We enrolled 20 participants and reached data saturation. The largest proportion were aged between 45 and 49 years, were married, belonged to the Bakiga tribe and the details of the socio-demographic characteristics are shown in Table 1 below. Most of the women were either members of the village health team or traditional birth attendants. The largest proportion of them did not have a formal education.
Table 1: Demographic characteristics for participants n=20 older women in Kabuyanda, Isingiro district, southwestern Uganda
65 and over
Traditional Birth Attendant
Village Health Team
Chairperson for women committee
*Occupation categories are not exclusive. * lower primary is from primary 1 to 4 and upper primary from primary 5 to primary 7.
Four themes emerged from our analysis namely; local name, causes and risk factors, remedies, and effects of preeclampsia/eclampsia and these are presented in Table 2 below. The theme local name emerged from the subthemes of no identifiable local name and a couple of other conditions namely meningitis and epilepsy which were mistakenly confused for pre-eclampsia. Causes and risk factors emerged from multiple pregnancy, ‘little’ blood, witchcraft, strained relationships like marital tension, ghost attack, drinking alcohol, having a big baby, poor feeding and a disease of the well-to-do cited as potential causes. The remedies emerged from the consistent mention of herbal treatment, prayers and counseling, corrective nutrition, appeasing the dead, ‘good treatment’ by spouse and seek medical help as potential solutions cited by the majority. The effects theme emerged from the mention of premature delivery, caesarian section delivery and death as potential consequences.
Table 2: Emerging themes on perceptions of pre-eclampsia among older women in Isingiro, south-western Uganda
No local name
Obuzimba bw’enda y’abarongo
No clear identifiable local name
Lack of craved foods
Puresha (high blood pressure)
A disease of the well-to-do
High blood pressure
Causes and risk factors
Prayers and Counseling
Appease the dead
“Good treatment” by spouse
Seek medical help at the hospital
Corrective nutrition Appease the dead
Seek medical help
Caesarian section delivery
Effects of preeclampsia/eclampsia
The Baganda tribe in central Uganda and Banyakitara tribes in southwestern Uganda call pre-eclampsia ‘amakilo and amakiro’ respectively but none of these KIs we interviewed seemed to know this name.
‘I am really not sure of the name for a disease that presents that way; besides I have never had those symptoms in combination but I see women with twin pregnancies having swollen feet’ 47-year VHT Member, mother of 4.
Instead, some KI seemed to have coined other names such as “Obuzimba bwe’enda y’abarongo” translated as ‘swelling of the body due to twin pregnancy”. The KIs seemed to suggest that the body swelling in preeclampsia was due to weight gain that happens when a woman is carrying a twin pregnancy.
“You can tell that a woman has multiple pregnancy if you see her body swollen up. But usually in the morning, the swelling has reduced but because the babies she is carrying are heavy, then her body swells up again, the swelling is there all the time but more pronounced during the day when it is difficult for her legs to carry her pregnancy and do chores as well. So I think this disease that presents this way together with body swelling is Obuzimba bw’enda y’abarongo , 73-year old widow , mother of 7.
Ensimbo, translated as ‘epilepsy’ was confused with pre-eclampsia by some of the women. Participants said that fits/convulsions in pregnancy are due to epilepsy especially if it has been pre-existing before the woman got pregnant.
‘Fitting in pregnancy is caused by [ensimbo]. It’s a bad omen to suffer from epilepsy. When someone is convulsing because of epilepsy, we run away from them because should they pass flatus when one is near them, he catches it too. It’s terrible, you don’t want your relative to have epilepsy of all diseases.’ 48-year-old, peasant, mother of 6.
‘Omuraramo, translated as ‘meningitis’ was considered to have symptoms equivalent to those of pre-eclampsia by some women. The fits/convulsions that manifest in eclampsia were perceived as meningitis by the participants.
‘When I was growing up there was an outbreak of omuraramo and sometimes patients would fit. It was a killer disease and they would remove fluid from their back. Your patient would never make it after this extraction of fluid from the back. I think a pregnant woman fitting has caught omuraramo [meningitis] and is destined to die with her pregnancy’.73-year old, TBA widow, mother of 7.
Causes and risk factors
Participants thought that the convulsions that occur in this disease can be caused by omuraramo or ensimbo literally meaning meningitis and epilepsy respectively in the local Runyankore-rukiga dialect.
‘Those symptoms could be caused by omuraramo [meningitis] and ensimbo [epilepsy] but now you see the confusion is that even men can have it and can fit.’ 44-year-old TBA, mother of 3.
The respondents associated the oedema or body swelling seen in preeclampsia and eclampsia patients with having anemia or ‘little blood’ in the pregnant woman’s body. Respondents mentioned that a poor diet dominated by matooke [steamed bananas] and no beans or greens or even millet porridge was to blame for the ‘little blood’ in women.
‘When you eat poorly, especially when you can’t find foods that give blood, then your whole body will swell.” 57years TBA, mother of 5.
Respondents mentioned that poor feeding resulting from a pregnant woman not being able to find foods rich in nutrients such as iron, not having enough to eat in general due to lack of money to buy the necessary food stuffs was seen as a cause of ‘little blood’ and body swelling in pregnant women.
‘I think the person is weak in this case and does not have enough blood because of poor feeding, you know village life where people don’t have money to buy foods rich in iron like the health worker tells us of meat and fish, so this may be the cause for the swelling in pregnant women, then the stress will bring about headache. As you know, our poor way of living in the village may have brought about this,’ 45-year-old VHT member, mother of 6.
This was echoed by other participants who thought not taking the right foods is solely responsible for body swellings in pregnant women.
‘I thought the pregnancy was big and also the woman was not having a balanced diet. At times the pregnancy restricts one and they have no appetite. A woman may end up eating matooke with no salt, they don’t want beans or other times they depend on only drinking water. Such a person may lack blood and end up getting swollen.’ 56 years, women’s leader, mother of 5.
‘The challenge is that some pregnant women are not feeding well or have other diseases that are left untreated and can swell up or even fit and so they will blame pregnancy when it isn’t the case’ 45-year-old VHT, mother of 4.
There was a common belief in spirits and ghosts. Some respondents thought the fits were linked to a ghost attack from recent demise of a close relative especially if the pregnant woman was not at peace or was liked too much by the deceased.
‘Some relatives don’t die completely. If at the time of demise, you had a misunderstanding or they loved you too much and are not resting in peace, they may strangle you so that you die too.’ 73-year old widow, mother of 7.
Some participants thought that life stressors like strained relationships, abusive spouses can cause stress resulting in a headache. Respondents mentioned that some women are in polygamous relationships with nagging co-wives, and poverty where they are unable to have enough nutritious foods such as those rich in iron. They believed that all these factors may cause a rise in one’s blood pressure especially when pregnant.
‘For us we always think that she has a lot of thoughts like when the woman is unstable at home, like the man doesn’t bring for her home necessities and when she encounters such problems , they can cause a headache and ‘puresha’ [high blood pressure].’, 48 year old , Peasant, mother of 6,
Several respondents believe the illness may be a result of witchcraft especially from persons that do not wish the pregnant woman well.
“Not everyone is happy for you when you get pregnant, for some reason, someone can bewitch you and you fit, a co-wife for example could wish you dead. When you are pregnant, she is already imagining that your child will compete for property with her children” 45-year-old VHT, mother of 5.
Multiple pregnancies are associated with a certain level of prestige but seemed to be associated with complications such as body swelling and anemia.
‘They are not many though I usually see some women with swollen hands, face and legs and I always think it is because one is expecting twins and at times, we joke about it.’ 45 -year old, VHT member, mother of 6.
Respondents believed that body swelling was predictive of the size of the baby the mother was carrying, and some respondents seemed to suggest that the more the swelling, the bigger the baby would be.
‘We say that a woman swelling during pregnancy means that she has a big baby who is demanding a lot of blood hence the swelling.’ 56-year-old, women’s leader, mother of 5
Majority of the respondents seemed to correctly relate having high blood pressure with symptoms of pre-eclampsia and eclampsia as evidenced in the narrative from a VHT member.
‘The signs that she has, the woman who has [high blood] pressure, she has severe headache, she tells you that the heart pumps a lot like it is about to fly out of the chest, and those are the only ones. I don’t do much with such a woman, I just give her a referral letter to hospital immediately. There is nothing more I can do really because am not empowered to help her’. 45 year, VHT coordinator, mother of 4.
Participants had different views on how a client with preeclampsia /eclampsia should be managed. The recommendations ranged from herbal medical treatment to referral to the formal health care facilities.
Some of the participants said that when getting medical treatment from the hospital is difficult, they resort to some herbal concoctions. The respondents believed that these had the ability to raise their blood levels and therefore the swelling would reduce.
‘The woman goes to a health facility and gets some tablets but these may not be very helpful most of the time. At times they go to Kabuyanda [county level] health center and are not helped so they are advised to seek further medical treatment in a hospital. But they do not go because they have no money. So, they resort to using herbs. …they can use a red herbal concoction that increases their blood levels’ a 45-year-old VHT member, Para 6+2.
Some respondents thought convulsions in a pregnant woman are linked to a ghost attack from recent loss of a close relative. They mentioned that the traditional healer would appease the dead by performing certain rituals.
‘The services of a traditional healer should be sought to appease the dead. I don’t know what the traditional healer does but I know that he should be performing some rituals to appease the dead’ 73-year old widow, retired TBA, mother of 7
Some respondents believed in spiritual healing as a remedy for eclampsia. Although this was not common, the few respondents that suggested so were very passionate about the potential effectiveness of the remedy.
‘Seeing a counselor can help her to be peaceful since they have troubles. She can join a prayer group and pray for peace in her home to save her the stresses of daily life.’ 60-year-old farmer, mother of 7.
Respondents alluded to a balanced diet for the participants as being essential, although their understanding of a balanced diet meant eating beans, green vegetables, sweet potatoes, and millet porridge to correct the anemia. They believe that this type of diet will correct the dizziness and body swelling and prevent the convulsions.
‘At times the pregnancy is very demanding on the woman to carry but also lack of enough blood. When they are swollen up, they are encouraged to feed well so that they can get enough blood like feeding on liver can bring back the blood and the body swelling will slowly go away. They say they get swollen and when they visit the hospital, they are advised on how to feed. Enough blood prevents them from fitting as well.’ 65 years VHT, mother of 6.
Some respondents believed that symptoms related to eclampsia were because the woman was being mistreated by her husband. They believed that if the husband treated her better and took good care of her, these symptoms would resolve or would not appear in the first place.
‘Loving each other and getting due attention from husband when a woman feels any pain , helps a lot. Also, a husband who treats his wife well saves her stress that can cause her [high blood] pressure.’ 65 years, VHT member, mother of 6.
Although some respondents were proponents of local herbal remedies, some strongly discouraged and recommended visiting the health facility.
‘Long time ago herbs used to help in every illness of our forefathers but nowadays they tell you they take but the herbs are of no help. So, they are better off going to hospital for treatment because herbs these days no longer help.’ 45-year-old VHT, mother of 4.
Effects of preeclampsia and eclampsia
Participants were aware of the potential consequences of the symptoms of eclampsia. They mentioned that the condition could lead to death of the baby in utero or even the mother. These potential adverse outcomes were mentioned by the majority of respondents.
‘The person may die if not referred to hospital. If the woman does not die, her baby will die in the womb. How can the baby survive with a mother that has no blood?’ 45 year, VHT coordinator, mother of 4.
Most of the participants linked the signs and symptoms of preeclampsia to little blood that causes body swelling. They said that such women can have premature deliveries.
‘Maybe the baby can become very weak or some women get swollen legs, little blood and this can sometimes lead to premature births. That is how we see them.’ 60-year old farmer, mother of 7
Participants thought that a woman with symptoms of preeclampsia/eclampsia becomes very weak and may get difficult deliveries. They mentioned that such women are likely to be surgically operated to remove the baby.
‘No, it’s not that they get all that well, they remain weak and at the time of giving birth they may still be weak, they may fail to push the baby and are delivered by caesarian section.’45-year-old VHT member, mother of 6.
Participants acknowledged that preeclampsia/eclampsia is a serious illness and life threatening. They agreed that if not attended to, the disease had some grave consequences including the potential to cause death.
‘I think such a person should get help from a health facility but because we are in village at times when a woman is in such a condition and you tell her to go to hospital, their husbands, don’t mind so they don’t care, in such a situation, the woman remains in that poor state of health and at times she dies.’ 57 year old TBA , Mother of 7.