**5. Perinatal and maternal outcomes of pre-eclampsia**

Globally, approximately 10% of pregnant women develop hypertension during pregnancy and 2–8% of the pregnancies are complicated by pre-eclampsia [23]. Approximately 10–15% of direct maternal deaths leading to undesirable physiological changes in the kidneys, liver, brain, and clotting systems, further associated with poor foetal outcomes such as poor foetal growth and prematurity [24]. More than a half-million women died during pregnancy and childbirth across the globe in 2000 and 2002. It was also estimated that half of these maternal deaths occurred in Africa (251000) and about 48% in Asia (253000) [25].

In Sub-Saharan Africa (SSA), a meta-analysis of 13 studies in Etopia revealed that out of 5894 women diagnosed with hypertensive disorder 4% died and 13% had HELLP syndrome. Moreover, adverse perinatal outcomes were reported with perinatal death at 25% and prevalence of low birth weight at 37% [26]. Hence it is of recommendations to develop strategies and policies to enhance quality maternal health services [26]. As cited by [27] WHO estimates that the prevalence of preeclampsia in developing nations is seven times that of developed nations, furthermore, the rates of pre-eclampsia in African countries vary from 1.8 to 7.1%, with Nigeria prevalence varying from 2–16%.

Gestational hypertension and pre-eclampsia are the major causes of maternal and perinatal morbidity and mortality in low and middle-income countries [28]. Severe pre-eclampsia remains a major burden health problem is Sub-Saharan Africa leading to undesirable perinatal and maternal outcomes [29]. Gestational hypertension and pre-eclampsia are the most prevalent in Sub-Saharan Africa with 4.1 and 4.1%, respectively; these may be due to poor-seeking behaviour, present late and with advanced disease [30].

A prospective cohort study conducted at three South African tertiary hospitals to describe the maternal and perinatal outcomes on women with pre-eclampsia reported that hypertensive disorders remain a burden amongst pregnant women [31]. It was also reported that the incidence of pre-eclampsia is relatively in obese women and pregnant teenagers. Further reported that obese women and pregnant teenagers were more prone to pre-eclampsia complications such as perinatal deaths and preterm deliveries [31]. Furthermore, Nathan et al. further reported that out of 1547 women having pre-eclampsia 1% died, 0.3% had a stroke whilst approximately 9.5% progressively developed eclampsia and kidney injury at 17.6% [31]. Moreover, it was reported out of 1589 of the births were associated with perinatal deaths at 21 and 84.5% of stillbirths; 1308 of live births were preterm deliveries. A dissertation on factors contributing to stillbirth at Witbank hospital corroborated that hypertensive disorders pose a significant risk to the well-being of the mother and the foetus. It was reported that approximately 12% of the women admitted at Witbank hospital had stillbirths were due to hypertensive disorders in pregnancy [32].

## **6. Early detection and treatment of pre-eclampsia**

Detection of early-onset pre-eclampsia can be achieved through effective screening as early as the first trimester. Moreover, screening can be achieved via certain methods such as maternal history screening by combination of maternal risk factors, placental growth factor, mean arterial blood pressure and uterine artery Doppler [33]. Digital health has been introduced in maternal health to help curve maternal mortalities rise due to preventable conditions such as pre-eclampsia. A retrospective study for early prediction of pre-eclampsia using machine learning through analysis of clinical and laboratory data in previous ANC visits; revealed that a significant set of features for prediction of pre-eclampsia were identified which shown significantly elevated prediction performances of the risk of preeclampsia [34]. Early detection of pre-eclampsia is a global burden that should be addressed. The study developed a wearable device to monitor women at risk of pre-eclampsia using the identified risk factors and blood monitoring the prototype yielded good results for identification of the biomedical signals. However, comparison of the methodology is still to be done with another facility [35].

Digital health can overcome access limiting factors and lack of trained HCP in low-resourced settings through mHealth solutions. Studies have evidently proven mHealth can benefit pre-eclampsia women through early detection and symptoms control. mHealth has a great potential for improving clinical practice as positive results were reported on maternal health improvement through digital health [28]. The use of digital health such as electronic health (eHealth) showed improved efficiency and suitability of care, moreover had an effect on mortality, readmissions, and total costs [36]. Furthermore, the use of digital health such as mobile technology through self-monitoring of blood pressure amongst women at risk of pre-eclampsia reduces perinatal and maternal mortalities and morbidities due to pre-eclampsia and reduces the number of hospitalisations [37].
