ArticlePloS one2013
Health system barriers to access and use of magnesium sulfate for women with severe pre-eclampsia and eclampsia in Pakistan: evidence for policy and practice.
Article in PloS one, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 25 papers, 1 of them a synthesis that pooled it.
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Who cites it
25 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Hypertensive disorders of pregnancy in low- and middle-income countries: a review of antenatal interventions to improve maternal outcomes.Frontiers in global women's health · 2026Pooled it
- Community health worker knowledge and management of pre-eclampsia in southern Mozambique.Reproductive health · 2016Trial
- Community health workers' knowledge and practice in relation to pre-eclampsia in Ogun State, Nigeria: an essential bridge to maternal survival.Reproductive health · 2016Trial
- Magnesium sulfate toxicity successfully managed with hemodialysis: a case report.Journal of medical case reports · 2025Article
- Synthesis of evidence for managing hypertensive disorders of pregnancy in low middle-income countries: a scoping review.BMC pregnancy and childbirth · 2024Article
- Challenges for research uptake for health policymaking and practice in low- and middle-income countries: a scoping review.Health research policy and systems · 2023Article
- Knowledge and skills of pre-eclampsia management among healthcare providers working in antenatal clinics in Zanzibar.BMC health services research · 2022Article
- Factors affecting use of magnesium sulphate for pre-eclampsia or eclampsia: a qualitative evidence synthesis.BJOG : an international journal of obstetrics and gynaecology · 2022Review
- Comparative risks and predictors of preeclamptic pregnancy in the Eastern, Western and developing world.Biochemical pharmacology · 2020Review
- The WHO Safe Childbirth Checklist implementation: impact on the prescription of magnesium sulphate through a one-year longitudinal study.BMC pregnancy and childbirth · 2020Article
- Quality of care in early detection and management of pre-eclampsia/eclampsia in health facilities in Afghanistan.BMC pregnancy and childbirth · 2019Article
- Gap analysis for drug development policy-making: An attempt to close the gap between policy and its implementation.PloS one · 2019Article
- Screening and management of pre-eclampsia and eclampsia in antenatal and labor and delivery services: findings from cross-sectional observation studies in six sub-Saharan African countries.BMC pregnancy and childbirth · 2018Observational
- Clinical practice patterns on the use of magnesium sulphate for treatment of pre-eclampsia and eclampsia: a multi-country survey.BJOG : an international journal of obstetrics and gynaecology · 2017Article
- Use of magnesium sulfate before 32 weeks of gestation: a European population-based cohort study.BMJ open · 2017Article
- Article
- Health care provider knowledge and routine management of pre-eclampsia in Pakistan.Reproductive health · 2016Article
- Situational analysis of facilitators and barriers to availability and utilization of magnesium sulfate for eclampsia and severe preeclampsia in the public health system in Brazil.BMC pregnancy and childbirth · 2016Article
- Improving access to medicines for non-communicable diseases in rural India: a mixed methods study protocol using quasi-experimental design.BMC health services research · 2016Article
- Availability and Quality of Emergency Obstetric and Newborn Care in Bangladesh.The American journal of tropical medicine and hygiene · 2016Article
Corrections and comments
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Authors and funding
4 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Severe pre-eclampsia and eclampsia are rare but serious complications of pregnancy that threaten the lives of mothers during childbirth. Evidence supports the use of magnesium sulfate (MgSO4) as the first line treatment option for severe pre-eclampsia and eclampsia. Eclampsia is the third major cause of maternal mortality in Pakistan. As in many other Low- and Middle-Income Countries (LMIC), it is suspected that MgSO4 is critically under-utilized in the country. There is however a lack of information on context-specific health system barriers that prevent optimal use of this life-saving medicine in Pakistan. Combining quantitative and qualitative methods, namely policy document review, key informant interviews, focus group discussions and direct observation at health facility, we explored context-specific health system barriers and enablers that affect access and use of MgSO4 for severe pre-eclampsia and eclampsia in Pakistan. Our study finds that while international recommendations on MgSO4 have been adequately translated in national policies in Pakistan, the gap remains in implementation of national policies into practice. Barriers to access to and effective use of MgSO4 occur at health facility level where the medicine was not available and health staff was reluctant to use it. Low price of the medicine and the small market related to its narrow indications acted as disincentives for effective marketing. Results of our survey were further discussed in a multi-stakeholder round-table meeting and an action plan for increasing access to this life-saving medicine was identified.
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