Joan Nduta: Four months ago, my friend lost her sister and her sister’s unborn child to high blood pressure complications in pregnancy – it was her first baby and would have been her parents’ first granddaughter. A tragic loss for this family and community. We later heard that the condition was not detected early and therefore not managed promptly and effectively as the obstetric emergency that it was.
Troubled by the news, I sought answers from my colleague Isabella Atieno (also known as Bella), an experienced midwife, public health practitioner, and clinical trainer, to understand how such tragedies can be prevented, identified, and treated.
Bella Atieno (BA): High blood pressure that starts in pregnancy is often silent, but it can lead to two serious conditions – preeclampsia and eclampsia. Preeclampsia develops after 20 weeks and is marked by high blood pressure and organ damage. When it worsens, it can progress to eclampsia, causing seizures and endangering both mother and baby. While the causes of preeclampsia/eclampsia are not well understood, we do know that certain girls and women are at increased risk of developing these conditions: women who are pregnant for the first time; women with twins or triplets, women with higher body weights, women with a past personal or family history of preeclampsia, and women with pre-existing conditions like hypertension, diabetes, or kidney disease.
High blood pressure can lead to serious complications for the mother and baby and hence, consistent prenatal care is essential for monitoring and managing potential risk factors. Preeclampsia and eclampsia claim up to 25% of mothers lives in Latin America and 10% in Africa and Asia, and are among the top killers of mothers and babies worldwide, hitting low- and middle-income countries the hardest (WHO pre-eclampsia fact sheet, 2025).
BA: Strong community-based actions such as early detection, prevention, and timely referrals can support effective identification and management and prevent these deaths. Evidence from Kenya shows that the prevalence of preeclampsia ranges from 5.6% to 6.5%, affecting women during antenatal, intrapartum, and postnatal periods (Ndwiga et al., 2020).
In response, Jhpiego has been working with Kenya’s Ministry of Health and prioritized strengthening provider capacity and increasing community awareness to improve the prevention, early detection, and prompt management of preeclampsia and eclampsia in Vihiga and Homa Bay Counties, together with ensuring that essential medicines to treat preeclampsia and eclampsia – like antihypertensive medications and magnesium sulfate - are available. The goal of Kenya’s community health strategy (2020-2025) is to improve public health and strengthen community-based services. It seeks to empower individuals, families, and communities to sustain resilient community health structures.
A case study conducted in Mozambique demonstrated that task-sharing with community health workers (CHWs) is feasible for early detection and referral of women with pre-eclampsia (Sevene et al. (2021). It showed that CHWs can be trained to perform blood pressure measurement and urine protein testing (measures needed to accurately diagnose pre-eclampsia), assess for dangers signs like severe headache, blurry vision, and upper abdominal pain, and initiate timely referral of women with suspected pre-eclampsia. Although definitive treatment must take place in health facilities, community-based strategies like mapping pregnant women, strengthening linkages with health facilities, and encouraging antenatal care visits increase early diagnosis, timely referral, and emergency management. With adequate support and supervision, CHWs can safely expand their roles to bridge gaps between households and health services, ultimately improving maternal and newborn outcomes.
BA: Health systems often focus on facility-based management, but community-level actions can be equally transformative and life-saving. They help bridge gaps in access, awareness, and care-seeking behaviors. This could be achieved through strategies such as community health education and awareness on danger signs of pre-eclampsia and eclampsia (like high blood pressure, headache, blurred vision, proteinuria, etc.) and training CHWs to identify risk factors early. These community workers could be provided with simple blood pressure machines, urine dipsticks for protein screening, and the referral of suspected cases for timely management.
BA: Antenatal care is more than a checklist. It should never be rushed. Every visit is an opportunity to look deeper into a mother’s overall physical and mental health, support optimal nutrition, prevent and assess for infections and other conditions that impact a woman and baby’s health and wellbeing, and spot early warning signs. It’s not a waste of time as some would think. When health professionals take time and remain alert, conditions like preeclampsia and eclampsia can be detected and managed before they become life-threatening. Slowing down antenatal care is about giving every mother and baby the best chance to survive and thrive. Group-based models of care in pregnancy are one way to support such a comprehensive approach.
BA: The World Health Organization recommends calcium supplementation (1.5–2.0 g/day) for pregnant women in populations with low dietary calcium to reduce preeclampsia risk (WHO 2016). Community awareness of common danger signs is also critical and families should be encouraged to develop birth preparedness and complication readiness plans. For example, identifying a skilled birth attendant, arranging transport to a health facility, saving money for emergencies, and knowing potential blood donors.
BA: By working together, families and community health workers can ensure that pregnant women receive timely care, reducing delays that often lead to preventable deaths. Exploring ways such as pooling resources to fund community outreach for families in hard-to-reach areas. These efforts make it possible to scale up proven responses such as integrating maternal and child health services – which has shown to reduce missed opportunities and save time for mothers. Over time, such actions improve newborn care and trust in the health system. The results: women and families feel supported throughout pregnancy and beyond.
JN: No mother or child should die from conditions we can detect early and manage effectively. Let’s work together to ensure that such losses do not happen again. Community-based responses are acts of love and duties of care. I am part of this community and hold hope that the health of mothers, their babies, and our shared legacies will continue to thrive. Rest in peace S and T, your story will continue to inspire safer beginnings for others.
