印度卡纳塔克邦北部两个选定地区医疗保健机构硫酸镁的供应和使用情况。
Availability and use of magnesium sulphate at health care facilities in two selected districts of North Karnataka, India.
机构信息
Department of Obstetrics and Gynaecology, S Nijalingappa Medical College, Bagalkot, Karnataka, India.
KLE Academy of Higher Education and Research's J N Medical College, Belagavi, Karnataka, India.
出版信息
Reprod Health. 2018 Jun 22;15(Suppl 1):91. doi: 10.1186/s12978-018-0531-6.
BACKGROUND
Pre-eclampsia and eclampsia are major causes of maternal morbidity and mortality. Magnesium sulphate is accepted as the anticonvulsant of choice in these conditions and is present on the WHO essential medicines list and the Indian National List of Essential Medicines, 2015. Despite this, magnesium sulphate is not widely used in India for pre-eclampsia and eclampsia. In addition to other factors, lack of availability may be a reason for sub-optimal usage. This study was undertaken to assess the availability and use of magnesium sulphate at public and private health care facilities in two districts of North Karnataka, India.
METHODS
A facility assessment survey was undertaken as part of the Community Level Interventions for Pre-eclampsia (CLIP) Feasibility Study which was undertaken prior to the CLIP Trials (NCT01911494). This study was undertaken in 12 areas of Belagavi and Bagalkote districts of North Karnataka, India and included a survey of 88 facilities. Data were collected in all facilities by interviewing the health care providers and analysed using Excel.
RESULTS
Of the 88 facilities, 28 were public, and 60 were private. In the public facilities, magnesium sulphate was available in six out of 10 Primary Health Centres (60%), in all eight taluka (sub-district) hospitals (100%), five of eight community health centres (63%) and both district hospitals (100%). Fifty-five of 60 private facilities (92%) reported availability of magnesium sulphate. Stock outs were reported in six facilities in the preceding six months - five public and one private. Twenty-five percent weight/volume and 50% weight/volume concentration formulations were available variably across the public and private facilities. Sixty-eight facilities (77%) used the drug for severe pre-eclampsia and 12 facilities (13.6%) did not use the drug even for eclampsia. Varied dosing schedules were reported from facility to facility.
CONCLUSIONS
Poor availability of magnesium sulphate was identified in many facilities, and stock outs in some. Individual differences in usage were identified. Ensuring a reliable supply of magnesium sulphate, standard formulations and recommendations of dosage schedules and training may help improve use; and decrease morbidity and mortality due to pre-eclampsia/ eclampsia.
TRIAL REGISTRATION
The CLIP trial was registered with ClinicalTrials.gov ( NCT01911494 ).
背景
子痫前期和子痫是孕产妇发病率和死亡率的主要原因。硫酸镁已被确认为这些疾病的首选抗惊厥药物，它被列入世界卫生组织基本药物清单和印度 2015 年国家基本药物清单。尽管如此，硫酸镁在印度并未广泛用于子痫前期和子痫。除其他因素外，供应不足可能是使用率不理想的原因。本研究旨在评估印度北卡纳塔克邦两个地区的公立和私立医疗保健机构硫酸镁的供应和使用情况。
方法
作为社区层面子痫前期干预（CLIP）可行性研究的一部分，进行了设施评估调查，该研究是在 CLIP 试验（NCT01911494）之前进行的。本研究在印度北卡纳塔克邦的 Belagavi 和 Bagalkote 区的 12 个地区进行，包括对 88 个设施的调查。通过采访医疗保健提供者在所有设施中收集数据，并使用 Excel 进行分析。
结果
在 88 个设施中，28 个是公立的，60 个是私立的。在公立设施中，10 个初级保健中心中有 6 个（60%）、8 个 taluka（分区）医院中有 8 个（100%）、8 个社区卫生中心中有 5 个（63%）和 2 个地区医院均有（100%）提供硫酸镁。60 家私立机构中有 55 家（92%）报告称有硫酸镁供应。在过去的六个月中，有六个设施报告了缺货情况——五个是公立的，一个是私立的。在公立和私立机构中，25%重量/体积和 50%重量/体积浓度的制剂供应情况各不相同。68 个设施（77%）将该药物用于重度子痫前期，12 个设施（13.6%）即使用于子痫也未使用该药物。不同的设施报告了不同的剂量方案。
结论
许多设施都发现硫酸镁供应不足，有些设施甚至出现缺货。还发现了使用方面的个体差异。确保硫酸镁的可靠供应、标准制剂以及剂量方案和培训建议，可能有助于提高使用率，并降低因子痫前期/子痫导致的发病率和死亡率。
试验注册
CLIP 试验已在 ClinicalTrials.gov 注册（NCT01911494）。
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