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Impact of Preconception Hypertension Screening on Hypertension Detection among Women of Reproductive Age in Nigeria

Abstract

Hypertension is an important public health concern among women of reproductive age and may remain undiagnosed until pregnancy or routine healthcare contact. Undetected hypertension before conception can increase the risk of adverse maternal and pregnancy outcomes and may limit opportunities for appropriate management and preconception counselling. Preconception hypertension screening provides an opportunity to identify women with previously undiagnosed elevated blood pressure and facilitate timely clinical assessment, lifestyle modification, treatment where indicated, and appropriate referral before pregnancy occurs. In Nigeria, however, access to routine preconception screening may be affected by limited awareness, financial constraints, geographical barriers, inadequate screening equipment, insufficient healthcare personnel, and weak integration of non-communicable disease screening into reproductive health services. Against this background, this study investigates the impact of preconception hypertension screening on hypertension detection among women of reproductive age in Nigeria. The study will be anchored on the Health Belief Model, Andersen's Behavioral Model of Health Services Use, and the Health Promotion Model. The Health Belief Model explains how women's perceptions of their susceptibility to hypertension, perceived severity of hypertension-related complications, perceived benefits of screening, perceived barriers, and cues to action may influence participation in preconception hypertension screening. Andersen's Behavioral Model explains how predisposing characteristics, enabling resources, and healthcare needs influence women's utilization of preventive and reproductive health services. The Health Promotion Model emphasizes individual experiences, perceived benefits and barriers, interpersonal influences, and behavioural factors that influence participation in preventive healthcare activities. Collectively, these theoretical perspectives provide a suitable framework for explaining how preconception hypertension screening may influence hypertension detection among women of reproductive age in Nigeria. The study will adopt a quantitative analytical cross-sectional or quasi-experimental research design. The study population will comprise women of reproductive age who are planning pregnancy or accessing reproductive, family planning, preconception, and primary healthcare services in selected facilities and communities across Nigeria. A multistage sampling technique will be used to select states, local government areas, communities, healthcare facilities, clinics, and eligible women. Preconception hypertension screening will be assessed using indicators such as availability of blood pressure screening, screening participation, frequency of blood pressure measurement, use of appropriate blood pressure measurement procedures, availability and functionality of blood pressure equipment, healthcare-worker training, risk assessment, counselling, documentation, referral arrangements, and follow-up of women with elevated blood pressure. Hypertension detection will be assessed using indicators such as newly identified elevated blood pressure, suspected hypertension, repeated abnormal blood pressure measurements, newly identified hypertension cases following appropriate clinical assessment, referral for further evaluation, and linkage to hypertension management services. Data will be collected using structured questionnaires, blood pressure measurement records, preconception clinic registers, medical records, referral registers, and relevant reproductive health and non-communicable disease programme documents. Descriptive statistics will be used to summarize participants' characteristics, screening coverage, blood pressure findings, and hypertension detection patterns. 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 impact of preconception hypertension screening on hypertension detection. Where a quasi-experimental design is adopted, hypertension detection outcomes before and after implementation of structured preconception screening may be compared, while relevant demographic, socioeconomic, family history, lifestyle, and healthcare-access factors are appropriately controlled. Diagnostic tests will also be conducted to assess the reliability, validity, and robustness of the findings. The study is expected to find that preconception hypertension screening has a significant positive impact on hypertension detection among women of reproductive age in Nigeria. Women who participate in preconception hypertension screening are expected to have a higher likelihood of previously undiagnosed hypertension being identified than women without access to routine screening. Early identification may provide opportunities for appropriate clinical evaluation, lifestyle counselling, treatment where indicated, risk assessment, and preconception planning before pregnancy occurs. Integrating blood pressure screening into preconception, family planning, and primary healthcare services may improve access to preventive screening and identify women who may not otherwise seek hypertension assessment. However, low awareness, inadequate blood pressure equipment, poor-quality measurement practices, limited healthcare personnel, financial barriers, geographical difficulties, and weak referral and follow-up systems may reduce the effectiveness of screening programmes. The study therefore expects accessible, reliable, affordable, and well-integrated preconception hypertension screening services to contribute significantly to improved hypertension detection among women of reproductive age in Nigeria. The study is expected to contribute to the literature on preconception hypertension screening, hypertension detection, preconception care, reproductive health, maternal health, cardiovascular disease prevention, non-communicable disease screening, 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, family planning clinics, healthcare professionals, reproductive health programmes, non-communicable disease programmes, development partners, and policymakers regarding strategies for strengthening preconception healthcare. The study will also provide evidence-based recommendations for integrating blood pressure screening into routine preconception and reproductive health services, improving access to functional blood pressure equipment, strengthening healthcare-worker capacity, promoting awareness of hypertension among women of reproductive age, establishing effective referral and follow-up systems, and linking women with appropriate hypertension management and preconception services across Nigeria.

Keywords: Preconception hypertension screening, hypertension detection, women of reproductive age, preconception care, blood pressure screening, reproductive health, maternal health, cardiovascular health, non-communicable diseases, Nigeria, public health.