Measuring regional and district variations in the incidence of pregnancy-induced hypertension in Ghana: challenges, opportunities and implications for maternal and newborn health policy and programmes.
OBJECTIVE
The objectives were to assess the quality of health management information system (HMIS) data needed for assessment of local area variation in pregnancy-induced hypertension (PIH) incidence and to describe district and regional variations in PIH incidence.


METHODS
A retrospective review of antenatal and delivery records of 2682 pregnant women in 10 district hospitals in the Greater Accra and Upper West regions of Ghana was conducted in 2013. Quality of HMIS data was assessed by completeness of reporting. The incidence of PIH was estimated for each district.


RESULTS
Key variables for routine assessment of PIH such as blood pressure (BP) at antenatal visits, weight and height were 95-100% complete. Fundal height, gestational age and BP at delivery were not consistently reported. The incidence of PIH differed significantly between Greater Accra region (6.1%) and Upper West region (3.2%). Prevalence of obesity among pregnant women in Greater Accra region (13.9%) was significantly higher than that of women in Upper West region (2.2%).


CONCLUSIONS
More attention needs to be given to understanding local area variations in PIH and possible relationships with urbanisation and lifestyle changes that promote obesity, to inform maternal and newborn health policy. This can be done with good quality routine HMIS data.
Ghana Health Service, Accra, Ghana.|Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, The Netherlands.
Edward
E
Antwi
Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, The Netherlands.|Division of Epidemiology & Biostatistics, University of the Witwatersrand, Johannesburg, South Africa.
Kerstin
K
Klipstein-Grobusch
Ghana Health Service, Accra, Ghana.
Gloria
G
Quansah Asare
Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon, Ghana.
Kwadwo A
KA
Koram
Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, The Netherlands.
Diederick
D
Grobbee
Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, The Netherlands.|School of Public Health, College of Health Sciences, University of Ghana, Legon, Ghana.
Irene A
IA
Agyepong
datos rutinarios; decision making; données de routine; hipertensión inducida por el embarazo; hypertension gravidique; local area variation; maternal and newborn health; pregnancy-induced hypertension; prise de décision; routine data; salud materno-infantil; santé maternelle et néonatale; toma de decisiones; variaciones locales; variation locale