Abstract
Background
The aim of this study is to examine rates of magnesium sulfate utilization by emergency obstetric care trainees to treat preeclampsia–eclampsia in India. Secondarily, structural barriers are identified which limit the use of magnesium sulfate, highlighting limitations of emergency obstetric care training, which is a commonly implemented intervention in resource-poor settings.
Methods
Trainees’ curriculum specified magnesium sulfate treatment for eclampsia and severe preeclampsia. Case records were analyzed for preeclampsia–eclampsia diagnosis, magnesium sulfate utilization, delivery route, and maternal and neonatal outcomes from 13,238 reported deliveries between 2006 and 2012 across 75 district hospitals in 12 Indian states.
Results
Of 1320 cases of preeclampsia–eclampsia, 322 (24.4%) had eclampsia. Magnesium sulfate was given to 12.9% of preeclamptic and 54.3% of eclamptic women, with lower usage rates in rural communities. Among the 1308 women with preeclampsia–eclampsia, only 24 deaths occurred (1.8%). In contrast, among the 17,179 women without preeclampsia–eclampsia, there were 95 reported deaths (0.6%). Both maternal mortality ratios were found to be much higher than the Millennium Development Goal target of 0.15%. Magnesium sulfate administration was associated with a higher death rate in preeclamptic but not eclamptic women, representing possible confounding by severity.
Conclusion
To optimize resources spent on emergency obstetric care training, the consistent availability of magnesium sulfate should be improved in India. Increasing drug availability, implementing clinical guidelines around its administration, and training health-care providers on the identification and treatment of preeclampsia–eclampsia could lead to notable improvements in maternal and infant mortality.
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References
CensusInfo India Dashboard 2011 [cited 2014 November 26]. http://www.censusindia.gov.in/2011-common/census_info_2011.html.
Sanneving L, Trygg N, Saxena D, et al. Inequity in India: the case of maternal and reproductive health. Glob Health Action. 2013;6:19145.
World Health Organization. Global health observatory country views: India. Statistics summary 200–2015. Geneva: World Health Organization; 2015. http://apps.who.int/gho/data/node.country.country-IND?lang=en.
India in Figures 2015, Ministry of Statistics and Programme Implementation Central Statistics Office, Research & Publication Unit, Government of India, New Delhi. http://mospi.nic.in/mospi_new/upload/India_in_figures-2015.pdf.
Press Information Bureau Government of India, Ministry of Health and Family Welfare. Millennium Development Goals May 2013 [cited 2015 5 February]. http://pib.nic.in/newsite/PrintRelease.aspx?relid=95498.
Planning Commission Government of India. Brief on the functions of Health, and Family Welfare Division, Twelfth Five Year Plan (2012–2017) [cited 2015 23 March]. http://planningcommission.gov.in/sectors/index.php?sectors=hea.
Gupta SK, Pal DK, Tiwari R, et al. Impact of Janani Suraksha Yojana on institutional delivery rate and maternal morbidity and mortality: an observational study in India. J Health Popul Nutr. 2012;30:464–71.
Salvador-Moysén J, Martínez-López Y, Ramírez-Aranda J, et al. The social conditions in the genesis of preeclampsia. Open J Epidemiol. 2014;4:115–21. doi:10.4236/ojepi.2014.43016.
Jayanna K, Mony P, Ramesh B, et al. Assessment of facility readiness and provider preparedness for dealing with postpartum haemorrhage and pre-eclampsia/eclampsia in public and private health facilities of northern Karnataka, India: a cross-sectional study. BMC Pregnancy Childbirth. 2014;14(1):304.
Health Management Information System. Health and Family Welfare Statistics in India 2013 Ministry of Health & Family Welfare2013 [cited 2014 November 26]. https://nrhm-mis.nic.in/SitePages/Pub-FW-Statistics2013.aspx.
Moran NF, Naidoo M, Moodley J. Reducing maternal mortality on a countrywide scale: the role of emergency obstetric training. Best Pract Res Clin Obstet Gynaecol. 2015;29:1102–18.
Ng M, Misra A, Diwan V, et al. An assessment of the impact of the JSY cash transfer program on maternal mortality reduction in Madhya Pradesh, India. Glob Health Action. 2014;7. http://www.globalhealthaction.net/index.php/gha/article/view/24939/0. Accessed 23 Jan 2017.
Guin G, Sahu B, Khare S, et al. Trends in maternal mortality and impact of Janani Suraksha Yojana (JSY) on maternal mortality ratio in a tertiary referral hospital. J Obstet Gynecol India. 2012;62(3):307–11.
Bhushan H, Bhardwaj A. Task shifting: a key strategy in the multipronged approach to reduce maternal mortality in India. Int J Gynecol Obstet. 2015;131:S67–S70.15.
Sajith M, Nimbargi V, Modi A, et al. Incidence of pregnancy induced hypertension and prescription pattern of antihypertensive drugs in pregnancy. Int J Pharma Sci Res. 2014;23:4.
Otolorin E, Gomez P, Currie S, et al. Essential basic and emergency obstetric and newborn care: from education and training to service delivery and quality of care. Int J Gynecol Obstet. 2015;130(Supplement 2):S46–53.
Ahmed U, Farid S, Luqman M, et al. An evaluative study of emergency obstetric care services in Southern Punjab. Int J Innov Appl Stud. 2015;10(4):1233.
American Society of Health-System Pharmacists. Current Shortages Magnesium Sulfate Injection 2015. http://www.ashp.org/menu/DrugShortages/CurrentShortages/Bulletin.aspx?id=757.
World Health Organization. WHO model list of essential medicines, 19th list. World Health Organization; 2015. http://www.who.int/medicines/publications/essentialmedicines/en/. Accessed 23 Jan 2017.
Ministry of Health and Family Welfare Government of India. National Health Mission Guidelines: Protocol posters from FRU to MC [cited 2015 5 February]. http://www.who.int/medicines/services/expertcommittees/essentialmedicines/TRS933SelectionUseEM.pdf.
Chaturvedi S, Randive B, Mistry N. Availability of treatment for eclampsia in public health institutions in Maharashtra, India. J Health Popul Nutr. 2013;31(1):86.
Acknowledgements
We would like to thank the maternal health division team at GOI (Dr. H Bhushan and Dr. Rajeev Agarwal), FOGSI, ICOG, chief coordinators, technical coordinators, master trainers, district trainers, nodal officers, state government officials, non-specialist physician trainees, and Avni Health Foundation team members, who have all contributed to successful program implementation. Additionally, the team thanks the UAB Sparkman Center for Global Health for their ongoing partnership.
Author Contributions
NAC was responsible for hypothesis formulation, data analysis, and initially drafting the manuscript. AB contributed to the development, implementation and management of the training program described, and revised the manuscript critically. CNP contributed to the development, administrative support for program implementation, and reviewing the manuscript. SD and PB conceptualized the EmOC program and developed partnerships with the Government and other agencies for the national scale up of the program and reviewed the manuscript. DB provided GOI led program support and reviewed the manuscript. HBu provided the public health perspective, coordinated communication between UAB and AVNI, and revised the manuscript critically. PS was one of the key program implementers and revised the manuscript critically.
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Ethical approval was provided by the University of Alabama at Birmingham’s Institutional Review Board (#N150209004).
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Dr. Henna Budhwani is an Assistant Professor and Deputy Director at School of Public Health, University of Alabama at Birmingham, Birmingham, USA; Dr. Poonam Shivkumar is a HOD at Mahatma Gandhi Institute of Medical Sciences, Wardha, India; Dr. Chittaranjan Narhari Purandare is a President at International Federation of Gynecology and Obstetrics, FIGO House, London, UK; Dr. Nicholas A. Cataldo is a Gynecologist and Obstetrician at School of Public Health, University of Alabama at Birmingham, Birmingham, USA; Dr. Sadhana Desai is a Gynecologist and Obstetrician at Federation of Obstetric and Gynaecological Societies of India, Mumbai, India; Dr. Prakash Bhatt is a Gynecologist and Obstetrician at Federation of Obstetric and Gynaecological Societies of India, Mumbai, India; Dr. Dinesh Baswal is a Deputy Commissioner—Maternal Health at Ministry of Health and Family Welfare, Government of India, New Delhi, India; Dr. Ajey Bhardwaj is a Founder Director at Avni Health Foundation, Mumbai, India.
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Budhwani, H., Shivkumar, P., Purandare, C.N. et al. Examining the Use of Magnesium Sulfate to Treat Pregnant Women with Preeclampsia and Eclampsia: Results of a Program Assessment of Emergency Obstetric Care (EmOC) Training in India. J Obstet Gynecol India 67, 330–336 (2017). https://doi.org/10.1007/s13224-017-0964-9
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DOI: https://doi.org/10.1007/s13224-017-0964-9