Expanding Access to Magnesium Sulfate in Kano State, Nigeria
Council research helped educate health providers on hypertensive disorders of pregnancy and administration of magnesium sulfate as a treatment for pre-eclampsia and eclampsia.
Christopher Ogedengbe, the Population Council's director of program support and services in Nigeria, meets with the Emir of Kano State. The Council's work to prevent maternal death resulting from pre-eclampsia and eclampsia in northern Nigeria has been influential and welcomed at the highest level by local leaders.
In Nigeria, the Population Council has been involved in a project in which magnesium sulfate (MgSO4) has been administered for the treatment of pre-eclampsia and eclampsia. The objectives of this study were threefold:
- To assess provider acceptability of the use of MgSO4 to control convulsions in eclamptic women entering maternity wards.
- To determine training needs and capacity-building support required to be able to introduce MgSO4 at tertiary and secondary hospital levels.
- To understand the factors that influence the referral of women with eclampsia to facilities.
Results from the initial study have been remarkable, and MgSO4 has been hailed a "miracle drug." Maternal mortality has been reduced by 40 percent across the ten sites where the project took place. The contribution of eclampsia to maternal mortality has been reduced by 68 percent. Toxicity has been found to be minimal, less than 2 percent, with no attributable deaths found. Service provider acceptability of the new scheme was found to be almost universal.
Following the success of the first phase of the project, the second phase commenced in November 2009 to address remaining challenges. The project's second phase seeks to further develop the capacity of health providers in the public and private health sector in northern Nigeria (Kano and a scale-up in Kaduna State) on the use of MgSO4 in the management of severe pre-eclampsia and eclampsia. This phase focuses on expanding the use of MgSO4 to primary health facilities in Kano State and ensuring effective monitoring of the use and distribution of MgSO4 in secondary and primary health facilities. In Kano State, this phase addresses delays in getting patients to hospitals following the introduction of MgSO4 in primary health care facilities as a loading dose and a strategy to reduce convulsions in pregnant women during transit. Data are being collected on a regular basis. The operations research evidence generated from these interventions will inform policies on maternal and child health in Nigeria.
(For information on pre-eclampsia and eclampsia and additional background on this project, click on the Details tab above.)
See also: Voices of Change feature on Hafsatu, who benefited from treatment with MgSO4
In northern Nigeria eclampsia accounts for up to 40 percent of maternal deaths. Pre-eclampsia and eclampsia are serious hypertensive disorders in pregnancy in terms of their incidence, morbidity, and resulting mortality. The incidence of eclampsia ranges from 10 to 50 per 1,000 deliveries in developing countries, and severe cases of pre-eclampsia and eclampsia are very common in Nigeria. Regional variation exists—the incidence rate is 3%–9% in the north and approximately 1%–3% in the south.
Pre-eclampsia and eclampsia are problems usually associated with a woman’s first pregnancy (primigravida). Given the tendency toward and culture of early marriage in northern Nigeria, the majority of those affected by eclampsia are teenagers. Other predisposing factors in the Nigerian context include poor access to antenatal care, past history of pregnancy-induced hypertension, multiple pregnancy, molar pregnancy, diabetes mellitus, and renal diseases. Social contributory factors include poverty, poor reproductive health care–seeking behavior, cultural perception of eclampsia, and lack of access to high-quality maternal services, including intrapartum care.
Eclampsia is usually asymptomatic until the woman's condition deteriorates. The insidious nature of the disease makes it life-threatening. Mild pre-eclampsia can progress to severe pre-eclampsia or eclampsia without warning. Pre-eclampsia is best detected by regularly measuring the blood pressure of pregnant women, which is possible if women regularly attend antenatal care. When the condition develops and symptoms begin to manifest, they include headache, epigastric or right hypochondrial pain, nausea, vomiting, and visual disturbances. These symptoms indicate that the disease has progressed to the severe-form states—fulminating pre-eclampsia, imminent eclampsia, and eclampsia. Eclampsia is characterized by convulsions or fits in pregnant women. Not all cases follow an orderly progression, and some women develop eclampsia suddenly, even where there is no prior hypertension, only proteinuria. Eclampsia can be antepartum, intrapartum, or postpartum.
MgSO4 can be used to treat pre-eclampsia and eclampsia in pregnant women. This Population Council project has led and managed a program to increase the administration of MgSO4 at a targeted few sites, and to investigate other relevant variables involved in MgSO4 administration, for example, training requirements and maternal behaviors and constraints affecting hospital attendance. A curriculum was developed for health service providers that covered resuscitation, hypertension, convulsions, fits, child delivery, postpartum care for women who have developed eclampsia, and MgSO4 clinical pharmacology, including clinical indications of use, dosage, route of administration, contraindications, precautions, side effects, and toxicity.
Benefits of using magnesium sulphate (MgSO4) for eclampsia management and maternal mortality reduction: Lessons from Kano State in northern Nigeria (abstract) (PDF)
Okereke,Ekechi; Ahonsi,Babatunde; Tukur,Jamilu; Ishaku,Salisu Mohammed; Oginni,Ayodeji
BMC Research Notes 5(421)
Publication date: 2012
Maternal and fetal outcomes after introduction of magnesium sulphate for treatment of preeclampsia and eclampsia in selected secondary facilities: A low-cost intervention (abstract)
Tukur,Jamilu; Ahonsi,Babatunde; Ishaku,Salisu Mohammed; Araoyinbo,Idowu; Okereke,Ekechi; Oginni Babatunde,Ayodeji
Maternal and Child Health Journal Published online ahead of print, 7 September
Publication date: 2012
Location: Nigeria (Kano State)
Duration: 2/2008 - 12/2008
The John D. and Catherine T. MacArthur Foundation