Health> Vol.5 No.9, September 2013

Attrition from care after the critical phase of severe pre-eclampsia and eclampsia: Insights from an intervention with magnesium sulphate in a primary care setting in northern Nigeria

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ABSTRACT

Background: Evidence has shown that Magnesium Sulphate (MgSo4) is the gold standard for treating severe pre-eclampsia and eclampsia (SPE/E), and calls for its widespread use at all levels of health service delivery, including the primary care level. Objective: To determine if administering loading dose of MgSo4 on pregnant women with severe preeclampsia and eclampsia at primary care level would improve maternal and fetal outcomes. Method: Two sets of Primary Health Care (PHC) facilities were identified; one served as experimental one and the other as control. The community health extension workers (CHEWs) and the community health officers (CHOs) at the experimental PHCs were trained to administer the loading dose of MgSo4 for patients with SPE/E, in addition to other supportive treatments, before making a referral while the control PHCs did not give MgSo4, and neither administered diazepam as an alternative or no anti-convulsant at all, before making a referral to higher centers. Patients from the experimental and control facilities were prospectively monitored for fetal and maternal outcomes, namely maternal and fetal deaths, and for toxic effects of MgSo4 in the experimental arm. Results: Of the 150 patients recruited, 82 (55%) were in the experimental group and 68 (45%) were in the control group. 90% of the patients in the experimental group defaulted after receiving the loading dose of MgSo4 while the remaining 10% completed the referral process. 44% of those in the control group completed the referral process. There were 3 maternal and 3 perinatal deaths, all in the control group. No adverse outcome (maternal or fetal death) or toxic effect was recorded among the recipients of MgSo4. Conclusion: This study suggests that lower-cadre health care professionals at PHCs can administer the loading dose of MgSo4 to SPE/E patients to improve maternal and fetal survival in critical states, without significant risk of adverse effects. However, the lack of compliance with referral processes remains a huge challenge.

Cite this paper

Ishaku, S. , Ahonsi, B. , Tukur, J. and Ayodeji, O. (2013) Attrition from care after the critical phase of severe pre-eclampsia and eclampsia: Insights from an intervention with magnesium sulphate in a primary care setting in northern Nigeria. Health, 5, 1461-1466. doi: 10.4236/health.2013.59199.

References

[1] World Health Organization (2011) Recommendations for prevention and treatment of pre-eclampsia and eclampsia; Geneva. http:www.who.int/publications/2011/9789241548335_eng.pdf
[2] Zwart, J.J., Richters, A., Ory, F., de Vries, J.I., Bloemenkamp, K.W. and van Roosmalen, J. (2008). Eclampsia in the Netherlands. Obstetrics & Gynecology, 112, 820. doi:10.1097/AOG.0b013e3181875eb3
[3] Liu, S., Joseph, K.S., Liston, R.M., Batholomew, S., Walker, M., Kirby, R.S. and Kramer, M.S. (2011) Incidence, risk factors and associated complications of eclampsia. Obstetrics & Gynecology, 118, 987. doi:10.1097/AOG.0b013e31823311c1
[4] Eke, A.C., Ezebialu, I.U. and Okafor, C. (2011) Presentation and outcome of eclampsia at a tertiary center in south east Nigeria—A 6-year review. Hypertens Pregnancy, 30, 125. doi:10.3109/10641955.2010.525283
[5] Adamu, Y.M., Hamisu, M.S., Nalini, S. and Greg, R.A. (2003) Maternal mortality in northern Nigeria: A population-based study. European Journal of Obstetrics & Gynaecology and Reproductive Biology, 109, 153-159. doi:10.1016/S0301-2115(03)00009-5
[6] Tukur, J., Rabi’u, A. and Gill, K.S. (2008) Pattern of eclampsia in a tertiary health facility situated in a semi-rural town in Northern Nigeria. Annals of African Medicine, 6, 164-167. doi:10.4103/1596-3519.55703
[7] Efetie, E.R. and Okafor, U.V. (2007) Maternal outcomes in eclamptic patients in Abuja, Nigeria: A 5-year review. Nigerian Journal of Clinical Practice, 10, 309-313.
[8] National Population Commission (NPC) [Nigeria] and ICF Macro (2009) Nigeria demographic and health survey 2008. National Population Commission and ICF Macro, Abuja.
[9] Tukur, J., Ahonsi, B., Salisu, I.M., Idowu, A., Ekechi and O., Oginni, A.B. (2012) Maternal and fetal outcomes after introduction of magnesium suphate for treatment of preeclampsia and eclampsia in selected secondary facilities: A low-cost intervention. Maternal and Child Health Journal, 15, 1.
[10] The Eclampsia Trial Collaborative Group (1995) Which anticonvulsant for women with eclampsia? Evidence from the collaborative eclampsia trial. Lancet, 345, 1455-1463.
[11] McDonald, S.D., Lutsiv, O., Dzaja, N. and Duley, L. (2012) A systematic review of maternal and fetal outcomes following magnesium sulphate for pre-ecalmpsia/eclampsia in real-world use. International Journal of Gynecology and Obstetetrics, 118, 90-96. doi:10.1016/j.ijgo.2012.01.028
[12] Prata, N., Ejembi, C., Fraser, A., Shittu, O. and Minkler, M. (2012) Community mobilization to reduce post-partum hemorrhage in home births in northern Nigeria. Social Science and Medicine, 74, 1288-1296. doi:10.1016/j.socscimed.2011.11.035
[13] World Health Organization (1978) Declaration of Alma Ata. International conference on primary health care. http:www.who/int/publications/almaata_declaration_en.pdf
[14] Alexander, M.M. and Rose, N. (2012) Survival of neonates in rural Tanzania. Does place of delivery or continuum of care matters? BMC Pregnancy and Child Birth, 12, 18. doi:10.1186/1471-2393-12-18
[15] Fiagbe, P., Asamoah, D. and Oduro, F.T. (2012) Assessing the role of transportation in the achievement of maternal mortality reduction in Ghana. International Journal of Business and Management, 7, 5. doi:10.5539/ijbm.v7n5p256
[16] Turner, J. (2013) Maternal health and transport: A need for action. http//www4.worldbank.org/afr/ssatp/Resources/HTML/Gender-RH/Resourcedocument/issue and strategy papers/ Maternal Health/IMSH1 MH and Transport Turner
[17] Begum, R., Begum, A., Johanson, R., Ali, M.N. and Akhter, S. (2001) A low-dose (“DHAKAR”) magnesium sulphate regime for eclampsia. Acta Obstetricia et Gynecologica Scandinavica, 80, 998-1002.
[18] Omu, A.E., Al-Harmi, J., Vedi, H.L., Mlechkova, L., Sayed, A.F. and Al Ragum, N.S. (2008) Magnesium sulphate therapy in women with pre-eclampsia and eclampsia in Kuwait. Medical Principles and Practice, 17, 227-232. doi:10.1159/000117797
[19] Okunsanya, B.O., Garba, K.D. and Ibrahim, H.M. (2012) The efficacy of intra-muscular loading dose of MgSo4 in severe pre-eclampsia/eclampsia at a tertiary referral centre in northwest Nigeria. The Nigerian Postgraduate Medical Journal, 19.
[20] Warriner, I.K., Dualao, W., My Huong, N.T., Kusum, T., Anand, T., Iqbal, S., David, T.B. and Olav, M. (2011) Can midlevel health-care providers administer early medical abortion as safely and effectively as Doctors? A randomized controlled equivalence trial in Nepal. doi:10.1016/S0140-6736(10)62229-5
[21] The Population Reference Bureau (2012) World population data sheet. http//www.prb.org/pdf12-population-data-sheet_eng.pdf

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