A hospital-based retrospective study with a quantitative approach was utilized to assess the prevalence and social demographic factors associated with pre-eclampsia using past medical information of pregnant women at the Ho Teaching Hospital. The University of Health and Allied Sciences ethical committee approved the study protocol (UHAS-RECA.12[177]20-21).

This study used the Hospital Administration and Management System (HAMS) to retrieve records of all pregnant women who reported at the Ho Teaching Hospital from January 2018 to December 2020 and were 18 years old or above. All pregnant women who were diagnosed with pre-eclampsia within this period were included in the study. The study excluded all pregnant women who had a history of hypertension before they became pregnant. The study was conducted for two months.

Data was collected using a checklist (Supplementary 1) that assessed the socio-demographic variables including; patient age, marital status, weight, height, residence, occupation, religion, educational level, and parity. The maternal age of the patient was classified into three categories (18 - 25, 25 - 35, and ≥35 years), marital status was dichotomized into married and unmarried, maternal educational level was grouped into primary, secondary, and tertiary levels, and maternal body mass index (BMI) as maternal weight in kilograms divided by maternal height in meters square and obstetric related factors grouped as gravidity, parity, gestational age.

This measured the rate of the occurrences of pre-eclampsia among pregnant women at the Ho Teaching Hospital; The complications associated with pre-eclampsia; Demographic distributions of pre-eclampsia cases in the Volta Region and the socio-demographic determinant of pre-eclampsia in the Volta Region.

This study included all pregnant women who reported at Ho Teaching Hospital from January 2018 to December 2020. The study retrieved data on 5609 pregnant women. The complete data in Microsoft Excel was exported to Statistical Package for Social Science (SPSS) version 22.01 (IBM Corporation, Armonk, NY, USA) which was used for data entry and analysis. Mean and SD were computed for quantitative variables such as age, weight, gestational age, and BMI. Descriptive analysis was done to evaluate the distribution of variables and statistical findings were reported as numbers, percentages, and frequencies. Binary analysis was done to determine the potential demographic associated with pre-eclampsia. The association between independent and dependent variables was measured and tested using chi-square and a P-value of ≤0.05 was considered significant.

5609 data on pregnant women were recorded at the Ho Teaching Hospital from January 2018 to December 2020. The mean age of the respondents was 28.89. The data showed that 314 respondents out of the 5609 pregnant women were diagnosed with pre-eclampsia, 27.7% of the pre-eclampsia cases were within the age group of 18 - 24 years old, 25.5% of them were within 25 - 29 years old, 26.1% were within the age group of 30 - 34 years old, whereas 4.8% of them were over 40 years old. The data also showed that 93% of the pre-eclampsia cases were Christian, whereas 7% of them were Muslims. The results showed that 67.5% of patients diagnosed with pre-eclampsia were married and 32.5% of them were not married. Regarding their level of education, the data showed that 38.9% of the pre-eclampsia patients had Junior High School education, whereas 4.5% had no education (Table 1).

We investigated the prevalence rate of pre-eclampsia in Ho Municipality from 2018 to 2020. The data showed a prevalence rate of 5.6% for 5609 pregnant women recorded. We also determined the yearly prevalence rate of pre-eclampsia and observed a rate of 4.6% in 2018 for 1950 pregnant women recorded, 5.6% in 2019 for 1809 pregnant women recorded, and 6.6% in 2020 for 1850 pregnant women recorded (Table 2).

The occurrence of complications associated with pre-eclampsia from the study recorded that 70.4% of the pre-eclampsia patients suffered from preterm delivery, 19.7% of them had intrauterine fetal death, 2.9% had their conditions progressed to eclampsia, 1.6% of them developed HELLP syndrome and 5.4% of them resulted in maternal deaths (Table 3).

We examined the distribution of pre-eclampsia cases within the Volta region from 2018 to 2020 the cases recorded at the Ho Teaching Hospital. The data

showed that 47 (15%) of the pre-eclampsia cases were from Kpetoe, 26 (8.3%) were from Peki, 24 (7.6) were from Hohoe, 22 (7%) were from Adaklu and 19 (6.1%) were from Adidome whilst Ho recorded the highest of 37.3% (Table 4).

The binary analysis from Table 5 and Table 6 indicates the association between demographic factors and pre-eclampsia among pregnant women diagnosed with pre-eclampsia at Ho Teaching Hospital within the said period. There was no significant association between age, BMI, marital status, religion, address, and gravidity (P-value ≥ 0.05). However, there was a significant association between parity, level of education, and occupation with a P-value of 0.004, 0.00, and 0.003 respectively (Table 5 and Table 6). The study observed that 117 of the women who were diagnosed with pre-eclampsia came from Ho, followed by 47 from Kpetoe (Table 6). The study also observed a yearly increase in the incidents of pre-eclampsia in certain areas of the Volta Region (Table 6).

The prevalence of pre-eclampsia throughout the study was 5.6% which is higher compared to other studies reported in Norway [9] , and Germany [10] with 3% and 2.3%, respectively. Our study fell below the estimated prevalence rate of 6.55% - 7.03% pre-eclampsia in a study conducted in Ghana [11] . A further study conducted at the Korle-Bu Teaching Hospital [12] supports Ahenkorah’s estimated range with a prevalence rate of 7.03% in pre-eclampsia. This is a clear indication of how medical performance improved during the years as practitioners showed interest in understanding and reducing the complications of pregnancy, especially pre-eclampsia. The high rate of prevalence at the Korle-Bu Teaching Hospital could also be due to the high patient attendance since it is one of the largest referral centers in Ghana. However, this prevalence was also lower compared to studies conducted in Ethiopia and Nigeria with a prevalence rate of 12.4% and 16% respectively [13] [14] . Over the study period, there was a slight increase in the prevalence from; 4.6% in 2018 to 5.6% in 2019 and 6.6% in 2020. The factors responsible for this slight increase are not clear in this study.

The difference between our findings and those of previous studies could also be due to the variations in the socio-demographic characteristics of pregnant women. Fondjo et al. [15] , stipulated that advanced age and age below 18 years of pregnant women are significantly predisposed to developing pre-eclampsia. Thus, the low prevalence rate observed in this study can be attributed to the fact that ages below 18 years were excluded from the sample and the highest rate of attendants were within the age group of 18 to 24 as well as few women above 45 years.

Pregnant women who had pre-eclampsia in this study were identified with complications including; preterm delivery, intrauterine fetal death (IUFD), eclampsia, and HELLP syndrome. When poorly managed pre-eclampsia could progress into eclampsia which is characterized by seizures, in addition to exhibiting the symptoms of pre-eclampsia [16] . The low recordings of pregnant women diagnosed with eclampsia could be the fact that medical personnel at the Ho Teaching Hospital put maximum effort into caring for pregnant women diagnosed with pre-eclampsia to prevent the progress of the condition into complications. Consistent with the findings of this study, Duley [17] , reported that up to about 20% of preterm deliveries are a result of pre-eclampsia and have been documented to result in high neonatal mortalities and prolonged neonatal morbidities. According to Jeyabalan [18] , pre-eclampsia does not only result in neonatal mortalities, but accounts for up to about 9% of maternal deaths in sub-Saharan Africa, and Asia. Consequently, adequate management of pre-eclampsia is the best means of preventing complications. It is noteworthy that although there have been several advances in medical science, the only known cure for pre-eclampsia is the delivery of the fetus and the placenta [18] .

The study identified a statistically significant association between parity and severity of Pre-eclampsia (P = 0.04) which is inconsistent with findings from a study conducted in Kenya, that nulliparous and primiparous women were at an increased risk of developing pre-eclampsia, compared to multiparous women [16] . Grum et al. [19] , also reported an association between parity and the development of pre-eclampsia among pregnant women. Also, level of education had an association with pre-eclampsia (p = 0.00). A study conducted by Fondjo et al., 2019 reported that pregnant women who had poor knowledge of pre-eclampsia stood at risk of being diagnosed with pre-eclampsia with the progress of their pregnancy.

In our study, women who completed their education at the junior high school level indicated an increased rise in pre-eclampsia than those who attained a higher educational level. The increased risk of pre-eclampsia among women with low education levels could be because, in Ho, people with low income are more likely to practice poor lifestyle practices including lack of physical exercise and poor eating habits that could lead to overweight or obesity which increases the risk of developing pre-eclampsia. On the other hand, the increased risk of pre-eclampsia among women with low education could be attributed to low maternal age, as women with reduced or less education achievement are more likely to have their children at an early maternal age. Similarly, a study conducted in Uganda has reported higher education to be protective against pre-eclampsia [20] . This study also found occupations associated with pre-eclampsia (P = 0.003) with the majority of the pregnant women being traders. Jeyabalan [18] , in his study, indicated that increasing BMI is associated with an increased risk of developing pre-eclampsia in pregnancy which conflicts with our study findings. The differences could be due to the study designs that were utilized. A retrospective cross-sectional study was used in our research as Jeyabalan, 2013 utilized the case-control method which offered the opportunity to identify risk factors.