Determinants of pre-eclampsia among women attending delivery services in public health institutions of Debre Tabor Town: a case–control study

Study design and setting

A facility-based unmatched case–control study was conducted in public health institutions of Debre Tabor Town from December 1, 2020, to January 15, 2021. Debre Tabor Town is the capital city of the south Gondar zone Amhara regional state which is located 665 km far from Addis Ababa (the capital city of Ethiopia) in a northwest direction and 103 km from Bahir Dar. The town has four public health institutions (one comprehensive specialized hospital and three health centres) that include Debre Tabor Comprehensive Specialized Hospital (DTCSH), Leul Alemayehu Health Centre (LAHC), Gaffat Health Centre (GHC), and Debre Tabor Health Centre (DTHC). These institutions provide community health care including maternal and child health services. All pregnant women attending delivery services in public health institutions were the source population. While women attending delivery services in public health institutions during the study periods were the study population.

Inclusion criteria

The cases were women with systolic blood pressure ≥ 140 mmHg or diastolic blood pressure ≥ 90 mmHg on two separate readings taken at least four hours apart or diastolic blood pressure of at least 110 mmHg on any one occurrence, plus proteinuria of at least 300 mg per 24 h or ≥ + 2 on a urine dipstick after the 20th week of gestation in a previously normotensive and non-proteinuric pregnant woman and women who have given written informed consent to participate in the study and attending delivery service in the hospital. The diagnosis involves history taking, physical examination, and laboratory investigation results. Women’s charts were reviewed to support the diagnosis.

Controls were women who were attending delivery services in the same health institutions during the same time and were not diagnosed as pre-eclamptics/ eclamptics. All cases and controls were seen by the most senior health professionals (obstetricians, general practitioners, and or midwives) in each health institution.

Exclusion criteria

Women with known chronic hypertension disorders and renal disease and attending delivery services in the public health institutions were excluded from the study.

Sample size determination and sampling procedures

The sample size was determined by double population proportion formula using EPI-INFO version 7 software by considering 95% CI, 80% power, 5% margin of error, and 1:2 cases to control ratio. The different sample size was calculated by using different risk factors of pre-eclampsia, but the maximum sample size was gained by taking primigravida as a determinant factor for PE (15) where the proportion of PE among cases and controls were 60% and 40% respectively. Therefore, the calculated sample size was 240 (80 cases and 160 controls). The final sample size after considering a 10% non-response rate was 264 (88 cases and 176 controls).

All women admitted for labour and delivery services who fulfilled the inclusion criteria in the health institutions were consecutively involved until the desired sample size was attained. Case–control incidence density sampling technique was applied to select the cases consecutively as they are diagnosed to have pre-eclampsia/eclampsia until the calculated sample size was attained. For every case included, two control mothers who came for delivery services in the same facility and same day/week were identified by using a simple random sampling technique. The sample size was distributed for each health institution proportionally based on their delivery case flow. According to information got from each institution the monthly average delivery report was (330 for DTSH, 125 DTHC, 105 GHC, and 100 LAHC). The total monthly delivery report was 660. Therefore, the allocated samples for each institution were 132 (44 cases, 88 controls) for DTSCH, 50 (17 cases, 33 controls) for DTHC, 42 (14 cases, 28 controls) for GHC, and 40 (13 cases 27 controls) for LAHC.

Data collection tools and procedure

Data were collected through a face-to-face interviewer-administered technique using a structured and pre-tested questionnaire. Mothers’ chart reviews were also performed to abstract clinical laboratory findings such as protein urea, organ function test (creatinine, liver enzymes), and findings of HELLP (Hemolysis, Elevated liver enzyme, Low platelet counts) syndrome. The tool was first prepared in English and translated to the local Amharic language for simplicity and then back to English to assure consistency by two language experts. The questionnaire has four parts that include socio-demographic characteristics like (age, educational status, marital status, residency, occupation) obstetrical and reproductive health characteristics like (gravidity, age at menarche, age at first pregnancy, ANC follow-up, the status of pregnancy, family history of PE), medical and lifestyle related characteristics like (family history of DM, family history of hypertension, physical exercise, drinking habit, and smoking habit). Four diploma midwives were hired for data collection and supervised by two BSc midwives.

Data quality control

To maintain the quality of the data, the tool was prepared after an intensive review of relevant literature searches. A pre-test was done on 5% (13 mothers) in Debre Tabor Hospital before the actual data collection period and modifications such as wording errors, skip patterns, and jargon words were made. Besides these, data collectors and supervisors were trained for two days on the aim of the study, items of the questionnaire, confidentiality, and the data collection process. Finally, the collected data were cleaned and compiled daily by supervisors and principal investigator.

Analysis and interpretation

The collected data were cleaned, coded, and entered using Epi-data software version 4.2, and analyzed by statistical package for social science (SPSS) version 23. Descriptive statistics was used to describe the study populations using measures of frequency and central tendency and summarized using tables compared between cases and controls.

Bivariate and multivariable logistic regression analyses were performed. In bivariate analysis variables that have an association with the development of PE with a p-value of less than 0.2 were fitted into a multivariable logistic regression model for further analysis. Finally, variables that have a significant association with PE at a p-value of 0.05 with 95% CI and AOR was declared as a statistically significant variable.

Ethical consideration

Ethical clearance was sought from Debre Tabor University College of Health Sciences research review committee. Also, a support letter was granted to each health institution. Moreover, all the study participants were informed about the purpose of the study, their right to refuse, and assurance of confidentiality. Then, written consent was obtained from each study participant. Strict confidentiality was assured through anonymous of all recording and coding of the questionnaire. This study was following the Declaration principles of Helsinki.

留言 (0)

沒有登入
gif