Pre-eclampsia: pregnancy complication stealing mothers and babies

In Kenya, maternal mortality remains high, with 355 maternal deaths reported for every 100,000 live births. [iStockphoto]

Getting pregnant is no longer a cause for celebration for some women and families. Instead, pregnancy can bring fears of complications that may claim the life of the mother, the baby or both.

For William Jalavikuba Munthali, a traditional leader from northern Malawi, pregnancy in his community has increasingly become a matter of survival.

“Pregnancy is never celebrated. When a woman gets pregnant, they are told they are courageous. In our setup, pregnancy is a matter of life and death,” says Munthali. “The probability of survival is very minimal, at 50/50. This is a challenge that should be addressed immediately.”

Munthali revealed his sister was due to deliver on August 24 but developed pre-eclampsia, a pregnancy complication characterised by high blood pressure. Doctors were forced to deliver the baby on August 15, but the child was born prematurely and died 24 hours later.

“It didn’t happen only to my sister, but a lot of women back in my community are dying. In my village, many women are dying,” he says.

Munthali was speaking in Nairobi during the launch of a campaign calling on governments, funders, manufacturers and regulators to ensure proven tools for preventing, detecting and treating pre-eclampsia and maternal anaemia reach women who need them.

The campaign brings together representatives from Kenya, Ghana, Malawi, Senegal and Tanzania under the SUPREME project, a Unitaid-funded initiative seeking to expand access to tools for preventing, detecting and treating pre-eclampsia and anaemia.

Pre-eclampsia is a hypertensive disorder of pregnancy and is among the leading causes of maternal and newborn deaths in Kenya, Africa and globally.

Figures cited by stakeholders estimate that about 76,000 women and 500,000 babies die annually from pre-eclampsia and eclampsia.

Pre-eclampsia increases the risk of preterm birth, low birth weight and stillbirth. Severe maternal anaemia can also increase the risk of complications, including pre-eclampsia and postpartum haemorrhage, or excessive bleeding.

Ngoni Traditional leader William Jalavikuba Munthali, during the communities and civil society launch of a campaign on prevention, detection, and treatment of pre-eclampsia and maternal anaemia. [Benard Orwongo,Standard]

Maternal anaemia affects about 37 per cent of pregnant women globally, with the greatest burden in sub-Saharan Africa and South Asia.

In Kenya, maternal mortality remains high, with 355 maternal deaths reported for every 100,000 live births.

Despite the risks, pre-eclampsia is often detected late, sometimes only after symptoms have become severe.

Stakeholders cite several barriers to early detection, including inadequate access to blood pressure machines, unreliable devices and cuffs that do not fit every woman. Transport costs and long waiting times at health facilities can also discourage women from seeking care.

The campaign, dubbed “Bring the Pressure Down. Put the Pressure On”, seeks to increase awareness while pushing governments and other stakeholders to make essential tools available to women.

“No woman should die while giving life from complications we know how to prevent and treat,” says Catherine Kakolo Mongella, chair and chief executive officer of the Thrive Beyond Pre-eclampsia Foundation, a SUPREME partner organisation in Tanzania.

“Medicines and diagnostics exist. But tools alone are not enough. They must reach women at the right time and the right place,” she adds.

Pre-eclampsia is a hypertensive disorder of pregnancy and is among the leading causes of maternal and newborn deaths in Kenya, Africa and globally. [iStockphoto]

Mongella, a mother of two, lost her third pregnancy to pre-eclampsia at 32 weeks. “I discovered I had pre-eclampsia during my first pregnancy at 23 weeks. I gave birth, and my boy is 13 years old. It was a lot of experience,” she says. “Nothing prepares you for a preterm child. The third pregnancy, I carried it until 32 weeks and lost my daughter. I still grieve my daughter.”

Although Mongella experienced swelling during her third pregnancy, the symptom was considered normal.

“The signs were overlooked, leading to the loss of a child at 32 weeks. No woman carries a pregnancy with the anticipation of not giving birth to a child,” she says.

She says women need better information about pre-eclampsia and its warning signs to enable them to seek care early.

The experiences are similar across countries participating in the campaign, says Rosemary Mburu, executive director of WACI Health.

For Ruth Wangari, it took two stillbirths to understand the risks associated with pre-eclampsia.

“I am here to show what we are pushing is doable. After two pregnancy losses, I was able to carry a pregnancy still with pre-eclampsia, and carried the pregnancy to term,” she says.

In Ghana, Dr Ehla Ofusua was diagnosed with pre-eclampsia in the eighth month of pregnancy and underwent an emergency Caesarean section after developing swollen feet.

“I kept a watch on my blood pressure levels, and after my delivery, during one of the ward rounds, a doctor asked a nurse what BP meant but the nurse gave wrong details,” Dr Ofusua says.

She adds, “Had I not intervened, perhaps the worst could have happened. Imagine what other women go through. I had an opportunity to point it out because I am a doctor.”

Dr Ofusua comes from a family with a history of pre-eclampsia. Her mother survived the condition, while her sister has experienced it four times.

Clinical Pharmacist and member of the Ghana Community Advisory Board, Dr Ofosua Ehia, during the community and civil society launch of a campaign on the prevention, detection, and treatment of pre-eclampsia and maternal anaemia. [Benard Orwongo, Standard]

In Kenya, Joyce Ng’ang’a of WACI Health says early and regular antenatal care visits remain critical in identifying and managing pre-eclampsia.

However, financial constraints continue to keep some women away from health facilities.

“Women are required to undertake ultrasounds during their first ANC visits, but they cannot afford to raise Sh1,000 for the tests. They therefore decide to skip visits until they are due for delivery,” says Ng’ang’a.

She says the first ultrasound is not covered under the Social Health Authority’s Linda Jamii package. “A majority of women prefer buying food instead of accessing ultrasound, and therefore delay care,” she adds.

Ng’ang’a says pregnancy-related symptoms such as swelling and dizziness are also often dismissed as normal.

“The swelling and dizziness are assumed because you are pregnant and are not viewed as danger signs. One of the things the project entails is to ensure women know danger signs and how to spot them for interventions,” she says.

SUPREME is also working with the Ministry of Health to strengthen health systems and ensure facilities have essential equipment, medicines and diagnostics, including blood pressure machines.

Community advisory boards have also been established in participating countries, with each comprising 10 members drawn from community representatives, including religious leaders, women with lived experience, people with disabilities, community health workers and civil society representatives.

In Kenya, the project started in Kilifi, selected because of its high burden of maternal deaths.

For Munthali, sharing his family's experience is part of a wider effort to ensure other women do not suffer the same fate.

“This is a fresh story I am sharing. I am deeply saddened because of the problems our women are struggling with. I am happy to be a champion, and what happens when we speak about pre-eclampsia and maternal deaths,” he says.

Dr Catherine Kanari, programme director of SUPREME Lifeline at Amref, says preventable deaths should no longer be accepted.