Barriers to recruitment and retention of postpartum women with hypertensive disorders in pregnancy in Nigeria: lessons from the impact HDP study
Authors & Affiliations
Chibundo Onyia MDα΅; Cecilia Nartey MD, MPHα΅; Chukwuebuka F. Okoye MBBSα΅; Kabiru Umar Ibrahim MBBSα΅; Nura Abdulkarim MBBSα΅; Adaego A. Orji MBBS, MPHαΆ ; Michael Ochem MBBSα΅; Ezinne M. Aba MBBSα΅; Adedoyin E. Olowookere MBBSα΅; Taiwo P. Odulana MBBSα΅, Greatness Eyenorα΅, Dennis Isah MBBSα΅, Joshua Zaman MBBSα΅; Dike B. Ojji MBBS, PhDα΅,α΅; Zainab Mahmoud MD, MScα΅,αΆ Author Affiliations a Cardiovascular Research Centre, University of Abuja and University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria b Department of Medicine, Cardiovascular Division and Global Health Center, Washington University in St. Louis, St. Louis, Missouri, USA c Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, Missouri, USA d Murtala Muhammad Specialist Hospital, Kano, Nigeria e Aminu Kano Teaching Hospital, Kano, Nigeria f National Hospital Abuja, Federal Capital Territory Abuja, Nigeria g Faculty of Clinical Sciences, University of Abuja, Abuja, Nigeria
π Abstract Content
Background In Nigeria, hypertensive disorders in pregnancy (HDP) complicate approximately 10% of pregnancies and increase the risk of persistent hypertension and future cardiovascular disease. Longitudinal follow-up is essential for early cardiovascular risk assessment and management, yet recruitment and participant retention remain major challenges. This study assessed barriers to recruitment and retention among women enrolled in the control phase of an ongoing stepped-wedge randomized controlled trial.
Methodology In this prospective cohort study, women with HDP were enrolled within 48 hours of delivery at the University of Abuja Teaching Hospital. Recruitment rates, 6-week follow-up attendance, and reasons for recruitment failures and missed visits were analyzed.
Results Among 175 eligible women, 136 (77.7%) were enrolled. Mean age was 32.5 Β± 5.7 years, mean gestational age at delivery was 35.6 Β± 3.8 weeks, and mean blood pressure at recruitment was 141/92 mmHg. Long travel distance to the follow-up site was the predominant barrier to participation, cited by 37 of the 39 (94.9%) eligible women who were not enrolled. Of 119 eligible participants for the 6-week follow-up, 73 (61.3%) attended. Distance and transportation difficulties were the leading reasons for missed visits. Participants completing follow-up lived a mean of 26 km from the study site, versus 56 km among non-compliant participants.
Conclusions Distance to the healthcare facility significantly affected both recruitment and participant retention among women with HDP. Decentralized postpartum cardiovascular care, improved patient tracking, and innovative follow-up strategies are needed to improve continuity of care while strengthening future maternal cardiovascular research in Nigeria.
