Community Perceptions of Pre-eclampsia/Eclampsia in Four Low- and Middle-Income Countries

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By: Sarah Hodin, MPH, CD(DONA), LCCE, National Senior Manager of Maternal Newborn Health Programs, Steward Health Care

Reproductive Health recently published a series of research articles describing community perceptions of pre-eclampsia/eclampsia in four low- and middle-income countries: India, Mozambique, Nigeria and Pakistan. Each study was conducted between 2011 and 2014 using qualitative methods. Participants in these communities used different terminology to describe symptoms of pre-eclampsia/eclampsia, often separating hypertension during pregnancy from seizures during pregnancy. However, participants from each of these communities displayed a basic understanding of the dangers of these conditions, acknowledging that they can lead to death of the mother or newborn.

Pre-eclampsia/eclampsia is one of the leading causes of maternal mortality globally. In partnership with Argentina’s Institute for Clinical Effectiveness and Health Policy (IECS), the Maternal Health Task Force (MHTF) recently published the Obstetric Emergency Drills Training Kit, a resource that helps providers prepare for obstetric emergencies such as complications from pre-eclampsia/eclampsia.

Download the Obstetric Emergency Drills Training Manual Kit.

Findings from India

Between 2012 and 2013, Vidler and colleagues conducted 14 focus groups in rural Karnataka State in southern India. They found that the same local terminology describing general hypertension and convulsions (translating to “blood pressure” and “fits”) were used to describe symptoms of pre-eclampsia and eclampsia respectively. Most participants believed that poor diet and stress—particularly as a result of marital conflict or worries about having a female child—were contributing causes of pre-eclampsia/eclampsia. Furthermore, participants commonly identified sweating, fatigue, dizziness, swelling, anger and excessive talking as warning signs of pre-eclampsia, and frothing, shaking, eyes rolling upwards, teeth clenching and tongue biting as warning signs of eclampsia. Participants agreed that these conditions could be fatal for the mother or newborn.

Read the full article.

Findings from Mozambique

Boene and colleagues conducted 20 focus groups and 10 interviews in southern Mozambique. Participants referred to symptoms of pre-eclampsia as “high blood pressure,” “illness of the heart,” or “fainting disease” depending on their primary language. For eclampsia, participants used terms such as “epilepsy”, “falling disease” and “illness of scares.” Pre-eclampsia and eclampsia were not perceived as unique to pregnancy or as pregnancy-related conditions. The most commonly reported causes of pre-eclampsia were marital problems, strenuous work, excessive thinking, worrying, anger, and sadness. Furthermore, warning signs of pre-eclampsia included headache, heart pain, shortness of breath, dizziness, sweating, and swollen feet. On the other hand, convulsions were considered to be associated with a childhood illness connected to moon phases and caused by a small snake living in the abdomen. Convulsions were not perceived as unique to pregnancy and could be treated during childhood using a plant-based medicine. However, participants reported that falling, eyes rolling back, and red eyes were signs of convulsions during pregnancy. Participants agreed that pre-eclampsia and eclampsia were dangerous conditions that could cause paralysis from falling, premature delivery, and death of the mother or newborn.

Read the full article.

Findings from Nigeria

Between 2011 and 2012, Akeju and colleagues conducted 28 focus groups and nine interviews in Ogun State, Nigeria. Participants used two terms in Yoruba, the local language, to describe hypertension in pregnancy, which roughly translated to “elevated blood pressure” and “stormy blood.” There is also local terminology to describe seizures, both generally and during pregnancy specifically. Perceived causes of pre-eclampsia included depressive thoughts and stress often resulting from marital or financial worries and a lack of rest. The most commonly reported causes of eclampsia were exposure to cold, heredity, depressive thoughts, stress, poor diet and medical conditions such as anemia and malaria. A number of home-based treatments for pre-eclampsia/eclampsia were reported, including eating onion, drinking a salt solution, applying a balm to the chest, praying and using traditional medicines. Men played an important role in ensuring proper care during pregnancy and labor. Participants consistently viewed pre-eclampsia/eclampsia as dangerous and potentially deadly.

Read the full article.

Findings from Pakistan

In 2012, Khowaja and colleagues conducted 26 focus groups in Sindh Province, Pakistan. While most participants did not recognize pre-eclampsia or eclampsia by name, they did know about hypertension during pregnancy. The term for hypertension during pregnancy in Sindhi, the local language, translated to headache, dizziness, nausea and weakness. Seizures, or “fits” in Sindhi, were not associated with high blood pressure, but they were considered a danger sign for mothers and newborns. The most commonly reported causes of hypertension during pregnancy were excessive thinking, stress, a lack of rest (which were often associated with the burden of household responsibilities), early marriages, anemia or low blood sugar. Most participants identified weakness, anemia and stress as causes of seizures during pregnancy. Since stress was considered a crucial factor contributing to these conditions, social support—especially from family—was considered the primary prevention strategy. Other strategies included eating foods rich in fats and getting adequate rest. Participants knew the dangers of hypertension and seizures during pregnancy, identifying maternal and fetal death as possible outcomes.

Read the full article.

The findings from these studies highlight the importance of providing not only high quality care, but also culturally appropriate care and accurate health information. Understanding and respecting local knowledge about pre-eclampsia/eclampsia is crucial for educating diverse communities about these dangerous conditions.

To learn more about pre-eclampsia/eclampsia, visit the MHTF blog archive.