System and market failures: the unavailability of magnesium sulphate for the treatment of eclampsia and pre-eclampsia in Mozambique and Zimbabwe

Objective: To determine the prevalence of drugs for comprehensive management of preeclampsia in national essential medicine lists (EMLs) in low and middle income countries (LMICs) Methods:We collected EMLs from the 144 LMICs identi ed by the World Bank through broad-based Internet searches and in collaboration with the World Health Organization We identi ed therapies for hypertension, eclampsia, preeclampsia complications (eg, pulmonary edema, thrombosis), preterm birth, and labour induction contained in the EMLs Resuts:In 91 EMLs obtained from 144 LMICs, the most commonly listed parenteral antihypertensive therapies were verapamil (637%), hydralazine (615%), sodium nitroprusside (483%), and propranolol (396%) The most prevalent oral antihypertensive therapies were nifedipine (956%), methyldopa (934%), propranolol (901%), and atenolol (879%) For eclampsia/ preeclampsia, magnesium sulphate was present in 846% of EMLs and calcium gluconate in 857% For pulmonary edema, most EMLs (945%) listed oral furosemide, for thrombosis 923% listed heparin, for acceleration of fetal pulmonary maturity 901% listed parenteral dexamethasone, and for labour induction 978% listed oxytocin or a prostanoid (usually misoprostol, 407%) Concusion: EMLs of LMICs provide comprehensive coverage of preeclampsia pharmacotherapy These EMLs may be used as advocacy tools to ensure the availability of these therapies within each country RésuméObjectif : Déterminer la prévalence des médicaments permettant la prise en charge exhaustive de la prééclampsie au sein des listes de médicaments essentiels (LME) nationales des pays ne disposant que d'un revenu faible ou moyen (PRFM)Méthodes : Nous avons regroupé les LME des 144 PRFM identi és par la Banque mondiale par l'intermédiaire de recherches généralisées sur Internet et en collaboration avec l'Organisation mondiale de la santé Nous avons identi é, au sein des LME, les traitements visant l'hypertension, l'éclampsie, les complications de la prééclampsie (p ex oedème pulmonaire, thrombose), l'accouchement préterme et le déclenchement du travailRésutats : Au sein des 91 LME obtenues auprès de 144 PRFM, les traitements antihypertenseurs parentéraux apparaissant le plus couramment ont été les suivants : vérapamil (63,7 %), hydralazine (61,5 %), nitroprussiate de sodium (48,3 %) et propranolol (39,6 %) Les traitements antihypertenseurs oraux les plus prévalents ont été les suivants : nifédipine (95,6 %), méthyldopa 216 l MARCH JOGC MARS 2013 OBSTETRICS (93,4 %), propranolol (90,1 %) et aténolol (87,9 %) Pour ce qui est de l'éclampsie / la prééclampsie, le sulfate de magnésium gurait dans 84,6 % des LME et le gluconate de calcium, dans 85,7 % de celles-ci Pour ce qui est de l'oedème pulmonaire, le furosémide oral gurait dans la plupart des LME (94,5 %); pour ce qui est de la thrombose, l'héparine gurait dans 92,3 % des LME; pour ce qui est de l'accélération de la maturité pulmonaire foetale, la dexaméthasone parentérale gurait dans 90,1 % des LME; et pour ce qui es...

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“…16 By 2005, most EMLs surveyed listed magnesium sulphate, 17,18 and our study con rmed that this is still the case.…”

Section: Geographica and Income Distribution Of Identi Ed Emls In 14supporting

confidence: 60%

Pharmacotherapy for Preeclampsia in Low and Middle Income Countries: An Analysis of Essential Medicines Lists

Lalani

Firoz

Magee

et al. 2013

Journal of Obstetrics and Gynaecology Canada

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“…A case in point was magnesium sulfate which was not on the country's essential drug list at the beginning of the project. Since it is the drug of choice for women with eclampsia and severe pre-eclampsia, project sites needed it among its supplies of emergency drugs, but changing a government's essential drug list takes a long time [24]. Those involved with efforts to reduce maternal mortality lobbied with the Ministry of Health Pharmaceutical Center to have it included and shipments of magnesium sulfate are now arriving directly from government stocks.…”

Section: Policy Changementioning

confidence: 97%

Improving emergency obstetric care in Mozambique: The story of Sofala

Santos

Diante

Baptista

et al. 2006

Intl J Gynecology & Obste

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“…The market for the drug is small and the drug is not widely used for other conditions thereby lacking the economy of scope. [22] The drug can be made cheaper or free to patients if the government and development partners subsidize it, as it is done for anti-retroviral drugs. The United Nations Population Fund (UNFPA) and the Canadian International Development Agency (CIDA) have provided a support in that regard to states in the northwest zone and are scaling up to other states of the country.…”

Section: Challengesmentioning

confidence: 99%

Use of magnesium sulfate to manage pre-eclampsia and eclampsia in Nigeria: Overcoming the odds

Ekele

2009

Ann Afr Med

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System and market failures: the unavailability of magnesium sulphate for the treatment of eclampsia and pre-eclampsia in Mozambique and Zimbabwe

Cited by 41 publications

References 10 publications

Pharmacotherapy for Preeclampsia in Low and Middle Income Countries: An Analysis of Essential Medicines Lists

Pharmacotherapy for Preeclampsia in Low and Middle Income Countries: An Analysis of Essential Medicines Lists

Improving emergency obstetric care in Mozambique: The story of Sofala

Use of magnesium sulfate to manage pre-eclampsia and eclampsia in Nigeria: Overcoming the odds

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