Factors affecting use of magnesium sulphate for pre-eclampsia or eclampsia: a qualitative evidence synthesis.

BACKGROUND

Hypertensive disorders account for 14% of global maternal deaths. Magnesium sulphate (MgSO ) is recommended for prevention and treatment of pre-eclampsia/eclampsia. However, MgSO remains underused, particularly in low- and middle-income countries (LMICs).

OBJECTIVE

This qualitative evidence synthesis explores perceptions and experiences of healthcare providers, administrators and policy-makers regarding factors affecting use of MgSO to prevent or treat pre-eclampsia/eclampsia.

SEARCH STRATEGY

We searched MEDLINE, EMBASE, Emcare, CINAHL, Global Health and Global Index Medicus, and grey literature for studies published between January 1995 and June 2021.

SELECTION CRITERIA

Primary qualitative and mixed-methods studies on factors affecting use of MgSO in healthcare settings, from the perspectives of healthcare providers, administrators and policy-makers, were eligible for inclusion.

DATA COLLECTION AND ANALYSIS

We applied a thematic synthesis approach to analysis, using COM-B behaviour change theory to map factors affecting appropriate use of MgSO .

MAIN RESULTS

We included 22 studies, predominantly from LMICs. Key themes included provider competence and confidence administering MgSO (attitudes and beliefs, complexities of administering, knowledge and experience), capability of health systems to ensure MgSO availability at point of use (availability, resourcing and pathways to care) and knowledge translation (dissemination of research and recommendations). Within each COM-B domain, we mapped facilitators and barriers to physical and psychological capability, physical and social opportunity, and how the interplay between these domains influences motivation.

CONCLUSIONS

These findings can inform policy and guideline development and improve implementation of MgSO in clinical care. Such action is needed to ensure this life-saving treatment is widely available and appropriately used.

TWEETABLE ABSTRACT

Global qualitative review identifies factors affecting underutilisation of MgSO for pre-eclampsia and eclampsia.