Expanding Access to Magnesium Sulphate to Manage Pre-eclampsia and Eclampsia
Photo: Population Council.
Ending Eclampsia seeks to expand access to proven, underutilized interventions and commodities for the prevention, early detection, and treatment of pre-eclampsia and eclampsia and to strengthen global partnerships.
The Issue
Each day around the world, 800 women die from pregnancy- and childbirth-related causes. In sub-Saharan Africa, 200,000 women die annually, and in Southern Asia 66,000 die each year. The second most common cause (after postpartum hemorrhage) is pre-eclampsia and eclampsia (PE/E)—life-threatening, pregnancy-induced high blood pressure and excess protein in the urine after 20 weeks gestation. PE/E most often occurs during the second half of pregnancy, but can happen before, during, or after delivery. It can lead to seizures, kidney and liver damage, and death, and increases the risk of preterm births, low birth-weight, anemia, and stunting.
One in four preterm infants dies as a result of the mother’s PE/E. These deaths are preventable, yet essential medicines and tools to treat this disorder are often unavailable in low-resource settings.
When a mother dies, her infant has an increased risk of dying during the first year of life. If the baby survives, he or she is less likely to receive proper health care services, attend school, and make healthy life choices. In sub-Saharan Africa and Southern Asia, where farming and agricultural work is performed primarily by women, local and national economies suffer as a result of maternal deaths.
High-Impact, Low-Cost Interventions
The World Health Organization (WHO) recommends magnesium sulphate (MgSO4) as the most effective, safe, and low-cost anticonvulsant treatment for severe pre-eclampsia and eclampsia. Twenty-eight countries include MgSO4 on their Essential Medicines List and have protocols on its use, but in practice the drug is often unavailable at community facilities or is not used in compliance with guidelines.
Supported by the United States Agency for International Development (USAID), Ending Eclampsia is a five-year (2014–19), $9 million project that builds upon previous Population Council research and interventions in Bangladesh, Mexico, and Nigeria to increase the availability and correct use of MgSO4 in maternal health care settings, and expands this work into Ethiopia and Pakistan.
In partnership with national midwifery and ob/gyn societies, Ending Eclampsia works to scale up successful strategies and to strengthen the capacity of local institutions to identify women at risk for PE/E, manage high blood pressure during pregnancy to prevent PE/E, and use MgSO4 and other drugs to manage PE/E and prevent poor maternal and newborn health (MNH) outcomes.
To identify and address policy, programming, and cost barriers to expanding the use of MgSO4 and other lifesaving commodities, Ending Eclampsia, along with health ministry officials and other stakeholders, is updating, developing, and implementing maternal health policies in project countries. Another priority is raising awareness about the importance of antenatal care by engaging with stakeholders across the health system, including community leaders, health workers, ministry officials, and families of pregnant women. Ending Eclampsia also convenes a global coalition to share lessons learned through global knowledge platforms and to inform strategies for improving detection and management of PE/E within the context of routine maternal health care.
Our findings will change the global conversation on maternal mortality, putting a greater focus on this preventable cause of death, and will be used to scale up access to these lifesaving medicines for approximately 3 million women at risk of PE/E annually.
In Bangladesh, Nigeria, and Pakistan, Ending Eclampsia minimizes the barriers to detecting and managing PE/E by:
- Increasing awareness around the utilization of antihypertensives to manage high blood pressure and prevent it from progressing to severe PE/E among high-risk women;
- Enhancing the capacity of doctors, nurses, and midwives to administer MgSO4;
- Reducing misconceptions about the causes of PE/E, raising awareness, and promoting positive health-seeking behaviors;
- Strengthening linkages between primary (lowest level) and secondary (referral) health facilities; and
- Reducing delays in accessing care among women who experience complications during pregnancy.
