title: Community perceptions of pre-eclampsia in rural Karnataka State, India: a qualitative study.
abstract: BACKGROUND
  Maternal deaths have been attributed in large part to delays in recognition of illness, timely transport to facility, and timely treatment once there. As community perceptions of pregnancy and their complications are critical to averting maternal morbidity and mortality, this study sought to contribute to the literature and explore community-based understandings of pre-eclampsia and eclampsia.
  
  
  METHODS
  The study was conducted in rural Karnataka State, India, in 2012-2013. Fourteen focus groups were held with the following community stakeholders: three with community leaders (n = 27), two with male decision-makers (n = 19), three with female decision-makers (n = 41), and six with reproductive age women (n = 132). Focus groups were facilitated by local researchers with clinical and research expertise. Discussions were audio-recorded, transcribed verbatim and translated to English for thematic analysis using NVivo 10.
  
  
  RESULTS
  Terminology exists in the local language (Kannada) to describe convulsions and hypertension, but there were no terms that are specific to pregnancy. Community participants perceived stress, tension and poor diet to be precipitants of hypertension in pregnancy. Seizures in pregnancy were thought to be brought on by anaemia, poor medical adherence, lack of tetanus toxoid immunization, and exposure in pregnancy to fire or water. Sweating, fatigue, dizziness-unsteadiness, swelling, and irritability were perceived to be signs of hypertension, which was recognized to have the potential to lead to eclampsia or death. Home remedies, such as providing the smell of onion, placing an iron object in the hands, or squeezing the fingers and toes, were all used regularly to treat seizures prior to accessing facility-based care although transport is not delayed.
  
  
  CONCLUSIONS
  It is evident that 'pre-eclampsia' and 'eclampsia' are not well-known; instead hypertension and seizures are perceived as conditions that may occur during or outside pregnancy. Improving community knowledge about, and modifying attitudes towards, hypertension in pregnancy and its complications (including eclampsia) has the potential to address community-based delays in disease recognition and delays in treatment that contribute to maternal and perinatal morbidity and mortality. Advocacy and educational initiatives should be designed to target knowledge gaps and potentially harmful practices, and respond to cultural understandings of disease.
  
  
  BACKGROUND
  NCT01911494.
authors.affiliation: Department of Obstetrics and Gynaecology, and the Child and Family Research Unit, University of British Columbia, Vancouver, BC, Canada. Marianne.vidler@cw.bc.ca.
authors.forename: Marianne
authors.initials: M
authors.lastname: Vidler
authors.affiliation: KLE University's Jawaharlal Nehru Medical College, Belgaum, Karnataka, India.
authors.forename: Umesh
authors.initials: U
authors.lastname: Charantimath
authors.affiliation: Department of Obstetrics and Gynaecology, S Nijalingappa Medical College, Bagalkot, Karnataka, India.
authors.forename: Geetanjali
authors.initials: G
authors.lastname: Katageri
authors.affiliation: Department of Community Medicine, S Nijalingappa Medical College, Bagalkot, Karnataka, India.
authors.forename: Umesh
authors.initials: U
authors.lastname: Ramadurg
authors.affiliation: KLE University's Jawaharlal Nehru Medical College, Belgaum, Karnataka, India.
authors.forename: Chandrashekhar
authors.initials: C
authors.lastname: Karadiguddi
authors.affiliation: Department of Obstetrics and Gynaecology, and the Child and Family Research Unit, University of British Columbia, Vancouver, BC, 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: Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Shafik
authors.initials: S
authors.lastname: Dharamsi
authors.affiliation: Department of Obstetrics and Gynaecology, and the Child and Family Research Unit, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Peter
authors.initials: P
authors.lastname: von Dadelszen
authors.affiliation: Department of Obstetrics, Christiana Care, Wilmington, Delaware, United States.
authors.forename: Richard
authors.initials: R
authors.lastname: Derman
authors.affiliation: KLE University's Jawaharlal Nehru Medical College, Belgaum, Karnataka, India.
authors.forename: Shivaprasad
authors.initials: S
authors.lastname: Goudar
authors.affiliation: Department of Obstetrics and Gynaecology, S Nijalingappa Medical College, Bagalkot, Karnataka, India.
authors.forename: Ashalata
authors.initials: A
authors.lastname: Mallapur
authors.affiliation: KLE University's Jawaharlal Nehru Medical College, Belgaum, Karnataka, India.
authors.forename: Mrutyunjaya
authors.initials: M
authors.lastname: Bellad
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003153:Community Health Services / Q000706:statistics & numerical data*; D003256:Community Participation; D004461:Eclampsia; D005260:Female; D006801:Humans; D007194:India; D008297:Male; D008428:Maternal Mortality; D008875:Middle Aged; D008880:Midwifery; D010342:Patient Acceptance of Health Care; D010465:Perception; D011225:Pre-Eclampsia; D011247:Pregnancy; D011295:Prenatal Care; D012111:Residence Characteristics; D012424:Rural Population; D055815:Young Adult
keywords: Attitude; Culture; Eclampsia; Hypertension; India; Perception; Pre-eclampsia; Pregnancy; Rural population; Seizures; Traditional, medicine