TITLE:
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
AUTHORS:
Salisu Ishaku, Babatunde Ahonsi, Jamilu Tukur, Oginni Ayodeji
KEYWORDS:
Magnesium Sulphate; Pre-Eclampsia Eclampsia; Primary Care Facilities; Attrition; Nigeria
JOURNAL NAME:
Health,
Vol.5 No.9,
September
13,
2013
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.