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Table 2 Major barriers and facilitators to the availability and use of MgSO4 identified at each level

From: Identifying barriers to the availability and use of Magnesium Sulphate Injection in resource poor countries: A case study in Zambia

  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