Diagnosing and Treating Preeclampsia and Eclampsia

Globally, an estimated 295,000 women and adolescent girls died as a result of pregnancy and childbirth related complications in 2017, around 99% of which occurred in low-resource settings. Hypertensive disorders are among the causes for all maternal deaths worldwide. Thus, improving the quality of maternal healthcare for women is a necessary step towards achievement of the health targets of the Sustainable Development Goals (SDGs).

The prevalence of pre-eclampsia in Northern Tanzania is 4.2%. Factors such as advanced maternal age (≥35 years), overweight, obesity, chronic hypertension, anemia and multiple pregnancies were significantly associated with higher risk of pre-eclampsia while having ≥4 antenatal care visits reduced the risk of pre/eclampsia in Northern Tanzania. 

Karimu conducted a review in February 2024 of the dispensaries and health centers in Arri and Ayalagaya to assess the readiness for handling preeclampsia and eclampsia. This included use of appropriate assessment protocols, reviewing and recording of women’s pregnancy history, availability of appropriate medications for treatment, and frequency and duration of medication outages. The assessment results showed that the clinics are:

• Measuring the woman's blood pressure.

• Testing for protein in the urine on the 1st visit or when blood pressure or other signs or symptoms are present  and potentially an indicator of preeclampsia

• Administering anti-hypertensive medication (or referring them to another facility if they don’t have it) and monitoring them more frequently.

The only issues identified were: 

1. The only record that the dispensary keeps for the mother is on the card and on the hospital book which can be lost.

2. Not all dispensaries have hypertensive drugs that lead them to refer the mother to either Dareda Kati Health Center or Dareda Mission hospital. Eclampsia is an emergency obstetric condition and dispensaries must treat a woman before transferring her.

Karimu plans to work with the clinics and with the government to ensure that

• Pregnant women have more awareness of hypertension, its signs and symptoms, what to eat to reduce hypertension, and when to see a doctor. 

• Every dispensary has an online record of each pregnant woman's medical history.

• Staff will review a woman's history at every antenatal consultation.

• Every dispensary has hypertensive drugs and magnesium sulphate in its inventory.

Karimu will work with the clinics to increase data collection and monitor that

• Pregnant women continue to be assessed for preeclampsia/eclampsia according to the protocol

• Hypertensive drugs are available when needed at least 95% of the time reducing referrals.

• The clinics are recording the data of all pregnant women accordingly.

The project will be concluded after 3 years provided all outlined criteria are successfully met

December 2024: Karimu developed a flyer to remind medical staff of material to review with pregnant women about eclampsia and preeclampsia and added a module about hypertension to the education videos shown at the clinics.  Medical staff are providing education to pregnant women, ensuring that blood pressure is checked during every antenatal visit, and administering appropriate medication to those diagnosed with preeclampsia or eclampsia.

Since the beginning of 2024, the government has supplied hypertensive medication to health facilities, although not all facilities received these medications initially, but by September all health facilities had access to hypertensive drugs.

No cases of preeclampsia or eclampsia were detected among pregnant women. Furthermore, all pregnant women attending the clinic had their blood pressure monitored during their visits.

Benefits:

• Prompt identification and treatment of pregnant women with preeclampsia and eclampsia

Cost: 

• Karimu cost $200