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.
Highlights
Eclampsia remains a major cause of perinatal and maternal morbidity and mortality worldwide
Eclampsia has been associated with a high perinatal mortality ratio of up to 406/1,000 births that has been documented in some health facilities in Nigeria [10, 11]
The included Primary Health Centers (PHC) facilities were stratified into comprehensive PHCs and Maternal and Child Health (MCH) centers in Bauchi; in Sokoto State, delivery services were available only in PHCs and upgraded dispensaries with assigned PHC status, and so no further stratification was feasible
Summary
Eclampsia remains a major cause of perinatal and maternal morbidity and mortality worldwide. Eclampsia is a major cause of perinatal and maternal morbidity and mortality worldwide [1]. In Nigeria, as well as being a leading cause of maternal deaths [3,4,5], eclampsia is a major cause of obstetric complications [6, 7]. Effective management of pre-eclampsia/eclampsia (PE/E) is one of the signal functions of Emergency Obstetric and Newborn Care (EmONC) to prevent and promptly treat complications, avert maternal and newborn deaths [12] and contribute to the attainment of Millennium Development Goals (MDGs) 4 and 5 and to the post-2015 development agenda
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