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