Background: In order to assess the effectiveness of antenatal care for prevention of eclampsia, a retrospective case-control study was performed at the Muhimbili National Hospital (MNH), Dar es Salaam, Tanzania. All women with eclampsia seen at MNH during 1999-2000 and controls without eclampsia were included.
Methods: The study used a labor ward database and antenatal cards of eclamptic women and non-eclamptic controls. For each of the 741 eclamptic women who delivered at MNH, two non-eclamptic controls were chosen from the database. For 399 of the eclampsia cases and 420 non-eclamptic controls, the antenatal records could be traced and compared. Main outcome measures. Maternal and perinatal mortality, detection of antenatal risk factors, appropriate referrals, and incidence of eclampsia.
Results: Hospital and population-based incidences of eclampsia were 200/10,000 and 67/10,000, respectively. The case-fatality rate for eclampsia was 5.0% for women who delivered at MNH and 16% for those referred to MNH after being delivered elsewhere. The risk of low birth weight and perinatal death was significantly increased in eclamptic women (odds ratio = 6 and 10, respectively). The screening coverage for signs of pre-eclampsia was >85%, except for proteinuria (33%). Fewer than 50% of the women who developed eclampsia had been referred from the ANC clinic and <10% were admitted to the antenatal ward at MNH before onset of eclamptic fits.
Conclusions: The current practice of antenatal care is insufficient as a prevention strategy for eclampsia in a low-resource setting with high incidence of eclampsia.