Published in PLOS One on 2026-09-03, this study is presented as an attributed evidence briefing. The excerpts below are the original researchers’ words, reproduced under their Creative Commons Attribution licence. Health Signal has selected the abstract and, where needed, opening background paragraphs; the complete methods, results, limitations and references remain in the linked paper.
Original authors: Ugo Okoli, Sylverius Obafemi, Comfort Okpe, Kendra Njoku, Nneka Mobisson, Chinyere Uzoama, Victoria Omoera, Emmanuel Ugwa, Kathleen Hill
Source: PLOS One • DOI 10.1371/journal.pone.0356879
Read the complete primary study ↗ · Creative Commons Attribution licence
From the researchers
Abstract
Hypertensive disorders of pregnancy (HDP) including chronic hypertension, gestational hypertension preeclampsia and eclampsia are a leading cause of maternal and perinatal mortality in Nigeria and globally and increase the risk for future cardiovascular disease among women of reproductive age (WRA). The quality improvement program was implemented from 2019 through 2022 in the Federal Capital Territory (FCT) and Lagos State of Nigeria to improve early detection and management of HDP and risk factors (anemia, diabetes) at key maternal and reproductive healthcare touch points. A facility-based assessment evaluated provider knowledge and practices related to antenatal care diagnosis and management of HDP and risk factors in pregnant women in 20 facilities. From 2019 to 2022 the program implemented a package of interventions in 40 public and private health facilities to improve prevention, early detection, and management of HDP and risk factors among WRA during antenatal care (ANC), postnatal care (PNC), and family planning (FP) visits. ANC assessment results demonstrated important gaps in ANC providers’ knowledge, self-reported confidence and observed adherence with HDP and risk factor management best practices. Among 93,384 ANC visits across program facilities the median proportion of women who had a blood pressure, anemia and diabetes check increased from 44% to 89%, 48% to 91% and 32% to 87%, respectively, from baseline (October 2019-March 2020) to the program final 6 months (July-December 2022). From January 2021 to December 2022, the median proportion of 57,658 PNC visits with a documented BP check increased from 81% to 90% and the median proportion of 105,237 FP visits with a BP check increased from 73% to 98% from an initial baseline period (January- June 2021) to the last 6 months of program implementation (July-December 2022). In a program setting with a high burden of maternal mortality and morbidity due to hypertensive disorders and a high prevalence of cardiovascular disease, improving identification and management of HDP and risk factors at key health care touch points for women of reproductive age has the potential to reduce HDP morbidity and mortality and future premature cardiovascular mortality among women of reproductive age.
Introduction
Hypertensive disorders of pregnancy (HDP) including preeclampsia, eclampsia, gestational hypertension, and chronic hypertension are leading causes of maternal mortality, preterm birth, and stillbirth in Nigeria and globally [1,2]. Globally, hypertensive disorders are the third most common cause of maternal death (16%) after hemorrhage (27%) and indirect obstetric deaths (23%) [3].The United Nations Maternal Mortality Estimation Inter-Agency Group (MMEIG) estimated the Nigeria maternal mortality ratio (MMR) to be 993 deaths per 100,000 live births in 2023 [4], modestly decreased from an estimated 1,065 per 100,000 live births in 2020.In a cross-sectional analysis of maternal and perinatal data across 54 tertiary-level facilities in Nigeria, hypertensive disorders were the leading cause of maternal deaths accounting for 31.8% of maternal deaths [5]. Approximately 5–10% of pregnancies in Nigeria are complicated by hypertensive disorders [6]. Globally, the prevalence of HDP is 116.4 per 100,000 women of childbearing age; sub-Saharan Africa has the highest prevalence of HDP, with a mean prevalence of 334.9 per 100,000 women of childbearing age [7]. A secondary analysis of global and regional trends in data from the Global Burden of Disease 2021 study, estimated that western Sub-Saharan Africa has the highest age-standardized incidence rate of HDP among women aged 15–49 years in the world at 3,378.94 per 100,000 females and that central sub-Saharan Africa has the highest age-standardized HDP mortality rates in the world at 8.27 per 100,000 population [8]. A systematic review and meta-analysis of prevalence and materno-fetal outcomes of pre-eclampsia and eclampsia (PE/E) among pregnant women in Nigeria revealed a pooled prevalence of 4.51% for preeclampsia and 1.39% (95% CI 1.02–1.84) for eclampsia and a pooled maternal mortality rate associated with PE/E of 6.04% (95% CI 3.67–8.89) and pooled fetal mortality rate of 16.73% [9].
Reading this evidence
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© 2026 Ugo Okoli, Sylverius Obafemi, Comfort Okpe, Kendra Njoku, Nneka Mobisson, Chinyere Uzoama, Victoria Omoera, Emmanuel Ugwa, Kathleen Hill. Excerpts reproduced under CC BY. Selection, formatting and contextual notes by Health Signal. The researchers are the authors of the source study, not members of Health Signal’s staff.
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