International Journal of Advanced Research and Publications

ISSN: 2456-9992

Pregnancy Induced Hypertension (Pih): Expectant

Mothers‟ Care Seeking Behavior In Ekiti-State
Nigeria.
Adeosun Foluke O., Ayorinde Margaret A., Ogundele Samuel B., Adewole Josephine O.
Afe Babalola University Ado – Ekiti, College of Social and Management Sciences, Department of Sociology, Nigeria, PH +2348039438880
Adeosunf@abuad.edu.ng

College of Medicine and Health Sciences, Afe Babalola University, Department of Nursing Science, Nigeria, PH- +2348075213798
apekeola@gmail.com

College of Medicine and Health Sciences, Afe Babalola University, Department of Nursing Science, Nigeria, PH- +2348029224659
Tosley2000@gmail.com

College of Medicine and Health Sciences, Afe Babalola University, Department of Nursing Science, Nigeria, PH- +2348029224659
e-mail: ibikunlejosphn@yahoo.com

Abstract: In Nigeria, women frequently suffer the outcomes of serious hypertensive disorders in pregnancy that may lead to death. Delay
in seeking care is a key contributor to worsening the complications of Pregnancy induced hypertension (PIH). This study therefore aimed at
contributing to the available body of research on the knowledge and Health seeking behaviour among pregnant women (18 to 40 years)
diagnosed with PIH in Ekiti-state, Nigeria. Data was collected through the use of questionnaire from pregnant women who have been
diagnosed with PIH. Research findings show that the level of knowledge of pregnancy induced hypertension among expectant mothers aged
18 to 40 years with PIH complications in Ekiti-state Nigeria is so low (15%). Again, the rate at which they seek healthcare (15.8%), calls for
urgent attention. In order to checkmate early complications of unmanaged PIH, maternal, foetal and neonatal mortality and morbidity; it is
therefore recommended that appropriate health interventions and education programmes for the pregnant women with PIH should be
designed by the government of Ekiti-State, Nigeria. For interventions to work, the knowledge gained via this study would sensitize
midwives on knowledge needs of pregnant women with PIH previously unrealized thereby strengthening the quality of antenatal care
education. In conclusion, there is a significant relationship between the level of knowledge of expectant mothers and the frequency at which
they seek health care, the point at which they seek healthcare; as well as the alternative choices available to them.

Keywords: Care seeking behavior, Expectant mothers, Knowledge, Pregnancy Induced Hypertension (PIH).

1. INTRODUCTION women (18 to 40 years) diagnosed with PIH complications

Pregnancy induced hypertension (PIH) is a global problem in Ekiti-state Nigeria.
[1] which Hypertension in pregnancy affects about 5-22%
of pregnancies worldwide [2]. PHI is an emerging clinical 2. RESEARCH QUESTIONS
and public health problem in Nigeria. However, there have 1. How knowledgeable are pregnant women age 18 -40
been very few researches on PIH in Nigeria and the few years in Ekiti State about induced hypertension
researches have focused more on the reduction, (PIH)?
management and treatment of PIH. In 2009, the 2. What are the health seeking behaviours of pregnant
prevalence of PIH ranges between 2% to 16.7% [3]. In women with pregnancy induced hypertension aged 18
northern Nigeria Pre-eclampsia/eclampsia accounts for up to 40 years in Ekiti - State?
to 40 percent of maternal deaths [3]. In 2011, Enugu town 3. What is the relationship between knowledge of
had 3.3%/77 cases of PIH out of 2337 cases [4]. In 2014, complications of PIH and health seeking behaviours
according to [5] the prevalence of hypertensive disorders among pregnant women (aged 18 to 40 years)
was estimated to be higher than 17% in Nigeria. This diagnosed with pregnancy induced hypertension in
calls for urgent attention. Health seeking behaviour is Ekiti - State?
defined as an activity undertaken by individuals who
perceive themselves to have a health problem, or are ill for 3. OBJECTIVES OF THE STUDY
the purpose of finding an appropriate remedy [6]. 1. To determine knowledge about complications of PIH
Research evidence suggests that women have health among pregnant women aged 18 to 40 years Ekiti –
seeking behaviours which range from buying over the State.
counter drugs to relieve headache, consulting relatives on 2. To identify the health seeking behaviours of pregnant
what to do with odema, epigastric pain and blurred vision, women aged 18 to 40 years who have been diagnosed
consulting a spiritual or traditional healer on convulsing of PIH in Ekiti – State.
and coming to hospital. All these health-seeking
behaviours may delay coming to hospital, worsening the 4. VARIABLES
PIH complications [7]. This study therefore aims at In this study the variables are Health Seeking Behaviour
contributing to the available body of research on the (dependent variable) and knowledge of complications
knowledge and Health seeking behaviour among pregnant (independent variable).

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 International Journal of Advanced Research and Publications
ISSN: 2456-9992
4.1 DEMOGRAPHIC VARIABLES
Demographic variables address expectant mothers‟ age,
religion, marital status, level of education, and
employment status.
5. HYPOTHESIS 1
Hi: There is a significant relationship between knowledge
of PIH complications and care- seeking among pregnant
women aged 18 to 40 who have been diagnosed of PIH in
Ekiti – State
Ho: There is no significant relationship between
knowledge of PIH complications and care- seeking among
pregnant women aged 18 to 40 who have been diagnosed
of PIH in Ekiti – State.
5.1 HYPOTHESIS 2
Hi: There is a significant relationship between knowledge
of PIH complications and the point when expectant
mothers aged 18 to 40 who have been diagnosed of PIH in
Ekiti – State seek care after diagnosis
Ho: There is no significant relationship between
knowledge of PIH complications and the point when
expectant mothers aged 18 to 40 who have been diagnosed
of PIH in Ekiti – State seek care after diagnosis.
5.2 HYPOTHESIS 3
Hi: There is a significant relationship between knowledge
of PIH complications and alternative choices of expectant
mothers aged 18 to 40 who have been diagnosed of PIH in
Ekiti – State.
Ho: There is no significant relationship between
knowledge of PIH complications and alternative choices
of expectant mothers aged 18 to 40 who have been
diagnosed of PIH in Ekiti – State.
6. SIGNIFICANCE OF THE STUDY
The knowledge gained through this study would sensitize
midwives on knowledge needs of pregnant women with
PIH previously unrealized thereby strengthening the
quality of antenatal care education.
7. LITERATURE REVIEW
Pregnancy induced hypertension (PIH) is the most
common medical dilemma of unknown causes during
pregnancy and linked with very high risk globally;
especially in developing countries [1]. According to the
American College of Obstetricians and Gynecologists [8],
Hypertensive disorders of pregnancy including
preeclampsia, complicate about 10-17% of pregnancies
worldwide, constituting one of the greatest causes of
maternal and perinatal morbidity and mortality worldwide
[1]. Pregnancy induced hypertension (PIH) is a generic
term used to define a significant rise in blood pressure
during pregnancy, occurring after 20 weeks. Pregnancy
induced hypertension (PIH) is defined as hypertension
(blood pressure ≥ 140/90 mmHg) with or without
proteinuria ( ≥ 300 mg/24 hours) emerging after 20 weeks
gestation, but resolving up to 12 weeks postpartum.1–10)
PIH is also defined as new onset proteinuria ( ≥ 300
mg/24 hours) in hypertensive women who exhibit no
proteinuria before 20 weeks gestation [9].
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7.1 Classification of PHI
Canadian Hypertension Society posits that PIH refers to
one of four conditions [10] :
7.1.2 Gestational hypertension (GH) is diagnosed in
women whose blood pressure reaches ≥ 140/90 mmHg for
the first time during pregnancy (after 20 weeks gestation),
but without proteinuria. Blood pressure normalizes by 12
weeks postpartum [9], [10].
7.1.3 Preeclampsia (PE)
Hypertension (blood pressure ≥ 140 / 90 mmHg)
accompanied with proteinuria exceeding 300 mg/24 hours
emerges for the first time after 20 weeks gestation, but
both symptoms normalize by 12 weeks postpartum [9].
7.1.4 Superimposed preeclampsia (S-PE)
Superimposed preeclampsia is diagnosed in the following
three cases. (1) New onset proteinuria ( ≥ 300 mg/24
hours) in hypertensive women who exhibit no proteinuria
before 20 weeks gestation. (2) Hypertension and
proteinuria documented antecedent to pregnancy and/or
detected before 20 weeks gestation, one or both of which
progressing after 20 weeks gestation. (3) Renal disease
with proteinuria documented antecedent to pregnancy
and/or detected before 20 weeks gestation, which is
accompanied with new onset hypertension after 20 weeks
gestation [9], [11].
7.1.5 Eclampsia (E)
Eclampsia is defined as the onset of convulsions in a
woman with PIH that cannot be attributed to other causes.
The seizures are generalized and may appear before,
during, or labor [9], [11].
7.2 Risk factors
Hypertension, collagen vascular disease, obesity, black
race, insulin resistance, diabetes mellitus, gestational
diabetes, increased serum testosterone concentrations and
thrombophilia, clotting disorders, and HELLP syndrome
are considered risk factors for PIH [12]–[14].
8. METHOD OF STUDY
The study adopted the qualitative/ descriptive correlational
study as the investigator sought to describe the
relationship between knowledge of PIH complications and
care-seeking among pregnant women aged 18 to 40 years
who have been diagnosed of PIH in Ekiti – State. The
study population of this study consists of 120 pregnant
women aged 18 to 40years, attending antenatal clinic and
emergency; whose gestation period has exceeded 20
weeks and diagnosed with PIH. Purposive sampling
technique was used in this study because only the people
affected were considered. Structured questionnaire was
used for the study and consisted of both open and closed
ended questions; with carefully constructed research
questions titled „pregnancy induced hypertension:
expectant mothers‟ perceptions and care seeking
behaviour in Ekiti-State Nigeria. Section A of the research
questions is made up of demographic information and
section B is made up of five (5) questions on knowledge
of expectant mothers about PIH; their perceptions and care
seeking behaviour. The data generated from the
respondents were addressed by answering the research
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 International Journal of Advanced Research and Publications
ISSN: 2456-9992

questions formulated for the study. The statistical method In figure 1, data gathered shows that an alarming number
employed is descriptive in nature using simple percentage. (61%) of respondents have no prior knowledge about
The informed consent of the hospital administrators were complications of PIH in Ekiti – State. 22% of expectant
obtained in writing while those of other health workers mothers in this study are uncertain about their knowledge
and the respondents were obtained orally. Completed of PIH while only a very little number (15%) of
Questionnaires were collected at the spot by the respondents have an understanding of complications of
researchers. Correlation coefficient model was used to PIH.
identify significant predictors with Level of significance
taken at 0.01. 80
60
9. RESULTS. 40
Table 1: SOCIO-DEMOGRAPHIC CHARACTERISTICS 20
0
Age 18– 29 yrs 63 52.5 Very often Often Not often Not at all
30 – 40 yrs 57 47.5
No response 0 0
Total 120 100
Marital status Single 24 20.0
Married 96 80.0

Total 120 100 Figure 2: Percentage distribution showing how often

Level of Education expectant mothers aged 18 to 40 years who have been
Primary 22 18.3 diagnosed of PIH in Ekiti – State seek care after
Secondary 32 26.7
Tertiary 54 45
diagnosis.
No education 12 10
Total 120 100 Results from figure 2 show that only a total of 6.7%of
expectant mothers who have been diagnosed with PIH in
Employment Employed 53 44.2
Status Unemployed 67 55.8 Ekiti – State seek healthcare very often, 15.8% seek
Total 120 100 healthcare often while a large number (75.8%) do not seek
Religion Islam 33 27.5 healthcare often. Only 1.7% of these women do not seek
Christianity 66 55.0 healthcare at all. Even though all of the expectant mothers
Traditional 6 5.0
Other 15 12.5
seek help in one way or the other, research shows that
Total 120 100 more women do not seek help as often as the others.

Source: field survey 2017. Table 2: Percentage distribution showing alternative

choices of expectant mothers, instead of going to the
The table above shows the age distribution of respondents hospital.
with 52.5% falling below 30 years of age. 80% of the Response Freq %
respondents are married while 20% are single. Majority
Buy over the counter drugs 54 45
(45%) of the respondents had tertiary education while
26.7%, 18.3%and 10% had secondary, primary and no Consult experienced relative 33 27.5
education respectively. 55.8% of the respondents are Consult a spiritual or traditional healer 28 23.3
unemployed while 44.2% are employed. Religious
Consult internet sources 5 4.2
affiliations of respondents include Islam (27.5%),
Christianity (55%), Traditional belief (5%) and others Total 120 100
(12.5%).
Source: field survey 2017.
No Yes Table 2 shows that 45% of expectant mothers practice self
response 15% medication by buying over the counter drugs, 27.5%
2% consult some of their experienced relatives to seek advice
Uncertain No on the actions to take, 23.3% consult their
61% spiritual/traditional healers while only a little fraction of
22%
expectant mothers consult internet sources for help.

Table 3: percentage distribution showing the point when

expectant mothers aged 18 to 40 years who have been
diagnosed of PIH in Ekiti – State seek care after
diagnosis.
Figure 1: Percentage distribution showing the Level of
knowledge of expectant mothers aged 18 to 40 years who Response Freq %
have been diagnosed of PIH in Ekiti – State , on PIH. Whenever I fall ill 17 14.1
Whenever I have an appointment at the clinic 33 27.5
Whenever I am less busy 26 21.6
When other options fail 44 36.6

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 International Journal of Advanced Research and Publications
ISSN: 2456-9992
Total 120 100
Source: field survey 2017.

Table 3 shows that 14.1% of expectant mothers seek

healthcare only when they fall ill while 27.5% seek
healthcare whenever they have appointment with the
doctor. Expectant women who seek help only when they
have the time to do so and when other options fail are
21.6% and 36.6% respectively.

10. TEST OF HYPOTHESIS

TABLE 4: TABLE 6: Relationship between knowledge of expectant mothers on PIH on the point of seeking healthcare.
Correlations
Level of The point when expectant mothers
knowledge of seek care after diagnosis.
expectant
mothers on PIH.

Correlation Coefficient 1.000 .752**

Level of knowledge of
expectant mothers on PIH. Sig. (2-tailed) . .000
Kendall's tau_b N 120 120
Correlation Coefficient .752** 1.000
The point when expectant seek
Sig. (2-tailed) .000 .
care after diagnosis.
N 120 120
**. Correlation is significant at the 0.01 level (2-tailed).

TABLE 5: TABLE 6: Relationship between knowledge of expectant mothers on PIH and alternative choices.
Correlations

Level of Alternative choices of expectant

knowledge of mothers
expectant on PIH.

Correlation Coefficient 1.000 .701**

Level of knowledge of expectant
on PIH. Sig. (2-tailed) . .000
Kendall's tau_b N 120 120
Correlation Coefficient .701** 1.000
Alternative choices of expectant
Sig. (2-tailed) .000 .
mothers
N 120 120
**. Correlation is significant at the 0.01 level (2-tailed).

TABLE 6: Relationship between knowledge of expectant mothers on PIH and healthcare seeking

` Level of knowledge How often expectant mothers

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of expectant mothers seek care after diagnosis.
www.ijarp.org
on PIH
Correlation
1.000 .584**
 International Journal of Advanced Research and Publications
ISSN: 2456-9992
This study established the fact that of the level of
knowledge of pregnancy induced hypertension(PIH)
among expectant mothers aged 18 to 40 years with PIH
complications in Ekiti-state, Nigeria is so poor(15%).
Again, the rate at which they seek healthcare(15.8%) calls
for urgent action because this study reveals that a large
number of these expectant women do not seek healthcare
regularly or at the right place (Hospital) thereby leading to
early complications of unmanaged PIH and maternal,
foetal and neonatal mortality and morbidity. In
conclusion, there is a significant relationship between the
level of knowledge of expectant mothers and the
frequency at which they seek health care, the point at
which they seek healthcare; as well as the alternative
choices available to them.
11.1 RECOMMENDATION
It is therefore recommended that appropriate health
interventions and education programmes for the pregnant
women with PIH should be designed by the government
of Ekiti-State. For interventions to work, the knowledge
gained via this study would sensitize midwives on
knowledge needs of pregnant women with PIH previously
unrealized thereby strengthening the quality of antenatal
care education. Gaining insight into the knowledge needs
of pregnant women with PIH complications will make an
important contribution to the midwifery body of
knowledge with the potential to improve quality of
midwifery education. This study will create an opportunity
for updating Maternal Child Health (MCH) knowledge on
PIH complications and improve the quality of care given
to these women. The knowledge expectant pregnant
women have on complications of PIH and their
preferences of care will be developed through this
research. These would guide the midwives to design
individualized care for pregnant women, thereby
enhancing their use of health care facilities.
11.1 REFERENCES
[1] S. Anjana, M. Poonam, B. Shradha, “Management of
pregnancy induced hypertension”, International
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[2] S. Azubuike, I. Danjuma, “Hypertension in
Pregnancy among Rural Women in Katsina State,
Nigeria”, Journal of Basic and Clinical Reproductive
Science doi: 10.4103/2278-960X.194500,pp.140-146,
2017.
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[3] A. Abubakar, R.A. Abdullahi, H.Z. Jibril, M.H.
Dauda, M.A. Poopola, “Maternal Ethnicity and
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[5] S. Singh, E.B. Ahmed, S.C. Egondu, N.E. Ikechukwu,
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[7] D. O. Akeju et al,” Determinants of health care
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[8] The American College of Obstetricians and
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28-4,2013.
[9] K. Watanabe, K. Naruse, K.Tanaka, H. Metoki, Y.
Suzuki, “Outline of Definition and Classification of
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[10] E. Kintiraki, S. Papakatsika, G. Kotronis, D. Goulis,
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HORMONES, 14(2), pp.211-223, 2015.
[11] www.elsevier.com, “Pregnancy Hypertension: The
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[12] J.M.. Roberts, G. Pearson, J. Cutler, M. Lindheimer,
“hypertension during pregnancy”, Summary of the
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NHLBI working group on research on Hypertension,

pp. 437-445, 2003.

[13] M. Koual, H. Abbou, M. Carbonnel, O. Picone, J.M.

Ayoubi, “Short-term outcome of patients with
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[14] R. Anujeet, A. Singh, S. Kapoor, “Pregnancy induced

hypertension: A retrospective study of 200 cases of
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43, 2016.

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