title: Community's perceptions of pre-eclampsia and eclampsia in Sindh Pakistan: a qualitative study.
abstract: BACKGROUND
  Maternal mortality is of global public health concern and >99 % of maternal deaths occur in less developed countries. The common causes of direct maternal death are hemorrhage, sepsis and pre-eclampsia/eclampsia. In Pakistan, pre-eclampsia/eclampsia deaths represents one-third of maternal deaths reported at the tertiary care hospital settings. This study explored community perceptions, and traditional management practices about pre-eclampsia/eclampsia.
  
  
  METHODS
  A qualitative study was conducted in Sindh Province of Pakistan from February to July 2012. Twenty-six focus groups were conducted, 19 with women of reproductive age/mothers-in-law (N = 173); and 7 with husbands/fathers-in-law (N = 65). The data were transcribed verbatim in Sindhi and Urdu, then analyzed for emerging themes and sub-themes using NVivo version 10 software.
  
  
  RESULTS
  Pre-eclampsia in pregnancy was not recognized as a disease and there was no name in the local languages to describe this. Women however, knew about high blood pressure and were aware they can develop it during pregnancy. It was widely believed that stress and weakness caused high blood pressure in pregnancy and it caused symptoms of headache. The perception of high blood pressure was not based on measurement but on symptoms. Self-medication was often used for headaches associated with high blood pressure. They were also awareness that severely high blood pressure could result in death.
  
  
  CONCLUSIONS
  Community-based participatory health education strategies are recommended to dispel myths and misperceptions regarding pre-eclampsia and eclampsia. The educational initiatives should include information on the presentation, progression of illness, danger signs associated with pregnancy, and appropriate treatment.
authors.affiliation: Division of Women and Child Health, Aga Khan University, Karachi, Pakistan.|Department of Obstetrics and Gynecology, Child and Family Research Institute, University of British Columbia, Vancouver, Canada.
authors.forename: Asif Raza
authors.initials: AR
authors.lastname: Khowaja
authors.affiliation: Division of Women and Child Health, Aga Khan University, Karachi, Pakistan. rahat.qureshi@aku.edu.
authors.forename: Rahat Najam
authors.initials: RN
authors.lastname: Qureshi
authors.affiliation: Division of Women and Child Health, Aga Khan University, Karachi, Pakistan.
authors.forename: Sana
authors.initials: S
authors.lastname: Sheikh
authors.affiliation: Division of Women and Child Health, Aga Khan University, Karachi, Pakistan.
authors.forename: Shujaat
authors.initials: S
authors.lastname: Zaidi
authors.affiliation: Division of Women and Child Health, Aga Khan University, Karachi, Pakistan.
authors.forename: Rehana
authors.initials: R
authors.lastname: Salam
authors.affiliation: Department of Obstetrics and Gynecology, Child and Family Research Institute, University of British Columbia, Vancouver, Canada.
authors.forename: Diane
authors.initials: D
authors.lastname: Sawchuck
authors.affiliation: Department of Obstetrics and Gynecology, Child and Family Research Institute, University of British Columbia, Vancouver, Canada.
authors.forename: Marianne
authors.initials: M
authors.lastname: Vidler
authors.affiliation: Department of Obstetrics and Gynecology, Child and Family Research Institute, University of British Columbia, Vancouver, Canada.
authors.forename: Peter
authors.initials: P
authors.lastname: von Dadelszen
authors.affiliation: Division of Women and Child Health, Aga Khan University, Karachi, Pakistan.
authors.forename: Zulfiqar
authors.initials: Z
authors.lastname: Bhutta
mesh_terms: D000328:Adult; D003153:Community Health Services / Q000706:statistics & numerical data*; D003256:Community Participation; D004461:Eclampsia; D005260:Female; D006801:Humans; D008297:Male; D008428:Maternal Mortality; D008880:Midwifery; D010154:Pakistan; D010342:Patient Acceptance of Health Care; D010465:Perception; D011225:Pre-Eclampsia; D011247:Pregnancy; D011295:Prenatal Care; D036301:Qualitative Research; D012111:Residence Characteristics; D012424:Rural Population