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

BMC Research Notes

Ayodeji Babatunde Oginni²  Salisu Mohammed Ishaku²  Jamilu Tukur¹  Babatunde Ahonsi²  Ekechi Okereke² 

[1] Department of Obstetrics and Gynaecology, Bayero University/Aminu Kano Teaching Hospital, Kano, Nigeria;Population Council, Abuja, Nigeria

关键词: Northern Nigeria;    Millennium Development goals;    Maternal mortality;    Magnesium sulphate;   

Others  :  1165974
DOI  :  10.1186/1756-0500-5-421

 received in 2012-03-14, accepted in 2012-07-23,  发布年份 2012

【 摘 要 】

Background

Despite 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.

Findings

This 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.

Conclusions

The 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.

【 授权许可】

   
2012 Okereke et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Harrison KA: Maternal mortality – a sharper focus on a major issue of our time. Trop J Obstet Gynaecol 1998, 1(1):9-13.
• [2]Loudon I: Maternal mortality in the past and its relevance to developing countries today. Am J Clin Nutr 2000, 72(1):241S-246S.
• [3]Khan KS, Wojdyla D, Say L, Gulmezoglu MA, Van Look PFA: WHO analysis of causes of maternal deaths: a systematic review. Lancet 2006, 367:1066-1074.
• [4]Nyamtema AS, Urassa DP, Van Roosmalenx J: Maternal health interventions in resource limited countries: a systematic review of the packages, impacts and factors for change. BMC Pregnancy and Childbirth 2011, 11:30. BioMed Central Full Text
• [5]World Health Organization: Make Every Mother and Child Count. The World Health Report 2005. Geneva: World Health Organization; 2005.
• [6]Langer A, Villar J, Tell K, Kim T, Kennedy S: Reducing eclampsia-related deaths – a call to action. Lancet 2008, 371:705-706.
• [7]Hogan MC, Foreman KJ, Naghavi M, Ahn SY, Wang M, Makela SM, Lopez AD, Lozano R, Murray C: Maternal mortality for 181 countries, 1980–2008: a systematic analysis of progress towards Millenium Development Goal 5. Lancet 2010, 375:1609-1623.
• [8]Society of Gynaecology and Obstetrics of Nigeria: Status of emergency obstetric service in six states of Nigeria – A needs assessment report,. 2004.
• [9]Tukur J, Rai’u , Gill KS: Pattern of eclampsia in a tertiary health facility situated in a semi-rural town in Northern Nigeria. Annals of African Medicine 2008, 6(4):164-167.
• [10]World Health Organization: Mother-baby package: implementing safe motherhood in countries. Geneva: World Health Organization; 1994.
• [11]Eclampsia Trial Collaborative Group: Which anticonvulsant for women with eclampsia? Evidence from the collaborative eclampsia trial. Lancet 1995, 345:1455-1463.
• [12]Magpie Trial Collaborative Group: Do women with pre-eclampsia and their babies benefit from magnesium sulphate? The magpie trial: a randomized placebo-controlled trial. Lancet 2002, 359:1877-1890.
• [13]Duley L, Gulmezoglu AM, Henderson-Smart DJ: Magnesium sulphate and other anticonvulsants for women with pre-eclampsia. Cochrane Database. Syst Rev 2003, 2:CD 000025.
• [14]Tukur J, Muhammad Z: Management of eclampsia at AKTH: before and after magnesium sulphate. Niger J Med 2010, 19(1):104-107.
• [15]Neilson JP: Magnesium sulphate: the drug of choice in eclampsia. BMJ 1995, 311:701-703.
• [16]Sevene E, Lewin S, Mariano A, Woelk G, Oxman AD, Matinhure S, Cliff J, Fernandes B, Daniels K: Systems and market failures: the unavailability of magnesium sulphate for the treatment of eclampsia and pre-eclampsia in Mozambique and Zimbabwe. BMJ 2005, 331:765-769.
• [17]National Population Commission (NPC) [Nigeria]: Final Results of the 2006 National Population and Housing Census of Nigeria. Abuja, Nigeria: National Population Commission; 2009.
• [18]National Population Commission (NPC) [Nigeria]: Nigeria Demographic and Health Survey 2008. Abuja, Nigeria: National Population Commission and ICT Macro; 2009.
• [19]Wolf M, Abubakar A, Tsui S, Williamson NE: Child spacing attitudes in Northern Nigeria. Arlington, VI: FHI; 2008.
• [20]Ekele B: Magnesium sulphate: The gold standard for the treatment of eclampsia and severe pre-eclampsia. Trop J Obstet Gynaecol 2006, 23:1-2.
• [21]Duley L, Henderson-Smart DJ, Walker GJA, Chou D: Magnesium sulphate versus diazepam for eclampsia. Cochrane Database of Systematic Reviews 2010., Art. No.: CD000127(Issue 12)
• [22]World Health Organization: WHO recommendation for the prevention and treatment of pre-eclampsia and eclampsia. Geneva: World Health Organization; 2011:30-32.
• [23]Ekele B: Use of magnesium sulfate to manage pre-eclampsia and eclampsia in Nigeria: overcoming the odds. Annals of African Medicine 2009, 8(2):73-75.
• [24]Sheth SS, Chambers I: Magnesium for preventing and treating eclampsia: Time for international action. Lancet 2002, 359:1872-1873.
• [25]Freedman LP, Waldman RJ, de Pinbo H, Wirth ME, Chowdhury AMR, Rosenfield A: Transforming health systems to improve the lives of women and children. Lancet 2005, 365:997-1000.