Knowledge and Practices of Health Workers in Relation to Preeclampsia at Ishaka Adventist Hospital in Western Uganda.

TABLE OF CONTENTS

Contents

DECLARATION....................................................................................................................................i

APPROVAL .......................................................................................................................................... ii

ACKNOWLEDGEMENT.................................................................................................................... iv

DEFINITION OF TERMS.................................................................................................................... v

LIST OF ACRONYMS. ....................................................................................................................... vi

TABLE OF CONTENTS .................................................................................................................... vii

CHAPTER ONE....................................................................................................................................1

1.1 BACK GROUND OF THE STUDY................................................................................1

1.2 PROBLEM STATEMENT..............................................................................................3

1.3 JUSTIFICATION ............................................................................................................3

1.4 STUDY OBJECTIVES....................................................................................................4

1.4.1 General objective...................................................................................................................4

1.4.2 Specific objective ...................................................................................................................4

1.5 RESEARCH QUESTIONS.........................................................................................4

1.6. Conceptual framework on health worker’s knowledge and practice concerning

preeclampsia in Ishaka Adventist hospital. ..........................................................................5

LITERATURE REVIEW......................................................................................................6

2.1. Knowledge of HWs in relation to preeclampsia. ....................................................................6

2.1.1. Classification of preeclampsia .....................................................................................6

2.1.2. Signs and symptoms of preeclampsia ..........................................................................7

2.1.3. Complications of preeclampsia....................................................................................7

2.1.4. Pathogenesis of preeclampsia. .....................................................................................8

2.2. Practices concerning diagnosis and Treatment of pre-eclampsia .................................8

2.2.1. Anticonvulsants....................................................................................................................8

1. Magnesium sulphate ..................................................................................................................8

2. Diazepam....................................................................................................................................9

2.2.2. Antihypertensive drugs used in management of pre -eclampsia................................9

1. Methyldopa ................................................................................................................................9

2. Hydralazine................................................................................................................................9

3. Labetalol................................................................................................................................... 10

4. Nifedipine ................................................................................................................................. 10

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METHODOLOGY ..............................................................................................................11

3.1 Study design ........................................................................................................................... 11

3.2 Study area ......................................................................................................................11

3.3 Study population............................................................................................................11

3.4 Sampling techniques......................................................................................................11

3.5 The sample size determination ......................................................................................11

3.5.1 Inclusion criteria. ................................................................................................................ 11

3.5.2 Exclusion criteria ........................................................................................................11

3.6 Data collection and tools................................................................................................12

3.7 Data analysis ..................................................................................................................12

3.8 Data presentation...........................................................................................................12

3.9 Data quality control, validity and reliability.................................................................12

3.10 Ethical considerations..................................................................................................12

CHAPTER FOUR ............................................................................................................................... 13

RESULTS ............................................................................................................................13

Table (1) percentage distribution knowledge of study sample about the definition of

preeclampsia. ............................................................................................................................... 13

Table (2) knowledge of study sample about classification of preeclampsia ............................... 13

Table (3) knowledge of study sample about causes of preeclampsia. ......................................... 13

Table(4) knowledge of study sample about risk factors for preeclampsia .............................. 13

Table(5) knowledge of study sample about serious (subjective) signs of severe preeclampsia.

...................................................................................................................................................... 14

Table(6) knowledge of study sample about mild to severe signs indicate progress of

preeclampsia ................................................................................................................................ 14

Table(7) knowledge of study sample about bed rest for preeclamptic mother ....................... 14

Table(8) knowledge of study sample about signs of HEELP syndrome. ................................. 14

Table(9) knowledge of study sample about the effects of preeclampsia on the mother .......... 15

Table(10) knowledge of study sample about the effects of preeclampsia on the fetus ............ 15

Table(11) practices of study sample about drug of choice in managing convulsions in severe

preeclampsia/eclampsia ............................................................................................................... 15

Table(12) practices of the study sample about dose of magnesium sulphate ............................. 16

Table(13) practices of the study sample on determining the sign of magnesium sulphate

toxicity.......................................................................................................................................... 16

Table(14) practices of the study sample about giving antidote for MgSO4 toxicity ................. 16

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Table(15) practices of the study sample about hypertensive drugs used in severe preeclampsia

...................................................................................................................................................... 16

Table(16) practices of the study sample about indications for delivery of preeclamptic mother

...................................................................................................................................................... 17

CHAPTER FIVE................................................................................................................................. 18

DISCUSSION, CONCLUSION AND RECOMANDATIONS ..........................................18

5.0 DISCUSSION OF THE RESULTS...............................................................................18

5.1 KNOWLEDGE OF HEALTH WORKERS IN RELATION TO PREECLAMPSIA 18

5.2 PRACTICES OF HEALTH WORKERS IN RELATION TO DIAGNOSIS AND

TREATMENT OF PREECLAMPSIA ...............................................................................19

5.3 CONCLUSION:.............................................................................................................19

5.4 RECOMMENDATIONS:..............................................................................................20

References............................................................................................................................21

APPENDIXES .....................................................................................................................24

APPENDIX I: KREJCIE AND MORGAN TABLE ..........................................................24

APPENDIX II: WORK PLAN............................................................................................24

APPEDIX III: proposed research budget...........................................................................26

Consent to participate in this study ....................................................................................27

APPENDIX IV: Geographical location of IAH..................................................................31

CHAPTER ONE 1.1 BACK GROUND OF THE STUDY Preeclampsia is a life threatening hypertensive disorder of pregnancy that normally starts after 20 weeks of gestation(Agrawal, 2014). with increased blood pressure (Bp≥140/90mmHg) and proteinuria (urinary albumin ≥300mg/24hrs). It is one of the leading causes of maternal mortality and morbidity amongst pregnant women in the world. Maternal mortality & morbidity are significant Public health problem in developing countries.(Kaushik et al., 2012) Despite many attempts towards understanding the possible causes of preeclampsia and contributing associated factors, the etiology of preeclampsia remains obscure .Studies have suggested several risk factors for preeclampsia including null parity, family or own history of hypertension, diabetes, body mass index(BMI)higher than normal, multiple pregnancy, maternal age (less than 20 and greater than 35 years), renal disease, hydatidifom mole, hydrops fetalis, oocyte donation or donor insemination, chronic hypertension ,chronic autoimmune disease.(Bilano et al., 2014) According to the World Health Organization(2008), postpartum hemorrhage is the leading cause of maternal deaths in developing countries, accounting for 27% of deaths, followed by hypertensive disorders of pregnancy(primarily pre-eclampsia and eclampsia) and sepsis, which each account for 12% of deaths, and obstructed labor (6% of deaths)(Barbara et al., 2014). About 10 million women develop preeclampsia every year with the estimated maternal mortality of about 630,000 women each year and about 500,000 fetal deaths. WHO reported that, globally an estimated number of 289,000 women died during and following pregnancy and childbirth related problem in 2013 alone(Gedefa A et al., 2016). The mortality is due to limited availability of services, poor access to care, and lack of knowledge by community members and HWs(Ruchi Puri., 2011)