Health intervention strategies to improve provider practice: A case study of magnesium sulfate use to treat pre/eclampsia in Mexico

Globally there are an estimated 600,000 maternal deaths, 99% of these take place in developing countries. Pre-eclampsia is a key cause of morbidity and mortality for women and their newborns and account for over 50,000 maternal deaths annually. In Mexico, gestational hypertensive disorders, such as pre-eclampsia and eclampsia (pre/eclampsia) are the leading causes of maternal mortality. In 1998, the Magpie Trial conducted a review of anti-convulsants for pre-eclamptic women which revealed that magnesium sulfate (MgSO4) halves the risk of eclampsia and reduces the risk of maternal death. Magnesium sulfate is the WHO drug of choice for women with eclampsia. Despite this evidence MgSO4 is not widely used in developing countries. There is concern of the failure of health care providers to translate evidence-based research into practice. Data from our study on provider knowledge and practice show that obstetric care physicians in Mexico City hospitals state that WHO guidelines influence their decision-making and they believe that MgSO4 is the drug of choice to prevent and treat pre/eclampsia. However, the majority of physicians surveyed do not use MgSO4 to treat pre/eclamptic convulsions resulting in poor health outcomes. The translation of evidence into policy and practice is vital to improving the evidence-base of health care and outcomes. While evidence for improving reproductive health continues to grow, concerns remain that the translation of this evidence into appropriate policy and practice is partial and slow and effective interventions remain underutilized. Therefore, targeted intervention strategies should be used to improve health care provider behavior.