Prevalence, predictors and management of pre-eclampsia among pregnant women attending antenatal clinics in Zanzibar

Abstract

Background: Pre-eclampsia is a significant public health concern worldwide that is responsible for severe maternal and neonatal morbidity and mortality. This study determined pre-eclampsia's prevalence, predictors, and management among pregnant women attending antenatal clinics in Zanzibar.

Methodology: This was a cross-sectional study involving 138 pregnant women attending antenatal clinics randomly selected from all levels of healthcare facilities in Zanzibar. A protein-in urine test and blood pressure measurement were performed to diagnose pre-eclampsia, and the patient’s case files were reviewed to assess pre-eclampsia management. The Chi-square test and logistic regression models determined the association between variables. The adjusted odds ratio and a 95% confidence interval were reported, and the significance level was set at 5%.

Results: The prevalence of pre-eclampsia was 20(14.25%), and it was predicted by a family history of pre-eclampsia (adjusted odds ratio=5.7, 95% confidence interval: 1.34-24.7), a previous history of pre-eclampsia (adjusted odds ratio =12.9, 95% confidence interval: 2.5-55.6), and current medication use (adjusted odds ratio =19.3, 95% confidence interval 3.9-95.6). A slight majority of mild pre-eclampsia cases were properly managed 7(53.8%), while only 9(29.50%) of severe pre-eclampsia cases were adequately managed. The proportion of cases of severe pre-eclampsia that were managed correctly was higher among cases admitted to national referral hospitals (68.5%) compared to those admitted to district hospitals (22.8%) and health centres (10.83%) (p < 0.002). However, for mild pre-eclampsia, there was no statistically significant difference in its management between facility levels (p>0.05).

Conclusion: The prevalence of pre-eclampsia among pregnant women attending antenatal clinics is high. The possible risk factors for pre-eclampsia are having a family history of pre-eclampsia, having a previous history of pre-eclampsia, and current medication use. The standard guidelines for the management of pre-eclampsia are not followed, and severe pre-eclampsia is mostly mismanaged at lower-level healthcare facilities. The findings are relevant to identifying high-risk pregnancies, improving maternal healthcare delivery, and saving lives.