Despite policy on use of MgSO4 in Nigeria, lower levels of the health system are unaware of protocols and guidelines.
Policymakers in Nigeria understand the enormous burden of PE/E and its consequences on maternal and newborn survival, and that WHO recommends magnesium sulphate (MgSO4) as the most effective, safe, and low-cost drug for treating it. They also know that if PE is detected during antenatal care (ANC) visits, eclampsia and other complications are avoidable. Many policymakers understand that the use of MgSO4 shapes maternal and newborn outcomes related to PE/E, however primary health providers must have the skills to detect and manage PE/E and refer patients to higher-level facilities after administering a loading dose of MgSO4—a large dose required to halt seizures.
There are several barriers to accessing MgSO4 for PE/E, including:
- Although MgSO4 is on national and state essential medicines lists, the guidelines for procurement and distribution at national or state levels are not available;
- Development of national policies for managing hypertensive disorders during pregnancy, and the use of antihypertensives and MgSO4 requires collaboration between national and state policymakers, but they are unaware of international guidelines for managing PE/E;
- Many PE/E patients cannot afford MgSO4 from private vendors, which is the most common way of obtaining it and makes quality control a concern.