title: Community perceptions of pre-eclampsia and eclampsia in southern Mozambique.
abstract: BACKGROUND
  Sub-Saharan Africa has the highest maternal mortality ratio at 500 deaths per 100,000 live births. In Mozambique maternal mortality is estimated at 249-480 per 100,000 live births and eclampsia is the third leading cause of death. The objective of this study was to describe the community understanding of pre-eclampsia and eclampsia, as a crucial step to improve maternal and perinatal health in southern Mozambique.
  
  
  METHODS
  This qualitative study was conducted in Maputo and Gaza Provinces of southern Mozambique. Twenty focus groups were convened with pregnant women, partners and husbands, matrons and traditional birth attendants, and mothers and mothers-in-law. In addition, ten interviews were conducted with traditional healers, matrons, and a traditional birth attendant. All discussions were audio-recorded, translated from local language (Changana) to Portuguese and transcribed verbatim prior to analysis with QSR NVivo 10. A thematic analysis approach was taken.
  
  
  RESULTS
  The conditions of "pre-eclampsia" and "eclampsia" were not known in these communities; however, participants were familiar with hypertension and seizures in pregnancy. Terms linked with the biomedical concept of pre-eclampsia were high blood pressure, fainting disease and illness of the heart, whereas illness of the moon, snake illness, falling disease, childhood illness, illness of scaresand epilepsy were used to characterizeeclampsia. The causes of hypertension in pregnancy were thought to include mistreatment by in-laws, marital problems, and excessive worrying. Seizures in pregnancy were believed to be caused by a snake living inside the woman's body. Warning signs thought to be common to both conditions were headache, chest pain, weakness, dizziness, fainting, sweating, and swollen feet.
  
  
  CONCLUSIONS
  Local beliefs in southern Mozambique, regarding the causes, presentation, outcomes and treatment of pre-eclampsia and eclampsia were not aligned with the biomedical perspective. The community was often unaware of the link between hypertension and seizures in pregnancy. The numerous widespread myths and misconceptions concerning pre-eclampsia and eclampsiamay induceinappropriatetreatment-seeking and demonstrate a need for increased community education regarding pregnancy and associated complications.
  
  
  BACKGROUND
  NCT01911494.
authors.affiliation: Centro de Investigação em Saúde da Manhiça (CISM), Manhiça, Mozambique.
authors.forename: Helena
authors.initials: H
authors.lastname: Boene
authors.affiliation: Department of Obstetrics and Gynaecology, and the Child and Family Research Unit, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Marianne
authors.initials: M
authors.lastname: Vidler
authors.affiliation: Centro de Investigação em Saúde da Manhiça (CISM), Manhiça, Mozambique.
authors.forename: Charfudin
authors.initials: C
authors.lastname: Sacoor
authors.affiliation: Centro de Investigação em Saúde da Manhiça (CISM), Manhiça, Mozambique.
authors.forename: Abel
authors.initials: A
authors.lastname: Nhama
authors.affiliation: Centro de Investigação em Saúde da Manhiça (CISM), Manhiça, Mozambique.
authors.forename: Ariel
authors.initials: A
authors.lastname: Nhacolo
authors.affiliation: Ministério da Saúde, Maputo, Mozambique.|Hospital Central de Maputo, Maputo, Mozambique.
authors.forename: Cassimo
authors.initials: C
authors.lastname: Bique
authors.affiliation: Centro de Investigação em Saúde da Manhiça (CISM), Manhiça, Mozambique.|Barcelona Institute for Global Health (ISGlobal)/Hospital Clinic - Universitat de Barcelona, Barcelona, Spain.
authors.forename: Pedro
authors.initials: P
authors.lastname: Alonso
authors.affiliation: Department of Obstetrics and Gynaecology, and the Child and Family Research Unit, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Diane
authors.initials: D
authors.lastname: Sawchuck
authors.affiliation: Division of Women and Child Health, Aga Khan University, Karachi, Sindh, Pakistan.
authors.forename: Rahat
authors.initials: R
authors.lastname: Qureshi
authors.affiliation: Centro de Investigação em Saúde da Manhiça (CISM), Manhiça, Mozambique.|Ministério da Saúde, Maputo, Mozambique.
authors.forename: Eusébio
authors.initials: E
authors.lastname: Macete
authors.affiliation: Centro de Investigação em Saúde da Manhiça (CISM), Manhiça, Mozambique.|Barcelona Institute for Global Health (ISGlobal)/Hospital Clinic - Universitat de Barcelona, Barcelona, Spain.
authors.forename: Clara
authors.initials: C
authors.lastname: Menéndez
authors.affiliation: Department of Obstetrics and Gynaecology, and the Child and Family Research Unit, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Peter
authors.initials: P
authors.lastname: von Dadelszen
authors.affiliation: Centro de Investigação em Saúde da Manhiça (CISM), Manhiça, Mozambique.|Universidade Eduardo Mondlane, Faculdade de Medicina, Maputo, Mozambique.
authors.forename: Esperança
authors.initials: E
authors.lastname: Sevene
authors.affiliation: Centro de Investigação em Saúde da Manhiça (CISM), Manhiça, Mozambique. khatia.munguambe@manhica.net.|Universidade Eduardo Mondlane, Faculdade de Medicina, Maputo, Mozambique. khatia.munguambe@manhica.net.
authors.forename: Khátia
authors.initials: K
authors.lastname: Munguambe
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003153:Community Health Services / Q000706:statistics & numerical data*; D003256:Community Participation; D004461:Eclampsia; D005260:Female; D006801:Humans; D008297:Male; D008428:Maternal Mortality; D008875:Middle Aged; D008880:Midwifery; D009073:Mozambique; D010342:Patient Acceptance of Health Care; D010465:Perception; D011225:Pre-Eclampsia; D011247:Pregnancy; D011295:Prenatal Care; D012111:Residence Characteristics
keywords: Africa South of the Sahara; Attitudes; Eclampsia; Hypertension; Maternal mortality; Mozambique; Pre-eclampsia; Seizures