Challenges and Prospects in Managing Hypertensive Disorders of Pregnancy in Sub-Saharan Africa: A Narrative Review

Constance Nguru Musese,1,2 Raha Maroyi,1– 3 Balagizi Ganywamulume,1,2,4 Alain Bakwanamaha Maha,5,6 Olivier Nyakio Ngeleza,1,2 Denis Mukengere Mukwege1– 3 1Department of Obstetrics and Gynecology, Evangelical University in Africa, Bukavu, South-Kivu, Democratic Republic of the Congo; 2Department of Obstetrics and Gynecology, Panzi Hospital, Bukavu, South-Kivu, Democratic Republic of the Congo; 3Denis Mukwege Centre of Excellence, Evangelical University in Africa, Bukavu, South-Kivu, Democratic Republic of the Congo; 4Research Department, Medical Research Circle (Medrec), Bukavu, South-Kivu, Democratic Republic of the Congo; 5Department of Surgery, Faculty of Medicine, Catholic University of Graben, Butembo, North-Kivu, Democratic Republic of the Congo; 6Department of Surgery, Kampala Internal University Western Campus, Ishaka, UgandaCorrespondence: Raha Maroyi, Evangelical University in Africa, P.O. Box 3323, Bukavu, Democratic Republic of the Congo, Tel +243997254812, Email [email protected]: Hypertensive disorders of pregnancy (HDP) are the leading cause of maternal mortality in sub-Saharan Africa (SSA), accounting for 70% of the global maternal death burden. Despite international guidelines, the management of these conditions, particularly preeclampsia, is hindered by significant structural, clinical, and sociocultural challenges in low-income countries. This narrative review critically analyzes the challenges in the prevention, diagnosis, and management of HDP in resource-constrained settings in SSA, and identifies contextually appropriate solutions to improve maternal outcomes.Methods: A literature search of studies published between 2014 and 2024 was conducted using the PubMed, Scopus, Google Scholar, and African Journal Online databases. This review synthesizes evidence from qualitative, quantitative, and mixed-method studies and systematic reviews focusing on the epidemiological, organizational, and community dimensions of care for hypertensive disorders across SSA countries. Studies were selected on the basis of their relevance to HDP care challenges and innovations in SSA. The Scale for the Assessment of Narrative Review Articles (SANRA) guided the rigor and reporting of this review, with six core criteria systematically applied: justification of article selection, comprehensive literature search, quality assessment, evidence synthesis, transparent reporting, and methodological transparency.Results: Key challenges identified included fragmented health systems, poor adherence to clinical protocols, shortages of essential medicines and equipment, inadequate healthcare worker training, delayed care-seeking due to low health literacy and cultural beliefs, and insufficient epidemiological data. Promising strategies include strengthening antenatal care and screening, maternal education, task-sharing with community health workers, providing targeted training for healthcare workers, implementing simplified protocols, utilizing task sharing with community health workers, and enhancing interdisciplinary coordination.Conclusion: Reducing maternal mortality due to HDP in SSA requires an integrated approach that combines strengthening health systems, community engagement, targeted training, and context-adapted guidelines. Sustained investment in local research, data sharing, and policy reform is essential for achieving sustainable improvements in maternal health care.Keywords: hypertensive disorders of pregnancy, preeclampsia, sub-Saharan Africa, maternal health, resource-limited settings, narrative review, health systems, task-sharing