Magnesium sulfate for severe preeclampsia and eclampsia management at the primary healthcare level in sub-Saharan Africa: a systematic review.

Background: Preeclampsia and eclampsia are major causes of maternal and perinatal morbidity and mortality in low- and middle-income countries. Magnesium sulfate (MgSO₄) is the most effective intervention for eclampsia prevention and treatment. However, evidence for its use at the primary healthcare level remains limited as most studies have focused on hospital settings. Methods: This systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Electronic databases were comprehensively searched for relevant studies published between January 2003 and December 2024. MEDLINE via PubMed, Cochrane Library, African Index Medicus, and Google Scholar were comprehensively searched for relevant studies. Studies reporting the use of MgSO₄ in primary healthcare settings were included. Data were extracted using a standardized data collection form. Results: Seven studies, most of which were conducted in Nigeria, met the inclusion criteria. MgSO₄ was available in most primary healthcare facilities but remained underutilized. Task sharing with community health workers was identified as a promising strategy for improving its use. Also, shortcomings were observed in the referral and evacuation system as well as in patient monitoring mechanisms. All studies highlighted the need to strengthen the continuous and regular training and supervision of CHWs to improve early detection and appropriate management of preeclampsia cases. Conclusion: MgSO₄ administration at the primary healthcare level is a critical intervention for reducing maternal and perinatal mortality associated with preeclampsia and eclampsia. Strengthening task-sharing approaches and community-level integration may enhance health system resilience in sub-Saharan Africa.