Maternal and Fetal Outcomes After Introduction of Magnesium Sulphate for Treatment of Preeclampsia and Eclampsia in Selected Secondary Facilities: A Low-Cost Intervention

Tukur, Jamilu; Ahonsi, Babatunde; Ishaku, Salisu Mohammed; Araoyinbo, Idowu; Okereke, Ekechi; Oginni, Ayodeji

doi:10.1007/s10995-012-1105-9

Cited by 28 publications

(34 citation statements)

References 17 publications

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“…It is a common cause of acute symptomatic seizures in women of reproductive age in sub-Saharan Africa; but generally not regarded as an epileptic disorder [39,40]. Further studies need to be conducted to determine whether it has any link or remote relationship with subsequent long term development of epilepsy.…”

Section: Discussionmentioning

confidence: 99%

Seizure occurrence, pregnancy outcome among women with active convulsive epilepsy: One year prospective study

Watila

Beida

Kwari

et al. 2015

Seizure

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Purpose To determine the prevalence of active convulsive epilepsy, seizure frequency and the outcome of pregnancy amongst a cohort of pregnant women attending antenatal clinic (ANC) at two tertiary hospitals. Methods An observational cohort study conducted at the University of Maiduguri Teaching Hospital and State Specialist Hospital, Northeast Nigeria. Pregnant women attending antenatal care were screened for previous history of active convulsive epilepsy, and recruited consecutively according to a specified protocol. A standardized questionnaire was administered to record pregnancy history, nature of epilepsy and treatments received. They were followed-up during the course of the pregnancy based on the ANC schedule up to delivery. The outcome of pregnancies was recorded. Results A total of 7063 pregnant women were screened, of whom 103 (1.46%) subjects had at least a past history of seizure. Seventy-eight (1.10%) had a past history of seizure(s) from eclampsia and 23 (0.33%) pregnant subjects recruited were identified to have active convulsive epilepsy. The unadjusted prevalence of active convulsive epilepsy in pregnant women was found to be 3.33 per 1000 (95% CI: 2.1–4.8). Subjects who had a history of head injury and encephalitis were more likely to have seizures during pregnancy. (P = 0.013 and P = 0.041). Those who had recurrent seizures within the last six months before recruitment were more likely to have a negative pregnancy outcome (P = 0.043). Conclusion Our study found a prevalence of active epilepsy of 3.33 per 1000 among pregnant women, with about one percent having a past history of seizure from eclampsia.

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Section: Discussionmentioning

confidence: 99%

Seizure occurrence, pregnancy outcome among women with active convulsive epilepsy: One year prospective study

Watila

Beida

Kwari

et al. 2015

Seizure

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“…In Nigeria, for example, the case fatality rate for severe PE/E at hospitals in Kano fell from 20.9% to 2.3% after MgSO 4 was introduced; perinatal mortality also fell significantly [17]. The drug has been identified in a list of 13 affordable, effective, but underutilized lifesaving commodities by the United Nations Commission on Life-Saving Commodities for Women and Children [18].…”

Section: Discussionmentioning

confidence: 99%

Prevention and management of severe pre-eclampsia/eclampsia in Afghanistan

Kim

Ansari

Kols

et al. 2013

BMC Pregnancy Childbirth

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BackgroundAn evidence-based strategy exists to reduce maternal morbidity and mortality associated with severe pre-eclampsia/eclampsia (PE/E), but it may be difficult to implement in low-resource settings. This study examines whether facilities that provide emergency obstetric and newborn care (EmONC) in Afghanistan have the capacity to manage severe PE/E cases.MethodsA further analysis was conducted of the 2009–10 Afghanistan EmONC Needs Assessment. Assessors observed equipment and supplies available, and services provided at 78 of the 127 facilities offering comprehensive EmONC services and interviewed 224 providers. The providers also completed a written case scenario on severe PE/E. Descriptive statistics were used to summarize facility and provider characteristics. Student t-test, one-way ANOVA, and chi-square tests were performed to determine whether there were significant differences between facility types, doctors and midwives, and trained and untrained providers.ResultsThe median number of severe PE/E cases in the past year was just 5 (range 0–42) at comprehensive health centers (CHCs) and district hospitals, compared with 44 (range 0–130) at provincial hospitals and 108 (range 32–540) at regional and specialized hospitals (p < 0.001). Most facilities had the drugs and supplies needed to treat severe PE/E, including the preferred anticonvulsant, magnesium sulfate (MgSO4). One-third of the smallest facilities and half of larger facilities reported administering a second-line drug, diazepam, in some cases. In the case scenario, 96% of doctors and 89% of midwives recognized that MgSO4 should be used to manage severe PE/E, but 42% of doctors and 58% of midwives also thought diazepam had a role to play. Providers who were trained on the use of MgSO4 scored significantly higher than untrained providers on six of 20 items in the case scenario. Providers at larger facilities significantly outscored those at smaller facilities on five items. There was a significant difference between doctors and midwives on only one item: continued use of anti-hypertensives after convulsions are controlled.ConclusionsDrugs and supplies needed to treat severe PE/E are widely available at EmONC facilities in Afghanistan, but providers lack knowledge in some areas, especially concerning the use of MgSO4 and diazepam. Providers who have specialized training or work at larger facilities are better at managing cases of severe PE/E. The findings suggest a need to clarify service delivery guidelines, offer refresher training, and reinforce best practices with supervision and reinforcement.

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“…In this study, 44% of the patients were having their first pregnancies and childbirths. Several studies from northern Nigeria such as Tukur et al [9] have shown positive association between educational attainment of women and utilization of essential preventive maternal and child health services, including the uptake of antenatal care services; an opportunity for detecting and averting high-risk pregnancies such as severe pre-eclampsia, eclampsia and other complications. Similarly, findings in this study showed that up to 47% of these eclamptic patients have not attained any form of formal education.…”

Section: Discussionmentioning

confidence: 99%

“…Individuals and communities have a right and responsibility to play a role in improving their health and wellbeing [13]. Convulsion and unconsciousness are two of the main reasons for presenting at the facility in much of rural northern Nigeria [9]. This calls for further actions in terms of patient and family education for the entire community to appreciate the different ramifications of the disease.…”

confidence: 99%

Attrition from care after the critical phase of severe pre-eclampsia and eclampsia: Insights from an intervention with magnesium sulphate in a primary care setting in northern Nigeria

Ishaku¹,

Ahonsi²,

Tukur³

et al. 2013

Health

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Background: Evidence has shown that Magnesium Sulphate (MgSo 4 ) is the gold standard for treating severe pre-eclampsia and eclampsia (SPE/E), and calls for its widespread use at all levels of health service delivery, including the primary care level. Objective: To determine if administering loading dose of MgSo 4 on pregnant women with severe preeclampsia and eclampsia at primary care level would improve maternal and fetal outcomes. Method: Two sets of Primary Health Care (PHC) facilities were identified; one served as experimental one and the other as control. The community health extension workers (CHEWs) and the community health officers (CHOs) at the experimental PHCs were trained to administer the loading dose of MgSo 4 for patients with SPE/E, in addition to other supportive treatments, before making a referral while the control PHCs did not give MgSo 4 , and neither administered diazepam as an alternative or no anti-convulsant at all, before making a referral to higher centers. Patients from the experimental and control facilities were prospectively monitored for fetal and maternal outcomes, namely maternal and fetal deaths, and for toxic effects of MgSo 4 in the experimental arm. Results: Of the 150 patients recruited, 82 (55%) were in the experimental group and 68 (45%) were in the control group. 90% of the patients in the experimental group defaulted after receiving the loading dose of MgSo 4 while the remaining 10% completed the referral process. 44% of those in the control group completed the referral process. There were 3 maternal and 3 perinatal deaths, all in the control group. No adverse outcome (maternal or fetal death) or toxic effect was recorded among the recipients of MgSo 4 . Conclusion: This study suggests that lower-cadre health care professionals at PHCs can administer the loading dose of MgSo 4 to SPE/E patients to improve maternal and fetal survival in critical states, without significant risk of adverse effects. However, the lack of compliance with referral processes remains a huge challenge.

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Maternal and Fetal Outcomes After Introduction of Magnesium Sulphate for Treatment of Preeclampsia and Eclampsia in Selected Secondary Facilities: A Low-Cost Intervention

Cited by 28 publications

References 17 publications

Seizure occurrence, pregnancy outcome among women with active convulsive epilepsy: One year prospective study

Seizure occurrence, pregnancy outcome among women with active convulsive epilepsy: One year prospective study

Prevention and management of severe pre-eclampsia/eclampsia in Afghanistan

Attrition from care after the critical phase of severe pre-eclampsia and eclampsia: Insights from an intervention with magnesium sulphate in a primary care setting in northern Nigeria

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