title: Facility and personnel factors influencing magnesium sulfate use for eclampsia and pre-eclampsia in 3 Indian hospitals.
abstract: OBJECTIVE
  To identify factors at the health facility and health professional levels that might hinder or facilitate the appropriate use of magnesium sulfate for the treatment of pre-eclampsia and eclampsia.
  
  
  METHODS
  Seven focus group discussions were conducted with a purposively sampled group of obstetricians/gynecologists, medical residents, and nurses at 3 hospitals in Nagpur, India. Data were collected on facility and drug availability, criteria for diagnosis and management of pre-eclampsia and eclampsia, attitudes about magnesium sulfate use, and perceived barriers to the treatment of pre-eclampsia and eclampsia.
  
  
  RESULTS
  Senior gynecologists seemed to encourage the use of magnesium sulfate, especially management prior to transfer to a higher facility. However, clinicians noted a lack of specific institutional guidelines on dose, timing, and indications, particularly in cases in which delivery was not imminent. In all facilities, service providers noted that their clinical care decisions were sometimes influenced by political and social factors, making management of eclampsia and pre-eclampsia cases difficult. Care was further challenged by limited drug availability, particularly at the tertiary-care center.
  
  
  CONCLUSIONS
  Limited drug supply and lack of specific institutional guidelines, equipment, and trained staff hinder the translation of evidence-based policy on magnesium sulfate into practice.
authors.affiliation: Consultant, Gujarat, India.
authors.forename: Alka
authors.initials: A
authors.lastname: Barua
authors.forename: Shuchita
authors.initials: S
authors.lastname: Mundle
authors.forename: Hillary
authors.initials: H
authors.lastname: Bracken
authors.forename: Thomas
authors.initials: T
authors.lastname: Easterling
authors.forename: Beverly
authors.initials: B
authors.lastname: Winikoff
mesh_terms: D001291:Attitude of Health Personnel; D003625:Data Collection; D004461:Eclampsia / Q000188:drug therapy*; D005260:Female; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D007194:India; D008278:Magnesium Sulfate / Q000008:administration & dosage / Q000600:supply & distribution / Q000627:therapeutic use*; D016134:Organizational Policy; D017410:Practice Guidelines as Topic; D011225:Pre-Eclampsia / Q000188:drug therapy*; D011247:Pregnancy; D015149:Tocolytic Agents / Q000008:administration & dosage / Q000600:supply & distribution / Q000627:therapeutic use*
chemical_list: D015149:Tocolytic Agents; D008278:Magnesium Sulfate