Table 2

Major barriers and facilitators to the availability and use of MgSO4 identified at each level

Barriers identified

Facilitators identified

Outcome


Government/Regulatory

MgSO4 injection not registered in Zambia

MgSO4 not licensed for use in severe pre-eclampsia or eclampsia

MgSO4 listed in Essential Medicines List and Standard Treatment Guidelines

MgSO4 being manufactured in Zambia

Unregulated MgSO4 available in the market place


Pharmaceutical supply system

MgSO4 not being procured by MoH

MgSO4 out of stock at the Central Medical Store

MgSO4 on Ministry of Health Procurement list

MgSO4 not available for delivery to health facilities


University Teaching Hospital (UTH)

Stock-outs of dipsticks for testing urine for proteinuria.

STG translated into suitable local protocol

Health professionals aware that MgSO4 is the 1st line treatment for severe pre-eclampsia/eclampsia

Obstetricians requested purchase of MgSO4

Hospital pharmacy is procuring MgSO4 from local wholesaler

Midwives have received training for use of MgSO4

Evidence that MgSO4 being used for treatment of eclampsia, but not severe pre-eclampsia


Health Centre 1

Health Centre 2

(findings at the two health centres were the same)

MgSO4 out of stock

Midwife on duty had never administered MgSO4

Local protocol did not follow evidence-based guidelines for use of MgSO4

Midwife on duty aware that MgSO4 is the first line treatment for severe pre-eclampsia and eclampsia

Evidence-based guidelines available

Equipment and supplies available to diagnose pre-eclampsia

Equipment and supplies available to administer MgSO4

No evidence of use of MgSO4. Cases of eclampsia treated with diazepam and referred to UTH


Ridge et al. BMC Health Services Research 2010 10:340   doi:10.1186/1472-6963-10-340

Open Data