Study Area, Period and Design
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.
Sample Size Determination
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).
n= sample size p=prevalence of preeclampsia =8.4% d= margin of error between the sample and the population=4%
z=1. 96 at confidence level 95%, by considering the non-response rate of 10%
n= (1.96) ² × 0.084 (1-0.084)/0.04²=185
Since our source population (N), is below 10,000 we use correction formula
nf = n/ (1+ (n/N))
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
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
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+.
Patient and Public Involvement statement
The data were collected using a structured questionnaire and a sphygmomanometer.
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.
Data Quality Management
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.
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 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.