Awareness and Knowledge of Pre-Eclampsia Among the General Population in Chamba, Himachal PradeshArticle HistoryReceived: 2024-08-09Revised: 2024-09-21Accepted: 2024-10-17Published: 2024-11-22Author DetailsDr Rupika1, Isha Bhatia2*Authors Affiliations1Medical officer (Obstetrics and Gynaecology specialist), Civil Hospital Chowari, Chamba Himachal Pradesh.2Senior Resident, Pediatrics, Pt JLNGMC Chamba, Himachal Pradesh.Corresponding Author*Isha Bhatiaishabhatia0806@gmail.comDOI:How to Cite the Article:Rupika&Isha Bhatia; Awareness and Knowledge of Pre-Eclampsia Among the General Population in Chamba, Himachal Pradesh, IAR Journal of Health Care and Prevention5.2 (2024) Pp: 1.-6.Copyright @ 2021: This is an open-access article distributed under the terms of the Creative Commons Attribution license which permits unrestricted use, distribution, and reproduction in any medium for non commercial use (NonCommercial, or CC-BY-NC. ND) provided the original author and source are credited.Abstract: Background: Pre-eclampsia, a hypertensive disorder of pregnancy, is a major contributor to maternal and perinatal morbidity and mortality worldwide, particularly in low-resource settings. This study aims to evaluate public awareness, knowledge, and understanding of pre-eclampsia among the general population of Chamba to identify gaps and inform health education initiatives. Materials & Methods: A descriptive, cross-sectional study was conducted among 400 participants from Chamba district over three months (August–October 2024). A pre-validated structured questionnaire was used to collect data, encompassing socio-demographic details and 20 multiple-choice and true/false questions assessing knowledge of pre-eclampsia symptoms, risk factors, complications, and preventive measures. Data were collected through online and in-person surveys and analyzed using Microsoft Excel and Epi Info V7. Knowledge scores were categorized as very good (>80% correct), good (60–79%), fair (41–59%), and poor (<40%). Results: The study revealed a gender-balanced population (54% females, 46% males) with the majority aged 26–35 years (34%). Educational levels ranged from no formal education (12%) to postgraduate degrees (9.5%), and 64.5% of participants were rural residents. Awareness levels were promising in areas such as identifying pre-eclampsia as a hypertensive disorder (74%) and recognizing the importance of blood pressure monitoring during pregnancy (79.5%). However, knowledge gaps were evident regarding proteinuria as a diagnostic criterion (61%) and preventive roles of lifestyle changes (64%) and calcium supplements (59.5%). Knowledge scores showed that 24% had very good awareness, 34% had good awareness, 30% had fair knowledge, and 12% demonstrated poor understanding. Conclusion: This study highlights foundational awareness of pre-eclampsia in Chamba but identifies significant gaps in technical knowledge and preventive strategies. Community-centered educational initiatives focusing on improving understanding of risk factors, diagnostic criteria, and preventive measures are critical for empowering individuals and enhancing maternal health outcomes. Keywords: Pre-eclampsia, Maternal Health, Awareness, Knowledge, Rural Population, Chamba, Himachal Pradesh, Antenatal Care, Hypertensive Disorders of Pregnancy.INTRODUCTIONPre-eclampsia, a hypertensive disorder of pregnancy, is a leading cause of maternal and perinatal morbidity and mortality globally, particularly in low- and middle-income countries. Preeclampsia is diagnosed when a woman has a systolic blood pressure of 140 mm Hg or higher or a diastolic blood pressure of 90 mm Hg or higher on two occasions at least 4 hours apart, along with evidence of proteinuria. Proteinuria is defined as a 24-hour urine collection showing more than 300 mg of protein, a protein/creatinine ratio of at least 0.3 in a single voided urine sample, or a dipstick reading of 2+ when quantitative methods are unavailable.[1,2]Characterized by high blood pressure and signs of organ dysfunction, pre-eclampsia often presents significant challenges in diagnosis, management, and prevention. Early detection and timely intervention are crucial to mitigate its life-threatening complications, including eclampsia, stroke, and organ failure. Despite its clinical significance, public awareness and knowledge of pre-eclampsia remain alarmingly low, especially in rural and resource-constrained regions where access to healthcare and antenatal education is limited.[3,4]Chamba, a district in Himachal Pradesh, India, presents a unique context for exploring public awareness of pre-eclampsia. With a predominantly rural population, geographical isolation, and limited healthcare infrastructure, the region faces significant barriers to maternal health education and access to specialized care. These challenges are further compounded by cultural beliefs, socioeconomic disparities, and low literacy levels, all of which can hinder the timely recognition of pre-eclampsia symptoms and the seeking of appropriate care.Existing research underscores the importance of community awareness in improving maternal health outcomes. Educating the general population about pre-eclampsia not only empowers pregnant women to seek timely medical advice but also enables family members and caregivers to recognize early warning signs.[5-8] However, there is a dearth of data on public knowledge and awareness of pre-eclampsia in rural Indian settings like Chamba, where the need for effective health education and community engagement is paramount.This study aims to evaluate the awareness and knowledge of pre-eclampsia among the general population in Chamba, Himachal Pradesh. By identifying gaps in understanding and potential barriers to accessing care, the research seeks to provide actionable insights for developing targeted health education initiatives. Empowering communities with knowledge about pre-eclampsia has the potential to improve maternal and neonatal health outcomes, reduce the burden of this preventable condition, and bridge critical gaps in healthcare accessibility in this underserved region.Aims & ObjectivesThe primary aim of this study is to assess the awareness and knowledge of pre-eclampsia among the general population in Chamba, Himachal Pradesh. Specifically, the study seeks to:Evaluate the population’s understanding of pre-eclampsia, including its symptoms, risk factors, and potential complications.Assess awareness of preventive measures and the importance of antenatal care in managing pre-eclampsia.MATERIALS & METHODSResearch ApproachThis descriptive, cross-sectional study was designed to assess the current level of awareness and knowledge regarding pre-eclampsia among the general population of Chamba, Himachal Pradesh.Study DesignA structured questionnaire-based survey was conducted to systematically evaluate public knowledge, attitudes, and awareness of pre-eclampsia and its associated healthcare needs.Study AreaThe study was conducted in Chamba district, Himachal Pradesh, a predominantly rural region characterized by geographical isolation, limited access to healthcare facilities, and significant socio-economic and educational disparities. This setting provided an ideal context to explore gaps in public knowledge about pre-eclampsia.Study DurationThe study was conducted over a three-month period, from August to October 2024, ensuring sufficient time for participant recruitment and data collection.Study PopulationThe target population included adults (aged 18 years and above) who had been residents of Chamba for at least one year. This criterion ensured respondents were familiar with local healthcare norms and maternal health challenges. Both men and women were included to assess the general population’s awareness of pre-eclampsia.Sample SizeA sample size of 400 participants was calculated using a 95% confidence level, an estimated 50% awareness level of pre-eclampsia, and a 5% margin of error. An additional 5% was factored in to account for potential non-responses, ensuring robust data collection.Study ToolA pre-validated structured questionnaire was employed to gather data. The questionnaire was divided into two main sections:Socio-Demographic Details: This section collected data on participants' age, gender, education level, occupation, income, and healthcare access.Knowledge and Awareness Assessment: This section comprised 20 multiple-choice and true/false questions focusing on:Recognition of pre-eclampsia symptoms (e.g., high blood pressure, swelling, and proteinuria).Understanding of risk factors (e.g., obesity, first pregnancy, and family history).Awareness of potential complications (e.g., eclampsia, stroke, and maternal mortality).Knowledge of preventive measures, such as regular antenatal visits, balanced nutrition, and blood pressure monitoring.Barriers to accessing maternal healthcare.Scores were assigned for correct responses, with awareness levels categorized as:Very Good:>80% correct responses.Good: 60–79% correct responses.Fair: 41–59% correct responses.Poor:<40% correct responses.Data CollectionData were collected through both online and in-person surveys. In-person surveys were conducted at community centers, healthcare facilities, and public spaces to ensure participation from individuals with limited internet access. Online surveys were distributed via social media platforms and messaging apps to include tech-savvy participants, ensuring broad demographic representation.Data AnalysisResponses were compiled, cleaned, and analyzed using Microsoft Excel and Epi Info V7 software. Descriptive statistics, including frequencies and percentages, were calculated to evaluate awareness levels and socio-demographic correlations. Chi-square tests were used to analyze relationships between socio-demographic variables and knowledge levels.Ethical ConsiderationsEthical approval was obtained from the relevant institutional review board. Participant anonymity and confidentiality were strictly maintained, and informed consent was obtained from all respondents. Participants were informed of their right to withdraw from the study at any time, ensuring adherence to ethical standards for research involving human subjects.RESULTSThe study involved 400 participants, providing insights into the awareness and knowledge of pre-eclampsia among the general population in Chamba, Himachal Pradesh.Table 1: Sociodemographic Variables of Study ParticipantsVariableCategoriesFrequency (n)Percentage (%)GenderMale18446.0Female21654.0Age Group (Years)18–258220.526–3513634.036–4510225.546–555814.556 and above225.5Education LevelNo formal education4812.0Primary school8822.0Secondary school11428.5Undergraduate degree11228.0Postgraduate degree or higher389.5OccupationAgriculture/Labor9824.5Homemaker8421.0Service (Private/Government)13433.5Business5614.0Student287.0Area of ResidenceUrban14235.5Rural25864.5Monthly Household Income<10,000 INR9223.010,001–20,000 INR15639.020,001–40,000 INR11228.0>40,000 INR4010.0The study included 400 participants with a balanced gender distribution, comprising 54% females and 46% males. The largest age group was 26–35 years (34%), followed by 36–45 years (25.5%), indicating that most participants were within the reproductive age group. Educational levels varied, with 28.5% completing secondary school and 28% holding undergraduate degrees, while 12% had no formal education, reflecting the educational diversity in the region. Participants were predominantly from rural areas (64.5%), with urban residents constituting 35.5%. Occupations were diverse, with 33.5% engaged in private or government services, 24.5% in agriculture or labor, and 21% homemakers. Most participants (39%) had a monthly household income between 10,001–20,000 INR, highlighting the socio-economic profile of the region.Table 2: Awareness and Knowledge Assessment of Pre-EclampsiaS.NoQuestionOptionsFrequency of Correct ResponsesPercent (%)1What is pre-eclampsia?a) Liver disease, b) Hypertensive disorder of pregnancy, c) Kidney infection, d) Genetic condition29674.02What are the common symptoms of pre-eclampsia?a) Headache, b) High blood pressure and swelling, c) Diarrhea, d) Joint pain27869.53Can pre-eclampsia lead to serious complications for the mother and baby?a) Yes, b) No, c) Only in severe cases, d) Rarely31278.04Is regular blood pressure monitoring important during pregnancy?a) Yes, b) No, c) Only if symptomatic, d) Rarely31879.55What is a key risk factor for pre-eclampsia?a) Low hemoglobin, b) First pregnancy, c) Overeating, d) Viral infection25463.56Can pre-eclampsia be detected through routine antenatal visits?a) Yes, b) No, c) Only in later stages, d) Rarely28471.07What is the role of proteinuria in diagnosing pre-eclampsia?a) None, b) Secondary indicator, c) Major diagnostic criterion, d) Irrelevant24461.08Is pre-eclampsia preventable with lifestyle modifications?a) Yes, b) No, c) Only with medication, d) Rarely25664.09Can untreated pre-eclampsia result in eclampsia?a) Yes, b) No, c) Rarely, d) Only in severe cases26867.010Is public awareness about pre-eclampsia important for improving outcomes?a) Yes, b) No, c) Only for high-risk individuals, d) Occasionally33283.011What is one major complication of pre-eclampsia?a) Stroke, b) Low birth weight, c) High blood sugar, d) Joint pain29273.012Can early antenatal care reduce the risk of pre-eclampsia complications?a) Yes, b) No, c) Only for high-risk mothers, d) Rarely31077.513What lifestyle changes can help prevent pre-eclampsia?a) Reduce stress, b) Maintain healthy weight, c) Avoid physical activity, d) Skip salt intake24661.514Is obesity a risk factor for pre-eclampsia?a) Yes, b) No, c) Rarely, d) Only in severe cases26466.015What is the role of calcium supplements in pre-eclampsia prevention?a) None, b) Reduces risk, c) Increases blood pressure, d) Neutral effect23859.516Can pre-eclampsia occur in subsequent pregnancies?a) Yes, b) No, c) Only if untreated previously, d) Rarely25263.017What organ systems are most affected by pre-eclampsia?a) Cardiovascular and renal, b) Gastrointestinal, c) Musculoskeletal, d) Immune system27669.018Can high-stress levels increase the risk of pre-eclampsia?a) Yes, b) No, c) Only if combined with other risk factors, d) Rarely24862.019Should pre-eclampsia education be part of maternal health programs?a) Yes, b) No, c) Only for high-risk groups, d) Occasionally32080.020What is the main aim of pre-eclampsia management?a) Avoid preterm delivery, b) Ensure maternal and fetal safety, c) Lower blood sugar, d) Reduce pain30075.0The awareness and knowledge assessment demonstrated varying levels of understanding about pre-eclampsia among participants. Encouragingly, 74% correctly identified pre-eclampsia as a hypertensive disorder of pregnancy, and 78% recognized its potential complications. Awareness of key symptoms like high blood pressure and swelling (69.5%) and the importance of regular blood pressure monitoring (79.5%) was strong. However, technical knowledge, such as the diagnostic role of proteinuria (61%) and lifestyle-related prevention measures (64%), was comparatively lower. While 83% emphasized the need for public awareness about pre-eclampsia, knowledge of risk factors like obesity (66%) and the role of calcium supplements (59.5%) remained moderate. Participants showed a high awareness of the criticality of early antenatal care (77.5%) and maternal education programs (80%). These findings highlight a foundational understanding of pre-eclampsia but underscore significant gaps in technical and preventive aspects.Table 3: Knowledge Score ClassificationKnowledge CategoryScore RangeFrequency (n)Percentage (%)Very Good16–209624.0Good12–1513634.0Fair8–1112030.0Poor<84812.0Knowledge scores were categorized into four levels, revealing a varied distribution of awareness. Among participants, 24% demonstrated very good knowledge with scores between 16–20, and 34% had good knowledge, scoring 12–15, reflecting a foundational awareness among the majority. However, 30% scored in the fair category (8–11), indicating partial understanding, while 12% had poor knowledge with scores below 8, pointing to a critical need for targeted educational interventions. These results emphasize the importance of improving technical knowledge and providing practical guidance to address the knowledge gaps among the population.DISCUSSIONThis study provides a detailed understanding of the awareness and knowledge regarding pre-eclampsia among the general population in Chamba, Himachal Pradesh. It highlights not only the foundational awareness present within the community but also significant gaps that hinder effective understanding and timely intervention for this potentially life-threatening maternal condition. These findings shed light on the critical need for targeted educational efforts to empower the population, particularly in resource-constrained and geographically isolated areas.The socio-demographic profile of the study participants reflects the diverse characteristics of Chamba's population, encompassing variations in gender, age, education, occupation, and socio-economic status. The representation of 54% females and 46% males is notable, as pre-eclampsia awareness is often assumed to be a women's issue; however, involving men is essential to fostering supportive family environments. The majority of participants were aged 26–35 years (34%) and 36–45 years (25.5%), aligning with the reproductive age group most likely to encounter maternal health challenges. Educational attainment varied significantly, with 28.5% completing secondary school and 28% holding undergraduate degrees, indicating that a substantial proportion of the population possesses foundational literacy. However, the 12% of participants with no formal education highlights an underserved segment likely to have limited access to maternal health information.The predominance of rural residents (64.5%) and a significant portion (39%) reporting monthly household incomes between INR 10,001–20,000 underline the socio-economic and geographic barriers to healthcare access. Occupations such as agriculture and labor (24.5%), homemaking (21%), and service roles (33.5%) reflect the economic diversity of the region but also indicate the potential challenges faced by those engaged in physically demanding jobs, which may limit their ability to seek timely antenatal care.The assessment of awareness and knowledge of pre-eclampsia revealed a mixed picture. Encouragingly, a majority of participants (74%) correctly identified pre-eclampsia as a hypertensive disorder of pregnancy, and 78% recognized its serious complications, including risks to both maternal and neonatal health. Awareness of key symptoms, such as high blood pressure and swelling, was also strong (69.5%). Importantly, 79.5% of respondents understood the importance of regular blood pressure monitoring during pregnancy, and 71% were aware of the critical role of routine antenatal visits in early detection and management. These findings suggest a reasonable baseline understanding among the population regarding the condition’s general aspects.However, deeper insights into technical and preventive measures revealed critical gaps. Only 61% of participants recognized the diagnostic role of proteinuria, a cornerstone in the clinical identification of pre-eclampsia. Similarly, knowledge about the protective role of lifestyle modifications was moderate, with 64% understanding the importance of maintaining a healthy weight and reducing stress. Awareness of obesity as a risk factor was also moderate (66%), and only 59.5% of participants knew about the preventive benefits of calcium supplements. Such gaps in technical knowledge could hinder the timely recognition of pre-eclampsia symptoms and limit the adoption of effective preventive strategies.Participants showed a high appreciation for the importance of public awareness programs, with 83% agreeing on their necessity, and 80% supported integrating pre-eclampsia education into maternal health initiatives. These findings reflect the population's readiness to engage with educational campaigns and highlight an opportunity to improve maternal health outcomes through structured public health interventions.The distribution of knowledge scores further illustrates the variability in awareness levels. While 24% of participants achieved very good knowledge scores (16–20 points), and 34% fell into the good category (12–15 points), a significant proportion (30%) exhibited only fair knowledge (8–11 points), and 12% demonstrated poor knowledge (<8 points). These results suggest that while there is a foundational understanding among a majority of the population, a large subset remains under-informed about pre-eclampsia, particularly regarding its risk factors, technical diagnostic criteria, and preventive measures.Several barriers to awareness were evident, particularly those stemming from geographic isolation, limited antenatal education, and cultural beliefs that may deter open discussions about pregnancy-related complications. The lack of formalized maternal health education in rural areas likely contributes to these gaps, as does the limited engagement of healthcare workers in delivering tailored, community-based information on pre-eclampsia. Additionally, socio-economic disparities and low literacy rates further exacerbate these challenges, making it difficult for certain segments of the population to access or understand health-related information.Implications for Public Health[9-12]The findings underscore the urgent need for targeted interventions to bridge these knowledge gaps. Educational campaigns tailored to the specific needs of rural and underserved populations in Chamba can play a transformative role. By leveraging community health workers, local healthcare providers, and culturally appropriate materials, these campaigns can deliver essential information on pre-eclampsia symptoms, risk factors, and preventive strategies. Integrating this education into routine antenatal care services and utilizing visual aids, videos, and group discussions can help make complex medical information accessible and actionable for all literacy levels.Men’s involvement in these initiatives is equally critical, as they often play a decisive role in family health decisions in rural settings. Collaborative approaches involving community leaders, educators, and government agencies can also enhance the reach and sustainability of these programs. Incorporating mobile health (mHealth) solutions, such as SMS alerts or smartphone apps, could further extend the reach of education campaigns, particularly in areas with limited physical access to healthcare facilities.Limitations and Future DirectionsWhile this study offers valuable insights, it is not without limitations. The reliance on self-reported data may introduce response bias, and the exclusion of individuals without access to surveys (in-person or online) may limit the representativeness of the findings. Future studies should consider employing mixed methods, including qualitative interviews and focus group discussions, to capture deeper, more nuanced perspectives on pre-eclampsia awareness. Additionally, longitudinal studies assessing the impact of educational interventions on maternal health outcomes would provide robust evidence for scaling such programs.CONCLUSIONThis study reveals a foundational understanding of pre-eclampsia among the general population in Chamba, Himachal Pradesh, while also identifying significant gaps in technical knowledge and preventive awareness. Addressing these gaps through targeted, community-centered interventions is essential for empowering individuals, fostering informed health-seeking behaviors, and improving maternal and neonatal health outcomes. By investing in sustained educational efforts and leveraging existing healthcare resources, this region can make significant strides in reducing the burden of pre-eclampsia and ensuring safer pregnancies for all.Conflict of Interest: The authors declare that they have no conflict of interestFunding: No funding sourcesEthical approval: The study was approved by theCivil Hospital Chowari, Chamba Himachal Pradesh.REFERENCES Kishen, S., and M. V. P. Rao. "Knowledge, Attitude, and Practice of Women Towards Preeclampsia in Port Blair: A Cross-Sectional Study." Int J Health Sci 6.S3 (2022), pp. 5907-5921.Fox, R., J. Kitt, P. Leeson, C. Y. L. Aye, and A. J. Lewandowski. "Preeclampsia: Risk Factors, Diagnosis, Management, and the Cardiovascular Impact on the Offspring." J Clin Med 8.10 (2019), p. 1625.Bahkali, N. M. et al. "Awareness of Preeclampsia and Measurement of Risk Factors in Women from the Western Region of Saudi Arabia: A Cross-Sectional Study." 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"Knowledge and Attitude of Pregnant Women Towards Preeclampsia and Its Associated Factors in South Gondar Zone, Northwest Ethiopia: A Multi-Center Facility-Based Cross-Sectional Study." BMC Pregnancy Childbirth 21.1 (2021), p. 160.Vidler, M. et al. "Community Perceptions of Pre-Eclampsia in Rural Karnataka State, India: A Qualitative Study." Reprod Health 13.Suppl 1 (2016), p. 35.Bohsas, H. et al. "Assessing Pre-Eclampsia Awareness Among Pregnant Women in Syria: A Cross-Sectional Study on Knowledge and Perceptions." BMC Pregnancy Childbirth 24 (2024), p. 185.Olaoye, T. et al. "Knowledge, Perception, and Management of Pre-EclampsiaAmong Health Care Providers in a Maternity Hospital." 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