Addressing risk factors for hypertensive disorders in pregnancy: A case study of a quality improvement program in two states in Nigeria
6 affiliations
- 1Jhpiego, an affiliate of Johns Hopkins University, Abuja, Nigeria
- 2mDoc Healthcare, Lagos, Nigeria
- 3Health & Human Services Secretariat, Abuja, Federal Capital Territory, Nigeria
- 4Ministry of Health, Lagos State Government, Lagos, Nigeria
- 5Department of Obstetrics & Gynaecology, Federal Medical Centre, Jigawa, Nigeria
- 6Jhpiego, an affiliate of Johns Hopkins University, Baltimore, Maryland, United States of America
Abstract
Hypertensive disorders of pregnancy (HDP) including chronic hypertension, gestational hypertension preeclampsia and eclampsia are a leading cause of maternal and perinatal mortality in Nigeria and globally and increase the risk for future cardiovascular disease among women of reproductive age (WRA). The quality improvement program was implemented from 2019 through 2022 in the Federal Capital Territory (FCT) and Lagos State of Nigeria to improve early detection and management of HDP and risk factors (anemia, diabetes) at key maternal and reproductive healthcare touch points. A facility-based assessment evaluated provider knowledge and practices related to antenatal care diagnosis and management of HDP and risk factors in pregnant women in 20 facilities. From 2019 to 2022 the program implemented a package of interventions in 40 public and private health facilities to improve prevention, early detection, and management of HDP and risk factors among WRA during antenatal care (ANC), postnatal care (PNC), and family planning (FP) visits. ANC assessment results demonstrated important gaps in ANC providers’ knowledge, self-reported confidence and observed adherence with HDP and risk factor management best practices. Among 93,384 ANC visits across program facilities the median proportion of women who had a blood pressure, anemia and diabetes check increased from 44% to 89%, 48% to 91% and 32% to 87%, respectively, from baseline (October 2019-March 2020) to the program final 6 months (July-December 2022). From January 2021 to December 2022, the median proportion of 57,658 PNC visits with a documented BP check increased from 81% to 90% and the median proportion of 105,237 FP visits with a BP check increased from 73% to 98% from an initial baseline period (January- June 2021) to the last 6 months of program implementation (July-December 2022). In a program setting with a high burden of maternal mortality and morbidity due to hypertensive disorders and a high prevalence of cardiovascular disease, improving identification and management of HDP and risk factors at key health care touch points for women of reproductive age has the potential to reduce HDP morbidity and mortality and future premature cardiovascular mortality among women of reproductive age.
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BibTeX
@article{okoli2026addressing,
title = {{Addressing risk factors for hypertensive disorders in pregnancy: A case study of a quality improvement program in two states in Nigeria}},
author = {Ugo Okoli and Sylverius Obafemi and Comfort Okpe and Kendra Njoku and Nneka Mobisson and Chinyere Uzoama and Victoria Omoera and Emmanuel Ugwa and Kathleen Hill},
journal = {PLOS One},
year = {2026},
month = sep,
doi = {10.1371/journal.pone.0356879},
url = {https://doi.org/10.1371/journal.pone.0356879},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Addressing risk factors for hypertensive disorders in pregnancy: A case study of a quality improvement program in two states in Nigeria
AU - Ugo Okoli
AU - Sylverius Obafemi
AU - Comfort Okpe
AU - Kendra Njoku
AU - Nneka Mobisson
AU - Chinyere Uzoama
AU - Victoria Omoera
AU - Emmanuel Ugwa
AU - Kathleen Hill
PY - 2026
DA - 2026/09/03
JO - PLOS One
DO - 10.1371/journal.pone.0356879
UR - https://doi.org/10.1371/journal.pone.0356879
AB - Hypertensive disorders of pregnancy (HDP) including chronic hypertension, gestational hypertension preeclampsia and eclampsia are a leading cause of maternal and perinatal mortality in Nigeria and globally and increase the risk for future cardiovascular disease among women of reproductive age (WRA). The quality improvement program was implemented from 2019 through 2022 in the Federal Capital Territory (FCT) and Lagos State of Nigeria to improve early detection and management of HDP and risk factors (anemia, diabetes) at key maternal and reproductive healthcare touch points. A facility-based assessment evaluated provider knowledge and practices related to antenatal care diagnosis and management of HDP and risk factors in pregnant women in 20 facilities. From 2019 to 2022 the program implemented a package of interventions in 40 public and private health facilities to improve prevention, early detection, and management of HDP and risk factors among WRA during antenatal care (ANC), postnatal care (PNC), and family planning (FP) visits. ANC assessment results demonstrated important gaps in ANC providers’ knowledge, self-reported confidence and observed adherence with HDP and risk factor management best practices. Among 93,384 ANC visits across program facilities the median proportion of women who had a blood pressure, anemia and diabetes check increased from 44% to 89%, 48% to 91% and 32% to 87%, respectively, from baseline (October 2019-March 2020) to the program final 6 months (July-December 2022). From January 2021 to December 2022, the median proportion of 57,658 PNC visits with a documented BP check increased from 81% to 90% and the median proportion of 105,237 FP visits with a BP check increased from 73% to 98% from an initial baseline period (January- June 2021) to the last 6 months of program implementation (July-December 2022). In a program setting with a high burden of maternal mortality and morbidity due to hypertensive disorders and a high prevalence of cardiovascular disease, improving identification and management of HDP and risk factors at key health care touch points for women of reproductive age has the potential to reduce HDP morbidity and mortality and future premature cardiovascular mortality among women of reproductive age.
SN - 1932-6203
ER -