Scale-up of magnesium sulfate for treatment of pre-eclampsia and eclampsia in Nigeria

Abstract

Although there is little understanding of what causes pre-eclampsia / eclampsia there is an effective treatment for this condition. In 1994 WHO recommended magnesium sulfate as the standard treatment for pre-eclampsia and eclampsia and within 2 years it was placed on WHO’s Essential Medicines List. Treatment of pre-eclampsia with magnesium sulfate has been shown to significantly lower the risk of eclampsia (by 58%) and the risk of mortality (by 45%). Despite its known efficacy this inexpensive drug is often underused partly because the diffusion of an innovation takes time but also because it requires a strong and effective referral system often a challenge in under-resourced health systems. Although the treatment of eclampsia seems simple -- introduce magnesium sulfate into the woman’s blood stream and deliver the fetus as soon as possible -- doing so in time and correctly is complicated and involves many steps and many players. In 2007 the MacArthur Foundation began funding a series of grants to expand the use of magnesium sulfate for pre-eclampsia / eclampsia in Nigeria. The impact of this work on maternal mortality was significant: the case fatality rate due to eclampsia dropped from 20.9% to 2.3% and the findings encouraged the government to scale up the intervention to other states. In 2014 the Foundation commissioned a process evaluation of this work to help to determine what factors facilitated uptake and expansion of magnesium sulfate services the challenges encountered while implementing the projects and existing opportunities for future scaling up of the services across the country. The present paper reports on the findings of that process evaluation. (Excerpts) © 2016 International Federation of Gynecology and Obstetrics. Open Access.