Translating research into policy and practice in developing countries: a case study of magnesium sulphate for pre-eclampsia

Abstract

BackgroundThe evidence base for improving reproductive health continues to grow. However, concerns remain that the translation of this evidence into appropriate policies is partial and slow. Little is known about the factors affecting the use of evidence by policy makers and clinicians, particularly in developing countries. The objective of this study was to examine the factors that might affect the translation of randomised controlled trial (RCT) findings into policies and practice in developing countries.MethodsThe recent publication of an important RCT on the use of magnesium sulphate to treat pre-eclampsia provided an opportunity to explore how research findings might be translated into policy. A range of research methods, including a survey, group interview and observations with RCT collaborators and a survey of WHO drug information officers, regulatory officials and obstetricians in 12 countries, were undertaken to identify barriers and facilitators to knowledge translation.ResultsIt proved difficult to obtain reliable data regarding the availability and use of commonly used drugs in many countries. The perceived barriers to implementing RCT findings regarding the use of magnesium sulphate for pre-eclampsia include drug licensing and availability; inadequate and poorly implemented clinical guidelines; and lack of political support for policy change. However, there were significant regional and national differences in the importance of specific barriers.ConclusionThe policy changes needed to ensure widespread availability and use of magnesium sulphate are variable and complex. Difficulties in obtaining information on availability and use are combined with the wide range of barriers across settings, including a lack of support from policy makers. This makes it difficult to envisage any single intervention strategy that might be used to promote the uptake of research findings on magnesium sulphate into policy across the study settings. The publication of important trials may therefore not have the impacts on health care that researchers hope for.

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

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

“…At the global level, barriers include gender inequality, infringement of human rights, politicization of sexual and reproductive health, and nancial constraints. 17,[35][36][37] However, the presence of a medication on an EML may assist those who advocate for the availability of appropriate medications and high-quality care. 9…”

Single Loading Dose of Magnesium Sulphate in Severe Preeclampsia and Eclampsia-Is it Effective? A Randomized Prospective Study

“…They explained that the reasons behind those dosing modifications on were concern about MgSO 4 toxicity (mainly because of smaller size of women and others), inconsistent supply of drugs, cost-effectiveness, lack of resources for monitoring and difficulties with repeated IM injections for the patients [9]. They also observed that MgSO 4 is underutilized in LMIC (low and middle income countries), thus emphasizing the need of policy changes to ensure the widespread availability of the drug and its use [9,10].…”

Evidence for informing health policy development in Low-income Countries (LICs): perspectives of policy actors in Uganda

“…In this article, we adopt the definition of evidence as provided by Lomas et al (3) defining evidence as facts (actual or asserted) intended to help the reader reach a conclusion and form an opinion about something. We acknowledge that evidence and the process of translating it into a decision or some form of action is shaped and is influenced by a number of factors which have been explored extensively by several scholars (4)(5)(6)(7). For example, the Overseas Development Institute's Research and Policy in Development (RAPID) framework in particular looks at these influences with a LIC perspective.…”