proteinuria and oedema or if in labour, failure to respond
to treatment and a diastolic pressure of greater
than or equal to 110mmHg during ANC or a diastolic
pressure of greater than or equal to 110 in labour. Key
informants thought that the reasons for an increase in
admissions due to PIH could be associated with an
increased awareness of the condition by nurses thus
improved diagnosis, improved health seeking behavior of
pregnant women and the increase in bookings with consequent
increase in detection of the condition as well as
the desire of primary level midwives to save lives of both
the mother and baby.
Focused ANC, educating women on the importance of
regular blood pressure checks and early booking were
mentioned as potential ways of reducing the burden of
PIH. Key informants thought nothing can be done about
the growing burden of referrals due to PIH as they
thought it’s not about referrals but about saving lives. To
quote “Midwives should not take risks. Referrals reflect
alertness. Better technology and obstetricians are found
at tertiary level.”
Various challenges were mentioned in the management
of PIH. Delay in seeking care was reported to result
in the use of more resources. Seventeen respondents
reported that shortage of resources challenged proper
management of PIH. Functional urine sticks, BP machines
and human resources for close monitoring of clients
were reported to be in short supply. Urinalysis was
conducted only for those with elevated blood pressure
due to the shortage of functional urine sticks. Seventeen
respondents mentioned transport as a challenge in the
referral of clients. Delays in ambulance response last up
to four hours and clients often do not have money for
Fig. 4 Common symptoms experienced by PIH study participants:
Harare, September 2012
Table 2 Management of women with PIH in Harare, Zimbabwe,
September 2012
Medication Mild PIH
(BP140/90mmHg)
N = 41 (n,%)
Severe PIH
(BP ≥ 160/110mmHg)
N = 15 (n,%)
No Medication/Bed rest 16 (39.0) 3 (20.0)
Methyl Dopa 19 (46.3) 9 (60.0)
Nifedipine 2 (4.9) 1 (6.7)
Methyldopa + nifedipine 4 (9.8) 1 (6.7)
Hydralazine 0 1 (6.7)
Table 3 Bivariate analysis of foetal outcomes of study
participants: Harare, Zimbabwe, 2012
Outcome With PIH Without PIH OR p-Value
N = 56
(n, %)
N = 233
(n, %)
Foetal Birth
weight
Low BW
(