J Tukur*, B Ahonsi**, A Karlyn**, I Araoyinbo**
*Aminu Kano Teaching Hospital,
Kano, Nigeria
**Population Council, Abuja, Nigeria



Describe the introduction of magnesium
sulphate to a state health system
Describe the results of the intervention
Discuss the results as well as challenges



Eclampsia is a common cause of maternal
mortality worldwide especially in the
developing countries.
It is estimated that every year eclampsia is
associated with about 50,000 maternal
deaths worldwide, most of which occur in
developing countries.
In Nigeria, eclampsia is a common cause of
maternal mortality.




The Collaborative Eclampsia Trial in 1995
confirmed the efficacy of MgSO4 in the treatment
of severe preeclampsia and eclampsia.
Women treated with MgSO4 had a 52% and 67%
lower recurrence of convulsions than those
treated with diazepam and phenytoin,
respectively.
Use of MgSO4 in patients with severe
preeclampsia reduced the risk of progression to
eclampsia by more than half and reduced
maternal mortality


The MagPie Trial demonstrated that when
magnesium sulphate was used in women with
preeclampsia, there was a 58% lower risk of
progression to eclampsia compared to those
who had placebo.
Maternal mortality was also reduced in those
who had magnesium sulphate


Despite these evidences, the use of
magnesium sulphate is still not universal in
Nigeria.
In Nigeria, the drug was not widely available
as at five to ten years ago but that has now
changed.

This presentation will describe introduction of
magnesium sulphate in an area where it was
not available and discuss the effects of its
introduction to maternity services



Presentation at SOGON Conference in 2007
Population Council sought funding for the
project from MacArthur Foundation
Project site was Kano: most populous state of
Nigeria with population over 10 million, 44
LGAs, 35 General Hospitals, free maternity
scheme



A pilot survey was first conducted in January
2009 to determine the use of Magnesium
sulphate in General Hospitals in Kano state.
It was being used occasionally in one of the
hospitals (Murtala Muhammad Specialist
Hospital)
Advocacy followed






A training of trainer workshop was held in February
2008 in Kano.
All the participants were either doctors or midwives
from 10 pilot general hospitals.
The intramuscular regime was chosen for its
simplicity in monitoring while toxicity was monitored
clinically.
Patella hammers and calcium gluconate were
supplied to all the centres.
Most of the participants physically sighted
magnesium sulphate for the first time at the
workshop.
A simple protocol for the use of magnesium sulphate
was also developed.





A total of 25 master trainers were trained at the first
workshop.
The 25 master trainers later conducted step down
trainings at 10 of the 35 general hospitals in the
state.
With training, the drug was introduced in the 10
General Hospitals.
The seed stock was supplied through the project to
the 10 hospitals via the State Hospitals Management
Board
Within a period of three months, the master trainers
trained 160 clinical providers through step down
trainings conducted at the various health facilities.



From February to December, 2008, a total of
1846 patients were treated with magnesium
sulphate in the 10 general Hospitals
Majority (43.3%) of them were treated the
Murtala Muhammad Specialist Hospital in the
state capital.
The highest frequency was in the
primigravida consisting of 1152 out of the
1846 (63.3%) patients.





1044 (57.7%) of the patients had antenatal care
while 764 (41.4%) did not have antenatal care.
Data was however missing in 38 (2.1%) of the
patients
The mean time in hours before presentation was
8.4 while the mean no. of fits was 3.2.
Twenty-three (1.24%) of the patients were noted
to have toxic effects of the drugs through clinical
monitoring.
For these few cases, the drug was stopped and
the antidote (calcium gluconate) administered.
There was no mortality or morbidity recorded
from the toxic effects of the drug.





Seventy-seven (4.1%) mothers died while 239
(12.9%) babies were delivered dead.
These deaths were recorded only in women who
delayed before presenting to the health facilities.
The 77 mothers who died within the 12 months
period of the project constituted 15.9% of the
total 483 maternal deaths recorded in the 10
hospitals (including those from other causes).
A review of the 12 months period prior to the
intervention revealed that eclampsia accounted
for 268 (47.3%) of the 567 maternal deaths.
This demonstrated a reduction in attributable
deaths from eclampsia by 66%.


All the facilities reported periods of stockout of magnesium sulphate at least once
during the 12 months of the project.
As the project was not directly responsible for
the supply of the drug to the health facilities,
joint meetings of the medical officers in
charge of the health facilities and the free
maternity drugs committee were called to
discuss the recurrent reports of stock-outs.


By the tenth month of the project, the state
government took over the purchase of the
drug and continued thereafter.
The decision of the government resulted from
the data that was generated from the project
and positive comments from both health
workers who use the drug and patient
relations.


The project was not about showing that
magnesium sulphate works.
That has already been proven




The project was about demonstrating the
following:
Evidence based interventions could be
introduced into ‘new areas’.
The project is sustainable: related to
engagement of stakeholders
Introduction of evidence based interventions
usually replicable

Project left a crop of master trainers who
have commenced knowledge transfer



Stock-outs in a setting of free maternity
scheme
Improving the quality of ANC
Delays by women in reaching health facilities

Thank you