PERCEIVED EFFECT OF MATERNAL HYPERTENSIVE  DISORDERS ON STILLBIRTH RATE AMONG WOMEN ATTENDING ANTE NATAL CARE IN SIR PATRICK IBRAHIM YAKOWA MEMORIAL HOSPITAL KAFANCHAN

TOPIC IS SUITABLE FOR:
1-Department of Nursing Science
2-Department of Midwifery
3-Department of Public Health
4-Department of Obstetrics and Gynaecology

TOPIC: PERCEIVED EFFECT OF MATERNAL HYPERTENSIVE  DISORDERS ON STILLBIRTH RATE AMONG WOMEN ATTENDING ANTE NATAL CARE IN SIR PATRICK IBRAHIM YAKOWA MEMORIAL HOSPITAL KAFANCHAN

TABLE OF CONTENT
Abstract
CHAPTER ONE: INTRODUCTION
1.1 Background to the Study
1.2 Statement of the Problem
1.3 Objectives of the Study
1.4 Significance of the Study
1.5 Research Questions
1.6 Scope/Delimitation of the Study
1.7 Definition of Terms
CHAPTER TWO: REVIEW OF RELATED LITERATURE
2.0 Introduction
2.1 Conceptual Review
2.2 Theoretical Review
2.3 The Relationship of the theory to the Study
2.4 Empirical Review
CHAPTER THREE: RESEARCH METHODOLOGY
3.0 Introduction
3.1 Research Design
3.2 Area of the Study
3.3 Target Population
3.4 Sample and Sampling Techniques
3.5 Instrument for Data Collection
3.6 Validity and Reliability of Instrument
3.7 Method of Data Collection
3.8 Method of Data Analysis
CHAPTER FOUR: DATA PRESENTATION, ANALYSIS AND DISCUSSION OF FINDINGS
4.1 Distribution of Questionnaire
4.2 Demographic Information of Respondents
4.3 Analysis of Research Questions
CHAPTER FIVE: SUMMARY, CONCLUSION AND RECOMMENDATIONS
5.0 Discussion of Findings
5.1 Conclusion
5.2 Summary of the Study
5.3 Implications for Nursing
5.4 Limitations of the Study
5.5 Recommendations
References
Appendix

ABSTRACT
This study reviewed the Perceived Effect of Maternal Hypertensive Disorders on Stillbirth Rate Among Women Attending Antenatal Care at Sir Patrick Ibrahim Yakowa Memorial Hospital, Kafanchan. The specific objectives were to find out the prevalence of maternal hypertensive disorders among women attending antenatal care, to determine the socio-demographic that influence perception of hypertensive disorders on stillbirth outcomes and to assess the level of perception of maternal hypertensive disorders among pregnant women in study area. A descriptive survey research design was adopted in the study. The target population was 232 women attending antenatal care at Sir Patrick Ibrahim Yakowa Memorial Hospital, Kafanchan. Using Taro Yamane formula, the sample size of 147 respondents were selected, but simple random sampling was applied to ensure that all participants were represented equally. Data collection was carried out through structured questionnaire prepared based on five-point Likert scale (Strongly Agree, Agree, Undecided, Disagree and Strongly Disagree). The instrument was validated by experts in maternal and child health and the instrument reliability was determined by the Cronbach Alpha method and its coefficient was 0.82. A total of 141 valid responses were analysed in frequency distribution tables. The results showed that 69% of the population agreed that hypertensive disorders are common in pregnant women in the hospital, 63% recognised socio-demological factors such as age, education and parity as important factors for perception, and 71% showed a high level of awareness of the condition and its complications on the outcomes of stillbirth. The study recommended that health authorities should increase antenatal education on hypertensive disorders, nurses should provide routine blood pressure screening and counselling and government should enhance the maternal healthcare system through better resources and accessibility. The study concluded that better awareness, early detection and regular antenatal monitoring are the key factors in reducing hypertensive-related stillbirths in Nigeria.

CHAPTER ONE
INTRODUCTION (Preview)
1.1 Background of the Study
Globally, maternal hypertensive disorders in pregnancy (HDPs) are one of the greatest contributors to maternal and perinatal morbidity and mortality, particularly in developing countries. The World Health Organisation identifies hypertensive disorders as one of the major causes of adverse pregnancy outcomes including stillbirths, preterm delivery, and maternal deaths (Gemechu et al., 2020). The prevalence of HDPs is calculated globally to reach around 5-10% of all pregnancies, thus it is a critical issue for maternal health systems (Lyu et al., 2021). According to Lugobe et al. (2020), HDPs, specifically preeclampsia and eclampsia, account for almost 1/3 of perinatal deaths worldwide. In a study conducted in Ethiopia, Wassie and Anmut (2020) highlighted that eclampsia leads to a much higher incidence of foetal mortality because of such complications as intrauterine growth restriction and placental abruption. Similarly, in Vietnam, Anh et al. (2024) reported that women with HDPs represent a high risk of stillbirth and perinatal loss compared to normal pressure pregnancies.
Across sub-Saharan Africa, the burden of HDPs and its reflected adverse foetal outcome is still disproportionately high due to limited access to quality antenatal and emergency obstetric care. Gemechu et al. (2020) have uncovered through meta-analysis that the prevalence of HDPs in sub-Saharan Africa is found to be significantly higher compared to other regions with grave implications on foetal survival. This finding is corroborated by Kasa et al. (2023), and they found that stillbirths in sub-Saharan Africa are frequently attributed to preventable maternal complications, such as hypertension, eclampsia, and preeclampsia. To corroborate this, Lugobe et al. (2020) reported the hypertensive pregnancies in Uganda causing a significant increase in adverse perinatal outcomes even rates of stillbirth exceeding globally. Similarly, Drechsel et al. (2022) hypothesized that HDPs are a major contributor to maternal near-miss and death among women with less access to timely medical interventions in Ghana. These trends demonstrate the close association of hypertensive disorders and stillbirth outcomes in the region.
In Nigeria, the picture is not different from that of the rest of sub-Saharan Africa with a number of studies proving increased incidence of hypertensive disorders among pregnant women and their direct correlation with Stillbirths. Abdurrahman et al (2024), HDPs contributed significantly as a percentage of maternal problems and adverse neonatal outcomes across tertiary hospitals in Nigeria. Likewise, Oriji et al. (2021) reported that hypertensive disorders formed a huge proportion of the obstetric complications resulting in the demise of the foetus in many cases. Onoh et al. (2020) further identified hypertension as an important predictor of poor obstetric outcomes with an often ending point of stillbirth and low-birth-weight. Supporting this, Mahmoud et al (2023) emphasised that the poor management of hypertensive disorders during pregnancy in the Nigerian primary health care facilities makes perinatal mortality worse and demonstrates an ongoing challenge in the maternal health delivery system.
Stillbirth is one of the most heart-breaking types of adverse pregnancy outcomes and an important indicator of maternal health care quality. Studies have proven that hypertensive disorders contribute significantly to the rate of stillbirths in Nigeria especially among women who do not receive adequate antenatal supervision. Milton et al. (2022a) noted that in Northern Nigeria, HDPs were highly linked with intrauterine foetal death, usually because of delayed presentation for care in the hospital and poor health-seeking behaviour. Consistent with this, Awoyesuku et al. (2024) reported that hypertensive pregnancies were a major cause of singleton stillbirths in Port Harcourt and this lends support on the impact of HDPs on perinatal survival. Similarly, Okunowo and Smith-Okonu (2020) emphasised that the stillbirth trends in Lagos demonstrated rising trends among women with unmanaged hypertensive disorders, and this indicated the systemic weaknesses in the maternal healthcare services.
The prevalence of stillbirths in Nigeria is compounded by socio-demographic factors such as the age of the mother, parity, and educational levels as well as socio-economic factors. Aliyu et al. (2024) noted that these variables are not only responsible for the prevalence of hypertensive disorders but also in the formation of women's perception on the risks of pregnancy complications. To corroborate this, Nonterah et al. (2020) stated in Ghana that women with higher levels of education and income were more likely to know the dangers of hypertension in pregnancy, leading to better pregnancy outcomes. Similarly, Ogunbode et al. (2022) Rousseau argued that demographic characteristics affect the perception as well as the outcomes of stillbirths since women in lower socio-economic classes are less likely to gain adequate antenatal care. Thus, it is important to understand these socio-demographic determinants of stillbirth outcomes in order to interpret the perceptions of pregnant women on the relationship between HDPs and stillbirth outcomes.
Women's perceptions of hypertensive disorders in pregnancy have a critical role in their preventative behaviour, healthcare seeking and reporting of complications in time. According to Abdurrahman et al. (2024), women in Nigeria are limited in their health literacy and as a result underestimate the severity of hypertensive disorders due to cultural misconceptions related to complications in pregnancy. Similarly, Addo et al. (2025) stressed that the perception of HDPs is often influenced by psycho-social and environmental factors which can influence the mother and neonatal outcome. Mforteh et al (2024) supported the underestimation of HDP-related risks by expectant mothers in Cameroon was associated with an increase in stillbirth and neonatal deaths. Therefore, understanding the perception of women towards hypertensive disorders is necessary to develop interventions that are specific to the context to attend awareness and preventive practises.
The continuous production of increasing number of literature is consistently highlighting about hypertensive disorders in pregnancy being a major risk factor for stillbirths in different settings where as perception and awareness among pregnant women is inadequate. Akaba et al. (2021) explained that the application of WHO's maternal mortality classification system has made it clear that hypertension is one of the most preventable causes of perinatal death in hospitals in Nigeria. In support, Dase et al. (2020) reported that the use of the international classification of diseases and problems of health (ICD-10-PM) of the WHO in northeast Nigeria revealed hypertensive disorders as one of the most important causes of stillbirths, indicating that there are opportunities for prevention. Furthermore, Akogu et al. (2024) stated that regional variations in healthcare access, education of the mother, and the level of antenatal attendance contribute to the variation in stillbirth rates, further supporting the importance of perception-based studies. As highlighted by Idama et al (2024), knowledge of the perceptions of hypertensive risks in women offers insight into the wider problem of maternal and child health disparity in Nigeria, and can inform evidence-based interventions to mitigate the preventable stillbirth.
In essence, the literature from all over the world establishes a consistent link between maternal hypertensive disorders and stillbirths, in which perception and socio-demographic factors are important mediators. Studies from Ethiopia, Nigeria, Ghana, and other parts of Africa highlight the need for understanding of the perception and response of pregnant women to hypertension-related complications in order to prevent foetal deaths. Hence, exploring the perceived impact of maternal hypertensive disorders on the incidence of stillbirths among women attending antenatal care at Sir Patrick Ibrahim Yakowa Memorial Hospital Kafanchan offers the context of this interplay in a local Nigerian setting, contributing to current academic arguments on maternal health, perception and perinatal outcomes

1.2 Statement of the Problem
Maternal hypertensive disorders remain a major cause of maternal and neonatal mortality, especially in low- and middle-income countries, where the access of good quality antenatal care is problematic. Hypertensive disorders of pregnancy are associated with about 14% of maternal deaths and are closely associated with stillbirth and poor perinatal outcome around the world (Gemechu et al., 2020; Lyu et al., 2021). Studies in sub-Saharan Africa have shown that hypertensive disorders like preeclampsia and eclampsia are very high compared to the developed countries and these are leading to stillbirths which could have easily been prevented by the early detection and proper management of the disorder (Kasa et al. 2023; Lugobe et al. 2020). In the recent researches in Nigeria, there is a rising trend of pregnancy-induced hypertension with a high volume of HDPs reported by Abdurrahman et al., (2024) and Oriji et al., (2021) as one of the major causes of stillbirths in tertiary hospitals. The current situation shows an alarming gap between the knowledge on the preventability of HDPs and the high rates of stillbirths that still occur in clinical practise. Ideally, regular monitoring of blood pressure during pregnancy, adequate patient education, early management of pregnancy induced hypertension should result in a great reduction of perinatal mortality, but this is still far from reality in many health facilities including semi-urban like Kafanchan.
The literature in Nigeria on hypertensive disorders in pregnancy is dominated by studies on medical outcome and epidemiological trends with little emphasis on pregnant women's perception on the association between hypertensive disorders and the risk of stillbirth (Milton et al., 2022a; Awoyesuku et al., 2024). Onoh et al. (2020) and Akogu et al. (2024) conducted a study on awareness and perception and has indicated that awareness and perception are very important for early detection and treatment compliance, and these factors are understudied in the northern Nigerian environment. The absence of empirical data on the perception of women towards the community constitutes an important gap in knowledge to avoid effective prevention strategies. Knowledge of the effects of socio-demographic factors like age, education and income on perception is important for specific antenatal education programme development and improvement of pregnancy outcomes (Aliyu et al., 2024; Addo et al., 2025). Hence, this study is an attempt to fill up this gap by investigating the perceived impact of maternal hypertensive disorders on stillbirth rate among women receiving antenatal care at Sir Patrick Ibrahim Yakowa Memorial Hospital Kafanchan with the aim of providing addition to the evidence-based interventions which can positively affect maternal and foetal health outcome.
1.3 Objectives of the Study
The broad objective of this study is to examine the perceived effect of maternal hypertensive disorders on stillbirth rates among women attending antenatal care at Sir Patrick Ibrahim Yakowa Memorial Hospital, Kafanchan. The specific objectives are to:
1.Determine the prevalence of maternal hypertensive disorders among women attending antenatal care at Sir Patrick Ibrahim Yakowa Memorial Hospital, Kafanchan.
2.Identify the socio-demographic factors influencing women’s perception of the impact of hypertensive disorders on stillbirth outcomes at the study site.
3.Assess the level of perception of maternal hypertensive disorders among pregnant women attending antenatal care at Sir Patrick Ibrahim Yakowa Memorial Hospital, Kafanchan.
OTHER PARTS OF CHAPTER ONE INCLUDE:
1.4  Significance of the Study
1.5 Research Questions
1.6 Scope / Delimitation of the Study
1.7 Definition of Terms

CHAPTER TWO
LITERATURE REVIEW (Preview)
This chapter critically examines relevant literature that would assist in explaining the research problem and, furthermore, recognizes the efforts of scholars who had previously contributed immensely to similar research. The chapter intends to deepen the understanding of the study and close the perceived gaps. This chapter, therefore, focuses on the concept of maternal hypertensive disorders, the concept of stillbirth, prevalence and causes of maternal hypertensive disorders, maternal hypertensive disorders and stillbirth rate, risk factors associated with stillbirth, etc. The chapter covers the following subheadings:

2.1 Conceptual Framework
2.2 Theoretical Framework
2.3 Empirical Review
2.4 Summary of Literature Review

CHAPTER THREE
RESEARCH METHODOLOGY (Preview)
Research Design: The study adopted a descriptive cross-sectional survey research design.
Population of the Study: The population of the study comprises pregnant women receiving antenatal care at Sir Patrick Ibrahim Yakowa Memorial Hospital, Kafanchan.
Sample Size Determination: The study adopted the Taro Yamane formula to determine a sample size of 147 participants.
Sampling Technique: The study employed a sampling technique to select the individual respondents.
Research Instrument: The study utilized a structured questionnaire as the instrument for data collection.
Methods of Data Analysis: The collected data were analyzed using frequencies and percentages to summarize and present the demographic characteristics of the respondents and their responses. The findings were presented using tables and charts to show patterns and associations between variables.

CHAPTER FOUR: DATA PRESENTATION AND ANALYSIS
MAJOR FINDINGS (Preview)
i. The study found that maternal hypertensive disorders are prevalent among women attending antenatal care at Sir Patrick Ibrahim Yakowa Memorial Hospital, Kafanchan, as evidenced by a grand mean of 3.69, which is above the acceptance benchmark of 3.00.

ii. The study found that socio-demographic factors significantly influence women’s perception of the impact of hypertensive disorders on stillbirth outcomes at Sir Patrick Ibrahim Yakowa Memorial Hospital, Kafanchan, as evidenced by a grand mean of 3.79, which is above the acceptance benchmark of 3.00.

iii. The study found that pregnant women attending antenatal care at Sir Patrick Ibrahim Yakowa Memorial Hospital, Kafanchan, have a high level of perception of maternal hypertensive disorders, as evidenced by a grand mean of 4.01, which is above the acceptance benchmark of 3.00.

CHAPTER FIVE:SUMMARY, CONCLUSIONS AND RECOMMENDATIONS
This chapter covers the following outline:
5.0 Discussion of Findings
5.1 Conclusion
5.2 Summary of the Study
5.3 Implication for Nursing
5.4 Limitations of the Study
5.5 Recommendations
References
Appendix

UPLOADED BY MIRACLE.