Knowledge, Practice, and Health System Challenges in the Management of Pre-Eclampsia: A Cross-Sectional Study of...

Pre-eclampsia (PE) is a pregnancy-related hypertensive disorder and the leading cause of worldwide maternal deaths with the greatest burden in sub-Saharan Africa. Pre-eclampsia is one of the leading causes of maternal mortality in Sierra Leone, where the rate is the highest globally, primarily due to hypertensive disorders. The purpose of this study was to gain insight into the level of knowledge and practice of managing PE among midwives working in a tertiary referral hospital (Princess Christian Maternity Hospital) in Freetown.

A cross-sectional survey of 50 midwives was conducted using a structured, valid questionnaire. The data were analyzed using descriptive statistics and Chi-square tests, with p<0.05, indicating a statistically significant association.

The majority of midwives (90%) were female and had obtained a midwifery diploma (62%). All of the midwives were able to link eclampsia with convulsions; however, there were significant gaps in their knowledge. Only 42% of midwives were able to identify the placenta as a cause of PE, 42% identified proteinuria as a sign of PE and only 10% recognized epigastric pain as a symptom of PE. Bachelor's degree qualifications were significantly associated with a greater level of knowledge regarding PE (p=0.004). Although the vast majority of midwives (90%) recognized magnesium sulfate (MgSO₄) as the first line treatment for seizures due to PE, 30% of the midwives reported that they had never given MgSO₄ and that the level of their education was significantly associated with having given MgSO₄ to a woman (p=0.012). Major barriers identified by the midwives included insufficient staffing (92%) and inadequate blood pressure monitoring equipment (16%).

There are significant gaps in knowledge and experience regarding MgSO₄ among midwives at PCMH and those with the highest level of education had a greater number of correct answers regarding the physiological aspects of managing PE. There is an urgent need for targeted in-service training and for systemic health system barriers to be addressed in order to improve maternal outcomes.