Benefits of using magnesium sulphate (MgSO4) for eclampsia management and maternal mortality reduction: lessons from Kano State in Northern Nigeria

Abstract

BackgroundDespite clear emphasis through the Millennium Development Goals, the problem of high maternal mortality persists especially within low and middle income countries. Various studies report remarkably high maternal mortality rates in northern Nigeria, where maternal mortality rates exceed 1,000 deaths per 100,000 live births and eclampsia contributes approximately 40% of maternal deaths. Across Nigeria, diazepam is routinely used for the management of eclampsia. Prior to February 2008, diazepam was widely used for the management of eclampsia in Kano State (within northern Nigeria) with case fatality rate being over 20%. While magnesium sulphate (MgSO4) is recognized as the most effective drug for the management of eclampsia; this study aims to compare MgSO4 therapy with diazepam therapy in terms of case fatality rates and costs.FindingsThis retrospective study, including 1045 patients with eclampsia and pre-eclampsia during the years 2008 and 2009, reports a drop in case fatality rates from 20.9% (95% CI: 18.7, 23.2) to 2.3% (95% CI: 1.4, 3.2) among eclampsia patients following the MgSO4 intervention. The study observed no significant difference in the cost of using MgSO4 therapy compared to diazepam therapy.ConclusionsThe study found a remarkable reduction in case fatality rate due to eclampsia in those who received MgSO4 therapy with minimal increase in costs when compared to diazepam therapy. Concerted efforts should be focused on properly introducing MgSO4 into emergency obstetric protocols especially within developing countries to reduce maternal mortality and also impact on health system performance.

Reducing maternal deaths in a low resource setting in Nigeria

“…Similar findings has recently been reported in Kano, in Northern Nigeria. [16,17] Magnesium sulfate is the drug of choice for prevention of both initial seizure [18] as well as recurrence of seizures. [19,20] Both randomized control trials as well as real world use of magnesium sulfate has shown a significant decline, almost a 50% drop in maternal death when compared to diazepam, or phenytoin and even lytic cocktail.…”

Reducing maternal mortality from preeclampsia and eclampsia in low‐resource countries – what should work?

“…Diagnosis of preeclampsia with blood pressure and proteinuria determinations and timely delivery through cesarean section or induction of labor are both important in reducing PE/E‐related maternal mortality . Magnesium sulfate (MgSO 4 ) is one of the most common interventions proposed to delay progression of preeclampsia to eclampsia and reduce maternal mortality . To better understand the interventions most likely to reduce PE/E‐associated maternal mortality in SSA, we created a model for this condition.…”

Women’s status within the household as a determinant of maternal health care use in Nigeria

“…In seeking to redress these low levels of maternity care use in sub-saharan Africa, most research has focused on addressing the clinical issues related to maternal mortality, less attention has been paid to the social determinants of maternal deaths 10,11,12 . Only a few studies have explored ways in which gender roles and relations may operate to restrict women's access to health care during pregnancy, at the time of delivery and after delivery.…”