldwide estimations of 5-10% [7,27]. Lower prevalence was observed in other studies conducted in Africa [28,29], as well as in a previous study in rural Tanzania [30]. Much higher occurrence of HDP (32.7%) was reported in south-east Nigeria [31].…”

A study on maternal and perinatal out comes in cases of eclampsia admitting to government medical college and general hospital, Anantapuramu, Andhra Pradesh, India

“…6 Morbidity from eclampsia is associated with acute renal failure, pulmonary edema, cardiopulmonary arrest, and aspiration. 7 The causes of perinatal death are chronic placental insufficiency, preterm delivery and placental abruption.…”

The need for quality improvement in diagnosing pregnancy induced hypertension in Sri Lanka

“…The healthcare workers had screened 65% of the pregnant women for hypertension, but had only informed the result of the BP measurement in 9% of the women. 24 Another similar study in Nigeria reports that 44% of the pregnant women attending the antenatal clinics were not examined by the midwives for BP measurement. 7 An overview of evidence of the effectiveness of antenatal care in relation to maternal mortality and serious morbidity conditions has shown that only a low proportion of risk factors are detected at antenatal clinics.…”