106. Use Magnesium sulfate (MgSO4) in low resource setting: A case narrative of two counties in Kenya

Abstract

Introduction Hypertension in pregnancy, particularly pre-eclampsia/eclampsia (PE/E) is a major cause of maternal morbidity and mortality in low income settings. MgSO 4 is used extensively for prevention of eclamptic seizures. Appropriate administration of MgSO 4 to manage pre-eclampsia or eclampsia is critically important in reducing maternal and neonatal complications. Objective To explore health systems challenges to the use MgSO 4 in two counties in Kenya. Methods We conducted 60 in-depth interviews with providers at various levels of health care on their perceptions, knowledge and practice on MgSO 4 in prevention and management of eclampsia. Respondents were purposefully selected in consultation with respective county health managers. The interviews were conducted in Kiswahili or English, transcribed, translated and analyzed with NVIVO 10. Results Although respondents describe MgSO 4 as being widely available at the national stores, one county reported un-interrupted supply while the other faced periodic stock outs. Both counties cite challenges in accountability and governance in health care management affecting procurement and supply process as factor that influence MgSO 4 use. Most providers in hospitals are aware of the recommended MgSO 4 dosages and have the necessary skills and knowledge, but those at health centers often lack the knowledge, skills and confidence to administer the drug. Provider training, accessibility and visibility of policy guidelines, operational level protocols and job aids at primary health care facilities affect providers’ knowledge, and practice on use of MgSO 4 . Severe pre-eclampsia or eclampsia patient caseloads at different levels of health facilities also seem to influence providers’ skills and practice its use, hence the quality of care. Discussion There is a need to strengthen capacity for improved coordination between national and county governments to ensure adequate supply of essential PE/E management commodities. Building confidence through training and mentorship of primary level providers to effectively use MgSO 4 in PE/E prevention and management.