Factors contributing to adverse outcomes of pre-eclampsia among pregnant women attending antenatal clinics in Kibera Slums, Nairobi
Kenya, like other developing countries, has a high maternal mortality ratio. Currently maternal deaths are estimated tc be 488 per 100,000 live births. Maternal mortality ratio (MMR) in slums is higher than the national average and the major direct causes are hemorrhage, sepsis and hypertensive diseases. Pre eclampsia is the main cause of hypertensive diseske in pregnancy, associated with maternal mortality. The aim of the study was to determine the factors that contribute to the adverse outcomes of pre-eclampsia among pregnant women attending ANC in Kiberaslums, Nairobi, as strategy to reduce the adverse outcomes in pregnancy including maternal mortality. The study design was cross sectional. Pregnant women of gestational age 20 weeks and above in selected health facilities in Kibera slums were approached to form the study population. Women meeting eligibility criteria were interviewed until a sample size of 229 was achieved. Primary data was collected using pre-coded, structured questionnaire targeting pregnant women attending ante natal clinic (ANC) in health facilities in Kibera. Secondary data was collected by retrieving information from the ANC cards Two hundred and twenty nine (229) respondents were interviewed, out of whom 14 were diagnosed with pre-eclamspia. The age of respondents ranged from 14-44 years with a median of 24 year, with 41.5% being in 2nd trimester while 58.5% in 3rd trimester. Less than 2% of respondents had no formal education, 52% primary education, 39.3% secondary education and 7% tertiary education. Income levels varied with 58.1 % earning less than Ksh. 2500 per month, 17.9% earning between Ksh 2501-5000, 10.5% earning between Ksh. 5001-7500, 6.l% earning a monthly average of Ksh. 7501- 10000 and 7.4% earning more than Ksh. 10000 per month. The prevalence of pre-eclampsia was found to be 6.1 % while the prevalence of known risk factors were; pre-existing diabetes mellitus (1.3%), young maternal age (22.3%), primagravidae (25.8%), previous history of pre-eclampsia (6.1 %), family history of pre-eclampsia, multiple pregnancy (4.8%) and pre-existing hypertension (6.6%). Referral of diagno'sed patients was found to be 7.1 %. Awareness of symptoms was found to be low with 37.1 % of respondents identifying severe headache, 28.8% identifying blurred vision, 31.0% identifying facial edema and 33.2% identifying edema of the hands as some of the symptoms of pre-eclampsia. Nearly all the respondents (98.7%) who were aware of symptoms would visit health facility if they noticed symptoms of pre-eclampsia or had any obstetric emergencies. In terms of preparedness to handle emergencies, 73% of respondents had set aside some emergency funds, 52.7% had identified means of transport, 66.4% had identified a companion and 72.9% had identified a decision maker. In conclusion, the prevalence of Pre-eclampsia among pregnant women attending ANC clinics in Kibera slums was found to be on the higher side of rates recorded in African settings (range of 1.8% to 7%). The most and least prevalent risk factors were primigravidae (25.8%) and diabetes mellitus (1.3%) respectively. Awareness of symptoms was low for severe headache (37.1 %), blurred vision (28.8%), facial edema (31.0%) and edema of the hands (33.2%). Screening of pregnant women for known risk factors coupled with health education on symptoms of the disease and preparedness for obstetric emergencies that might occur during the pregnancy are recommended.