title: Factors influencing the use of magnesium sulphate in pre-eclampsia/eclampsia management in health facilities in Northern Nigeria: a mixed methods study.
abstract: BACKGROUND
  Eclampsia remains a major cause of perinatal and maternal morbidity and mortality worldwide. We examined facilitators and barriers to the use of magnesium sulphate (MgSO4) in the management of pre-eclampsia/eclampsia (PE/E) in health facilities in Bauchi and Sokoto States in Nigeria.
  
  
  METHODS
  Data were collected from 80 health facilities using a cross-sectional, mixed method (quantitative and qualitative) design. We assessed health facility readiness to manage PE/E and use MgSO4 as the drug of choice, through provider interviews, in-depth interviews with facility managers and an inventory of equipment and supply in facilities. Bivariate and qualitative data analyses were performed to isolate the principal enabling factors and barriers to the management of PE/E and use of MgSO4.
  
  
  RESULTS
  The majority of health facility providers correctly mentioned MgSO4 as the drug of choice for the prevention and termination of convulsions in severe PE/E (65 %). Sixty-four percent of the health facilities had service registers available. About 45 % of providers had been trained on the use of MgSO4 for the management of PE/E. Regarding providers' practices, 45 % of respondents indicated that MgSO4 was used to prevent and treat convulsions in severe PE/E in their facilities. Barriers to management of PE/E included inadequate numbers of skilled providers, frequent shortages of MgSO4, lack of essential equipment and supplies, irregular supply of electricity and water, and non-availability of guidelines and clinical protocols at the health facilities. Technical support to providers was inadequate.
  
  
  CONCLUSIONS
  The study revealed that a constellation of factors adversely affect the management of PE/E and especially the use of MgSO4 by service providers. Efforts to improve the management of PE/E in facilities should include integrated programs that substantially improve provider and facility readiness to manage PE/E for better maternal and newborn health outcomes in Northern Nigeria.
authors.affiliation: USAID/TSHIP Abuja Nigeria, 3 Emir Sulaiman Adamu Street, GRA, Bauchi. ooguntunde@futuresgroup.com.|Futures Group, Chapel Hill, USA. ooguntunde@futuresgroup.com.
authors.forename: Olugbenga
authors.initials: O
authors.lastname: Oguntunde
authors.affiliation: Futures Group, Chapel Hill, USA. zcharyeva@futuresgroup.com.
authors.forename: Zulfiya
authors.initials: Z
authors.lastname: Charyeva
authors.affiliation: Futures Group, Chapel Hill, USA. mcannon@futuresgroup.com.
authors.forename: Molly
authors.initials: M
authors.lastname: Cannon
authors.affiliation: USAID/TSHIP Abuja Nigeria, 3 Emir Sulaiman Adamu Street, GRA, Bauchi. william.sambisa@gmail.com.|JSI Research and Training Institute, Boston, USA. william.sambisa@gmail.com.
authors.forename: William
authors.initials: W
authors.lastname: Sambisa
authors.affiliation: USAID/TSHIP Abuja Nigeria, 3 Emir Sulaiman Adamu Street, GRA, Bauchi. norobaton@tshipnigeria.org.|JSI Research and Training Institute, Boston, USA. norobaton@tshipnigeria.org.
authors.forename: Nosakhare
authors.initials: N
authors.lastname: Orobaton
authors.affiliation: USAID/TSHIP Abuja Nigeria, 3 Emir Sulaiman Adamu Street, GRA, Bauchi. ikabo@tshipnigeria.org.
authors.forename: Ibrahim A
authors.initials: IA
authors.lastname: Kabo
authors.affiliation: USAID/TSHIP Nigeria, Block 14 Shehu Kangiwa Secretariat, Sokoto, Nigeria. kshoretire@tshipnigeria.org.
authors.forename: Kamil
authors.initials: K
authors.lastname: Shoretire
authors.affiliation: USAID/TSHIP Abuja Nigeria, 3 Emir Sulaiman Adamu Street, GRA, Bauchi. sdanladi@tshipnigeria.org.
authors.forename: Saba'atu E
authors.initials: SE
authors.lastname: Danladi
authors.affiliation: USAID/TSHIP Nigeria, Block 14 Shehu Kangiwa Secretariat, Sokoto, Nigeria. nlawal@tshipnigeria.org.
authors.forename: Nurudeen
authors.initials: N
authors.lastname: Lawal
authors.affiliation: USAID/TSHIP Abuja Nigeria, 3 Emir Sulaiman Adamu Street, GRA, Bauchi. hsadauki@tshipnigeria.org.
authors.forename: Habib
authors.initials: H
authors.lastname: Sadauki
mesh_terms: D003430:Cross-Sectional Studies; D004461:Eclampsia / Q000188:drug therapy*; D004864:Equipment and Supplies / Q000600:supply & distribution; D005260:Female; D006268:Health Facilities / Q000592:standards / Q000706:statistics & numerical data*; D006280:Health Workforce; D006801:Humans; D008278:Magnesium Sulfate / Q000600:supply & distribution / Q000627:therapeutic use*; D009549:Nigeria; D011225:Pre-Eclampsia / Q000188:drug therapy*; D011247:Pregnancy; D036301:Qualitative Research; D015149:Tocolytic Agents / Q000600:supply & distribution / Q000627:therapeutic use*
chemical_list: D015149:Tocolytic Agents; D008278:Magnesium Sulfate