By HLUPEKILE NKUNIKA –
HYPERTENSION is one of the most common medical complications
encountered during pregnancy in the Southern Africa Development
Committee (SADC).
Accounting for 16 per cent of maternal related deaths, hypertension is
becoming an increasing concern among expectant mothers.
It is currently the second leading cause of death after hemorrhage among
pregnant women in the region.
Low socio-economic status have been proven to be important risk
factors for high blood pressure though, there is inadequate data on the
determinants of this condition.
The situation is further compounded by inadequate qualified staff in
health facilities, long distances that some expectant mothers have to walk
to access medical services.
Poor road infrastructure to carry expectant mothers to health
facilities as well as lack of health facilities in some areas, are
other factors leading to maternal deaths.
Some of complications caused by hypertension are the abnormal
amount of protein in urine, an abnormal kidney or liver function and pain
over the upper abdomen.
Changes in vision, fluid in the lungs and low number of platelets in
the blood or a severe headache in affected pregnant women, are other
complications caused by hypertension.
According to the SADC, Health Policy Framework, Hypertension may also
lead to a decrease in the flow of nutrients to the baby through the
placenta.
This may result into growth problems of the baby.
If the placenta is not providing enough nutrients and oxygen to the
baby, it may be decided that early delivery is better for the baby
than allowing the pregnancy to continue.
Another complication known as placental abruption, a condition in
which the placenta prematurely detaches from the wall of the uterus,
may occur.
Some women have had to undergo cesarean delivery due to hypertension.
A cesarean delivery carries risks of infection, injury to internal
organs and bleeding.
Long-term complications of hypertensive pregnancy related syndrome
include increased risk of cardiovascular events in both mother and
child, which may contribute to the rising epidemic of cardiovascular
disease.
In Zimbabwe, Pregnancy Induced Hypertension (PIH) is one of the most
common causes of both maternal and neonatal morbidity.
A research on prevalence and induced hypertension by Biomed Central
Limited observes that hypertension affects about 5-8 per cent of
pregnant women.
It is associated with adverse pregnancy outcomes as
well as maternal morbidity and mortality.
Harare city experienced an increase in referrals to central
hospitals between 2009 and 2011, due to PIH.
Delays in seeking care and shortage of resources,  were the major
challenges in the management of PIH.
The report concludes that PIH is high and that women with hypertension
are at a higher risk of adverse pregnancy outcomes than those without.
Poor knowledge of management of hypertension and inadequate resources
are a threat to the management of the condition.
Increased human
resource and capacity building as well as, resource mobilisation,  are
important for pregnant women.
Urinalysis must be done for all pregnant
women regardless of their blood pressure.
According to the World Health Organisation (WHO), hypertension is one
of the primary causes of maternal mortality in Malawi.
Hypertension accounts for 14 per cent of pregnancy related deaths.
Even  though hypertension cannot be cured during pregnancy, treatment
options like magnesium sulphate can suppress life threatening
incidents of seizures.
In Eastern Province of Zambia, Chipata General Hospital is also faced
with an increase of pregnancy related complications due to
hypertension.
According toGynecologist Obstetrician Augustine Cyimana, high blood
pressure accounted for 23 admissions of expectant mothers in the first
quarter of this year.
“We recorded 29 cases in quarter two and 33 in quarter three.
As you can see, the number of cases is increasing.
It is a serious health
concern that needs concerted efforts to be controlled,” he said.
Dr Cyimana noted that hypertension usually leads to eclampsia or
convulsions or seizures which he said affect most of the expectant
mothers that have high BP.
“This may be before, during, or after delivery.
Most often it is
during the second half of pregnancy.
The seizures last about a minute.
“Following the seizure,  there is typically either a period of confusion
or coma.
High blood pressure can also lead to aspiration pneumonia,
cerebral hemorrhage, kidney failure and cardiac arrest,” he said.
He explained that one death was recorded of an expectant mother who
was taken to the health facility after she had already started
bleeding from the brain.
The blood pressure of the patient was too high and it could not be
controlled at a clinic.
The patient had lapsed into a coma by the time
she reached the hospital.
Dr Cyimana noted that it is difficult to identify the causes of
hypertension during pregnancy.
He however, noted that expectant mothers who
report hypertension within 20 weeks of their pregnancy are
hypertensive even before getting pregnant.
“It means that the hypertension was there even before though,  it may
manifest during pregnancy.
But if it is caused by pregnancy, it
manifests 20 weeks after the conception,” he said.
Dr Cyimana stated that it was important for expectant mothers to seek
ante natal services for early detection to ensure that health experts
control the condition.
“All pregnant women should have their blood pressure checked and those
that already have hypertension can be closely monitored and their
blood pressure can be controlled before it is too late,” he said.
It is worth noting that SADC’s integration agenda accords priority to
social and human development including fostering of cooperation in
addressing health challenges which are reflected in the high burden of
both communicable diseases such as HIV and AIDS, tuberculosis and
malaria and non-communicable diseases which include diabetes,
hypertension and cancer.
The region also prioritised the development of a protocol on health
matters as this was seen as critical for enhancing regional
integration within a legally enforceable framework.
Three key policy documents were developed to underpin
implementation of the programme, namely: the Health Policy Framework,
SADC Protocol on Health and the Regional Indicative Strategic
Development Plan (RISDP).
The SADC Health Programme was developed taking into account global and
regional health declarations and targets.
In this health policy, SADC noted that changing lifestyles and
standards of living were altering the disease landscape in Southern
Africa.
The World Health Organisation states that: “In African
nations, non-communicable diseases are rising rapidly and are
projected to exceed communicable, maternal, peri natal and nutritional
diseases, as the most common causes of death by 2030.”
Incidents of
non-communicable diseases such as heart disease, diabetes, and cancers
can rise with improved economic development, resulting in an
unhealthy, aging population.
It is important to note that countries in the region have made efforts
to address hypertension by improving access to health facilities.
In Zambia, a number of health facilities have been constructed leading
to a reduced distances that expectant mothers have to walk in order to
access health facilities.
This is the case even in other countries in
the region.
This can further be enhanced by improving staffing levels in the
health sector especially among rural areas where in some cases,
expectant mothers are attended to by unqualified staff.
There is need to improve access to ante natal services with adequate
equipment and drugs for expectant mothers.
It is also important that SADC member states sensitise citizens to
change their lifestyles and improve diet because, as these countries
improve their economic statuses, the risk of non-communicable diseases
such as hypertension is getting higher.
Ante natal services should be encouraged for early detection and
treatment of this life threatening disease.
There is need for countries in the SADC region to enhance partnerships
and seek ways in which hypertension among expectant mothers, can be
controlled especially that, it is the second leading cause of death
among pregnant women in the region.- ZANIS.