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

Ekele, BA

doi:10.4103/1596-3519.56231

Cited by 13 publications

(14 citation statements)

References 16 publications

(13 reference statements)

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“…First, there is need for the Nigerian government to ensure proper price control mechanisms for the drug are put in place while offering market incentives to encourage local production of the drug. Second, there maybe need to introduce subsidies for MgSO 4 as presently occurs with anti-retroviral drugs [23]. …”

Section: Discussionmentioning

confidence: 99%

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

et al. 2012

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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.

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Section: Discussionmentioning

confidence: 99%

“…Ministries of Health at state and national levels could also create more awareness about the benefits of using the drug, in collaboration with the World Health Organization as indicated in a previous publication [23]. Appropriate trainings for health care workers on the use of the drug should be a priority.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2012

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“…In several tertiary institutions accredited for postgraduate training, MgSO 4 is not found in the emergency trays of their labour wards even though it is available in their pharmacy. 14 The situation is better imagined at the secondary and primary health care centres. Factors responsible include the lack of guidelines on its use, non-inclusion in many national essential drug lists, the wrong perception that the drug is meant for use only at the highest level of facilities (such as those with intensive care facilities), lack of training of health workers on its use, cost of the drug and its availability.…”

Section: Introductionmentioning

confidence: 99%

“…Factors responsible include the lack of guidelines on its use, non-inclusion in many national essential drug lists, the wrong perception that the drug is meant for use only at the highest level of facilities (such as those with intensive care facilities), lack of training of health workers on its use, cost of the drug and its availability. 14 Despite the benefit of this drug, its toxicity is still a major concern. A potential concern is the risk of side effects which could increase with the duration of treatment especially if there are challenges in clinical monitoring of the patients.…”

Section: Introductionmentioning

confidence: 99%

Shortened versus standard post-partum maintenance therapy of magnesium sulphate in severe pre-eclampsia: a randomised control trial

Orisabinone

Onwudiegwu

Adeyemi

et al. 2020

Int J Reprod Contracept Obstet Gynecol

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Background: Pre-eclampsia is a pregnancy-associated multi-organ disorder caused by altered trophoblastic invasion and endothelial cell dysfunction. It is associated with significant maternal and perinatal morbidity and mortality, especially in developing countries. Magnesium sulphate (MgSO4) is effective in the management of severe pre-eclampsia/eclampsia. Objective of this study was to compare the effectiveness of a shortened course of MgSO4 to the Pritchard regimen in patients with severe pre-eclampsiaMethods: This study was carried out at the obstetrics and gynecology department of the Obafemi Awolowo University Teaching Hospital, Ile-Ife. It was a randomised control study of 116 patients, 58 in each group. Group A received the standard Pritchard regimen: a loading dose of MgSO4 4g slow IV bolus plus 10 g IM (5 g in each buttock), followed by maintenance dose of 5g MgSO4 IM 4-hourly into alternate buttocks until 24 hours after delivery. Group B received same loading dose, but the maintenance dose was limited to three doses of 5g MgSO4 IM four hours apart after delivery. In both regimens, 2g MgSO4 was given IV for breakthrough fit. Data were analyzed using SPSS version 20.Results: This study revealed that twelve-hour postpartum MgSO4 was as effective as the Pritchard regime with no statistically difference in occurrence of seizures (X2 = 0.341, df = 1, p = 0.514). The average total dose of magnesium sulphate used was lower in the study Group B.Conclusions: Twelve-hour postpartum MgSO4 is as effective as the standard 24-hour Pritchard regime.

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“…Magnesium sulfate was included in Nigeria's Essential Drug List for the treatment of eclampsia in 2009 . However, its use is yet to be institutionalized or scaled up in the country because of multiple factors including its relative non‐availability , limited clinician experience in its use, and the persisting misconception about its toxicity in the absence of facilities to monitor serum magnesium levels . However, recent evidence indicating that magnesium sulfate can be used in resource‐constrained settings without the need for intensive care has stimulated interest in the use of the drug in the country.…”

Section: Introductionmentioning

confidence: 99%

Training health workers for magnesium sulfate use reduces case fatality from eclampsia: results from a multicenter trial

Okonofua

Ogu

Fabamwo

et al. 2013

Acta Obstet Gynecol Scand

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

Cited by 13 publications

References 16 publications

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

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

Shortened versus standard post-partum maintenance therapy of magnesium sulphate in severe pre-eclampsia: a randomised control trial

Training health workers for magnesium sulfate use reduces case fatality from eclampsia: results from a multicenter trial

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