PREVALENCE OF HYPERTENSION AMONG PREGNANT WOMEN IN NSUKKA URBAN, ENUGU STATE (2007 – 2011)

ABSTRACT

The purpose of this study was to determine the prevalence of hypertension among pregnant women in Nsukka Urban from 2007-2011.To achieve the purpose of the study, five objectives were formulated with corresponding research questions and four hypotheses were formulated. The descriptive survey research method utilizing the expost-facto design was used for the study. The instrument for data collection was a researcher designed hypertension in pregnancy inventory Proforma (HIPI). Five experts in the Department of Health and Physical Education and Department of Science Education validated the proforma. The population for the study consisted of all registered pregnant women in the twenty –three health facilities in Nsukka urban of Nsukka L.G.A in Enugu State from 2007- 2011. This gave an estimated population of 23,520 pregnant women, while the sample for the study consisted of 706 cases. Data collected from the health facilities were used for analysis. In analyzing the data, frequencies and percentages were used to answer the research questions while chi-square statistic was used to test all the null hypotheses at .05 level of significance. The result of the study showed that the highest prevalence cases (26.3%) and (25.1%) were recorded in 2007 and 2009 respectively while the lowest prevalence cases occurred in 2010 (14.5%). Pregnant women aged 30-49 years recorded the highest prevalence of (90.7%) while the lowest prevalence was recorded in pregnant women aged 15-29 years (9.5%). Prevalence of hypertension was also higher in pregnant women who have up to 6 -9 children and above (66. 9%) while lowest prevalence occurred in pregnant women who have 0-5 pregnancies. The highest cases of prevalence of hypertension among pregnant women were recorded among the uneducated pregnant women (65.4%) while the educated pregnant women recorded the lowest. Pregnant women who are civil servants and traders recorded the highest prevalence of (75.7%) cases of hypertension while those who are house wives and farmers recorded the lowest. From the findings of the study, it was therefore recommended that there should be continual increase in creation of awareness on possible factors that can predispose pregnant women to hypertension as this has been shown to be responsible in the reduction of hypertension, awareness should be created for women on the dangers of late pregnancy cases, so as to enable them control their chances of getting pregnant as they get older, adequate birth control measures should be put in place and adopted by women so as to check the number of children a woman will have thereby reducing their chances of hypertension cases during pregnancy, poor level of education has been implicated in the high prevalence of hypertension, therefore adequate awareness and education should be provided for pregnant women with primary education on the factors associated with hypertension, It is also recommended that appropriate policies should be put in place by the government to reduce work load on women during pregnancy, such policies may include among others pregnancy leave or break.

TABLE OF CONTENTS

Title Page

Table of Contents

List of Tables

Abstract

CHAPTER ONE: Introduction

Background to the Study

Statement of the Problem

Purpose of the Study

Research Questions

Hypotheses

Significance of the Study

Scope of the Study

CHAPTER TWO: Review of Related Literature

Conceptual Framework

Measurement of prevalence

Demographic factors associated with prevalence of hypertension among pregnant women

Theoretical Framework

Hierarchy of needs

Self care theory

Empirical Studies on Prevalence of Hypertension among Pregnant Women

Summary of Literature Review

CHAPTER THREE: Methods

Research Design

Area of the Study

Population for the Study

Sample and Sampling Techniques

Instrument for Data Collection

Validity of the instrument

Reliability of the instrument

Method of Data Collection

Method of Data Analysis

CHAPTER FOUR: Results and Discussion

Results

Summary and Findings

Discussion

CHAPTER FIVE: Summary, Conclusions, and Recommendations

Summary

Conclusions

Recommendations

Limitations of the Study

Suggestion for Further Study

References

Appendices

CHAPTER ONE

Introduction

Background to the Study

Globally, pregnant mothers face different complications that may endanger their lives and their foetuses. Such complications include haemorrhage, obstructed labour, sepsis, abortion and hypertension. Among these complications, hypertension contributes directly or indirectly to millions of material deaths each year around the world. Lucas and Gilles (2003) opined that in many developing countries, complications of pregnancy and child birth are the leading causes of death among women of reproductive age. Hypertension in pregnancy has been a disease of great concern. UNICEF (2001) and WHO (2002) estimated that in Nigeria, there is a raising prevalence of pregnancy induced-hypertension ranging from 10-15 per cent of direct medical causes of maternal mortality. Worldwide, it is far greater problem with an estimated 72, 000 deaths annually due to lack of awareness of the health problem (Baker, 2006). Similarly, this disease is at a high prevalence in Nigeria which is a developing country where health services and facilities are not yet adequately made available to the population. James and Piercy (2004) observed that hypertension is the most common medical problem encountered in pregnancy and remains an important cause of maternal and fetal morbidity and mortality. Hypertensive disorders in pregnancy are among the leading causes of maternal mortality, along with thromboemboilsm, haemorrhage and nonobstetric injuries. They further stated that hypertension in pregnancy is one of the most serious morbidity conditions of the expectant mother, which the cause remains unknown.

Anthony and Glaser (2010) indicated that with high blood pressure in pregnancy, there is an increase in the resistance of blood vessels. They further stressed that this may hinder blood flow in many different organ systems in the expectant mother including the liver, brain, uterus and placenta. Other problems include placental abruption i.e. premature detachment of the placenta from the uterus, poor fetal growth and stillbirth.

Hyman and Parlik (2003) defined hypertension as the persistent raised level of blood pressure in which systolic pressure is 140mm Hg and diastolic pressure above 90mm Hg. However, Gordon (1989) viewed that pregnancy-induced hypertension is characterized by high blood pressure with a diastolic of 90mm Hg or more and a systolic of 140mm Hg or greater. The types of hypertension in pregnancy differ primarily in the incidence and not the nature of maternal and prenatal complications. Hence, Gibson (2009) classified hypertensive disorders of pregnancy into four categories: chronic hypertension, gestational hypertension, preeclampsia and eclampsia. He further explained that chronic hypertension is a known hypertension before pregnancy or a rise in blood pressure > 140/90mm Hg before 20 weeks gestation and persistently 6 weeks after delivery; gestational hypertension is the development of hypertension without other signs of preeclampsia. It is also hypertension that is diagnosed for the first time in pregnancy and that does not resolve postpartum. Preeclampsia is diagnosed on the basis of hypertension with proteinuria. In the absence of proteinuria, preeclampsia is suspected when hypertension is accomplished by symptoms including headache, blurred vision, abdominal/epigastric pain, or altered biochemistry, specifically low platelet counts and abdominal liver enzyme levels. Eclampsia is defined as the new onset of convulsions during pregnancy or postpartum, unrelated to other cerebral pathological conditions in a woman with preclampsia. In the context of the present study therefore, all the four categories of hypertension will be considered.

The occurrence of hypertension cannot be determined without the concept of prevalence. Onwasigwe (2002) defined prevalence of a disease as the number of people in a population that have a disease at a given period (old and new cases). Similarly, Millidot (2009) conceptualized prevalence as the number of people with a disease or condition in a given population at a specified time (point prevalence). Also, Onwasigwe (2002) further indicated that there are two types of prevalence rates: the point prevalence and the period prevalence. Point prevalence measures the probability of people having a disease at a specific point of time. That specific point of time may be an hour, day or week while period prevalence is the prevalence during a given time interval. This time interval is usually in months or years. Hence, period prevalence will be appropriate measure for the present study as it aims to determine the prevalence of hypertension among pregnant women in Nsukka urban from 2007-2011. In this study therefore, prevalence is the number of all new and old cases of hypertension among pregnant women between 2007 and 2011. Prevalence is expressed as a ratio in which the number....

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