Antenatal clinic,a missed opportunity for hypertension education?? Helen Naa Oyoo Akaba FWACS,09/16

Introduction/Background Case presentation 24 years . P 1.Had emergency caesarean section at 33 weeks in previous pregnancy on account of PIH. Made a total of 6 antenatal visits 12/3/15 BP 140/100 mmHg at 31 weeks , urine protein one plus. From notes,no documentation of danger signs,managed as outpatient on antihypertensives,asked to do some investigations ,to report in 2 weeks. After a week she complained of headaches to her mother at about 8 :00 pm and relatives gave her paracetamol and put in bed. She was found fitting in bed the next morning and rushed to a facility where she died shortly.  

Introduction/Background Globally,Hypertension in pregnancy is the second major cause of maternal mortality after haemorrhage. Leads in Nigeria,Latin America ,Carribean,Institutional maternal deaths(Ghana),Greater Accra. Diagnosis: Elevated blood pressure above or equal to 140/90 mmHg. Disease spectrum, Complications Pathognomic signs of imminent eclampsia: DEATH THREATS given to patient first.Effective interventions. Late reporting.80% of deaths community or 24 hrs stay Antenatal coverage 96.4% (1visit);76.7%(4 visits)

OBJECTIVES GENERAL: To determine if the Korle bu Teaching Hospital(KBTH) is seizing the opportunity of the antenatal clinic to educate attendants on the prodromal danger signs of hypertension in pregnancy SPECIFIC: Compared knowledge of danger signs Expectant mothers who have not received antenatal care in KBTH, in that index pregnancy [ booking] Expectant mothers who have received antenatal care in KBTH in the index pregnancy,4 visits,34+ wks, continuing

Methods Study design & area Cross-sectional study on pregnant women attending antenatal clinic of KBTH Two groups :Booking and Continuing.Simple random sampling to select the first patient followed by systematic random sampling. Total of 260,130 from each group. Exposure and Outcome variable.Exposure-age,referral staus,parity,highest education,occupation,residence,history Tools An interviewer –administered questionnaire was used. Data analysis Analysis Stata 13.Means,SD and frequencies,chi-square Statistical significance at 5%,p value <0.05

RESULTS (1) Background Characteristics Total 260, Six excluded from each group, Final 248 Booking (no antenatal )Continuing(4 visits ,34weeks +) No statistical difference in background characteristics except gestational age Age: Booking 29.8 yrs+/- 6.1 SD. Cont 30.8 yrs +/-5.3SD Booking: gestational age 19-42 w.70(56.4%)34w+ Majority were referred B:110(88.7%) .C 102(82.3%) History of Hyp in Pregnancy B:25(20.2%)C:18(14.5) Awareness Hyp B:95.2%.C:100% p value 0.013. Hyp in Preg B:8/10 C:9/10 p value 0.002

RESULTS (1) Awareness of hypertension Awareness Hypertension B:95.2%.C:100% p value 0.013. Awareness of hypertension in pregnancy B:8/10 C:9/10 p value 0.002

RESULTS (1) Headache was the most mentioned sign Blurred vision 2-BOOKING 9 –CONTINUING Light flashes 1 from each group Nausea 1 –BOOKING Epigastric pain 2- CONTINUING Vomitting 0

Results(2) Knowledge of danger signs. At least one danger sign   No sign known Sign known P value  Group n(%) 0.327  Booking 104(83.9) 20(16.1) Continuing 98(79.0) 26(21.0)

Results(3) Determinants of knowledge: Respondents who had attained tertiary level of education were more aware compared to other educational stata, p value 0.037 More respondents from the hospital, KBTH knew more signs than referred cases, p value 0.045 No significant difference in knowledge between respondents who had a history(high risk patients) and those with no history.

Results(3) Developed countries- Melbourne ,Florida :Pre education 40 % Post education[6 years] 70 % (Wallis, Tsigas 2013) Chicago: 14% .Multiparity, past history, educational status,health education (You et al 2012)

Results(3) Developing countries- Gambia 24.6 % (Anya et al 2008) Uganda 19%

Conclusion An opportunity to educate clients through the antenatal clinic on the danger signs of a leading cause of maternal mortality is being missed by many health facilities Women despite the fact that they have made the recommended number of antenatal visits lack the knowledge on the danger signs of hypertension in pregnancy, a topic of such immense public health importance

DISCUSSION Tennessee Reduction in eclampsia during antenatal period Continous education of clients and providers on danger signals, and seeking attention in response to cardinal signs (Chames et al 2002) Even in high literacy places people do not like to read (Mac Gilivray et al,2006)

Discussion Health literacy is defined by WHO as follows: Health literacy represents the cognitive and social skills which determine the motivation and ability of individuals to gain access to, and understand, and use the information in ways which promote and maintain good health. Health literacy means more than being able to read pamphlets and successfully make appointments. By improving peoples access to health information and their capacity to use it effectively, health literacy is critical to empowerment (WHO 1998).  

Recommendations An urgent need to restructure the antenatal education given at the antenatal clinic in KBTH and especially other facilities. High risk patients must be given special education. Audience segmentation may be useful Female education beyond JSS level Further research to assess health workers knowledge on danger signs

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