Background: Pre-eclampsia is a multi-organ system disorder that occurs after the 20th
week of gestation in pregnancy and is characterized by hypertension and proteinuria with
or with out oedema. It is a major cause of morbidity and mortality for the woman and her
child. Based on surveillance data, pre-eclampsia is one of the leading causes of maternal
mortality in Namibia. However, there is no in depth study done in Namibia that looks at
the extent of confirmed pre-eclampsia and its contribution to maternal and perinatal
morbidity and mortality. There is also no standard management protocol currently
recommended in Namibia.
The aim of the study is to evaluate the outcomes and quality of care given to preeclamptic
patients treated in Windhoek Central and Katutura referral hospitals in
Namibia with in the period of January 2003 to December 31, 2004.
Research design/ Research Methodology: The study is a retrospective, hospital based
study. One hundred and ninety five records of women were retained for final study
sample. A data abstraction tool was designed and information retrieved from the patients’
files and record books were transferred to each individual abstraction tool. The data were
transferred to an Epi-info 2002 program. Frequency and means for age, hospital stay,
birth weight, and laboratory investigation were analyzed. Risk ratio, P-value, and 95%
confidence interval were analyzed to compare across groups of variables. Permission to
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conduct the study was granted by the ethical committee of Namibia and the Higher
Degrees committee of the University of the Western Cape.
Results: The incidence of pre-eclampsia in the two-referral hospitals was 3.4%. The
mean ages were 28.9 years, 27.5 and 24.1 years for the mild pre-eclamptic, severe preeclamptic
and eclamptic women, respectively, P-value 0.0181 with a trend towards
increasing severity with younger age. The mean hospital stay was 7 days for the mild preeclamptic,
7.3 days for the severe pre-eclamptic and 8.14 days for the eclamptic, P-value
0.5634. The mean gestational age for mild pre-eclamptics was 34.8 weeks, for severe preeclamptics
33.1 weeks and for the eclamptics 35.3 weeks, P-value 0.0158. Only 16.9% of
the study group received magnesium sulphate. 88.7% gave birth by means of caesarean
section. 31.8% of the pre-eclamptic women developed complications. Pre-maturity was
observed in 51.5% of the neonates. Birth weight less than 2.5 Kg, gestational age <34
weeks, caesarean section and non-reactive CTG were risk factors for admission to
neonatal ICU. Teenage pregnancy, being a state patient, lack of antenatal care, and living
outside Windhoek were risk factors for severity of the disease. 51.5% were managed
according to international or South African regional guidelines for pre-eclampsia.
Conclusion: Care given to the pre-eclamptic women was not totally in line with the
international or South African regional guidelines of pre-eclampsia management. A
guideline on the management and prevention of pre-eclampsia needs to be produced for
Namibia, and further research on risk factors and on cost effectiveness of premature
termination of pregnancy needs to be seriously looked at.