Developing non-medical intervention strategies to reduce maternal and neonatal mortality associated with hypertension during pregnancy in Capricorn District, Limpopo Province, South Africa

Abstract

Hypertension is a global health concern, including in South Africa. It is one of the major risk factors of maternal and neonatal morbidity and mortality. The purpose of the study was to develop non-medical intervention strategies to reduce maternal and neonatal mortality, associated with hypertension during pregnancy in Capricorn District. A convergent parallel- mixed method was used in this study. The population of the study were all pregnant women aged 14 years to 49 years who were attending their antenatal services at the selected hospitals and clinics. In quantitative design anthropometric measurements and questionnaire were used to collect data. The chi-square test and logistic regression analysis were used to analyse the association of hypertension and its risk factors. In qualitative design a face-to- face unstructured interview was used to collect data and thematic analysis was used to analyse data. Ethical clearance was obtained from the University of Venda Ethics Committee. Permission to collect data was obtained from the Limpopo Department of Health manager and the Capricorn District Municipality manager. All ethical issues were observed, to ensure safety of the participants. The prevalence of hypertension was 126(21.50%) (CI 95%, 18.29% to 25.1%). The Chi-squire test showed that the prevalence of hypertension was significantly associated with age (P=0.00262), family history of hypertension (P=0.003), unemployment (P=0.04181), type of cooking oil (P=0.0436), salt intake (P=0.0111), obesity (P=1.664e-05), classification of BMI (P=5.765e-07), chronic hypertension (P=0.0000), gestational diabetes (P=0.0000) and a previous history of hypertension (P=2.2e-16). The multiple logistic regression showed that the prevalence of hypertension was significantly associated with a previous history of hypertension during pregnancy (P=1.93e-1), gestational diabetes (P=0.00317), chronic hypertension (P=0.01926) and salt intake (P=0.03355). Knowledge of hypertension among the pregnant women was found to be poor. Most of the participants indicated that they did not receive health education during antenatal care services. Good knowledge of hypertension was observed among those who were both employed and educated. The majority of the participants indicated that they had heard about hypertension, but only few of them bothered to find out more about it. Barriers to knowledge of hypertension were poor communication between patients and healthcare providers, education and ignorance of patients. Poor hypertension management was linked with preferred treatment, beliefs and poor knowledge about hypertension. In this study health information, social support and in-service training of staff are the proposed intervention strategies. Stakeholder were involved the development and validation of the program.