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Effect of Preeclampsia Screening Services on Early Preeclampsia Detection among Pregnant Women in Nigeria

Abstract

Preeclampsia is a serious hypertensive disorder of pregnancy and remains an important maternal and fetal health concern because delayed recognition and management may result in severe complications, including eclampsia, stroke, organ dysfunction, placental complications, preterm birth, fetal growth restriction, and maternal or perinatal death. Early detection through appropriate antenatal screening and monitoring can provide opportunities for timely clinical assessment, treatment, referral, and closer maternal and fetal surveillance. However, pregnant women in Nigeria may experience limited access to consistent preeclampsia screening because of inadequate antenatal attendance, financial constraints, geographical barriers, shortage of trained healthcare personnel, limited screening equipment, and inconsistent monitoring of blood pressure and other relevant clinical indicators. Against this background, this study investigates the effect of preeclampsia screening services on early preeclampsia detection among pregnant women in Nigeria. The study will be anchored on the Health Belief Model, Andersen's Behavioral Model of Health Services Use, and the Social Ecological Model. The Health Belief Model explains how pregnant women's perceptions of susceptibility to preeclampsia, perceived severity of complications, perceived benefits of screening, perceived barriers, and cues to action may influence participation in screening services. Andersen's Behavioral Model explains how predisposing characteristics, enabling resources, and perceived healthcare needs influence utilization of antenatal and preeclampsia screening services. The Social Ecological Model emphasizes the interaction between individual, family, community, healthcare-system, and broader environmental factors that influence access to maternal screening and timely detection. Collectively, these theoretical perspectives provide a suitable framework for explaining how preeclampsia screening services may influence early detection among pregnant women in Nigeria. The study will adopt a quantitative quasi-experimental, retrospective cohort, or analytical cross-sectional research design, depending on the availability of antenatal and screening records. The study population will comprise pregnant women attending selected antenatal clinics, primary healthcare centres, hospitals, maternity facilities, and maternal health programmes across Nigeria. A multistage sampling technique will be used to select states, local government areas, communities, healthcare facilities, and eligible pregnant women. Preeclampsia screening services will be assessed using indicators such as availability of routine blood pressure measurement, appropriate blood pressure equipment, trained healthcare personnel, urine protein assessment where clinically indicated, assessment of maternal risk factors and symptoms, appropriate antenatal monitoring, screening frequency, documentation of findings, referral arrangements, and follow-up systems. Early preeclampsia detection will be assessed using indicators such as newly identified elevated blood pressure, documented proteinuria or other clinically relevant findings where appropriate, suspected preeclampsia, confirmed diagnosis, gestational age at detection, referral for further assessment, and timely initiation of appropriate management. Data will be collected using structured questionnaires, antenatal records, maternal health records, blood pressure monitoring records, laboratory records, screening registers, referral records, and relevant programme documents. Descriptive statistics will be used to summarize participants' characteristics, screening coverage, screening findings, and patterns of preeclampsia detection. Inferential statistical techniques, including chi-square tests, t-tests, correlation analysis, and logistic or multiple regression analysis where appropriate, will be used to determine the effect of preeclampsia screening services on early detection. Where a quasi-experimental design is adopted, early detection rates before and after implementation or strengthening of screening services may be compared to determine changes associated with the intervention. Diagnostic tests will also be conducted to assess the reliability, validity, and robustness of the findings. The study is expected to find that preeclampsia screening services have a significant positive effect on early preeclampsia detection among pregnant women in Nigeria. Women who receive consistent antenatal screening are expected to have a higher likelihood of having early signs of hypertensive disorders identified before severe complications develop. Routine blood pressure monitoring and appropriate assessment of other relevant clinical findings may facilitate early recognition, timely referral, closer maternal and fetal monitoring, and appropriate management. Screening services may also increase pregnant women's awareness of preeclampsia warning signs and encourage timely healthcare-seeking when concerning symptoms occur. However, inadequate antenatal attendance, shortage of healthcare personnel, malfunctioning blood pressure equipment, limited laboratory services, financial barriers, geographical inaccessibility, poor documentation, and weak referral systems may reduce the effectiveness of screening programmes. The study therefore expects accessible, routine, standardized, and well-coordinated preeclampsia screening services to contribute significantly to improved early detection and management of preeclampsia in Nigeria. The study is expected to contribute to the literature on preeclampsia screening, early preeclampsia detection, hypertensive disorders of pregnancy, antenatal care, maternal health, obstetric screening, pregnancy monitoring, maternal mortality prevention, and public health in Nigeria. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, National Primary Health Care Development Agency, state ministries of health, hospitals, primary healthcare centres, obstetricians, nurses, midwives, community health workers, maternal health organizations, development partners, and policymakers regarding strategies for strengthening preeclampsia screening and maternal healthcare. The study will also provide evidence-based recommendations for improving routine antenatal blood pressure monitoring, strengthening healthcare-provider training, ensuring availability of functional screening equipment, improving documentation and referral systems, increasing pregnant women's awareness of preeclampsia warning signs, and integrating effective screening and follow-up into routine maternal healthcare services across Nigeria.

Keywords: Preeclampsia screening services, early preeclampsia detection, pregnant women, hypertensive disorders of pregnancy, antenatal care, maternal health, blood pressure screening, obstetric screening, maternal mortality prevention, pregnancy monitoring, Nigeria, public health.