FACTORS CONTRIBUTING TO MANAGEMENT OF HYPERTENSIVE DISORDERS IN PREGNANCY, IN KILIFI COUNTY REFERRAL HOSPITAL

Abstract

Hypertensive disorders in pregnancy are one of the common causes for perinatal and maternal morbidity and mortality in developing countries. Preeclampsia is a multisystem disorder that complicates about 3-8% pregnancies worldwide. The risk is forty fourfold more in developing countries compared to developed countries. Pre-eclampsia/eclampsia has taken the lead as a direct cause of maternal mortality. In Kenya, a developing country, an approximated 360 deaths per 100,000 births have been recorded. Thus, this current study was aimed at assessing the management and factors associated with hypertensive disorders during pregnancy at Kilifi County Referral Hospital (KCH). To achieve these objectives, the study adopted a cross sectional descriptive study design amongst the healthcare workers and a case-control of mothers delivering at KCH. A case was defined as pregnant woman with pre eclampsia/eclampsia while control was a pregnant woman presenting for delivery at KCH but without pre-eclampsia/eclampsia. Self-administered questionnaire was used as a tool for data collection amongst the health workers. Data were extracted from medical records for the case control study. Out of the targeted 58 health workers, data was collected from all the 58 participants, thus giving a response rate of 100%. The collected data were keyed into EpiData (Version 3.1) database then exported to R (Version 3.6.3) for analysis. A triangulation of cross sectional survey was used to collect data from 13 medical officers, 3 consultants, 20 clinical officers and 22 nurses working in maternity unit. Data from patients’ files and maternity register (MOH 333) were also retrieved to ascertain nursing care and investigation done. For the case-control a total of 500 pregnant women: 250 cases and 250 controls were recruited. Approximately 97% of the health workers were fully knowledgeable on hypertensive disorders condition during pregnancy and also well aware of the existence of national standardized guidelines outlining the diagnosis, classification and treatment of pre eclampsia/eclampsia/HELLP. Catheterization of patients usually done for input and output monitoring in hypertensive disorders in pregnancy as the complications may compromise the kidney function. Magnesium sulphate infusions as was the most common treatment used to xv take care of pregnant mothers with hypertensive disorders before further complications and prepare for the mode of delivery depending on status of the mother and the fetus. In the multivariable model, age per year (aOR 1.24 (95%CI 1.20–1.27)) and being a student (aOR 15.0 (95%CI 3.20–70.3)) were positively associated with pre-eclampsia pregnancy. Single/divorced/separated (aOR 0.32 (95%CI 0.19–0.55)), having at least secondary education level (aOR 0.29 (95%CI 0.15–0.56)), multiparity (aOR 0.15 (95%CI 0.08–0.26)) and grand multiparity (aOR 0.03 (95%CI 0.01–0.06)) were negatively associated with pre-eclampsia in pregnancy. Of the cases and controls, age in years of the pregnant mothers p-value <0.001 and being a student p-value 0.001 were associated with hypertensive disorder in pregnancy. Although majority of the front liners attending to pregnant women with hypertensive disorders at Kilifi County Referral Hospital are well knowledgeable on the condition, there’s still need to conduct frequent refresher course to all the health care professionals to improve their knowledge