758ea1d4-f2d2-4b49-8ea1-d6a97ebdea6f
758ea1d4-f2d2-4b49-8ea1-d6a97ebdea6f
758ea1d4-f2d2-4b49-8ea1-d6a97ebdea6f
Research article
Keywords: Pre-eclampsia, pregnant mothers, Felege Hiwot Referral Hospital, ANC Follow-up.
DOI: https://doi.org/10.21203/rs.2.11607/v1
License: This work is licensed under a Creative Commons Attribution 4.0 International License.
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Abstract
Introduction Preeclampsia, also called pregnancy-induced hypertension is a pregnancy-specific
hypertensive disorder usually occurs after 20 weeks of gestation and affects both the mother and the
fetus. preeclampsia is one of the driving causes of maternal and perinatal horribleness and mortality.
Objective To assess the prevalence of preeclampsia and associated factors among women attending
antenatal care service at Felge Hiwot Referral Hospital, Bahir Dar, Ethiopia, 2017. Methods Institution
based cross-sectional study was conducted from March 1st up to 30th 2017. Study participants was
recruited by using systematic random sampling technique. A pre-tested questionnaire was used for data
collection. The data were checked for its completeness and consistency each day and the collected data
was coded and entered into Epi Data version 3.1 and analyzed by using Statistical package for social
science version 23. The logistic regression assumption was checked and fitted at P >0.05. Result The
prevalence of preeclampsia was found to be 13.0% (95%CI: 8.3,17.6). Factors that had a statistically
significant association with preeclampsia were women having a family history of hypertension
[AOR=4.61(1.06, 20.07)], Gestational diabetes mellitus [AOR=11.41(1.40, 92.83)], using traditional
medicine during pregnancy [AOR= 26.29(3.68, 187.84)]. Conclusion the result indicated that the
prevalence of preeclampsia in this hospital was higher than similar studies conducted in Ethiopia.
Preventable and risk factors Having a family history of Diabetes Mellitus, Gestational Diabetes Miletus
and taking traditional medicines during pregnancy were statistically associated with preeclampsia.
Abstract
Introduction: Preeclampsia, also called pregnancy-induced hypertension is a pregnancy-specific
hypertensive disorder usually occurs after 20 weeks of gestation and affects both the mother and the
fetus. preeclampsia is one of the driving causes of maternal and perinatal horribleness and mortality.
Objective: To assess the prevalence of preeclampsia and associated factors among women attending
antenatal care service at Felge Hiwot Referral Hospital, Bahir Dar, Ethiopia, 2017.
Methods: Institution based cross-sectional study was conducted from March 1st up to 30th 2017. Study
participants was recruited by using systematic random sampling technique. A pre-tested questionnaire
was used for data collection. The data were checked for its completeness and consistency each day and
the collected data was coded and entered into Epi Data version 3.1 and analyzed by using Statistical
package for social science version 23. The logistic regression assumption was checked and fitted at P
>0.05.
Result: The prevalence of preeclampsia was found to be 13.0 % (95%CI: 8.3,17.6). Factors that had a
statistically significant association with preeclampsia were women having a family history of
hypertension [AOR=4.61(1.06, 20.07)], Gestational diabetes mellitus [AOR=11.41(1.40, 92.83)], using
traditional medicine during pregnancy [AOR= 26.29(3.68, 187.84)].
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Conclusion: the result indicated that the prevalence of preeclampsia in this hospital was higher than
similar studies conducted in Ethiopia. Preventable and risk factors Having a family history of Diabetes
Mellitus, Gestational Diabetes Miletus and taking traditional medicines during pregnancy were
statistically associated with preeclampsia.
Keywords: Pre-eclampsia, pregnant mothers, Felege Hiwot Referral Hospital, ANC Follow-up.
It is difficult to establish a causal relationship b/n the dependent and independent variables.
Being an institutional based study, it could be difficult to infer the finding of the study to the target
population as all pregnant women may not attend their pregnancy in the hospital.
Since the current study was not triangulated with a qualitative method; it might not help to in-depth
explore on factors that contribute to the occurrence of preeclampsia.
Introduction
Severe pre-eclampsia commonly occurs during the second trimester or third trimester of gestation, which
is characterized by blood pressure, elevated than 160/110 mmHg, proteinuria greater than 5g per 24 hrs.,
visual disturbances, epigastric pain or more specifically right upper quadrant pain (1, 2).
The factors that have been postulated to influence the risk of pre-eclampsia in various studies include
diabetes and gestational diabetes, obesity, multiple pregnancy, personal and family history of pre-ec-
lampsia, chronic infections, urinary tract infection, first pregnancy and older maternal age or younger than
20 years age, renal disease and autoimmune disorder, the prolonged interval between pregnancies and
the history of abortion and maternal diet (3).
In the world, Pre-eclampsia influences a considerable public ill health, a tributary to maternal and
perinatal dreariness and mortality. Its impact accounts between 5 to 10 percent of pregnancies (4). There
is approximately one maternal death due to pre-eclampsia-eclampsia per 100,000 live birth with a case-
fatality rate of 6.4 deaths per 10,000 cases (5, 6).
In developing countries, the impact of the condition, however, is thought to be more severe and with the
prevalence of between 1.8% and 16.7% which is significantly higher than 2%, the maternal and infant
mortality and morbidity (7).
The world health organization estimated the incidence of pre-eclampsia to be seven times higher in
developing countries than in developed countries (8).
In Africa, preeclampsia occurs in 10% of pregnancy, which is significantly higher than the global average
of 2 percent (9).
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The Ethiopian national emergency obstetric and newborn care showed that eclampsia contributed for the
complication of approximately 1% of all deliveries and 5% of all pregnancies moreover, it had contributed
to 16% of direct maternal mortality and 10% of all maternal mortality and morbidity (10).
This study was provided a clear picture of risk factors by depicting their association with eclampsia. It
also can be used as baseline information for other researchers who could conduct further study on a
similar issue.
The study was conducted at FHRH, which is one of the top ten governmental hospitals in Ethiopia, it’s
situated in Bahir Dar city, which is the capital city of Amhara National Regional State. It is found 565 km
away from Addis Ababa, the Capital city of Ethiopia. Currently, the Hospital is giving services for more
than 5 up to 7 million people per year in the western part of the region as a referral hospital. The present
capacity of the hospital has more than 350 beds of which 55 are currently allocated for the department of
Obstetrics and Gynecology, about 3,521 mothers attend in antenatal care each year, and the hospital has
61 medical doctors among those 19 senior specialized doctors, 17 medical residents, 25 General
practitioners, from Gynecology and Obstetrics ward; 2 gynecologist, 33 midwives and 6 medical doctors,
3 ANC classroom. (11). The study was conducted from March 1st up to 30th /2017 G.C using an
institutional based cross-sectional study design.
The sample size was determined using a single population proportion formula with an assumption of
95% confidence interval, 4% margin of error and the proportion of preeclampsia among ANC attendant
mothers was 8.4% (12).
Where
Since our source population (N), is below 10,000 we use correction formula
nf = n/ (1+ (n/N))
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Where: N- Source population, nf- final sample size
Thus: nf =185÷1+185÷3521=176
Therefore; the final sample size for this study was 193
Sampling Procedure
Study participants were selected by using a systematic random sampling technique by considering a list
of ANCs follows up as a sampling frame. Pregnant women’s gestational age was measured based on
their recall of the last menstrual period. Ultrasound estimation for gestational age was also considered
when women fail to remember the last menstrual period.
Inclusion criteria: Among ANC attending women, those with SBP > 140mmHg and DBP >90mm Hg on two
separate readings taken at least four hours apart with previously normal blood pressure and when
proteinuria is greater than or equal to 300 mg per 24-hour urine collection or dipstick reading of 1+ were
included in the study.
Exclusion Criteria: Women who were unable to speak due to severe illness at the time of data collection
and women with known hypertension and renal disease were excluded from the study.
Obstetric history: Gravidity Parity, Pregnancy, Stillbirth, Interval multiplicity of pregnancies of newborn,
Material blood group, Rh-factor
Behavior factors: Nutrition advice during ANC, alcohol consumption, ANC visit during pregnancy, Coffee
intake during pregnancy
Operational Definitions
Pre-eclampsia: Gestational hypertension SBP > 140mmHg and DBP >90mm Hg after 20 Weeks of
gestation plus the presence of proteinuria.
Proteinuria: Protein in the urine, which is greater than or equal to 300 mg per 24hours or Dipstick reading
1+ .
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Patient and Public Involvement statement
Four clinical nurses and one BSC midwifery supervisor were involved in the data collection process.
Therapeutic records were likewise looked into for some clinical and laboratory results including
proteinuria. Each participant was allowed to take rest for ten minutes before measuring her blood
pressure. Blood pressure readings were taken while the woman was seated in the upright position using a
mercury sphygmomanometer apparatus which covers two-thirds of the upper arm. The measurement
was taken from the participant's right hand. The cuff was inflated at a rate of 2–3 mmHg per second.
Systolic blood pressure was taken upon hearing the first sound, and diastolic blood pressure was taken
up on the 4th (muffled) Korotkoff sound. Those pregnant women with abnormal findings were checked
again and again and then have undergone another BP measurement after 4–6 hours in order to confirm
the diagnosis. For the sake of assuring whether the mercury sphygmomanometer apparatus was
functioning correctly, the data collectors checked it by measuring the blood pressure of other data
collectors. When a pregnant woman was found to have severe preeclampsia (BP of 160/110 mmHg), she
was sent for immediate re-checkup and medical advice. Data regarding proteinuria and other clinical
information was accessed from the women’s medical record books. Proteinuria was assessed using a
urine dipstick, which is a routine investigation for all pregnant women.
The questionnaire was first prepared in English then translated to the local language (Amharic) and back-
translated into English to maintain conceptual consistency. Data collectors and supervisors were trained
on the objective of the study, interviewing technique, and other activities. The questionnaire was pretested
for its completeness, consistency, and accuracy at Addis Alem Hospital in Bahir Dar City. Day to day
supervision was made on how data were collected during the data collection and data collectors were
informed to brief the respondents for any misunderstanding during the data collection.
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Data Entry and analysis
Each datum was checked for its completeness, coded, cleaned and entered using Epi info version 3.5 and
exported to SPSS version 21 statistical software for further analysis. Descriptive summaries such as
frequencies, proportions, percentages, mean and standard deviations were determined. For determinant
variable identification, bivariate logistic regression analysis was carried out to first at P-value < 0.2.
Variables that were associated at p-value < 0.2 in bivariate regression were entered in the multivariate
logistic regression. At this step, model fitness and the presence of multicollinearity were assessed. The
model fitness was checked by observing the difference of the -2-log likelihood ratio between the model
with only the constant and with the factors. Statistically, the significance level for all variables was set at
P-values < 0.05.
Ethical Consideration
Ethical approval was obtained from GAMBY Medical and Business College research and ethics
committee and letter of permission were obtained from the Amhara Regional Health Bureau and from
FHRH. The purpose of the study was explained to all pregnant women and verbal informed consent was
obtained from them. Secrecy of data was kept up by removing any personal identifier from the
questionnaires.
Result
Socio-Demographic characteristics
A total of 193 participants were approached for the study and all of them gave complete responses that
make a response rate of 100%. The mean (±SD) ages of the participants were found to be 27.73 (4.3)
years. Among these 45 (23.3 %) of the mothers were below the age of 24 years, whereas 15 (7.8%) of the
mothers were equal above at the age of 35 years.
Regarding their ethnicity 150 (77.7%) of the study, participants were Amhara, and 25 (13%) were Oromo.
One hundred twenty-eight (66.3%) of the respondents were orthodox Christianity followers; while 39
(20.2%) were Muslim. And regarding the educational status of mothers 31 (16.1%) was unable to read
and write. All of the mothers were married and 65 (33.7%) were housewives. Concerning their partners,
educational status 96 (47.7%) of the respondents were complete primary school (Table 1).
Concerning chronic illness, about 46 (23.8%) of the respondents had a parental history of hypertension
among this 58.7 % of them were from fathers. About 5% of study participants had a parental history of
Diabetes Mellitus. Concerning the respondent's chronic illness issues, about five percent of the
participants had a history of DM and 8.3%t of them had a history of asthma (Table 2).
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Obstetric Related Characteristics
Among the study participants 112 (58.0%) had the previous history of pregnancy, among these 96(85.7%)
had no history gestational hypertension. On the other hand, among those who had the previous history of
pregnancy, 109 (97.3%) has no history of gestational diabetes mellitus. Concerning modern contraceptive
use among the study participants, 173 (89.6%) were using modern as a contraceptive (Table 3).
Considering personal behaviors during pregnancy, all women reported that they were not smokers.
Among the study participants, 111 (57.5%) of the reported that they never drank alcohol. About 17 (8.8%)
of respondents were used to traditional medical treatment for different reasons like nausea and vomiting
treatment during pregnancy. Based on clinical laboratory investigation 23 (11.9%) of participants were
positive for albumin urea which was (+1 and above) and 159 (82.4%) were free. Fifty-seven (29.5%) of
participants blood pressure was>140/90 mm of Hg (Table 4).
Prevalence of preeclampsia
By considering gestational hypertension (SBP > 140mmHg and DBP >90mm Hg after 20 Weeks of
gestation) plus the presence of proteinuria, the prevalence of preeclampsia was found to be 13.0 % (95%
CI: 8.3,17.6).
In bivariate analysis family history of hypertension, family history of diabetes mellitus, Gestational DM,
History of abortion, Fruit intake, Vegetable intake, traditional medicine, alcohol drinking during pregnancy
was significantly associated with Preeclampsia. While in multivariate analysis, family history of HPN,
gestational DM and using traditional medicine during pregnancy did show significant statistical
association with preeclampsia.
The study revealed that women who had a family history of hypertension had higher risk for
preeclampsia compared to those women who had no family history of hypertension ( AOR: 4.61; 95% CI
(1.06-20.07)), similarly women who gestational DM had an increased risk of preeclampsia compared to
their counterparts,(AOR:11.41; 95% CI (1.40-92.83)), and those pregnant woman who had used traditional
medicines during pregnancy were significantly associated with Preeclampsia as compared to those
women who had not consumed (AOR: 26.29; 95% CI (3.68-187.84)) (Table 5).
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Discussion
Preeclampsia is a disorder of pregnancy characterized by high blood pressure and a significant amount
of protein in the urine. It is one of the major causes of maternal mortality worldwide. This study
endeavored to examine the prevalence and factors associated with preeclampsia on a sample of 193
pregnant women who had ANC follow up at Felege Hiwot Referral Hospital. According to this study, the
prevalence of preeclampsia was found to be 13.0 % (95%CI: 8.3,17.6). This was in line with the study
finding in Dessie referral hospital (8.4%)(12). However higher than the studies conducted in Dilla
university referral hospital which were 2.2% [21]. respectively However this finding was lower than a
study finding at Arba Minch town public health institutions 18.3% (13). The difference might be due to
sampling size variation and study period.
In this study having a family history of hypertension, gestational DM and taking traditional medicine
during pregnancy were significantly associated with pre-eclampsia were.
In the present study, those pregnant women with a family history of hypertension were about four points
six times more likely to develop preeclampsia. This finding was supported by a study done in Pakistan
(14), in Dessie referral hospital(12), in Arba Minch public health institution (13), and in Addis Ababa
Selected Public hospitals(15). The reason might be the association of some cardiovascular disorders
with the genetic inheritance that can expose for preeclampsia.
The odds of mothers who had gestational DM were about eleven points four times more likely to develop
preeclampsia as compared to those who had no gestational DM. This finding was supported by a study
done in low and middle-income countries(16)
Those pregnant women who used traditional medicines during pregnancy were at high risk of developing
preeclampsia as compared to their counterparts. This finding was also supported by a study done in
Alexandria, USA use of herbal medicine among pregnant women were significant risk for the developing
preeclampsia compare with those who couldn’t use (7)and this finding was also in agreement with a
study conducted in Nigeria on the use herbal medicine during pregnancy that showed users of traditional
medicines during pregnancy were exposed to pregnancy-induced hypertension(17).
Due to its cross-sectional nature of the study, it is difficult to establish a causal relationship between
the dependent and independent variables.
Being an institutional based study, it could be difficult to infer the finding of the study to the target
population as all pregnant women may not attend their pregnancy in the hospital.
Since the current study was not triangulated with a qualitative method; it might not help to in-depth
explore on factors that contribute to the occurrence of preeclampsia.
Page 9/22
Conclusion
The result indicated that the prevalence of preeclampsia in this hospital was higher than similar studies
conducted in Ethiopia. Having a family history of hypertension, Gestational DM and using traditional
medicines during pregnancy were statistically associated and preventable risk factors with preeclampsia.
Identifying risk factors at early gestational age would be valuable for the prevention of occurrence,
treatment, and prevention of complications of pre-eclampsia.
Declarations
Ethics approval and consent to participate
Ethical approval was obtained from the GAMBY College of Medical Sciences, Research and Publication
Office and approval letter were obtained from Felege Hiwot Referral Hospital. The purpose of the study
was explained to the mothers and Verbal informed consent was obtained from them. Secrecy of data
was kept up by removing any personal identifier from the questionnaires. The study participant
information sheet was attached in the front page of the questionnaire and before the actual data
collection process the participants were well informed and the data collection was on a voluntary basis.
Written consent was obtained that the interview will be included in publications
The data can be accessed from the corresponding author through the following address
fentahun143@gmail.com // agumlt@yahoo.com.
Competing interests
Authors' contributions
GM: Conceived the proposal, approved the proposal with some revisions
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TB and AA: Had participated in the preparation of the manuscript. We authors read and approved the final
manuscript.
Acknowledgments
We would like to thank our data collectors, patient advisories and the supervisor for their invaluable effort;
without them, this study would not have come to be completed. Our deep gratitude also goes to our study
participants who volunteered and took their time to give us all the relevant information for the study. Last
but not least, we would like to thank the Felege Hiwot Referal Hospital administration workers for their
cooperation and help during the data collection.
Authors Information
Getasew Mulat earned an MPH, in 2015, from the Joint MPH program, i.e., GAMBY College of
Medical Sciences and Debre Markos University, College of Medicine and Health Sciences and is a
lecturer at GAMBY College of Medical Sciences, Public Health Department, Bahir Dar, Ethiopia.
Agumas Fentahun: Earned his MPH in Epidemiology from Bahir Dar University in 2019, and he works
at Family Guidance Association, Bahir Dar Model SRH clinic, Ethiopia.
Tigabu Birhan: earned his MPH from the University of Gondar in 2012, and Lecturer at Bahir Dar
Health Science College, Bahir Dar, Ethiopia.
Ashenafi Abate: Earned his MSC in Biostatistics from the University of Gondar, Lecturer at Bahir Dar
Health science college, Bahir Dar, Ethiopia.
Abbreviations
ANC ------------Antenatal Care
BP ---------------Blood Pressure
CI ----------------Confidence Interval
DM --------------Diabetes Mellitus
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FHRH------------Felge Hiwot Referral Hospital
FP-----------------Family Planning
mmHg----------Millimeter of Mercury
PE/E--------------Preeclampsia/Eclampsia
PR ----------------Pulse Rate
RH ----------------Rhesus factor
UN-----------------United Nation
References
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Atrash HK. Pregnancy-related mortality from preeclampsia and eclampsia. Obstetrics & Gynecology.
2001;97(4):533-8. 7. Osungbade KO, Ige OK. Public health perspectives of preeclampsia in developing
countries: implication for health system strengthening. J Pregnancy. 2011;2011:481095. 8. Ota E,
Ganchimeg T, Mori R, Souza JP. Risk factors of pre-eclampsia/eclampsia and its adverse outcomes in
low-and middle-income countries: a WHO secondary analysis. PloS one. 2014;9(3):e91198. 9. Hutcheon
JA, Lisonkova S, Joseph K. Epidemiology of pre-eclampsia and the other hypertensive disorders of
pregnancy. Best practice & research Clinical obstetrics & gynaecology. 2011;25(4):391-403. 10. Adukwu
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BO. Factors affecting maternal health care services utilization among rural women with low literacy in
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pregnant women attending antenatal care in Dessie referral hospital, Northeast Ethiopia: a hospital-based
study. BMC pregnancy and childbirth. 2015;15:73. 13. Shimbre M, Markos Y, Estifaons W, Taye I.
Magnitude and Associated Factors of Preeclampsia Among Pregnant Women who Attend Antenatal Care
Service in Public Health Institutions in Arba Minch Town, Southern Ethiopia, 20162016. 14. Shamsi U,
Saleem S, Nishtar N. Epidemiology and risk factors of preeclampsia; an overview of observational
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Tables
Table 1 Socio-Demographic characteristics of the pregnant mothers attended ANC service in Felege Hiwot
Referral Hospital, Bahir Dar, Ethiopia, 2017. (n=193).
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Variable Category Frequency Percent
25-29 91 47.2
30-34 42 21.8
>35 15 7.8
Oromo 25 13.0
Tigre 18 9.3
Muslim 39 20.2
Catholic 12 6.2
Protestant 14 7.3
Merchant 56 29.0
Student 17 8.8
Primary 96 49.7
Secondary 36 18.7
Farmer 38 19.7
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1000-2000 69 35.8
2000-3500 28 14.5
>3500 47 24.4
Table 2: chronic illness concerning characteristics of the pregnant mothers attended ANC Service in
Felege Hiwot Referral Hospital, Bahir Dar, Ethiopia, 2017. (n=193).
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Variable Category Frequency Percent
Yes 46 23.8
Father 27 58.7
No 182 94.3
Father 7 63.6
No 184 95.3
No 177 91.7
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Table 3: Obstetric concerning characteristics of the pregnant mothers attended ANC service in Felege
Hiwot Referral Hospital, Bahir Dar, Ethiopia, 2017. (n=193).
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Variable Category Frequency Percent
No 81 42.0
1-2 55 49.1
Number of Previous gravidities 3-4 23 20.5
>5 34 30.4
1 year 18 16.1
Pregnancy interval 2 year 55 49.1
>3 39 34.8
No 96 85.7
No 109 97.3
No 84 75.0
>=5children 21 18.8
No 26 13.5
No 50 25.9
2 times 68 47.6
3 times 46 32.2
4 times 5 3.5
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No 25 17.5
No 20 10.4
Pill 36 20.8
Type of contraceptive Injectable 90 52.0
Implant 43 24.9
Others ¥ 4 2.3
Table 4: Personal Behavioral related characteristics of the pregnant mothers attended antenatal care
service in Felege Hiwot referral hospital, Bahir Dar, Ethiopia, 2017. (n=193).
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Variable Category Frequency Percent
No 111 57.5
Tela 50 61.0
No 97 50.3
Sometimes 45 46.9
No 52 26.9
No 41 21.2
No 185 95.9
No 176 91.2
+1 23 11.9
Above 1 9 4.7
+1 29 15.0
Above 1 5 2.6
>140/90 34 17.7
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160/100 21 10.8
Table 5: Factors associated with pre-eclampsia among women currently attending ANC follow up in Felge
Hiwot Referral hospital 2017.
Pre-
eclampsia
Variable Category
COR (95%CI) AOR (95%CI)
No Yes
No 8 33 1.0 1.0
Supplementary Files
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