Benefits of using magnesium sulphate (MgSO_4) for eclampsia management and maternal mortality reduction: Lessons from Kano State in northern Nigeria

Background: Despite clear emphasis through the Millennium Development Goals, the problem of high maternal mortality persists especially within low and middle income countries. Various studies report remarkably high maternal mortality rates in northern Nigeria, where maternal mortality rates exceed 1,000 deaths per 100,000 live births and eclampsia contributes approximately 40% of maternal deaths. Across Nigeria, diazepam is routinely used for the management of eclampsia. Prior to February 2008, diazepam was widely used for the management of eclampsia in Kano State (within northern Nigeria) with case fatality rate being over 20%. While magnesium sulphate (MgSO_4) is recognized as the most effective drug for the management of eclampsia; this study aims to compare MgSO_4 therapy with diazepam therapy in terms of case fatality rates and costs. Findings: This retrospective study, including 1,045 patients with eclampsia and pre-eclampsia during the years 2008 and 2009, reports a drop in case fatality rates from 20.9% (95% CI: 18.7, 23.2) to 2.3% (95% CI: 1.4, 3.2) among eclampsia patients following the MgSO_4 intervention. The study observed no significant difference in the cost of using MgSO_4 therapy compared to diazepam therapy. Conclusions: The study found a remarkable reduction in case fatality rate due to eclampsia in those who received MgSO_4 therapy with minimal increase in costs when compared to diazepam therapy. Concerted efforts should be focused on properly introducing MgSO_4 into emergency obstetric protocols especially within developing countries to reduce maternal mortality and also impact on health system performance