Maternal and Perinatal Outcomes among Eclamptic Patients Admitted to Bugando Medical Centre, Mwanza, Tanzania

Eclampsia continues to be a major problem, particularly in developing countries such as Tanzania, contributing significantly to high maternal and perinatal morbidity and mortality. We conducted a study to establish the incidence of eclampsia and the associated maternal and perinatal outcomes among eclamptic patients admitted to our center. A descriptive cross-sectional study of all women presenting with eclampsia was performed from June 2009 to February 2010. Seventy-six patients presented with eclampsia out of a total 5562 deliveries during the study period (incidence of 1.37%). Antenatal attendance was 96% among patients with eclampsia; however, only 45.21% and 24.66% were screened for blood pressure and proteinuria respectively. Maternal and perinatal case fatality rates were 7.89% and 20.73% respectively. The main factors contributing to maternal deaths were acute renal failure (10.5%), pulmonary oedema (10.5%), maternal stroke (8.8%), HELLP syndrome (50.9%), and Disseminated Intravascular Coagulopathy (3.5%). Perinatal deaths were caused by prematurity (42.9%) and birth asphyxia (57.1%). Forty-eight babies had low-birth weight (58.54%). The high incidence of eclampsia and its complications during this study period may indicate the need for earlier and more meticulous intervention at both the clinic and hospital levels Keywords: Eclampsia, maternal, perinatal, morbidity, mortality, TanzaniaAfr J Reprod Health 2012; 16[1]:35-4

Conséquences maternelles et périnatales chez les patientes atteintes de l’éclampsie qui sont admisses à Bugando Medical Centre, Mwanza, Tanzanie

Eclampsia continues to be a major problem, particularly in developing countries such as Tanzania, contributing significantly to high maternal and perinatal morbidity and mortality. We conducted a study to establish the incidence of eclampsia and the associated maternal and perinatal outcomes among eclamptic patients admitted to our center. A descriptive cross-sectional study of all women presenting with eclampsia was performed from June 2009 to February 2010. Seventy-six patients presented with eclampsia out of a total 5562 deliveries during the study period (incidence of 1.37%). Antenatal attendance was 96% among patients with eclampsia; however, only 45.21% and 24.66% were screened for blood pressure and proteinuria respectively. Maternal and perinatal case fatality rates were 7.89% and 20.73% respectively. The main factors contributing to maternal deaths were acute renal failure (10.5%), pulmonary oedema (10.5%), maternal stroke (8.8%), HELLP syndrome (50.9%), and Disseminated Intravascular Coagulopathy (3.5%). Perinatal deaths were caused by prematurity (42.9%) and birth asphyxia (57.1%). Forty-eight babies had low-birth weight (58.54%). The high incidence of eclampsia and its complications during this study period may indicate the need for earlier and more meticulous intervention at both the clinic and hospital levels (Afr J Reprod Health 2012; 16[1]:35-41).L’éclampsie ne cesse d’être un problème majeur, surtout dans les pays en développement tel que la Tanzanie, ce qui contribue significativement à la morbidité et à la mortalité maternelle et périnatale élevées. Nous avons mené une étude pour établir l’incidence de l’éclampsie et les conséquences maternelles et périnatales qui y sont associées chez les patientes atteintes de l’éclampsie admises dans notre Centre. Nous avons fait une étude transversale descriptive de toutes les femmes qui souffraient de l’éclampsie et qui venaient nous consulter dans notre Centre du mois du juin 2009 au mois du février 2010. Sur un total de 5562 accouchements au cours de l’étude, soixante-seize patientes souffraient de l’éclampsie (Incidence de 1,37%). La fréquentation au service de l’anténatal était de 96% chez les femmes souffrant de l’éclampsie ; toutefois, seulement 42,21% et 24,66% ont subi le test de dépistage pour détecter la pression artérielle et la protéinurie respectivement. Les taux de fatalité des cas maternels et périnatals étaient de 7,89% et 20,73% respectivement. Les principaux facteurs qui contribuent au décès maternel étaient l’insuffisance rénale (10,5%), l’œdème pulmonaire (10,5%), l’apoplexie cérébrale maternelle (8,8%), le syndrome de HELLP (50, 9%), et la coagulopathie intra vasculaire disséminée (3,5%). Les décès périnatals ont été causés par la prématurité (42,9%) et l’asphyxie de la naissance (57,1%). Quarante huit bébés avaient des poids de naissance bas (58,54%). La haute incidence de l’éclampsie et ses complications au cours de cette étude peuvent indiquer la nécessité des interventions plus tôt et plus méticuleuses aux niveaux de la clinique et de l’hôpital (Afr J Reprod Health 2012; 16[1]:35-41)

Why don’t illiterate women in rural, Northern Tanzania, access maternal healthcare?

Abstract Background In 2017, roughly 540 women in Sub-Saharan Africa died every day from preventable causes related to pregnancy and childbirth. To stem this public-health crisis, the WHO recommends a standard continuity of maternal healthcare, yet most women do not receive this care. Surveys suggest that illiteracy limits the uptake of the recommended care, yet little is understood about why this is so. This gap in understanding why healthcare is not sought by illiterate women compromises the ability of public health experts and healthcare providers to provide culturally relevant policy and practice. This study consequently explores the lived experiences related to care-seeking by illiterate women of reproductive age in rural Tanzania to determine why they may not access maternal healthcare services. Methods An exploratory, qualitative study was conducted in four communities encompassing eight focus group discussions with 81 illiterate women, 13 in-depth interviews with illiterate women and seven key-informant interviews with members of these communities who have first-hand experience with the decisions made by women concerning maternal care. Interviews were conducted in the informant’s native language. The interviews were coded, then triangulated. Results Two themes emerged from the analysis: 1) a communication gap arising from a) the women’s inability to read public-health documents provided by health facilities, and b) healthcare providers speaking a language, Swahili, that these women do not understand, and 2) a dependency by these women on family and neighbors to negotiate these barriers. Notably, these women understood of the potential benefits of maternal healthcare. Conclusions These women knew they should receive maternal healthcare but could neither read the public-health messaging provided by the clinics nor understand the language of the healthcare providers. More health needs of this group could be met by developing a protocol for healthcare providers to determine who is illiterate, providing translation services for those unable to speak Swahili, and graphic public health messaging that does not require literacy. A failure to address the needs of this at-risk group will likely mean that they will continue to experience barriers to obtaining maternal care with detrimental health outcomes for both mothers and newborns