Lived experiences of women who survived from pre-eclampsia and eclampsia in public hospitals of Shashemene Town, Oromia Region, Ethiopia: a qualitative study.

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Design An institution-based exploratory qualitative study with a descriptive phenomenological study design Setting The present study was conducted in Shashemene referral hospital and Melka Oda general hospital from March 03 to May 18, 2021. Participants A total of 17 individual in-depth interviews (IDIs) were conducted with women who experienced and survived pre-eclampsia and eclampsia. Data were analyzed through thematic analysis using Atlas-ti software. Result The present study revealed that women’s level of awareness on raised blood pressure and or convulsion occurring during pregnancy was poor. Barriers that limit pregnant women from getting treatment at the earliest point included misconception, lack of insight, failure to accept counseling from health care providers, low income, and influence from husbands. Discussions with the women in this study showed that these mothers were not counseled on danger signs during antenatal care check-ups. Almost all of the women were very concerned and frustrated due to their diagnosis. Conclusions Women’s awareness of pre-eclampsia and eclampsia was poor. Improving awareness of hypertensive disorders in pregnancy and enhancing the quality of antenatal care is essential. " } { "@context": "http://schema.org", "@type": "BreadcrumbList", "itemListElement": [ { "@type": "ListItem", "position": "1", "item": { "@id": "https://f1000research.com/", "name": "Home" } }, { "@type": "ListItem", "position": "2", "item": { "@id": "https://f1000research.com/browse/articles", "name": "Browse" } }, { "@type": "ListItem", "position": "3", "item": { "@id": "https://f1000research.com/articles/12-1464/v3", "name": "Lived experiences of women who survived from pre-eclampsia and eclampsia..." } } ] } Home Browse Lived experiences of women who survived from pre-eclampsia and eclampsia... ALL Metrics - Views Downloads Get PDF Get XML Cite How to cite this article Gebeyehu N, Urgessa A, Yohannes D et al. Lived experiences of women who survived from pre-eclampsia and eclampsia in public hospitals of Shashemene Town, Oromia Region, Ethiopia: a qualitative study. [version 3; peer review: 1 approved, 2 approved with reservations] . F1000Research 2025, 12 :1464 ( https://doi.org/10.12688/f1000research.129648.3 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Close Copy Citation Details Export Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente EXPORT Select a format first Track Share ▬ ✚ Research Article Revised Lived experiences of women who survived from pre-eclampsia and eclampsia in public hospitals of Shashemene Town, Oromia Region, Ethiopia: a qualitative study. [version 3; peer review: 1 approved, 2 approved with reservations] Negeso Gebeyehu https://orcid.org/0000-0002-8117-8323 1 , Aman Urgessa 1 , Daniel Yohannes https://orcid.org/0000-0002-8214-1581 1 , Aster Yalew 1 , Muluneh Ahmed 2 , Meron Admasu 3 Negeso Gebeyehu https://orcid.org/0000-0002-8117-8323 1 , Aman Urgessa 1 , [...] Daniel Yohannes https://orcid.org/0000-0002-8214-1581 1 , Aster Yalew 1 , Muluneh Ahmed 2 , Meron Admasu 3 PUBLISHED 07 Apr 2025 Author details Author details 1 Midwifery, Madda Walabu University, Shashemene Campus, Shashemene, Oromia, 264, Ethiopia 2 Nursing, Madda Walabu University, Shashemene Campus, Shashemene, Oromia, 264, Ethiopia 3 Nursing, Wachemo University, Durame Campus, Durame, SNNPR, 640, Ethiopia Negeso Gebeyehu Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Software, Writing – Original Draft Preparation Aman Urgessa Roles: Formal Analysis, Supervision, Writing – Review & Editing Daniel Yohannes Roles: Formal Analysis, Funding Acquisition, Supervision, Writing – Review & Editing Aster Yalew Roles: Methodology, Supervision, Writing – Review & Editing Muluneh Ahmed Roles: Investigation, Supervision, Writing – Review & Editing Meron Admasu Roles: Formal Analysis, Investigation, Methodology, Writing – Review & Editing OPEN PEER REVIEW DETAILS REVIEWER STATUS Abstract Objective The main purpose of this study was to explore experiences of women who survived pre-eclampsia and eclampsia in Shashemene referral hospital and Melka Oda general hospital, 2021. Design An institution-based exploratory qualitative study with a descriptive phenomenological study design Setting The present study was conducted in Shashemene referral hospital and Melka Oda general hospital from March 03 to May 18, 2021. Participants A total of 17 individual in-depth interviews (IDIs) were conducted with women who experienced and survived pre-eclampsia and eclampsia. Data were analyzed through thematic analysis using Atlas-ti software. Result The present study revealed that women’s level of awareness on raised blood pressure and or convulsion occurring during pregnancy was poor. Barriers that limit pregnant women from getting treatment at the earliest point included misconception, lack of insight, failure to accept counseling from health care providers, low income, and influence from husbands. Discussions with the women in this study showed that these mothers were not counseled on danger signs during antenatal care check-ups. Almost all of the women were very concerned and frustrated due to their diagnosis. Conclusions Women’s awareness of pre-eclampsia and eclampsia was poor. Improving awareness of hypertensive disorders in pregnancy and enhancing the quality of antenatal care is essential. READ ALL READ LESS Keywords Experiences, preeclampsia, eclampsia, survivors, Shashemene Corresponding Author(s) Negeso Gebeyehu ( [email protected] ) Close Corresponding author: Negeso Gebeyehu Competing interests: No competing interests were disclosed. Grant information: This work was supported by Madda Walabu University (EMU-2/88/667). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Copyright: © 2025 Gebeyehu N et al . 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, provided the original work is properly cited. How to cite: Gebeyehu N, Urgessa A, Yohannes D et al. Lived experiences of women who survived from pre-eclampsia and eclampsia in public hospitals of Shashemene Town, Oromia Region, Ethiopia: a qualitative study. [version 3; peer review: 1 approved, 2 approved with reservations] . F1000Research 2025, 12 :1464 ( https://doi.org/10.12688/f1000research.129648.3 ) First published: 13 Nov 2023, 12 :1464 ( https://doi.org/10.12688/f1000research.129648.1 ) Latest published: 07 Apr 2025, 12 :1464 ( https://doi.org/10.12688/f1000research.129648.3 ) Revised Amendments from Version 2 The authors have edited the article as per the comment given by the reviewer. We have refined the conclusion section. The authors have edited the article as per the comment given by the reviewer. We have refined the conclusion section. See the authors' detailed response to the review by Margaret P. Kasaro READ REVIEWER RESPONSES Strengths and limitations of the present study ▪ As far as our knowledge is concerned, this the first study in Ethiopia investigating the lived experiences of women who have survived pre-eclampsia and eclampsia. ▪ The study design employed which is a qualitative study design enabled a thorough investigation of lived experiences of women who survived pre-eclampsia and eclampsia in public hospitals of Shashemene Town. ▪ The interviews were done in Afan Oromo and Amharic, the participants’ native language; a thorough translation process was used to make sure that no meaning was lost. ▪ Selection bias exists due to the fact that women were recruited only from hospitals. Introduction Pre-eclampsia is a multi-system disorder, specific to pregnancy, that is associated with raised blood pressure (≥140 mmHg/90 mmHg) and proteinuria which usually occurs after 20 weeks of gestation. Eclampsia is one or more convulsions in association with the syndrome of pre-eclampsia. 1 Worldwide, pre-eclampsia complicates 2% to 8% of pregnancies whereas, in resource-poor countries, estimates of the incidence of eclampsia vary from 1/100 to 1/1700 deliveries. 1 Pre-eclampsia and eclampsia are associated with increased complications including placenta abruption, preterm birth, fetal growth restriction acute renal failure cerebrovascular and cardiovascular complications, disseminated intravascular coagulation, and maternal death. 2 Evidence shows that in Sub-Saharan African (SSA) countries, pre-eclampsia and eclampsia are among the top five leading causes of morbidity and mortality of women and neonates. Consequently, SSA countries experience the highest maternal and newborn mortality. 3 , 4 Despite efforts made to reduce maternal mortality in Ethiopia, there is still a high burden of maternal death with pre-eclampsia and eclampsia being major contributing factors. 5 , 6 It is crucial to comprehend the sociocultural and behavioral aspects of pregnant women who have survived preeclampsia and eclampsia. Hence, the findings from this study could be used in designing appropriate interventions in handling bottlenecks related with these women. Early diagnosis and management can help to reduce the dangers of pre-eclampsia and eclampsia and their complications; the majority of deaths related to this condition are avoidable when care is given at the right time. Avoiding delays and hindrances that are currently occurring in diagnosis and management are critical in this regard. 7 To the best of our knowledge, so far, studies have not been conducted to explore experiences of women survived from pre-eclampsia and eclampsia in Ethiopia. Previous studies merely focused on prevalence and factors associated with pre-eclampsia. 8 , 9 Therefore, this study aimed to explore lived experiences of women who survived pre-eclampsia and eclampsia in Shashemene referral hospital and Melka Oda general hospital – the two public hospitals in the town. It identifies the barriers and enabling factors that affect their healthcare-seeking behaviors, and it describes ideas raised by these women to overcome these challenges. Methods Study setting and design An institution-based exploratory qualitative study with a descriptive phenomenological study design was carried out from March 03 to May 18, 2021, at the two public hospitals of Shashemene town: Shashemene referral hospital and Melka Oda general hospital. Shashemene referral hospital is found in Shashemene town which is situated 238 km from Addis Ababa and nine Kms North of Shashemene town and Melka Oda general hospital, which is located in Shashemene town, 250 km away from the capital city, Addis Ababa. Sample size determination The sample size was estimated using previous methodological research 10 conducted on similar topic, the level of information saturation, and the diversity of ideas among the participants. As a result, a total of seventeen individual in-depth interviews (IDIs) were conducted with women who experienced and survived pre-eclampsia and eclampsia. Participants The source populations were all women who suffered and survived from pre-eclampsia and eclampsia and were discharged from the hospitals. The study population encompassed all purposively selected women who suffered and survived from pre-eclampsia and eclampsia and were discharged from the hospitals. Women who suffered and survived from pre-eclampsia and eclampsia and were discharged from the hospital were included in the present study whereas women who were not willing to participate in the study were excluded. Data collection Purposive sampling technique was employed to approach study participants. Individual in-depth interviews (IDIs) were conducted with women who suffered from pre-eclampsia and eclampsia, survived, and were discharged from the hospital. Information on socio-demographic characteristics, pregnancy, delivery, postnatal experiences, antenatal care (ANC), knowledge on pre-eclampsia and eclampsia, and factors that affect care-seeking at individual, household, community, and health systems levels were collected using a semi-structured interview guide. Instruments were pre-tested in Negelle Arsi Primary Hospital by authors to ensure that appropriate questions are being asked and that questions do not make respondents uncomfortable and/or confused because of combining two or more important issues in a single question. The pretest was approved by Institutional Review Board (IRB) of the University. Two people attended each interview; one conducted the interview and the other took field notes. Criterion followed while note taking include but not limited to taking basic information like study tile, PI of the study, season and date of data collection, geographic setting, demographics of the study participants, and setting. To maintain the integrity of the participants; from the very beginning, sufficient information was provided to study participants on the aim of the study, and they were also told that the information they offer will be kept confidential. Semi-structured interview guides used in the present study were taken from a similar study conducted in Nigeria which were validated. 10 Interview guide questions were prepared first in English, then translated to Afan Oromo, and Amharic and translated back to English to check for consistency by expert (health professional) who is familiar with both local languages and English. Thus, a thorough translation process was used to make sure that no meaning was lost. There were no changes made after the translation is made. 40–50 minutes were spent on the interview. Confidentiality was stressed in order to foster a relaxed atmosphere where participants may divulge more personal information and give an in-depth account of their experiences. Open ended questions and probing were used to extract additional information. During the data collection period, supplementary notes were taken through the non-participatory observation technique for non-verbal response and the context of the interview. The tape-recorded audio was checked for completeness and field notes were expanded soon after the end of each interview. To assure the credibility of the study, the data collection process was completed at the data saturation point when no new information was obtained. Both the audio recorder and the field notes were used to collect data, and this enabled cross-checking. NG, AU and DY were data collectors. Due to the fact that non-verbal replies are just as significant as verbal responses, this technique allowed us to ensure credibility of the study. Moreover, to assure dependability, the present study has clearly described the process selection of study participants, the process of data collection procedure, and data analysis in the method section. To maintain transferability, the finding of the data was precisely described with sufficient details, and a thick description of data was provided by the principal investigator and co-investigators. Lastly, to assure conformability, the audio and field note transcripts were compared and contrasted with the final research report so that to ensure consistency with original data. Analysis Data were analyzed by Atlas-ti software by applying thematic analysis. Researchers who want to reproduce our analysis and have no access for Atlas.ti (since Atlas.ti proprietary software) can use Qualcoder which is the best alternative. After listening repetitively to the audio record of individual IDIs, it was then transcribed verbatim into Afan Oromo and Amharic. The Afan Oromo and Amharic transcripts were then translated to the English language for analysis and made it in line with the interviewers’ field notes. The Afan Oromo, Amharic and English data were cross-checked for accuracy and completeness of the translation before analysis. To ensure that the participants’ identities could not be deduced from the transcripts, they were anonymized. All the transcripts were cautiously and repetitively read to become familiar with it. Codes were developed to extract meanings out of texts and were defined based on contained information, and central meaning. DY verified consistency after NG and AU completed the initial code. The researchers have established a consensus regarding the codes and have clarified intercoder discrepancies. Then, codes were taken to build emerging themes. Inductively, the codebook was created while going over the transcripts. The themes were generated in accordance with the study’s aim by summarizing the codes and organizing them into logical groups with descriptive data segments. The findings were displayed as themes along with exact quotes that provided support. The researchers were not instrumental and did not contribute their own viewpoints in any degree of interpretation. The translated primary documents, quotes, codes and interview guide questions are all available in our underlying and extended data. Result Socio-demographic & obstetrics characteristics of participants A total of 17women were participated in this study. The age of participants ranged from 18-35 years (median age: 25 years). The number of children that the women had ranged from one to six. The median age of women at first birth was 19 years. Regarding educational status, three didn’t attend formal education, eight completed primary education, four secondary primary education, one has a diploma, and one has a BSc degree. A total of nine study participants resided in urban while eight resided in rural areas. Sixteen women had attended ANC check-ups during their current pregnancy. A total of four individuals had faced complications in their previous pregnancies. Of the women who had faced complication in their previous pregnancies, three women had pre-eclampsia and eclampsia previously while one woman had experienced antepartum hemorrhage. A total of five women had eclampsia while 12 had pre-eclampsia in the current pregnancy ( Table 1 ). Table 1. Socio-demographic & obstetrics characteristics of participants. Variable Category Frequency (n=17) Percent Age 18-24 7 41.2 25-34 8 47.1 ≥35 1 5.9 I don’t know 1 5.9 Educational status No formal education 3 17.6 Primary education 8 47.1 Secondary education 4 23.5 Diploma 1 5.9 BSc & above 1 5.9 Place of residency Urban 9 52.9 Rural 8 47.1 ANC check-up Yes 16 94.1 No 1 5.9 Previous obstetrics complications Pre-eclampsia & Eclampsia 3 17.6 Antepartum hemorrhage 1 5.9 No history of obstetrics complication 13 76.5 Type of hypertensive disorders in pregnancy currently developed Pre-eclampsia 12 70.6 Eclampsia 5 29.4 Emerged themes The emerged themes in the current study include antenatal care services received and its quality, awareness of raised blood pressure and or convulsion during pregnancy, symptoms experienced, and quality of care received, women’s reaction towards the diagnosis, barriers, and suggestions made by the women to improve health care services received by those who developed pre-eclampsia and eclampsia. Antenatal care service offered and its quality Antenatal care is a maternal healthcare service provided by skilled health professionals to pregnant women. It is provided throughout pregnancy to ensure the best health outcomes for both the mother and neonates. The narratives of the women interviewed showed that blood pressure measurement, urine test, blood test, tetanus toxoid vaccination, and ultrasound were services received at the antenatal care unit. Others, though, disclosed that they were not provided with the aforementioned services. One of the study participants explained the service she received as follows: “…they have measured my BP and weight. I have taken tetanus toxoid vaccination” (Participant 16, 20-year-old woman). Another participant expressed that tablets for anemia and tetanus toxoid vaccination were given at the ANC unit. “They gave me tablets to prevent the occurrence of anemia. They also gave me vaccination here on my arm” (Participant One, 18-year-old woman). Another participant said that only a blood test was done. She expressed that the health professionals simply examined her belly. “They did nothing. They simply examined me with their hands and sent me here (hospital). However, they have tested my blood” (Participant Two, 22-year-old woman). One of the women stated that nothing had been offered to her while she attended ANC check-ups. “They didn’t do a urine test and also not measured my blood pressure” (Participant 5, 35-year-old woman). Counseling about danger signs is so vital issue that will enable pregnant women to come to a health facility at the earliest point when they develop the symptoms. Hence, complications can be reduced significantly. 10 In this regard, most of the women said that they were not counseled for danger signs while they attend ANC check-ups during their current pregnancy. “They didn’t tell me these signs [danger signs]. I went for check-ups because I have some headaches. What enabled me to go to the health facility early was the experience I had during the last pregnancy. Unfortunately, they told me that it was common cold & come back home. I went to the health facility because I have fear that some complications might happen. This fear was due to complications that occurred during the last pregnancy. Nobody told me these danger signs” (Participant One, 18-year-old woman). Another participant also shares the above experience in which she said that she wasn’t told the danger signs in detail. “They did not inform me that [danger sign]. They didn’t tell me in in detail. They simply told me to come back” (Participant 3, 18-year-old woman). One of the study participants who developed eclampsia said that the health professional had not counseled her on danger signs. “They informed me nothing. I even asked the doctor if I come back for the check-up. The doctor told me that there is no need to come back. He (doctor) told me even I can give birth with no complication” (Participant Four, 30-year-old woman). The other participant expressed that one should go repeatedly to receive counseling on danger sign “The health professionals have informed me nothing. But, to have such information one should go repeatedly. I went only once and therefore I didn’t get the chance of receiving such counseling” (Participant Five, 35-year-old woman). Similarly, the other woman stated that she got the information from her previous experience. However, she said that she is not counseled during her current pregnancy. “They didn’t inform me this at all. I had this information during my first pregnancy. Because I suspected hypertension, I was the one who insist to check my BP. When I told them, I have suspected hypertension in the current pregnancy because I had it before, they overlooked my concern and said you will not develop hypertension for you had it in the past” (Participant Seven, 25-year-old woman). Another woman stated that she has received counseling on danger signs. She listed the danger signs she was counseled on. “Yes, they have informed me…… Bleeding through the vagina before childbirth and also the passage of white discharge before the birth of the baby. They told me to come to the health facility as soon as possible if I see these signs” (Participant Six, 17 year-old woman). One participant also stated that she was counseled for danger signs, and she has also listed the signs. “Yes, they have informed me. For instance, if the baby is not moving well, its weight is increasing rapidly, swelling of the body, they told me to come to a health facility as early as possible” (Participant 13, 29 year-old woman). Women were requested to give opinions on the quality of antenatal care services they received. One woman stated that the health professional didn’t evaluate her thoroughly and they “disrespected” her. “All professionals here (at the hospital) disrespected me. They didn’t evaluate me thoroughly. They didn’t serve patients properly” (Participant 13, 29 year-old woman). Participant 16 also raised that the health professionals have no extensive experience and said they don’t treat mothers with respect. She also mentioned a lack of ultrasound equipment as a significant problem. “The shortcomings are: the facility is not neat, the doctors have no experience, and they didn’t treat mothers with respect, they don’t have an ultrasound. Ultrasound is available everywhere even at the level of kebeles [Kebele is the lowest administrative unit as per the context of study setting]. So, the lack of ultrasound is a significant problem. Health professionals working at the delivery unit are better in terms of the experience they have and the respectful care they provide. Health professionals working at the ANC unit disrespect women. They have no extensive experience. I am not happy with their work” (Participant 16, 20-year-old woman). One of the study participants stated that the health professional working at the antenatal care clinic didn’t inform her as her blood pressure increased. “There (at ANC), they have checked my blood pressure. But they didn’t inform me that my BP is increasing and the stage of the disease. Otherwise, they have checked me thoroughly” (Participant 13, 29-year-old woman). One other participant shares a similar idea to the above, in which she stated that the health professional didn’t inform her as her blood pressure was rising. “They did give me drugs. They did not inform me that my blood pressure is rising. When I come back in the third month, they told me that I had raised blood pressure. I was shocked at that moment. Finally, they transferred me to labour ward” (Participant 11, 25-year-old woman). One of the women said that the lack of ultrasound was the shortcoming she noticed. “The shortcoming is lack of ultrasound. They didn’t check me by ultrasound [at the health center]. Here [at hospital], they checked by ultrasound and said the baby have malformation on its head. Here [at hospital], they said why you just stayed all these seven months. If they had an ultrasound, I wouldn’t have stayed all these months. So, the shortcoming is lack of ultrasound” (Participant Seven, 25-year-old woman). However, one of the women stated that she received the right ANC check-up. “They had given me the right service. They told me that the gestational age is seven months and two weeks in line with the information here (hospital)” (Participant Five, 35-year-old woman). Symptoms experienced and quality of care received Study participants developed a wide range of symptoms including headaches, heartburn, loss of consciousness, epigastric pain, blurring of vision, fever, swelling face, and feet. One of the study participants said she had a headache and blurring of vision. “I had a headache. I had also “qaanqee” before the headache [qaanqee is local Afan Oromo language term which means a blurring of vision]. I feel as if something has blown into my eyes. I had this symptom occasionally” (Participant One, 27-year-old woman). This participant also stated that she had lost consciousness. She remembered the moment as follows: “During that time, I was sleeping. During the early morning I lost my consciousness. My families brought me here tell me that I have oral secretions. I came here by ambulance and finally gave birth” (Participant One, 27-year-old woman). Another participant stated that she was experiencing epigastric pain and blurring of vision. This woman also lost her consciousness. “I had epigastric pain. After a moment, I developed a blurring of vision. Even before I had blurring of vision, I felt like seeing an object in a mirror. After I experienced these symptoms, I came here……. I lost my consciousness right after I arrived here” (Participant Four, 30 year-old woman). One of the women stated that she has developed fever, swelling face, and feet. “I had a headache from the moment I develop fever and swelling of face and feet. The health professional told me that the swelling of feet has no significant impact and be vigilant on the swelling of face” (Participant Five, 35-year-old woman). The other woman said that she developed fever, her feet swollen, and had heartburn. “I went there (health center) because I have an appointment. However, I had a fever. When I splash water on my body, it will be resolved. But, a few minutes later, it will start. My feet were swollen, and I had also heartburn. Then, I requested them to check my BP. When they check it, it was very high. Finally, they referred me to this hospital” (Participant Seven, 25-year-old woman). However, one of the study participants said that she had no symptoms at all. I don’t have these symptoms [blurring of vision, raised BP, headache] at all. They told me to watch these symptoms. I am waiting for these symptoms. But no such symptoms till now. If they told me I have raised blood pressure, my option is to accept their opinion (Participant 13, 29-year-old woman). Study participants expressed the treatment they received after they arrived at the hospital. One of the women stated that health professionals were following her closely and administered drugs. “They are following me closely and giving me drugs” (Participant 12, 27 year-old woman). Other participants also stated satisfaction with the care given. “I am satisfied with the care given” (Participant Eight, 30-year-old woman). Another study participant expressed that she received satisfactory care. “Well, I have received satisfactory care here. They saved my life here with the help of God. The health professionals here saved my life with the help of God, and I am so excited” (Participant Four, 30-year-old woman). The other participant stated that her symptoms resolved after she received treatment at a hospital. Right after they gave me injections, I am fine. I have taken also pills and my headaches are gone (Participant Six, 24-year-old woman). Women’s reaction after informed of the diagnosis Different reactions were observed when women were told they have hypertension. Several women were shocked, frustrated, anxious, and depressed when they heard their diagnosis. One of the women stated that she was shocked when she was told she had raised blood pressure. “I was very shocked. I was having headache & blurring of vision at that moment. I was much stressed. Yesterday, they brought me here because I was very sick. But God gave me this child” (Participant 10, 20-year-old woman). The other woman was also concerned when they told her she has hypertension. “I said to myself, are they again to terminate this pregnancy as before? I was shocked and disturbed. When they saw me as I am very worried, they counseled me not to be worried and told me that the baby will be born soon. They told me that the pregnancy has to be terminated. By counseling me thoroughly, they calm me” (Participant 11, 25-year-old woman). The other study participant also said that she was concerned when they tell her she has hypertension. Besides, she said hypertension is so dangerous. “I know that raised blood pressure is dangerous. I was concerned. Then, I calmed down when they gave me drugs and told me that my BP is dropping” (Participant 13, 29-year-old woman). One of the women expressed that it is so difficult to have raised blood pressure and it will also result in depression. It’s so difficult to have raised blood pressure. The headache and swelling are so difficult. It will result in depression (Participant 17, 22-year-old woman). Women’s awareness of hypertensive disorders occurring during pregnancy Women’s level of awareness on raised blood pressure and or convulsion occurring during pregnancy was modest and poor. Most of the women (82.35%) were not aware that pregnant women may suffer from raised blood pressure and convulsions. One of the women said she hadn’t heard of raised blood pressure in pregnant women. “I didn’t hear this raised blood pressure on pregnant women. This raised blood pressure occurs in mothers who stopped giving birth. I heard when neighbors say this woman has hypertension. But I didn’t see a pregnant woman who suffered & died from raised blood pressure. This raised blood pressure usually occurs in mothers who stopped giving birth. We need to restrain from consuming meals with high salt, black coffee, and stress. I didn’t see a pregnant woman who suffered from raised blood pressure” (Participant Eight, 30-year-old woman). Many of the other study participants didn’t know about raised blood pressure and convulsion occurring during pregnancy. “…I don’t know” (Participant 11, 25-year-old woman). However, one of the study participants mentioned the symptoms of raised blood pressure. “They said women who have raised blood pressure can’t stand, have headache on one side and blurring of vision. But I have not experienced this problem previously” (Participant 15, 26 year-old woman). Most of the women stated that raised blood pressure can cause maternal and fetal death. One of the women said that if raised blood pressure is left untreated it will cause hypertension and cardiac disease in the long run. “She [the mother] may develop hypertension and cardiac disease later on. The baby weight might be low and can be exposed for different diseases. Even they [both the mother & baby] might die” (Participant 16, 20-year-old woman). One of the study participants expressed that the effect of raised blood pressure and convulsion may escalate to the level of death “…to the extent of death” (Participant 15, 26-year-old woman). One of the women said that staying at home may cause death. “They need to check their blood pressure at a health center or a private clinic. If they simply stayed home, they may die. In the rural, they say it’s “Daataa” [A Local Afan Oromo Language which means blood which shaded during childbirth] and encourage women to stay home” (Participant 3, 18-year-old woman). Other women didn’t know the fate of a woman who was left untreated for raised blood pressure and/or convulsion. “I don’t know what happens to these women” (Participant 8, 30-year-old woman). Barriers to receiving treatments from health facilities Study participants listed a wide range of barriers that limit pregnant women who developed raised blood pressure and or convulsion from getting treatment at the earliest point. These include misconception, lack of knowledge, fear of keeping children at home alone, low income, unsupportive husband, criticizing & blaming, and failure to be counseled by healthcare providers. Misconceptions Women’s narratives suggested the presence of misconception in society on hypertensive disorders occurring during pregnancy. For instance, swelling of the face & feet during pregnancy is thought to be normal. They believe that blood is accumulated in the face & feet till childbirth, and hence they are swollen. According to the local language, this process is termed “Daataa”. The other misconception which was mentioned by the women was dryness of the head a responsible phenomenon for headache. Women also mentioned that these kinds of misconceptions are very risky as they may cost their lives. One of the women stated this as follows: “They [some of the women] believe that swellings of face & feet are a normal event. These swellings occur during the stage of childbirth. Until childbirth, the blood stays in the feet and face, and they name it “Daataa”. People in rural areas believe that severe headache is due to dryness of the head. Because of these, misconception among mothers will cost their lives. It is very important to check blood pressure. Not only mothers, but it will also be better if all individuals check their blood pressure. If you take my situation, firstly, I came here for leakage of fluid. However, as days passed, I developed raised blood pressure. So, if I were at home, I would have missed the opportunity of knowing of the problem” (Participant Eight, 30-year-old woman). The other woman also shares the idea of the above mother. “There is a misconception in the society. For instance, when I suffered from hypertension during the last pregnancy, my face and legs were swollen. Society perceives that the swollen face and legs are due to blood during pregnancy. They told me it was “daataa” and that’s why you are gaining weight” (Participant One, 27-year-old woman). Lack of knowledge Women reported a lack of knowledge to be the barrier to receiving adequate care. Sufficient knowledge of pre-eclampsia & eclampsia contributes significantly to its prevention, management, and treatment. Knowledge of the patient’s illness has significant benefits in terms of treatment compliance and helps reduce illness-related complications. One of the women said that lack of knowledge is a barrier to not getting early treatment. “It’s lack of knowledge. If she has sufficient knowledge on hypertension, she will go to a facility to get the necessary treatment. Nobody wants to suffer from disease” (Participant Five, 35-year-old woman). The other woman also supported the above idea. “It’s lack of insight. If you lack insight, you will face complications” (Participant Nine, 20-year-old woman). One of the women said that lack of insight and failure to accept counseling of health professionals are factors that limit women. “I think it is because they have no insight and failure to accept counseling from health professionals” (Participant 11, 25-year-old woman). The other study participant shared a similar idea and additionally stated that there is criticizing and blaming. “Lack of insight on this issue. Some mothers might say rather than going to a health facility it is better to gather information from women in the community. This is because they lack knowledge. There is also criticizing and blaming each other” (Participant 16, 20-year-old woman). Poor financial status and an unsupportive spouse Women mentioned a lack of husband support to be responsible for not getting treatment. Men’s role as a major decision-maker and a major supplier of economic resources in developing countries can strongly influence wives’ choices in health-seeking behavior. Husbands may limit the mothers from getting treatment. Women described a financial barrier as a factor for not getting treatment. This is also related to the lack of support from her husband. One of the mothers stated that fear of keeping children alone at home, lack of husband support and low-income limits women from getting treatments “If they have children, they believe that if they come to health facility their children at home will not be safe. Husbands might limit the woman from going to health facilities by telling her she is normal. There is a husband that limits his wife from using family planning. They didn’t come even for ANC check-ups unless they get permission from their husband. Their income will also limit them. She might not have money even for transport and other expenses. I think these are the reasons” (Participant 13, 29-year-old woman). Suggested advice for mothers, families, and health facilities Study participants forwarded plenty of ideas on the way that pregnant mothers suffering from raised blood pressure and convulsion can access and receive sufficient treatment at the earliest point. These include ANC check-ups regularly, counseling & encouraging mothers, coming to a hospital at the earliest point, husband support, receiving advice only from health professionals, support from families and health professionals, and arranging referrals for the complicated cases. One of the study participants said that mothers should go regularly for ANC check-ups, and the need to counsel, inform, and encourage mothers. “The mother should go regularly for ANC check-up. We [other community members] need to inform, counsel, and encourage mothers to come to a health facility. The government and families should encourage the mothers to visit health facilities when they develop symptoms related to hypertension or other health problems” (Participant One, 27-year-old woman). The other study participants also said mothers should come to a hospital at the earliest point and families and health professionals should help them. “If she didn’t lose her consciousness, she needs to say bring me to hospital. She needs to come to the hospital earlier. It’s really difficult if her family didn’t encourage and support her [women]. That will be good if she lacks interest than if they lack interest in going to a health facility. They need to treat mothers. They need to give drugs on time” (Participant 10, 20-year-old woman). Another mother also shared a similar idea with the above study participants. “Firstly, mothers need to get ANC check-ups. They need to have regular ANC check-ups. They will know their status when they have ANC check-ups. Besides, their families need to support them. Families need to counsel them to avoid worry. Families need to encourage her and fulfill all required things. Health facilities need to provide all necessary treatments. They need to provide required treatment” (Participant 13, 29-year-old woman). Similarly, the other mother said that health facilities should refer cases beyond their capacity. “Health facilities need to treat the mothers. However, if it is beyond their capacity, they need to transfer the mother to the best set-up” (Participant 15, 26-year-old woman). One of the study participants also raised husbands should support their wives and mothers should receive information from health care providers. “Every husband, whether educated or uneducated, needs to support his wife. Mothers should receive information from health professionals. The doctors need to respect and give due attention for the baby for we don’t know the destiny of that baby” (Participant 16, 20-year-old woman). Discussion The current study explored the experiences of women who suffered and survived pre-eclampsia and eclampsia in the public hospitals of Shashemene Town, within the Oromia Region, of Ethiopia. The emerged themes in the current study include antenatal care services received and their quality, awareness on raised blood pressure and or convulsion during pregnancy, symptoms experienced, and quality of care received, women’s reaction towards the diagnosis, barriers, and suggested advice to improve health care services received by women who developed pre-eclampsia and eclampsia. Counseling received during antenatal care is one of the most significant markers of quality services for antenatal care. Women’s narratives in this regard showed that during their antenatal check-ups for the current pregnancy, they did not get counseling. According to Hutchinson, women in their study received inadequate preeclampsia education throughout the antenatal period, and they believed that this was a significant factor in the delays that women with preeclmapsia had when trying to get treatment for their disease. 11 The present study showed that women’s level of awareness on raised blood pressure and or convulsion occurring during pregnancy was modest and poor. Most of the women were not aware that pregnant women may suffer from raised blood pressure and convulsion. The current finding is in line with the study conducted in Brazil by Lima de Souza N et al . which revealed unawareness of women about eclampsia during prenatal care. They only became aware after hospitalization or by the imminent premature delivery. 9 This finding is in line with a study carried out in Nigeria where only a few study participants associate eclampsia with raised blood pressure. 12 , 13 Similarly, the finding is consistent with the study conducted in Ghana which reported a high prevalence of inadequate knowledge of pre-eclampsia among the pregnant study population. 14 Women’s naratives in the present study revealed that raised blood pressure can cause maternal and fetal death. This finding is consistent with the study done in Southwestern Uganda which showed that participants were aware of the potential consequences of the symptoms of eclampsia and mentioned that the condition could lead to the death of the baby in utero or even the mother. 15 Similarly, the present study is in line with the study done in India in which study participants mentioned the most serious and most commonly cited consequences of hypertension or seizures in pregnancy to be the death of the mother and/or infant. 16 Participating women’s narratives in the present study revealed that mothers might not have money even for transport and other expenses. This was one of the factors that limit pregnant women who developed pre-eclampsia and eclampsia from accessing and getting treatment from health facilities. This finding is supported by the recent study carried out among survivors of pre-eclampsia and eclampsia in which financial barriers affected access to transportation and affordability of health services or medicines. 16 Women also mentioned misconception as a barrier for not getting treatment at the earliest point. They stated that swelling of the face & feet during pregnancy is thought to be normal within socio-cultural context. They believe that blood is accumulated in the face & feet till childbirth, and hence they are swollen. Similarly, in a study conducted in Nigeria, it was found that spirituality and tradition affected women’s lives profoundly, which has significantly affected care-seeking decisions. 10 Such misconception in society may delay mothers or make them stay at home which may result in life-threatening complications. Women’s discourses in our study also revealed that unsupportive husbands are barriers to not getting treatment. Husbands are mostly the only financial contributor to a family, and thus the single decision-maker in a family. Therefore, if they are uncooperative, they can significantly delay healthcare seeking or forbid the mothers from going to health facilities. This finding is supported by a study carried out in Nigeria 10 & Bangladesh. 17 In the present study, women were often not counseled on danger signs, and, as a result, they didn’t know these signs when they experienced them. Few women mentioned that women who have raised blood pressure can’t stand, have headaches on one side, and blurring of vision. But, in the study carried out in India women reported signs or symptoms of pre-eclampsia were sweating, fatigue, dizziness-unsteadiness, swelling, anger, talking too much, frothing, shaking, eyes rolling upwards, clenching teeth, and tongue biting. 16 Women’s narratives showed that they were very concerned when they were told that they had hypertension, which they described to be so dangerous. Study subjects also expressed that it is difficult to have raised blood pressure and it will also result in depression. The present finding is consistent with the study done in Australia where understandably, women were very concerned about the life-threatening nature of pre-eclampsia and focused their attention on the consequences of pre-eclampsia across different end-organs, including brain, liver, and kidneys. 18 The present study is also in line with the study in which women described that they were afraid of this disease because they thought that not only themselves but also their babies were at risk and even death and also, they had negative emotions and thoughts when suffering pre-eclampsia. Sadness, frustration, or low-spiritedness were their usual emotions. 19 Participating women’s narratives suggested that every husband, whether educated or uneducated, needs to support her to enhance access to health care services. Besides, they described the importance of support from families & society as a key tactic for mitigating complications from pre-eclampsia & eclampsia. This finding is in line with the study done in Nigeria which showed that engaging in discussions with family and communities emerged as a critical cue to action as these groups often provide instrumental support in women’s ANC and delivery care-seeking. 10 Women’s naratives suggested the importance of regular ANC check-ups to avert complications of pre-eclampsia and eclampsia. ANC allows early detection & management of complications. They also mentioned the importance of counseling on danger signs of pregnancy during ANC check-ups. This finding is supported by a study conducted in Indonesia which revealed that antenatal care visits affect early detection of pre-eclampsia, and pregnant women who regularly make antenatal visits can prevent possible dangers of pregnancy as early as possible. 20 Conclusion The current study showed that women lacked adequate knowledge about preeclampsia and eclampsia. Besides, misconceptions about the disease, failure to get counselling on danger signs of pregnancy, not getting standard ANC and being scared and frustrated about the disease are some of issues experienced by the women. It is crucial to raise community leaders’ and health extension workers’ awareness of hypertensive disorders in pregnancy, improve the standard of ANC checkups, and increase the counseling services offered to women attending antenatal care regarding pregnancy danger signs. Encouraging husbands to involve in the care of their wives is also invaluable. The community, families & health care providers are expected to provide all the required support & care for women with pre-eclampsia & eclampsia. Ethical considerations Ethical approval was taken from Madda Walabu University, Shashemene campus, research, and community service coordinating office (reference number: R/C/S/T/T/014/13). Formal letters were obtained from officials of respective hospitals. In addition, informed verbal consent was obtained from study participants because the study participants were uneducated, and this was approved by Institutional Review Board (IRB) of the University. The consent form were translated in to local language and data collector read out for the respondents and took consent before commencing data collection. The consent was narrated to the participants and their responses were tape-recorded. Respondents were notified about their right to refuse or terminate at any point of the interview. The information that was provided by each respondent was kept confidential. All personal identifiers were removed from transcripts and quoted texts. In addition, the Institutional Review Board (IRB) of the University approved the pre-testing of the instruments at Negelle Arsi Primary Hospital and protected the rights of the study participants. Data availability Zenodo: Lived experiences of women who survived from pre-eclampsia and eclampsia in Public Hospitals of Shashemene Town, Oromia Region, Ethiopia: a qualitative study, https://doi.org/10.5281/zenodo.7576222 . 21 This project contains the following underlying data: - Negeso project.atlcb (which contains primary translated document, quotes and codes) This project contains the following extended data: - S1 Interview Guide Question.docx. Data are available under license Creative Commons Attribution 4.0 International (CC BY 4.0). Acknowledgments We want to express our profound gratitude to respondents, officials from respective health facilities without whom this research work would not have been possible. References 1. Gestational Hypertension and Preeclampsia: ACOG Practice Bulletin, Number 222. Obstet. Gynecol. 2020; 135 (6): e237–e260. Publisher Full Text 2. Portelli M, Baron B: Clinical Presentation of Pre-eclampsia and the Diagnostic Value of Proteins and their Methylation Products as Biomarkers in Pregnant Women with Pre-eclampsia and Their newborns. Hindawi: J. Pregnancy. 2018; 2018 : 1–23. Publisher Full Text 3. Alkema L, Chou D, Hogan D, et al. : Global, regional and national levels and trends in maternal mortality between 1990 and 2015, With Scenario-based projections to 2030: a systematic analysis by UN Maternal Mortality Estimation Inter-Agency Group. Lancet. 2016; 387 : 462–474. PubMed Abstract | Publisher Full Text | Free Full Text 4. CSA: Central Statistical Agency. Ethiopian Demographic and Health Survey. Ethiopia: Addis Ababa; 2016. Reference Source 5. Gym A, Bailey P, Pearson L, et al. : Disease burden due to pre-eclampsia/eclampsia and the Ethiopian health system’s response. Int. J. Gynaecol. Obstet. 2011; 115 : 112–116. PubMed Abstract | Publisher Full Text 6. Maternity World Wide: The Three Delays Model and Our Integrated Approach.2014. Reference Source 7. Belay AS, Wudad T: Prevalence and associated factors of pre-eclampsia among pregnant women attending anti-natal care at Mettu Karl referral hospital, Ethiopia: cross-sectional study. BMC Clinical. Hypertension. 2019; 25 (14). Publisher Full Text 8. Tessema GA, Tekeste A, Ayele TA: Pre-eclampsia and associated factors among pregnant women attending antenatal care in Dessie referral hospital, Northeast Ethiopia: a hospital-based study. BMC Pregnancy Childbirth. 2015; 15 (73): 73. PubMed Abstract | Publisher Full Text | Free Full Text 9. Lima de Souza N, Fernandes Araújo AC, Dantas de Azevedo G, et al. : Percepção materna com o nascimento prematuro e vivência da gravidez com pré-eclampsia [Maternal perception of premature birth and the experience of pre-eclampsia pregnancy]. Rev. Saude Publica. 2007 Oct; 41 (5): 704–710. Publisher Full Text 10. Sripad P, Kirk K, Adoyi G, et al. : Exploring survivor perceptions of pre-eclampsia and eclampsia in Nigeria through the health belief model. BMC Pregnancy Childbirth. 2019; 19 : 1–11. Publisher Full Text 11. Hutchinson K: Identifying behavioral, demographic and clinical risk factors for delayed access to emergency obstetrical care in preeclamptic women in Port au Prince, Haiti (Publication number 10193363) [Doctoral dissertation, Boston University School of Public Health]: ProQuest LLC; 2016. 12. Assaf S: Counseling and Knowledge of Danger Signs of Pregnancy Complications in Haiti, Malawi, and Senegal. Matern. Child Health J. 2018 Nov; 22 (11): 1659–1667. PubMed Abstract | Publisher Full Text | Free Full Text 13. Adamu AN, Tunau K, Hassan M, et al. : The perception of patients’ relations on the cause of Eclampsia. Gynecol. Obstet. 2014; 04 : 1–4. Publisher Full Text 14. Fondjo LA, Boamah VE, Fierti A, et al. : Knowledge of pre-eclampsia and its associated factors among pregnant women: a possible link to reduce related adverse outcomes. BMC Pregnancy Childbirth. 2019; 19 : 1–8. Publisher Full Text 15. Nabulo H, Ruzaaza G, Mugabi F, et al. : Perceptions on pre-eclampsia and eclampsia among older women in rural southwestern Uganda. BMC. Reprod. Health. 2020; 20. 16. Vidler M, Charantimath U, Katageri G, et al. : Community perceptions of pre-eclampsia in rural Karnataka State, India: a qualitative study. Reprod. Health. 2016; 13 (Suppl 1): 35. PubMed Abstract | Publisher Full Text | Free Full Text 17. Dempsey A, Sripad P, Sultana K, et al. : Pathways to service access for pre-eclampsia and eclampsia in rural Bangladesh: Exploring women’s care-seeking. PLoS One. 2021; 16 (2): e0245371. PubMed Abstract | Publisher Full Text | Free Full Text 18. Duffy J, Thompson T, Hinton L, et al. : What outcomes should researchers select, collect and report in pre-eclampsia research? A qualitative study exploring the views of women with lived experience of pre-eclampsia. BJOG. 2019; 126 : 637–646. PubMed Abstract | Publisher Full Text 19. Værland IE, Vevatne K, Brinchmann BS: Mothers’ experiences of having a premature infant due to pre-eclampsia. Scand. J. Caring Sci. 2017; 23 : 1–8. 20. Fadilah DR, Devy SR: Antenatal Care Visits and Early Detection of Pre-eclampsia among Pregnant Women. Int. J. Public Health Sci. 2018; 7 (4): 248–253. 21. Gebeyehu N, Urgessa A, Yohannes D, et al. : Zenodo: Lived experiences of women who survived from pre-eclampsia and eclampsia in Public Hospitals of Shashemene Town, Oromia Region, Ethiopia: a qualitative study. Publisher Full Text Comments on this article Comments (0) Version 3 VERSION 3 PUBLISHED 13 Nov 2023 ADD YOUR COMMENT Comment Author details Author details 1 Midwifery, Madda Walabu University, Shashemene Campus, Shashemene, Oromia, 264, Ethiopia 2 Nursing, Madda Walabu University, Shashemene Campus, Shashemene, Oromia, 264, Ethiopia 3 Nursing, Wachemo University, Durame Campus, Durame, SNNPR, 640, Ethiopia Negeso Gebeyehu Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Software, Writing – Original Draft Preparation Aman Urgessa Roles: Formal Analysis, Supervision, Writing – Review & Editing Daniel Yohannes Roles: Formal Analysis, Funding Acquisition, Supervision, Writing – Review & Editing Aster Yalew Roles: Methodology, Supervision, Writing – Review & Editing Muluneh Ahmed Roles: Investigation, Supervision, Writing – Review & Editing Meron Admasu Roles: Formal Analysis, Investigation, Methodology, Writing – Review & Editing Competing interests No competing interests were disclosed. Grant information This work was supported by Madda Walabu University (EMU-2/88/667). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Article Versions (3) version 3 Revised Published: 07 Apr 2025, 12:1464 https://doi.org/10.12688/f1000research.129648.3 version 2 Revised Published: 30 Aug 2024, 12:1464 https://doi.org/10.12688/f1000research.129648.2 version 1 Published: 13 Nov 2023, 12:1464 https://doi.org/10.12688/f1000research.129648.1 Copyright © 2025 Gebeyehu N et al . 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, provided the original work is properly cited. Download Export To Sciwheel Bibtex EndNote ProCite Ref. Manager (RIS) Sente metrics Views Downloads F1000Research - - PubMed Central info_outline Data from PMC are received and updated monthly. - - Citations open_in_new 0 open_in_new 0 open_in_new SEE MORE DETAILS CITE how to cite this article Gebeyehu N, Urgessa A, Yohannes D et al. Lived experiences of women who survived from pre-eclampsia and eclampsia in public hospitals of Shashemene Town, Oromia Region, Ethiopia: a qualitative study. [version 3; peer review: 1 approved, 2 approved with reservations] . F1000Research 2025, 12 :1464 ( https://doi.org/10.12688/f1000research.129648.3 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS track receive updates on this article Track an article to receive email alerts on any updates to this article. TRACK THIS ARTICLE Share Open Peer Review Current Reviewer Status: ? Key to Reviewer Statuses VIEW HIDE Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Version 3 VERSION 3 PUBLISHED 07 Apr 2025 Revised Views 0 Cite How to cite this report: Bernstein I. Reviewer Report For: Lived experiences of women who survived from pre-eclampsia and eclampsia in public hospitals of Shashemene Town, Oromia Region, Ethiopia: a qualitative study. [version 3; peer review: 1 approved, 2 approved with reservations] . F1000Research 2025, 12 :1464 ( https://doi.org/10.5256/f1000research.180022.r382244 ) The direct URL for this report is: https://f1000research.com/articles/12-1464/v3#referee-response-382244 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 03 Jun 2025 Ira Bernstein , University of Vermont, Burlington, Vermont, USA Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.180022.r382244 This study by Gebeyehu et al is a descriptive study performed via purposive sampling to preeclampsia/eclampsia patients in Ethiopia to explore their experience, understanding, and barriers to care for their pregnancy complication. This is an important study ... Continue reading READ ALL This study by Gebeyehu et al is a descriptive study performed via purposive sampling to preeclampsia/eclampsia patients in Ethiopia to explore their experience, understanding, and barriers to care for their pregnancy complication. This is an important study that examines factors that greatly influence patient outcomes, both short- and long-term after complex pregnancies. The study design is appropriate, including 17 women, 12 with preeclampsia and 5 with eclampsia, cared for in two hospitals who underwent individual interviews, as adapted from a prior study also conducted in Africa. Responses were coded by 3 reviewers using both verbal data via audio recording and non-verbal responses as noted during the interview, with additional review for conformability. The data from patient narratives highlighted a need for improvement in education on and routine assessment for signs/symptoms of HTN in pregnancy, education at time or and after patients' diagnoses, a lack of trust in the provider-patient relationship, and a need for self-advocacy to receive appropriate care. Barriers to treatment were appropriately highlighted, emphasizing areas for improvement which would likely influence rate/timeliness of seeking and accessing care among the patient population examined. I am impressed by the authors' pursuit of understanding such a fraught and important topic from the patient perspective. I do believe their findings are of interest for dissemination. I would recommend additional revision, perhaps by a native English speaker, both to improve grammar and ensure appropriate utilization of medical phrases in the article prose and interview translations to English. For example, a "termination" was referred to under "Women's reaction after informed of the diagnosis" though it seems this was referring to a delivery of a preterm infant rather than ending a pregnancy with the intention not to deliver a viable infant. An expansion in the number of subjects could highlight if dominant and recurrent specific issues in clinical care could be addressed. am not clear how a sample size determination in made for qualitative data? Perhaps this section could be expanded It would be of value to have a more detailed outline of the prenatal care environment (ANC) for these subjects i.e. frequency of visits, training of the prenatal care providers, location of visits? Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Partly Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? Not applicable Are all the source data underlying the results available to ensure full reproducibility? Partly Are the conclusions drawn adequately supported by the results? Partly Competing Interests: No competing interests were disclosed. Reviewer Expertise: Preeclampsia physiology and prepregnancy predisposition, Preeclampsia follow-up and cardiometabolic risk I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Bernstein I. Reviewer Report For: Lived experiences of women who survived from pre-eclampsia and eclampsia in public hospitals of Shashemene Town, Oromia Region, Ethiopia: a qualitative study. [version 3; peer review: 1 approved, 2 approved with reservations] . F1000Research 2025, 12 :1464 ( https://doi.org/10.5256/f1000research.180022.r382244 ) The direct URL for this report is: https://f1000research.com/articles/12-1464/v3#referee-response-382244 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Version 2 VERSION 2 PUBLISHED 30 Aug 2024 Revised Views 0 Cite How to cite this report: Kasaro MP. Reviewer Report For: Lived experiences of women who survived from pre-eclampsia and eclampsia in public hospitals of Shashemene Town, Oromia Region, Ethiopia: a qualitative study. [version 3; peer review: 1 approved, 2 approved with reservations] . F1000Research 2025, 12 :1464 ( https://doi.org/10.5256/f1000research.170549.r319023 ) The direct URL for this report is: https://f1000research.com/articles/12-1464/v2#referee-response-319023 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 19 Sep 2024 Margaret P. Kasaro , Division of Global Women's Health, Department of Obstetrics and Gynecology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.170549.r319023 I have reviewed the revised version of the paper and happy with the progress so far. There however may still be need to for further revision eg: Conclusion in abstract could be edited to not imply that quality of ... Continue reading READ ALL I have reviewed the revised version of the paper and happy with the progress so far. There however may still be need to for further revision eg: Conclusion in abstract could be edited to not imply that quality of care is poor but that it was reported so The data collection section of methodology still has details that may not need to be in the final write up: Pretesting details Line 2 in paragraph 3 of data collection could be deleted Data collection details Transcription details Consider if the last paragraph in data collection is needed Conclusion is still too long and not summarised to deliver message effectively In general review for English usage may be beneficial Competing Interests: No competing interests were disclosed. Reviewer Expertise: Women's healthHmaternal and child health I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Kasaro MP. Reviewer Report For: Lived experiences of women who survived from pre-eclampsia and eclampsia in public hospitals of Shashemene Town, Oromia Region, Ethiopia: a qualitative study. [version 3; peer review: 1 approved, 2 approved with reservations] . F1000Research 2025, 12 :1464 ( https://doi.org/10.5256/f1000research.170549.r319023 ) The direct URL for this report is: https://f1000research.com/articles/12-1464/v2#referee-response-319023 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Author Response 07 Apr 2025 Negeso Gejo , Midwifery, Madda Walabu University, Shashemene Campus, Shashemene, 264, Ethiopia 07 Apr 2025 Author Response Responses to Reviewer: We would like to appreciate Margaret P. Kasaro, for reviewing the second version of the article. We would like to extend our gratitude her constructive comments and ... Continue reading Responses to Reviewer: We would like to appreciate Margaret P. Kasaro, for reviewing the second version of the article. We would like to extend our gratitude her constructive comments and presented our point by point responses as follows: Comment 1: Conclusion in abstract could be edited to not imply that quality of care is poor but that it was reported so Response: We have refined it as per the comment. Comment 2: The data collection section of methodology still has details that may not need to be in the final write up: Pretesting details: Line 2 in paragraph 3 of data collection could be deleted. Data collection details, Transcription details. Consider if the last paragraph in data collection is needed Response: During the initial process of the review process, editors form journal gave due attention on the methodology section and recommended the authors to write details of methodology section including the data collection process and analysis. That’ why we write up the aforementioned issues in details. It’s known that every scientific paper has to be done as per the standard. Every steps that was gone to ensure the quality of the research has to be clearly written and communicated to the scientific community. Thus, we kindly request the reviewer to consider the above issue. Comment 3: Conclusion is still too long and not summarised to deliver message effectively. Response: We have summarized it as per the comment. Responses to Reviewer: We would like to appreciate Margaret P. Kasaro, for reviewing the second version of the article. We would like to extend our gratitude her constructive comments and presented our point by point responses as follows: Comment 1: Conclusion in abstract could be edited to not imply that quality of care is poor but that it was reported so Response: We have refined it as per the comment. Comment 2: The data collection section of methodology still has details that may not need to be in the final write up: Pretesting details: Line 2 in paragraph 3 of data collection could be deleted. Data collection details, Transcription details. Consider if the last paragraph in data collection is needed Response: During the initial process of the review process, editors form journal gave due attention on the methodology section and recommended the authors to write details of methodology section including the data collection process and analysis. That’ why we write up the aforementioned issues in details. It’s known that every scientific paper has to be done as per the standard. Every steps that was gone to ensure the quality of the research has to be clearly written and communicated to the scientific community. Thus, we kindly request the reviewer to consider the above issue. Comment 3: Conclusion is still too long and not summarised to deliver message effectively. Response: We have summarized it as per the comment. Competing Interests: No competing interests were disclosed. Close Report a concern Respond or Comment COMMENTS ON THIS REPORT Author Response 07 Apr 2025 Negeso Gejo , Midwifery, Madda Walabu University, Shashemene Campus, Shashemene, 264, Ethiopia 07 Apr 2025 Author Response Responses to Reviewer: We would like to appreciate Margaret P. Kasaro, for reviewing the second version of the article. We would like to extend our gratitude her constructive comments and ... Continue reading Responses to Reviewer: We would like to appreciate Margaret P. Kasaro, for reviewing the second version of the article. We would like to extend our gratitude her constructive comments and presented our point by point responses as follows: Comment 1: Conclusion in abstract could be edited to not imply that quality of care is poor but that it was reported so Response: We have refined it as per the comment. Comment 2: The data collection section of methodology still has details that may not need to be in the final write up: Pretesting details: Line 2 in paragraph 3 of data collection could be deleted. Data collection details, Transcription details. Consider if the last paragraph in data collection is needed Response: During the initial process of the review process, editors form journal gave due attention on the methodology section and recommended the authors to write details of methodology section including the data collection process and analysis. That’ why we write up the aforementioned issues in details. It’s known that every scientific paper has to be done as per the standard. Every steps that was gone to ensure the quality of the research has to be clearly written and communicated to the scientific community. Thus, we kindly request the reviewer to consider the above issue. Comment 3: Conclusion is still too long and not summarised to deliver message effectively. Response: We have summarized it as per the comment. Responses to Reviewer: We would like to appreciate Margaret P. Kasaro, for reviewing the second version of the article. We would like to extend our gratitude her constructive comments and presented our point by point responses as follows: Comment 1: Conclusion in abstract could be edited to not imply that quality of care is poor but that it was reported so Response: We have refined it as per the comment. Comment 2: The data collection section of methodology still has details that may not need to be in the final write up: Pretesting details: Line 2 in paragraph 3 of data collection could be deleted. Data collection details, Transcription details. Consider if the last paragraph in data collection is needed Response: During the initial process of the review process, editors form journal gave due attention on the methodology section and recommended the authors to write details of methodology section including the data collection process and analysis. That’ why we write up the aforementioned issues in details. It’s known that every scientific paper has to be done as per the standard. Every steps that was gone to ensure the quality of the research has to be clearly written and communicated to the scientific community. Thus, we kindly request the reviewer to consider the above issue. Comment 3: Conclusion is still too long and not summarised to deliver message effectively. Response: We have summarized it as per the comment. Competing Interests: No competing interests were disclosed. Close Report a concern COMMENT ON THIS REPORT Views 0 Cite How to cite this report: Johansen M. Reviewer Report For: Lived experiences of women who survived from pre-eclampsia and eclampsia in public hospitals of Shashemene Town, Oromia Region, Ethiopia: a qualitative study. [version 3; peer review: 1 approved, 2 approved with reservations] . F1000Research 2025, 12 :1464 ( https://doi.org/10.5256/f1000research.170549.r319024 ) The direct URL for this report is: https://f1000research.com/articles/12-1464/v2#referee-response-319024 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 11 Sep 2024 Marianne Johansen , Department of Obstetrics, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark Approved VIEWS 0 https://doi.org/10.5256/f1000research.170549.r319024 I still believe that this paper needs a thorough proof reading by a native English speaking person. Also some grammar and spelling mistakes exist in the paper. The Methods section is still somewhat unclear and too detailed. ... Continue reading READ ALL I still believe that this paper needs a thorough proof reading by a native English speaking person. Also some grammar and spelling mistakes exist in the paper. The Methods section is still somewhat unclear and too detailed. The reference to the Nigerian study (reference 10) does cover some of the text that could be shortened. Besides, I believe it would be of interest to the reader to know how many women were invited to participate in order to include 17 interviews. In my opinion the manuscript still contains too many repetitions – both regards content and text. Also too many themed quotes are included in the paper not all allowing for new insight. In the “Emerged themes” section the authors write “ One woman”, “Another woman”, “One of the participant”, “the above woman” and many more ways to characterize the participants. I suggest that they use participant numbers instead to simplify. Table 1 is fine Reviewer 1 comment no 4 has not been addressed sufficiently in this revised version of the paper. Good luck with the final revisions of the paper. Competing Interests: No competing interests were disclosed. Reviewer Expertise: Preeclampsia I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Johansen M. Reviewer Report For: Lived experiences of women who survived from pre-eclampsia and eclampsia in public hospitals of Shashemene Town, Oromia Region, Ethiopia: a qualitative study. [version 3; peer review: 1 approved, 2 approved with reservations] . F1000Research 2025, 12 :1464 ( https://doi.org/10.5256/f1000research.170549.r319024 ) The direct URL for this report is: https://f1000research.com/articles/12-1464/v2#referee-response-319024 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Version 1 VERSION 1 PUBLISHED 13 Nov 2023 Views 0 Cite How to cite this report: Kasaro MP. Reviewer Report For: Lived experiences of women who survived from pre-eclampsia and eclampsia in public hospitals of Shashemene Town, Oromia Region, Ethiopia: a qualitative study. [version 3; peer review: 1 approved, 2 approved with reservations] . F1000Research 2025, 12 :1464 ( https://doi.org/10.5256/f1000research.142346.r304794 ) The direct URL for this report is: https://f1000research.com/articles/12-1464/v1#referee-response-304794 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 16 Aug 2024 Margaret P. Kasaro , Division of Global Women's Health, Department of Obstetrics and Gynecology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.142346.r304794 Hypertensive disorders in pregnancy are an important contributor to maternal morbidity and mortality. This is a write up on the experiences of the women who survived preeclampsia and eclampsia for knowledge of symptomatology, antenatal services - information and education on ... Continue reading READ ALL Hypertensive disorders in pregnancy are an important contributor to maternal morbidity and mortality. This is a write up on the experiences of the women who survived preeclampsia and eclampsia for knowledge of symptomatology, antenatal services - information and education on danger signs, referral and management of the disorder. The study has highlighted gaps in the health care delivery as experienced by the women who survived the disorder but in conclusion has not included the implications and recommendations in working towards effective engagement. Here are few comments to consider for the next version of the paper: Strengths and limitations 1.The study design may need to be reconsidered to be mentioned as a strength of there study 2. If the translation process was rigorous to ensure the meaning is not lost in translation, can this point still be a limitation 3. Selection bias exists not exits Introduction 1. Does the use of the words commonly and usually in the definition of Preeclampsia affect the meaning here? 2. Paragraph 2, 3 and 4 are repetitious in the discussion of effects of PE and eclampsia please edit 3. Paragraph 5 there is repeating of a sentence. In editing consider including how data on experiences may be used to reduce the negative effects of the disease Sample size calculation 1. It may not be necessary to explain when to stop sampling plus there is repeating Data collection 1. Please note the repetition of sampling techniques description 2. Naming the staff who were actually doing the data collection should be reserved for an appropriate section 3. Last sentence in paragraph 1 is not clear 4. In paragraph 2 please consider the following: You have described the translation process, is it rigorous not to have information lost in the process? The relationship between confidentiality and discomfort Indicate that open ended questions and probing were used rather that specific questions Is collection to saturation equal to credibility Data collected is collectors In the last sentences - which technique is being referred to for the nonverbal Dependability, transferability and conformability confirm the meaning in this context Analysis Overall consider editing the analysis section to use standard format of reporting qualitative analysis then consider removing the bold in the sentence … translation by PI and co investigators Results Please pay attention to the tenses space between 17 and women In sentence number 2 edit to add bold word as follows - the number of children that the women Themes Quality of care is repeated Please clarify on the suggested pieces of advice ANC Edit the sentence to clarify if each participant reported different care or is it their interpretation that care offered to women varies Last sentence suggested edit - Services that women reported to have received included...… Women requested to give opinions on the quality …. by data collectors may imply the care was provided by the data collectors Women's reactions Consider not explaining what procedure to terminate means Barriers Repeating meaning of daataa Consider rephrasing the unsupportive husbands and low income/advice preamble Discussion Paragraph one summarises the findings well Tackle each theme in order of how presented in paragraph 1 Women's discourse could be edited with synonyms Conclusions Please consider editing the conclusion without repeating results in detail and put in implications and recommendations Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? Yes Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Partly Competing Interests: No competing interests were disclosed. Reviewer Expertise: Women's healthHmaternal and child health I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Kasaro MP. Reviewer Report For: Lived experiences of women who survived from pre-eclampsia and eclampsia in public hospitals of Shashemene Town, Oromia Region, Ethiopia: a qualitative study. [version 3; peer review: 1 approved, 2 approved with reservations] . F1000Research 2025, 12 :1464 ( https://doi.org/10.5256/f1000research.142346.r304794 ) The direct URL for this report is: https://f1000research.com/articles/12-1464/v1#referee-response-304794 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Views 0 Cite How to cite this report: Johansen M. Reviewer Report For: Lived experiences of women who survived from pre-eclampsia and eclampsia in public hospitals of Shashemene Town, Oromia Region, Ethiopia: a qualitative study. [version 3; peer review: 1 approved, 2 approved with reservations] . F1000Research 2025, 12 :1464 ( https://doi.org/10.5256/f1000research.142346.r250739 ) The direct URL for this report is: https://f1000research.com/articles/12-1464/v1#referee-response-250739 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 21 Mar 2024 Marianne Johansen , Department of Obstetrics, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.142346.r250739 This exploratory qualitative study by N Gebeyehu et al on the lived experiences of 17 women who have all experienced preeclampsia or eclampsia in two public Ethiopian hospitals - one general and one referral hospital - is generally an important ... Continue reading READ ALL This exploratory qualitative study by N Gebeyehu et al on the lived experiences of 17 women who have all experienced preeclampsia or eclampsia in two public Ethiopian hospitals - one general and one referral hospital - is generally an important and well conducted study. The authors and investigators address and explore some very important issues on different aspects like levels of awareness of the preeclampsia syndrome in the general population and at a healthcare level in the ANC, misconceptions in the society, barriers to access to healthcare and the the level of quality of counselling and healthcare provided. Importantly, the interviewed women bring suggestions to the table on how healthcare counselling and better access to qualified healthcare may improve the clinical outcome in the region for women suffering from preeclampsia. These are all very essential issues to address in order to better inform healthcare workers on how to improve counselling of women in Ethiopia on preeclampsia and eclampsia; both still potentially severe and life threatening conditions for both mother and child. I would like to commend the authors for addressing this very important topic as preeclampsia and eclampsia is still one of the leading causes of maternal mortality in the Sub-Saharan African countries. However, I have some general and some more specific comments in relation to the submitted paper. General comments: Generally a well written manuscript. However, I find that the manuscript is too long and with many repetitive quotes in the result section. One suggestion would be to put the quotes in themed boxes for each of the respective emerged themes; Antenatal care service offered and its quality, Symptoms experienced and quality of care received, Barriers to receiving treatments from health facilities, Misconceptions, lack of knowledge, Unsupportive husband and low income, and Suggested advice for mothers, families and health facilities. I also suggest that the overall number of quotes appearing in the manuscript is reduced, as several of the quotes are very alike from a thematic perspective. Besides, the manuscript would benefit from a thorough proof reading by a native English speaking person. Specific comments: Women are quoted for saying that access to health care services is lacking. In this context it would be relevant to mention whether prescribed medicine is free of charge? I am curious to know whether women who participated did in any way differ from women who rejected to participate. Also, I would like to know how many women were invited to participate to allow for 17 participants? 5/17 of the participants suffered eclampsia. Is this a normal proportion amongst women with preeclampsia in Ethiopia? Please specify. Is the work clearly and accurately presented and does it cite the current literature? Partly Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? Not applicable Are all the source data underlying the results available to ensure full reproducibility? Partly Are the conclusions drawn adequately supported by the results? Yes Competing Interests: No competing interests were disclosed. Reviewer Expertise: Preeclampsia I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Johansen M. Reviewer Report For: Lived experiences of women who survived from pre-eclampsia and eclampsia in public hospitals of Shashemene Town, Oromia Region, Ethiopia: a qualitative study. [version 3; peer review: 1 approved, 2 approved with reservations] . F1000Research 2025, 12 :1464 ( https://doi.org/10.5256/f1000research.142346.r250739 ) The direct URL for this report is: https://f1000research.com/articles/12-1464/v1#referee-response-250739 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Comments on this article Comments (0) Version 3 VERSION 3 PUBLISHED 13 Nov 2023 ADD YOUR COMMENT Comment keyboard_arrow_left keyboard_arrow_right Open Peer Review Reviewer Status info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Reviewer Reports Invited Reviewers 1 2 3 Version 3 (revision) 07 Apr 25 read Version 2 (revision) 30 Aug 24 read read Version 1 13 Nov 23 read read Marianne Johansen , Copenhagen University Hospital, Copenhagen, Denmark Margaret P. Kasaro , The University of North Carolina at Chapel Hill, Chapel Hill, USA Ira Bernstein , University of Vermont, Burlington, USA Comments on this article All Comments (0) Add a comment Sign up for content alerts Sign Up You are now signed up to receive this alert Browse by related subjects keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Bernstein I. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 03 Jun 2025 | for Version 3 Ira Bernstein , University of Vermont, Burlington, Vermont, USA 0 Views copyright © 2025 Bernstein I. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions This study by Gebeyehu et al is a descriptive study performed via purposive sampling to preeclampsia/eclampsia patients in Ethiopia to explore their experience, understanding, and barriers to care for their pregnancy complication. This is an important study that examines factors that greatly influence patient outcomes, both short- and long-term after complex pregnancies. The study design is appropriate, including 17 women, 12 with preeclampsia and 5 with eclampsia, cared for in two hospitals who underwent individual interviews, as adapted from a prior study also conducted in Africa. Responses were coded by 3 reviewers using both verbal data via audio recording and non-verbal responses as noted during the interview, with additional review for conformability. The data from patient narratives highlighted a need for improvement in education on and routine assessment for signs/symptoms of HTN in pregnancy, education at time or and after patients' diagnoses, a lack of trust in the provider-patient relationship, and a need for self-advocacy to receive appropriate care. Barriers to treatment were appropriately highlighted, emphasizing areas for improvement which would likely influence rate/timeliness of seeking and accessing care among the patient population examined. I am impressed by the authors' pursuit of understanding such a fraught and important topic from the patient perspective. I do believe their findings are of interest for dissemination. I would recommend additional revision, perhaps by a native English speaker, both to improve grammar and ensure appropriate utilization of medical phrases in the article prose and interview translations to English. For example, a "termination" was referred to under "Women's reaction after informed of the diagnosis" though it seems this was referring to a delivery of a preterm infant rather than ending a pregnancy with the intention not to deliver a viable infant. An expansion in the number of subjects could highlight if dominant and recurrent specific issues in clinical care could be addressed. am not clear how a sample size determination in made for qualitative data? Perhaps this section could be expanded It would be of value to have a more detailed outline of the prenatal care environment (ANC) for these subjects i.e. frequency of visits, training of the prenatal care providers, location of visits? Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Partly Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? Not applicable Are all the source data underlying the results available to ensure full reproducibility? Partly Are the conclusions drawn adequately supported by the results? Partly Competing Interests No competing interests were disclosed. Reviewer Expertise Preeclampsia physiology and prepregnancy predisposition, Preeclampsia follow-up and cardiometabolic risk I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (0) Bernstein I. Peer Review Report For: Lived experiences of women who survived from pre-eclampsia and eclampsia in public hospitals of Shashemene Town, Oromia Region, Ethiopia: a qualitative study. [version 3; peer review: 1 approved, 2 approved with reservations] . F1000Research 2025, 12 :1464 ( https://doi.org/10.5256/f1000research.180022.r382244) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/12-1464/v3#referee-response-382244 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2024 Kasaro M. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 19 Sep 2024 | for Version 2 Margaret P. Kasaro , Division of Global Women's Health, Department of Obstetrics and Gynecology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA 0 Views copyright © 2024 Kasaro M. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (1) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions I have reviewed the revised version of the paper and happy with the progress so far. There however may still be need to for further revision eg: Conclusion in abstract could be edited to not imply that quality of care is poor but that it was reported so The data collection section of methodology still has details that may not need to be in the final write up: Pretesting details Line 2 in paragraph 3 of data collection could be deleted Data collection details Transcription details Consider if the last paragraph in data collection is needed Conclusion is still too long and not summarised to deliver message effectively In general review for English usage may be beneficial Competing Interests No competing interests were disclosed. Reviewer Expertise Women's healthHmaternal and child health I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (1) Author Response 07 Apr 2025 Negeso Gejo, Midwifery, Madda Walabu University, Shashemene Campus, Shashemene, 264, Ethiopia Responses to Reviewer: We would like to appreciate Margaret P. Kasaro, for reviewing the second version of the article. We would like to extend our gratitude her constructive comments and presented our point by point responses as follows: Comment 1: Conclusion in abstract could be edited to not imply that quality of care is poor but that it was reported so Response: We have refined it as per the comment. Comment 2: The data collection section of methodology still has details that may not need to be in the final write up: Pretesting details: Line 2 in paragraph 3 of data collection could be deleted. Data collection details, Transcription details. Consider if the last paragraph in data collection is needed Response: During the initial process of the review process, editors form journal gave due attention on the methodology section and recommended the authors to write details of methodology section including the data collection process and analysis. That’ why we write up the aforementioned issues in details. It’s known that every scientific paper has to be done as per the standard. Every steps that was gone to ensure the quality of the research has to be clearly written and communicated to the scientific community. Thus, we kindly request the reviewer to consider the above issue. Comment 3: Conclusion is still too long and not summarised to deliver message effectively. Response: We have summarized it as per the comment. View more View less Competing Interests No competing interests were disclosed. reply Respond Report a concern Kasaro MP. Peer Review Report For: Lived experiences of women who survived from pre-eclampsia and eclampsia in public hospitals of Shashemene Town, Oromia Region, Ethiopia: a qualitative study. [version 3; peer review: 1 approved, 2 approved with reservations] . F1000Research 2025, 12 :1464 ( https://doi.org/10.5256/f1000research.170549.r319023) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/12-1464/v2#referee-response-319023 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2024 Johansen M. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 11 Sep 2024 | for Version 2 Marianne Johansen , Department of Obstetrics, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark 0 Views copyright © 2024 Johansen M. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions I still believe that this paper needs a thorough proof reading by a native English speaking person. Also some grammar and spelling mistakes exist in the paper. The Methods section is still somewhat unclear and too detailed. The reference to the Nigerian study (reference 10) does cover some of the text that could be shortened. Besides, I believe it would be of interest to the reader to know how many women were invited to participate in order to include 17 interviews. In my opinion the manuscript still contains too many repetitions – both regards content and text. Also too many themed quotes are included in the paper not all allowing for new insight. In the “Emerged themes” section the authors write “ One woman”, “Another woman”, “One of the participant”, “the above woman” and many more ways to characterize the participants. I suggest that they use participant numbers instead to simplify. Table 1 is fine Reviewer 1 comment no 4 has not been addressed sufficiently in this revised version of the paper. Good luck with the final revisions of the paper. Competing Interests No competing interests were disclosed. Reviewer Expertise Preeclampsia I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. reply Respond to this report Responses (0) Johansen M. Peer Review Report For: Lived experiences of women who survived from pre-eclampsia and eclampsia in public hospitals of Shashemene Town, Oromia Region, Ethiopia: a qualitative study. [version 3; peer review: 1 approved, 2 approved with reservations] . F1000Research 2025, 12 :1464 ( https://doi.org/10.5256/f1000research.170549.r319024) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/12-1464/v2#referee-response-319024 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2024 Kasaro M. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 16 Aug 2024 | for Version 1 Margaret P. Kasaro , Division of Global Women's Health, Department of Obstetrics and Gynecology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA 0 Views copyright © 2024 Kasaro M. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Hypertensive disorders in pregnancy are an important contributor to maternal morbidity and mortality. This is a write up on the experiences of the women who survived preeclampsia and eclampsia for knowledge of symptomatology, antenatal services - information and education on danger signs, referral and management of the disorder. The study has highlighted gaps in the health care delivery as experienced by the women who survived the disorder but in conclusion has not included the implications and recommendations in working towards effective engagement. Here are few comments to consider for the next version of the paper: Strengths and limitations 1.The study design may need to be reconsidered to be mentioned as a strength of there study 2. If the translation process was rigorous to ensure the meaning is not lost in translation, can this point still be a limitation 3. Selection bias exists not exits Introduction 1. Does the use of the words commonly and usually in the definition of Preeclampsia affect the meaning here? 2. Paragraph 2, 3 and 4 are repetitious in the discussion of effects of PE and eclampsia please edit 3. Paragraph 5 there is repeating of a sentence. In editing consider including how data on experiences may be used to reduce the negative effects of the disease Sample size calculation 1. It may not be necessary to explain when to stop sampling plus there is repeating Data collection 1. Please note the repetition of sampling techniques description 2. Naming the staff who were actually doing the data collection should be reserved for an appropriate section 3. Last sentence in paragraph 1 is not clear 4. In paragraph 2 please consider the following: You have described the translation process, is it rigorous not to have information lost in the process? The relationship between confidentiality and discomfort Indicate that open ended questions and probing were used rather that specific questions Is collection to saturation equal to credibility Data collected is collectors In the last sentences - which technique is being referred to for the nonverbal Dependability, transferability and conformability confirm the meaning in this context Analysis Overall consider editing the analysis section to use standard format of reporting qualitative analysis then consider removing the bold in the sentence … translation by PI and co investigators Results Please pay attention to the tenses space between 17 and women In sentence number 2 edit to add bold word as follows - the number of children that the women Themes Quality of care is repeated Please clarify on the suggested pieces of advice ANC Edit the sentence to clarify if each participant reported different care or is it their interpretation that care offered to women varies Last sentence suggested edit - Services that women reported to have received included...… Women requested to give opinions on the quality …. by data collectors may imply the care was provided by the data collectors Women's reactions Consider not explaining what procedure to terminate means Barriers Repeating meaning of daataa Consider rephrasing the unsupportive husbands and low income/advice preamble Discussion Paragraph one summarises the findings well Tackle each theme in order of how presented in paragraph 1 Women's discourse could be edited with synonyms Conclusions Please consider editing the conclusion without repeating results in detail and put in implications and recommendations Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? Yes Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Partly Competing Interests No competing interests were disclosed. Reviewer Expertise Women's healthHmaternal and child health I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (0) Kasaro MP. Peer Review Report For: Lived experiences of women who survived from pre-eclampsia and eclampsia in public hospitals of Shashemene Town, Oromia Region, Ethiopia: a qualitative study. [version 3; peer review: 1 approved, 2 approved with reservations] . F1000Research 2025, 12 :1464 ( https://doi.org/10.5256/f1000research.142346.r304794) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/12-1464/v1#referee-response-304794 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2024 Johansen M. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 21 Mar 2024 | for Version 1 Marianne Johansen , Department of Obstetrics, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark 0 Views copyright © 2024 Johansen M. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions This exploratory qualitative study by N Gebeyehu et al on the lived experiences of 17 women who have all experienced preeclampsia or eclampsia in two public Ethiopian hospitals - one general and one referral hospital - is generally an important and well conducted study. The authors and investigators address and explore some very important issues on different aspects like levels of awareness of the preeclampsia syndrome in the general population and at a healthcare level in the ANC, misconceptions in the society, barriers to access to healthcare and the the level of quality of counselling and healthcare provided. Importantly, the interviewed women bring suggestions to the table on how healthcare counselling and better access to qualified healthcare may improve the clinical outcome in the region for women suffering from preeclampsia. These are all very essential issues to address in order to better inform healthcare workers on how to improve counselling of women in Ethiopia on preeclampsia and eclampsia; both still potentially severe and life threatening conditions for both mother and child. I would like to commend the authors for addressing this very important topic as preeclampsia and eclampsia is still one of the leading causes of maternal mortality in the Sub-Saharan African countries. However, I have some general and some more specific comments in relation to the submitted paper. General comments: Generally a well written manuscript. However, I find that the manuscript is too long and with many repetitive quotes in the result section. One suggestion would be to put the quotes in themed boxes for each of the respective emerged themes; Antenatal care service offered and its quality, Symptoms experienced and quality of care received, Barriers to receiving treatments from health facilities, Misconceptions, lack of knowledge, Unsupportive husband and low income, and Suggested advice for mothers, families and health facilities. I also suggest that the overall number of quotes appearing in the manuscript is reduced, as several of the quotes are very alike from a thematic perspective. Besides, the manuscript would benefit from a thorough proof reading by a native English speaking person. Specific comments: Women are quoted for saying that access to health care services is lacking. In this context it would be relevant to mention whether prescribed medicine is free of charge? I am curious to know whether women who participated did in any way differ from women who rejected to participate. Also, I would like to know how many women were invited to participate to allow for 17 participants? 5/17 of the participants suffered eclampsia. Is this a normal proportion amongst women with preeclampsia in Ethiopia? Please specify. Is the work clearly and accurately presented and does it cite the current literature? Partly Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? Not applicable Are all the source data underlying the results available to ensure full reproducibility? Partly Are the conclusions drawn adequately supported by the results? Yes Competing Interests No competing interests were disclosed. Reviewer Expertise Preeclampsia I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (0) Johansen M. Peer Review Report For: Lived experiences of women who survived from pre-eclampsia and eclampsia in public hospitals of Shashemene Town, Oromia Region, Ethiopia: a qualitative study. [version 3; peer review: 1 approved, 2 approved with reservations] . F1000Research 2025, 12 :1464 ( https://doi.org/10.5256/f1000research.142346.r250739) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/12-1464/v1#referee-response-250739 Alongside their report, reviewers assign a status to the article: Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved - fundamental flaws in the paper seriously undermine the findings and conclusions Adjust parameters to alter display View on desktop for interactive features Includes Interactive Elements View on desktop for interactive features Competing Interests Policy Provide sufficient details of any financial or non-financial competing interests to enable users to assess whether your comments might lead a reasonable person to question your impartiality. 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