66 A comparative study of knowledge, attitudes and perceptions of women and men around pre-eclampsia and eclampsia in Nigeria

Abstract

Introduction Pre-eclampsia and eclampsia (PE/E) are life-threatening complications accounting for nearly 40% maternal deaths in northern Nigeria. Maternal deaths due to PE/E could be averted, if pregnant women develop healthy care-seeking behaviors and attend antenatal care early in their pregnancies. Objective This study compared gender differences in the knowledge, attitudes and perceptions around PE/E in Nigeria in order to gauge women’s health care-seeking behaviors during pregnancy. Methods The study design was cross-sectional involving qualitative methods: focus group discussion (FGD). The study was conducted in seven states in Nigeria between June–August, 2015 following an Institutional Review Board (IRB) approval from the National Health Research Ethics Committee (NHREC) of the Federal Ministry of Health (FMoH) and the ethics committees of all the participating states. Overall, data was collected through twenty-eight (28) focus group discussions, four (4) per state, and two in urban and rural communities respectively. Each group was made up of eight (8) discussants. The discussants were identified and purposively selected with the assistance of the officer in charge of the public health facility in each community. The FGDs were held with married women ( n = 112) and men ( n = 112) aged 18 and 49, who had at least one child. Data were obtained by tape-recording supplemented by hand-written notes. The recorded data were transcribed verbatim and content analysis was done using QSR NVivo 10 software. Results Both men and women showed negative perceptions, attitudes and low knowledge on issues associated with PE/E, although men’s and women’s perceptions regarding PE/E did not differ much. Men perceived attacks from enemies, spiritual attacks or evil curses, attacks suffered in polygamous homes, financial constraints, physical and emotional stress on the woman, anxiety, fear of the delivery process or fear of multiple births as possible causes of PE/E. Women reported early marriage, unpleasant surprises, emotional shock, witchcraft, and attack from the family and/or familial conflict, and martial issues as causes of PE/E. Traditional or spiritual healing, such as the use of herbs and fruits, or religious leaders are often sought before seeking medical care. Both men and women and many pregnant women do not access health facilities for fear of death and their husbands’ anger on constant complaints of ill health. Conclusions Misconceptions, myths and mistrust among community members negatively influence their care-seeking behaviors. There is need to educate men and their spouses on the biological signs, symptoms, and dangers of PE/E and their amenability to medical interventions. This may improve health-seeking behaviors including the antenatal period and improve prevention, early case detection and effective management of PE/E in Nigeria.