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

Hypertensive disorders account for 14% of global maternal deaths. Magnesium sulphate (MgSO₄ ) is recommended for prevention and treatment of pre-eclampsia/eclampsia. However, MgSO₄ remains underused, particularly in low- and middle-income countries (LMICs).

This qualitative evidence synthesis explores perceptions and experiences of healthcare providers, administrators and policy-makers regarding factors affecting use of MgSO₄ to prevent or treat pre-eclampsia/eclampsia.

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

Primary qualitative and mixed-methods studies on factors affecting use of MgSO₄ in healthcare settings, from the perspectives of healthcare providers, administrators and policy-makers, were eligible for inclusion.

We applied a thematic synthesis approach to analysis, using COM-B behaviour change theory to map factors affecting appropriate use of MgSO₄ .

We included 22 studies, predominantly from LMICs. Key themes included provider competence and confidence administering MgSO₄ (attitudes and beliefs, complexities of administering, knowledge and experience), capability of health systems to ensure MgSO₄ 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.

These findings can inform policy and guideline development and improve implementation of MgSO₄ in clinical care. Such action is needed to ensure this life-saving treatment is widely available and appropriately used.

Global qualitative review identifies factors affecting underutilisation of MgSO₄ for pre-eclampsia and eclampsia.