Spotlight on Magnesium Sulfate for Pre-eclampsia and Eclampsia

This document summarises an evidence review that was conducted in order to understand the social and behavioural drivers of demand for, and utilisation of, magnesium sulfate (MgSO4), a medication for the prevention and treatment of pre-eclampsia and eclampsia (PE/E). The risk that a woman in a developing country will die of PE/E is approximately 300 times higher than that for a woman in a developed country, according to this document. MgSO4 is one of 13 underutilised commodities identified by the United Nations Commission on Life-Saving Commodities for Women's and Children's Health (UNCoLSC), whose purpose is to examine effective practices in implementing demand generation programmes and inform future programming.

The evidence review found 14 documents related to demand generation for MgSO4 that met the inclusion criteria. The evidence was documented from Latin America (2), Africa (7), and Asia (2), along with 3 documents with a global focus. Selected findings:

• Challenges: There are "a number of barriers to increasing the uptake of MgSO4, including the lack of provider and community knowledge about MgSO4 and symptoms of PE/E." Furthermore, there is "a gap in policy and practice regarding the use of MgSO4", including "lack of political will for the issue."
• Interventions: Policy and service delivery changes to increase use of MgSO4 have focused on building health care provider knowledge and capacity to administer the medication - as reflected, for instance, in an initiative in Kano, Nigeria, that integrated advocacy, collaborative protocol development, and health care provider training. "Low-cost, participatory, upstream efforts also can engage policy makers and researchers to create a window of opportunity where priorities for maternal health and MgSO4 overlap."

One recommendation going forward is to conduct further research on community-level implementation of MgSO4 treatment, per the results of a quasi-experimental intervention in rural Bangladesh that "showed remarkable achievements in using MgSO4 at the community level for cases of eclampsia and severe eclampsia."