Factors influencing the use of magnesium sulphate in pre-eclampsia/eclampsia management in health facilities in Northern Nigeria: a mixed methods study

Abstract

BackgroundEclampsia remains a major cause of perinatal and maternal morbidity and mortality worldwide. We examined facilitators and barriers to the use of magnesium sulphate (MgSO4) in the management of pre-eclampsia/eclampsia (PE/E) in health facilities in Bauchi and Sokoto States in Nigeria.MethodsData were collected from 80 health facilities using a cross-sectional, mixed method (quantitative and qualitative) design. We assessed health facility readiness to manage PE/E and use MgSO4 as the drug of choice, through provider interviews, in-depth interviews with facility managers and an inventory of equipment and supply in facilities. Bivariate and qualitative data analyses were performed to isolate the principal enabling factors and barriers to the management of PE/E and use of MgSO4.ResultsThe majority of health facility providers correctly mentioned MgSO4 as the drug of choice for the prevention and termination of convulsions in severe PE/E (65 %). Sixty-four percent of the health facilities had service registers available. About 45 % of providers had been trained on the use of MgSO4 for the management of PE/E. Regarding providers’ practices, 45 % of respondents indicated that MgSO4 was used to prevent and treat convulsions in severe PE/E in their facilities. Barriers to management of PE/E included inadequate numbers of skilled providers, frequent shortages of MgSO4, lack of essential equipment and supplies, irregular supply of electricity and water, and non-availability of guidelines and clinical protocols at the health facilities. Technical support to providers was inadequate.ConclusionThe study revealed that a constellation of factors adversely affect the management of PE/E and especially the use of MgSO4 by service providers. Efforts to improve the management of PE/E in facilities should include integrated programs that substantially improve provider and facility readiness to manage PE/E for better maternal and newborn health outcomes in Northern Nigeria.

Clinical practice patterns on the use of magnesium sulphate for treatment of pre‐eclampsia and eclampsia: a multi‐country survey

“…Barriers to accessing MgSO 4 at facility level included inadequate supplies and perceived high costs to both health facility (e.g. costs of equipment and materials to administer and monitor MgSO 4 ) and users, which are consistent with findings in other studies …”

“…costs of equipment and materials to administer and monitor MgSO 4 ) and users, which are consistent with findings in other studies. 12,14,15 Despite the fact that coverage of MgSO 4 for the prevention and treatment of eclampsia has improved, it has not necessarily translated into recommended clinical practice at different health facility levels. We found that about onequarter of all facilities were using MgSO 4 for treatment of mild pre-eclampsia, despite a lack of recommendation on such practice.…”

“…These include MgSO 4 not being registered or licensed for use for pre-eclampsia/eclampsia, lack of centralised purchasing and distribution mechanisms, lack of evidence-based clinical protocols, insufficient training and shortage of staff to safely deliver MgSO 4 and fear of toxicity. [10][11][12][13][14][15] Nonetheless, there is evidence to suggest that limited coverage of MgSO 4 may be related more to local clinical practices than the availability of the medication. For instance, the WHO Multi-Country Survey on Maternal and Newborn Health (WHO MCS) in 2010/11 reported high coverage of MgSO 4 use for eclampsia prevention and treatment in facilities in many low-and middle-income countries; however, it did not appear to be related to lower rates of adverse outcomes due to pre-eclampsia/eclampsia.…”

Access barriers to obstetric care at health facilities in sub-Saharan Africa—a systematic review

“…Generally, women expect to receive care promptly on reaching a health facility; therefore, long waiting times present a significant challenge to accessing health facility-based services [22, 29, 31, 53, 82, 87, 97, 107, 115, 123, 154, 155]. A shortage or absence of drugs and other essential supplies in health facilities were reported in other studies [31, 48, 56, 67, 76, 111, 115, 150, 155, 157, 163, 165–168], and poor referral practices/systems [104, 105, 159, 165] such as referred clients being transported unaccompanied by healthcare staff [89], lack of feedback mechanisms on referred patients [152], and late or no referral [29] hinder efficient patient care and may result in adverse outcomes.…”

Addressing barriers to quality of underutilized commodities and services for prevention and management of pre-eclampsia and eclampsia in Kenya

“…Our findings resonate with another study in Kenya showing gaps in provision of parenteral anticonvulsant, where 75 percent and 52 percent of providers reported administering injectable diazepam and MgSO4, respectively22 . Other studies concur with low provider competence and confidence in MgSO4 use in PE/E management5,34,35 . Staff are either reluctant to use it or administer it inconsistently with current WHO recommendations6,36,37 .…”