1.

1 BACKGROUND
Pre-eclampsia is the most prevalent and severe kind of pregnancy-induced
hypertension and can

affect every organ system. It is considered the major cause of maternal and fetal mortality
world

wild. [2]. Preeclampsia is defined as a pregnancy specific disorder characterized by hypertension,

significant proteinuria, with or without edema. [3] In new research this definition has been modified

were preeclampsia is defined as a multisystem progressive disorder characterized by the new

onset of hypertension and proteinuria or the new onset of hypertension plus significant end-

organ dysfunction with or without proteinuria, typically presenting after 20 weeks of or

postpartum. [4] It is multifactorial and forms an integral part of the classes of hypertensive

disorders in pregnancy.[5].The end stage of preeclampsia is eclampsia which is defined

generalized tonic- clonic seizures, with or without raised blood pressure and proteinuria.[6 ]

[].Studies in India have shown that preeclampsia is a multisystem disorder with a profound

implication for both the mother and the fetus, where abnormal reactions between fetal trophoblast

and maternal decidua including the cells of the maternal immune system lead to inadequate

placental invasion and maternal vascular remodeling, thus the origin of preeclampsia lies in the early

stages of pregnancy.[7] The etiology of preeclampsia is still daggling in theories hence medical

practitioners do all best to manage the symptoms.

Globally, pregnancy-induced hypertension is the second leading cause of

maternal mortality,

contributing to around 14% of maternal deaths world wide[8]. It is estimated to

occur in 5 to

7 percent of all pregnancies. Annually, preeclampsia is responsible for over 70,000

maternal deaths and 500,000 fetal deaths worldwide[9]. In the United States, the rate
of preeclampsia in Black women is 60 percent higher than in White women [10].

NOT only are black women more likely to develop preeclampsia, but they are more

likely to suffer from its complications.[10 ]. It is responsible for 16% of

maternal

mortality in Sub-Saharan Africa and 16.9% of maternal mortality in

Ethiopia.

Preeclampsia and eclampsia are associated with hypertension and

are known to

poorly impact maternal and newborn mortality and morbidity [8]

In developing countries, the prevalence of pre-eclampsia ranges

from 1.8 to

16.7%. [11, 12]. The adverse effects of severe pre-eclampsia have been

reported in the literature, for example a study conducted on

characteristics and outcomes of patient with eclampsia and pre-

eclampsia in a rural hospital in Tanzania demonstrated

significant impact on neonates. In this study, 27% of

deaths occurred among women with severe pre-eclampsia. In

addition, more than one-third of neonates had a birth weight of

less than 2.5kgs and 86% had birth weight less than 1.5kgs

Furthermore, the study demonstrated that 38% of low birth weight

babies did not survive and that poor neonatal outcomes were

associated with long durations between admission time and

delivery .[31,32]

In Ethiopia, it as well varies from 1.2% to 19.1%.[11,12] In Africa,

preeclampsia occurs in 10 % of pregnancies, which is significantly higher than the

global average of approximately 2 % [13] .In Nigeria, the prevalence of pre-eclampsia

ranges from 2% to 16.7%, with approximately 37,000 women dying from pre-

eclampsia annually.[14]. In Ghana, the prevalence of preeclampsia is estimated to be

between 6.55% and 7.3%, making it one of the major causes of maternal and

neonatal deaths .[15] In Cameroon preeclampsia occurs 4.9 to 7.7 percentages of

the pregnancy.[16]. In the Far North Region, hypertension in pregnancy was the first cause of

maternal death, representing 17.5% of the 63 maternal deaths recorded between 2003 and 2005 .
[17]

In the South West Region, the prevalence of PIH [ preeclampsia in hypertension] was 5.02% and

Maternal Mortality was estimated at 1887/100,000 live birth [18] . In the centre region, Mboudou E.
et

al. reported a prevalence of 8.2% with PE [ preeclampsia] [19] . In the NWR, though Egbe et al.,

showed that 14.5% of maternal deaths in Mezam Division were due to HDP [hypertension disorders
in pregnancy] [20, 21]

In Cameroon, the diagnosis of hypertension in pregnancy is based on the criteria

defined by the National High Blood Pressure Education Programme Working

on High Blood Pressure in Pregnancy . Severe preeclampsia was defined by the

presence of one or more of the following criteria: blood pressure ≥ 160/110 mmHg,

proteinuria ≥ 3.5 g/24 h, oliguria (<600 ml/24 h), IUGR (<10 th percentile),

oligoamnios; symptoms suggesting end organ failure such as headache, visual

disturbances, epigastric pain; medical complications including pulmonary edema,

cerebral edema, acute renal failure, hepatic hematoma, HELLP syndrome

(hemolysis, elevated liver enzymes and low platelets count). The occurrence of

convulsions not attributable to other conditions in a patient with preeclampsia was

considered as eclampsia. [22]

 Risk Factors for Preeclampsia
Risk factors for the development of preeclampsia have been studied extensively. Major risk factors

include a history of preeclampsia, chronic hypertension, pre -gestational diabetes mellitus,

antiphospholipid syndrome, and obesity, among others. [23] Other risk factors include advanced

maternal age, null parity, history of chronic kidney disease, and use of assisted reproductive

technologies. Relatively rare risk factors are a family history of preeclampsia and mother carrying a

trisomy 13 fetus. [24,25] Genetic susceptibility to preeclampsia has been extensively studied. [26’27]

Preeclampsia is also more common among women who have histories of certain health

conditions, such as migraines,diabetes9 rheumatoid arthritis lupus, ,scleroderma, urinary

tract infections, gum disease, polycystic ovary syndrome,15 multiple sclerosis, gestational

diabetes, and sickle cell disease. [26]. It is also more common in pregnancies resulting from

egg donation, donor insemination, or in vitro fertilization. [26] The first signs of

preeclampsia are often detected during routine prenatal

visits with a health care provider.

Along with high blood pressure, preeclampsia signs and

symptoms may include:

Excess protein in urine (proteinuria) or kidney problems, decreased levels of platelets in

blood(thrombocytopenia),increased liver enzymes that indicate liver problems, severe

headaches, changes in vision, including temporary loss of vision, blurred vision or light

sensitivity, shortness of breath, caused by fluid in the lungs, pain in the upper belly,

usually under the ribs on the right side, nausea or vomiting. Weight gain and swelling

(edema) are typical during healthy pregnancies. However, sudden weight gains or a
sudden appearance of edema — particularly in your face and hands — may be a sign of

preeclampsia.[28]. Some complications from preeclampsia in pregnancy include; fetal

growth restriction, preterm birth , placental abruption , hemolytic elevated liver enzyme

low platelet syndrome, eclampsia, organ damage and cardiac disease.[28]

1.2 STATEMENT OF THE PROBLEM

In the Buea Regional Hospital located in the Southwest Region of Cameroon, there is limited

recent data on the prevalence and associated risk factors of preeclampsia and eclampsia

among pregnant women attending antenatal care. Antenatal care is a critical component of

maternal health care, providing opportunities for early detection, monitoring, and

management of pregnancy –related complications. However, without accurate data on the

prevalence and risk factors of both preeclampsia and eclampsia, healthcare provider’s may

struggle to implement targeted interventions and preventive strategies.

1.3 JUSTIFICATION
The aim of this study is to estimate the prevalence of preeclampsia and eclampsia among pregnant
women attending antenatal care and also identify socio-demographic and clinical risk factors
associated with preeclampsia and eclampsia.

1.4 RESEARCH QUESTIONS

1. What is the prevalence of preeclampsia and eclampsia among pregnant women attending
antenatal care in the Buea Regional Hospital

2. What are the risk factors associated with the development of preeclampsia and eclampsia?

3. What is the impact of maternal age on the prevalence of preeclampsia and eclampsia?

4. What are the socio-demographic characteristics of women who develop preeclampsia

1.5 RESEACH HYPOTHESIS

1.5.1; NULL HYPOTHESIS
 1. The prevalence of preeclampsia and eclampsia among pregnant women attending antenatal
care is high.

2. Risk factors associated with preeclampsia and eclampsia are unknown.

3. Maternal age has an impact on the prevalence of preeclampsia and eclampsia.
4.

1.5.2; ALTERNATE HYPOTHESIS

1. The prevalence of preeclampsia and eclampsia among pregnant women attending antenatal
care is low.

2. Risk factors associated with preeclampsia and eclampsia are known.

3. Maternal age has no impact on the prevalence of preeclampsia and eclampsia.

4.

1.6 RESEARCH OBJECTIVES

1.6.1; General Objectives

To determine the prevalence and assiociated risk factors of preeclampsia and

eclampsia among women attending antenatal care in the Buea Regional Hospitsl.

1.6.2; Specific Objectives

1. To determine the prevalence of preeclampsia and eclampsia at the Buea Regional

Hospital.

2. To determine the associated risk factors of preeclampsia and eclampsia.

3. to determine the impact of maternal age on the prevalence of preeclampsia.

CHAPTER 2; MATERIALS AND METHODOLOGY

2.1; STUDY DESIGN

This study employs a cross sectional design to determine the prevalence and

associated risk factors of preeclampsia and eclampsia among pregnant women

attending antenatal care in the Buea Regional Hospital. A cross sectional design allows
for the simultaneous collection of data on exposure and outcome variables, making it

suitable for estimating prevalence rates and identifying potential risk factors.

2.2 STUDY SITE AND SETTING

The study will be conducted at the antenatal care clinic of the Buea Regional Hosptal

,located in the Southwest Region of Cameroon . The hospital serves as a referral center

for pregnant women in the region and provides comprehensive antenatal care services,

monitoring and management of pregnancy related complications.

2.3 STUDY POPULATION

The study population will consist of pregnant women attending antenatal care at the

Buea Regional Hospital during the study period. Pregnant women with a

gestational age of 20 weeks and above will be eligible for inclusion in the study.

Women with known medical conditions such as hypertension , diabetes melitus or renal

disease will also be included.

2.4 INCLUSION CRITERIA

1. All pregnant women with gestational age of 20 weeks and above attending antenatal
care at

the time of study.

2. All pregnant women with gestational age 20 weeks and above confirmed with

medical conditions such as hypertension, diabetes Meletus or renal failure disease.

3. all pregnant women who will give their consent

4. all files on delivery cases from 2023 – 2025 that will be available at the time of study
2.5 EXCLUSION CRITERIA

1. all pregnant women below 20 weeks of gestational age

2.all file with up to 15 percent incompletely filled information

2.6 SAMPLING TECHNIQUE

A systematic sampling technique will be used to select participants from the antenatal

Care clinic . The sampling frame will consist of all pregnant women attending antenatal

care during the study period , and participants will be selected at regular intervals based

on their order of arrival at the clinic . This approach ensures that each eligible

participant has an equal chance of being included in the study.

2.7 DATA COLLECTION

Data will be collected using a structured questionnaire administered by trained research

assistants . The questionnaire will collect information on socio- demographic

characteristics ,medical history, obstetric history ,and current pregnancy status . Clinical

measurements such as blood pressure , weight and urine protein levels will also be

recorded during the antenatal care visits.

2.8 INSTRUMENTS AND MATERIALS

The main instrument for data collection will be a well structured questionnaire with

closed ended multiple choice questions and data extraction sheet . The questionnaire

will be divided into socio-demographic data of participants , risk factors associated with
preeclampsia and eclampsia, medical history, and current pregnancy condition .

2.9 SAMPLE SIZE CALCULATIONS7 DATA ANALYSIS

2.10 ETHICAL CONSIDERATION

Administrative and ethical clearance will be obtained from the Faculty of Health Science

of the University of Buea, The Regional Delegation of Public Health of the Southwest

Region in Buea and the director of the Buea Regional hospital . Participants will sign a

consent form and will be informed of their rights to refuse from participating in the

research. Confidentiality of the participant will be respected by not using their names or

any information that can be used to identify them.

Autonomy; The decision of the participant to participate in this study or not will be

respected.

Confidentiality; all information gotten from each participant will be kept confidential and

questionnaires discarded properly after use.

2.10 DATA ANALYSIS

Descriptive statistics will be used to summarize the demographic and clinical

characteristics of the study population. The prevalence of preeclampsia and eclampsia

will be estimated, an logistics regression analysis will be performed to identify factors

associated with these conditions. Statistical significance will be set at p < 0.05.

Additionally, subgroup analysis will be conducted to explore potential differences and

risk factors among different socio- demographic and clinical groups.

Questionnaire

Certainly! Here's an extended questionnaire with at least 20 questions for your master's
thesis on the prevalence and associated risk factors of preeclampsia and eclampsia
among pregnant women attending antenatal care in the Buea Regional Hospital:

**Questionnaire on Prevalence and Associated Risk Factors of Preeclampsia and

Eclampsia**

1. **Demographic Information**

a. Age: __________

b. Education level: __________

c. Occupation: __________

d. Marital status: __________

 e. Monthly income: __________

2. **Pregnancy History**

a. Gravidity (number of pregnancies): __________

b. Parity (number of live births): __________

c. Gestational age of current pregnancy: __________

d. History of miscarriages or abortions: Yes / No

3. **Medical History**

a. History of hypertension: Yes / No

b. History of diabetes: Yes / No

c. History of renal disease: Yes / No

d. History of autoimmune disorders: Yes / No

4. **Antenatal Care Attendance**

a. Number of antenatal care visits during current pregnancy: __________

b. Gestational age at first antenatal care visit: __________

c. Compliance with antenatal care appointments: Always / Sometimes / Rarely / Never

5. **Lifestyle Factors**

a. Smoking habits: Yes / No

b. Alcohol consumption: Yes / No

c. Physical activity level (hours per week): __________

 d. Dietary habits (e.g., consumption of fruits and vegetables): __________

6. **Awareness and Knowledge**

a. Awareness of preeclampsia/eclampsia: Yes / No

b. Knowledge about signs and symptoms of preeclampsia/eclampsia: High / Moderate

/ Low

7. **Access to Healthcare**

a. Distance to healthcare facility: __________ (in kilometers)

b. Availability of transportation to healthcare facility: Always / Sometimes / Rarely /

Never

c. Satisfaction with healthcare services: Satisfied / Neutral / Dissatisfied

8. **Family History**

a. Family history of preeclampsia/eclampsia: Yes / No

b. Family history of other hypertensive disorders: Yes / No

9. **Psychosocial Factors**

a. Stress level during pregnancy: Low / Moderate / High

b. Support from family and friends: Sufficient / Insufficient

10. **Use of Medications and Supplements**

a. Use of antihypertensive medications during pregnancy: Yes / No

b. Use of prenatal vitamins and supplements: Yes / No

11. **Perception and Attitudes**

a. Perception of the seriousness of preeclampsia/eclampsia: Very serious /

Somewhat serious / Not serious

b. Willingness to seek medical help for symptoms of preeclampsia/eclampsia:

Definitely / Maybe / Not willing

12. **Previous Birth Outcomes**

a. Gestational age at previous deliveries: __________

b. Birth weight of previous babies: __________

c. Complications during previous deliveries: Yes / No

13. **Blood Pressure Monitoring**

a. Frequency of blood pressure monitoring during pregnancy: __________ (times per

month)

b. Awareness of blood pressure readings during antenatal care visits: Yes / No

14. **Symptoms and Signs**

a. Experience of symptoms such as headaches, vision changes, or swelling during

pregnancy: Yes / No

b. Monitoring of symptoms and signs at home: Yes / No

15. **Body Mass Index (BMI)**

a. Pre-pregnancy weight: __________ (in kilograms)

b. Height: __________ (in meters)

 c. Calculation of BMI: __________ (BMI = weight / height^2)

16. **Blood and Urine Tests**

a. Frequency of blood tests during pregnancy: __________ (times per trimester)

b. Results of urine protein tests: __________ (if available)

17. **Management of Preeclampsia/Eclampsia**

a. Treatment received for preeclampsia/eclampsia: __________

b. Hospitalization due to preeclampsia/eclampsia: Yes / No

18. **Complications and Outcomes**

a. Maternal complications during pregnancy: __________

b. Fetal complications during pregnancy: __________

19. **Knowledge of Complications**

a. Knowledge of potential complications of untreated preeclampsia/eclampsia: Yes /

No

b. Sources of information about preeclampsia/eclampsia: __________

20. **Postpartum Follow-up**

a. Follow-up visits after delivery: Yes / No

b. Monitoring of blood pressure postpartum: Yes / No

Thank you for your participation in this questionnaire. Your responses will contribute to
important research on the prevalence and risk factors of preeclampsia and eclampsia in
our community.

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