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

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Friday, 1 September 2017

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

Sada Danmusa, 

Francine Coeytaux, Jennifer Potts, Elisa Wells
By successfully implementing the MacArthur Foundation's multifaceted strategy and paying attention to the necessary steps in the scale-up process, grantees have collectively made substantial progress toward the full integration of the use of magnesium sulfate into the Nigerian healthcare system.

In less than a decade, use of magnesium sulfate has gone from sporadic use by a handful of providers to use in more than 400 of Nigeria's 1042 secondary and tertiary hospitals across the country. This transition is particularly remarkable given the general challenges faced by the health infrastructure in Nigeria and the fact that magnesium sulfate involves a complicated clinical protocol.

Numerous challenges still remain as the country continues to scale up the program. Correct use of magnesium sulfate is very inconsistent and there is the need to address the underlying factors that prevent health workers from providing magnesium sulfate according to acceptable standards. These factors include: continued provider hesitancy about the complexity of the dosing protocol; inadequate number of trained staff as a result of transfers, retirements, and attrition; inadequate drug supply; and failure to follow the protocol to refer and/or deliver the pregnancy (sometimes even sending the woman home), mainly because of the misperception that the loading dose of magnesium sulfate (which effectively stops convulsions) has treated the problem.

Continued monitoring will be important to ensure that the new guidelines and curricula are included in the training of all new healthcare workers. Although work with the regulatory agencies at the national level and selected training institutions has provided evidence of workability, there is a critical need to include magnesium sulfate in the curricula of all institutions that train midwives and community health extension workers. Until the curricula are viewed as integral to medical and nursing training, monitoring and advocacy will be required.