On a warm Sunday afternoon in Nairobi’s Woodley estate, Sixty-six year old Rosemary Ogano gently puts on compression socks over her swollen feet, this is a slight flare up from her lifelong hypertension, a disease she has been living with since she was 20 years old.
“In 1979 When I was pregnant with my first child I got diagnosed with hypertension in pregnancy, little did I know what awaited me, was lifetime of this illness, the doctors told me that I had chronic HBP.”
For many women like Rosemary who have had a high risk pregnancy because of underlying medical condition specifically her case hypertension,risks to both a pregnant person and the fetuses are usually higher with some lasting in lifetime and others ending up being fatal.
These non-communicable diseases (NCDs) which present in pregnancy are responsible for most worst maternal health outcomes in the country.
In Kenya, the story of maternal health is often told through statistics of maternal mortality, which stands at 355 deaths per 100,000 live births. Yet surviving childbirth is not the hurdle Kenyan women have to jump through whilst bringing life.
According to the Ministry of Health (MoH) data, nearly 40 percent of all mortality and more than 50 percent of hospital admissions in the country are due to NCDs, but within the realm of maternal health, they remain under-discussed, under-diagnosed, and underfunded.
According to Maternal, newborn and child health specialists hypertension in pregnancy (HDP), which refers to group of Hypertensive disorders of pregnancy represent group of disorders related to high blood pressure they include preeclampsia, eclampsia, gestational hypertension, and chronic hypertension.
Globally this condition account for 10 percent of all pregnancies. According to the studies done in Africa maternal death due to HDP is around 9.1 percent.
Prof. Moses Obimbo, an obstetrician-gynecologist and lecturer at the University of Nairobi, observes that many women are unaware that they have HDP until pregnancy.
He explains that for instance, hypertension can lead to preeclampsia, eclampsia, and severe bleeding after birth. Risk factors of HDP is extreme birth ages either too young or too old and behavioral risk factors like: unhealthy diet, hurtful use of alcohol, deficiency of physical exercise, overweight and sustained stress.
“We need to sensitize our women on the importance of antenatal care visits and preconception care. For example Women should be screened and counseled before they get pregnant. This would help detect and manage conditions early. But right now, most women only come to health facilities once they are already pregnant. That limits what can be done.”
He says that most women first get diagnosed with NCDs late during pregnancy, or when giving birth due to failure to attend antenatal clinics.
“The risk of non-communicable diseases in pregnancy is increasing in Kenya. We are seeing more mothers presenting with hypertension, diabetes, and obesity during labor and child birth, however these conditions should be identified earlier enough in pregnancy journey to manage complications and delivery outcomes.”
According to Rosemary back in 1979 the diagnosis came with little explanation and almost no follow-up, however most things have since changed and now the healthcare providers engage patients in explaining diagnosis and management of these conditions.
“I was just told to be calm and stop being stressed,” she recalls. “I didn’t even understand what high blood pressure was at the time and I thought once I had the baby, it would go away.”
However, she says, this turned out not to be the case, as once she got pregnant again, the hypertension returned and managing it has been part of her life to date. The doctors have been advising her to avoid stress, but the condition which she has endure for almost five decades now has drained her finances and severely impacted her lifestyle.
“It changed my life completely. I have to buy medicine every month. When I was still working in the civil service, insurance covered it. But after retirement, it became very expensive.”
She feels like the gap in healthcare at that time did not sufficiently prepare her for the journey that lay ahead of her.
“I wish I was told earlier enough of any preventive measures which healthcare workers share with patients with similar conditions these days, like exercising, eating healthy, maybe it would have changed the trajectory of my life and this illness.”
Decades apart, same story
While, Sharon Atieno a young mother in her late twenties got different maternal care when she was diagnosed with high blood pressure in her third trimester.
“At first, I thought it was stress or walking in the sun,” she recalls. But I was told that my blood pressure was dangerously high and that my life and my baby’s life was at a dangerous point.”
She was referred to Nairobi hospital for an emergency caesarian section (CS), there she was diagnosed with eclampsia-a severe pregnancy complication which can cause seizures and death, the condition comes from pre-eclampsia which is a disorder in pregnancy that is characterized by high blood pressure.
“They explained that eclampsia could kill me and the baby. The only solution was to deliver early. I signed the consent form for a CS that evening.”
Her son, now three years old was born healthy, but the thought of how dangerously they both almost came to an end shook her up.
As she plans to have more kids she is worried about a reoccurrence, however this time she feels like she knows a little more about the condition and is open to talking to her doctors for a preconception consultation.
Echoing her sentiments Prof Obimbo heavily recommends preconception care as a prevention measure for the occurrence of NCDs in pregnancy and the subsequent complications that they bring on.
According to Dr Mitei Chepwogen, an Obstetrician and Gynecologist factors such as nutrition heavily impact the health of a mother and the newborn.
She says that one of the intervention for the NCDs like hypertension is eating a balanced diet, this however is not an option for every mother, especially in food scarce areas such as the coast region which relies on food supply from other counties.
“This not only make the food expensive compared to other regions, but the travel time is significant impacting nutritional value,” she said.
Dr Mitei added that, “Nutrition in the Coast region is quite poor,” she explains. “By the time food reaches here from other regions, most of its nutritional value is gone. Even the fish we rely on has high mercury levels because it’s sourced from the sea, which affects blood formation.”
She says that insufficient diet can lead to anemia causing a double burden for a hypertensive mother leaving them at a higher risk of bleeding out during childbirth-a condition that is referred to as postpartum hemorrhage.
“Hypertension affects the platelets that help blood clot,” Dr. Mitei explains. “So, when a hypertensive mother bleeds, it’s like opening a tap. Nothing is there to close it.”
For women like Rosemary, pregnancy marks the beginning of lifelong illness, pregnancy induced hypertension or gestational diabetes and Kenya’s health system isn’t keeping up. Their story challenges the common narrative that maternal health ends at delivery.
Experts like Dr.Mitei and Professor Obimbo urge that maternal health strategies go beyond managing the delivery room. To reduce maternal deaths the system needs to invest in the prevention and management of the NCDs that silently claim women’s health years after delivery.
“If we don’t address NCDs, then mothers will continue to suffer complications, both during pregnancy and long after. The goal should not just be survival, but healthy survival.”
