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Effect of Preeclampsia Awareness on Early Antenatal Care Attendance among Pregnant Women in Nigeria

Abstract

Preeclampsia is a serious pregnancy-related hypertensive disorder and an important contributor to maternal and perinatal morbidity and mortality worldwide. The condition can develop during pregnancy and may progress rapidly, making timely antenatal care important for early identification of elevated blood pressure and other warning signs, appropriate risk assessment, monitoring, referral, and management. Preeclampsia awareness refers to pregnant women's knowledge and understanding of the condition, including its risk factors, signs and symptoms, potential complications, importance of antenatal monitoring, and the need for timely professional care. Early antenatal care attendance provides an opportunity for healthcare professionals to establish baseline maternal health status, identify pregnancy-related risk factors, provide preventive interventions, monitor blood pressure and other relevant indicators, and educate women about pregnancy danger signs. In Nigeria, delayed initiation of antenatal care may be associated with inadequate knowledge, misconceptions about pregnancy care, financial constraints, distance to healthcare facilities, transportation difficulties, cultural practices, previous uncomplicated pregnancies, and limited awareness of pregnancy-related complications. Improving awareness of preeclampsia may increase pregnant women's perception of the importance of early antenatal care and encourage timely attendance. Against this background, this study investigates the effect of preeclampsia awareness on early antenatal care attendance among pregnant women in Nigeria. The study is anchored on the Health Belief Model (HBM), Andersen's Behavioral Model of Health Services Use, and the Knowledge-Attitude-Practice (KAP) framework. The Health Belief Model explains health-seeking behaviour through perceived susceptibility, perceived severity, perceived benefits, perceived barriers, and cues to action, providing a basis for understanding how awareness of preeclampsia may influence women's decisions to initiate antenatal care early. Andersen's Behavioral Model explains healthcare utilization through predisposing, enabling, and need-related factors and provides a framework for understanding how knowledge, access, affordability, and perceived need influence antenatal care attendance. The Knowledge-Attitude-Practice framework provides a basis for examining how improved knowledge of preeclampsia may influence attitudes toward antenatal care and subsequent attendance practices. Collectively, these theoretical perspectives provide a comprehensive framework for explaining how preeclampsia awareness may influence early antenatal care attendance among pregnant women in Nigeria. The study adopts a quantitative cross-sectional research design. Primary data will be collected from pregnant women attending selected public and private healthcare facilities and antenatal clinics in Nigeria using a structured interviewer-administered questionnaire. A multistage sampling technique will be employed to select states, local government areas, healthcare facilities, antenatal clinics, and eligible participants. Preeclampsia awareness will be measured using knowledge of the condition, risk factors, warning signs and symptoms, potential maternal and fetal complications, importance of blood pressure monitoring, and the role of antenatal care in pregnancy monitoring. Early antenatal care attendance will be assessed based on the gestational age at which the woman initiated antenatal care, with timing classified according to applicable national and international recommendations. Information on antenatal attendance may be verified using antenatal records where available. Descriptive statistics will be used to summarize participants' sociodemographic and obstetric characteristics, levels of preeclampsia awareness, and timing of antenatal care initiation. Inferential statistical techniques, including chi-square tests, correlation analysis, and multiple logistic regression analysis, will be employed to determine the effect of preeclampsia awareness on early antenatal care attendance. Appropriate diagnostic tests will also be conducted to assess multicollinearity, model specification, goodness of fit, and the robustness of the findings. The study anticipates that higher levels of preeclampsia awareness will have a significant positive effect on early antenatal care attendance among pregnant women in Nigeria. Women with better knowledge of preeclampsia and its potential complications are expected to recognize the importance of early pregnancy monitoring and demonstrate a greater likelihood of initiating antenatal care promptly. Increased awareness may also encourage women to recognize pregnancy danger signs and seek professional care when concerning symptoms occur. However, awareness alone may not guarantee early antenatal attendance because pregnant women may continue to experience barriers such as healthcare costs, transportation difficulties, distance to health facilities, long waiting times, cultural beliefs, household decision-making constraints, and inadequate availability of quality antenatal services. Consequently, preeclampsia awareness interventions are expected to be more effective when combined with accessible, affordable, respectful, and high-quality antenatal care services. This study is expected to contribute to the literature on maternal health, hypertensive disorders of pregnancy, antenatal care, health education, maternal healthcare utilization, and public health in Nigeria by providing empirical evidence on the relationship between preeclampsia awareness and early antenatal care attendance. The findings will provide useful information for the Federal Ministry of Health and Social Welfare, National Primary Health Care Development Agency (NPHCDA), state ministries of health, hospitals, primary healthcare facilities, midwives, community health workers, maternal and newborn health programmes, development partners, and policymakers regarding strategies for promoting timely antenatal care. The study will also provide evidence-based recommendations for strengthening preeclampsia education during community outreach and reproductive health programmes, integrating pregnancy danger-sign education into antenatal and community health services, improving early pregnancy referral systems, and increasing awareness of the importance of timely antenatal care among women of reproductive age across Nigeria.

Keywords: Preeclampsia awareness, early antenatal care, antenatal care attendance, pregnant women, hypertensive disorders of pregnancy, maternal health, pregnancy complications, health education, maternal healthcare utilization, public health, Nigeria.