AUTHOR=Adu-Bonsaffoh Kwame , Tamma Evelyn , Nwameme Adanna Uloaku , Browne Joyce L. 

TITLE=Health professionals' perspectives on clinical challenges in managing hypertensive disorders of pregnancy and recommendations for improving care: A multi-center qualitative study

JOURNAL=Frontiers in Global Women's Health

VOLUME=Volume 3 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/global-womens-health/articles/10.3389/fgwh.2022.968914

DOI=10.3389/fgwh.2022.968914

ISSN=2673-5059

ABSTRACT=Background: Hypertensive disorders of pregnancy is a leading cause of maternal mortality and morbidity globally despite the intensive national effort to improving maternal care. Substandard clinical care has emerged as a major contributing factor to high maternal deaths due to maternal hypertension globally and the impact is more severe in low- and middle-income countries (LMICs). Context specific challenges impact negatively on the quality of maternity care and health providers play a crucial role in achieving positive pregnancy experiences for women. This study explored the perspectives of healthcare professionals on the clinical challenges associated with the management of HDP in Ghana and recommendations to improving care.
Methods: A multi-center qualitative study using in-depth interviews (IDIs) was conducted in five major hospitals in the Greater Accra Region of Ghana between June 2018 and March 2019. Health professionals (40 midwives/nurses and 22 medical doctors) who have worked in the study sites for at least one year were included. NVivo was used in the coding and carrying out the thematic content analysis of the data. 
Results: Health providers highlighted major challenges in the clinical management of hypertension in pregnancy: 1) patient-related factors (inadequate understanding and misconceptions about hypertension in pregnancy, women’s non-compliance with clinical advice, financial constraints); 2) health system-related challenges (frequent unavailability of logistics, medications and laboratory support, delays in provision of care and limitations in the health insurance coverage); 3) health provider associated factors (inadequate number of health professionals and poor attitudes). Context-specific recommendations suggested for improving the quality of care in managing maternal hypertension include restructuring of the health system to reduce delays in providing care, improving financial coverage of medical insurance, encouraging social/family support, enhancing education on hypertension in pregnancy and strengthening the health workers’ numbers and working conditions.
Conclusion: Major challenges in the clinical management of HDP were related to the health system, health professionals and hypertensive mothers. Context-specific interventions are required to improve the quality of care for hypertensive mothers including regular health education, re-structuring of the health systems, refresher courses for health providers, improvement in health insurance coverage and government subsidy for hypertensive women.