Extracts below. Full text here: http://www.endingeclampsia.org/what-ails-good-policies-on-prevention-and-management-of-pre-eclampsia-and-eclampsia-two-counties-in-kenya/

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In Kenya, despite the maternal mortality rate remaining high—between 2003 and 2014 (more than 400 deaths per 100,000 live births)—the proportion of mothers accessing antenatal care (ANC) and emergency obstetric and newborn care (EmONC) increased by 8 and 20 percentage points, respectively (KDHS, 2014; UNICEF, 2016). Hypertensive disorders in pregnancy, including pre-eclampsia and eclampsia (PE/E), and hemorrhage are the most common causes of maternal deaths.

In Kenya, barriers to accessing maternal health services have a significant impact on the country’s burden of PE/E… And providers’ inability to detect and manage complications and refer a woman to a hospital for safe delivery limit a health systems’ capacity to provide effective and efficient services that prevent adverse maternal and newborn outcomes (Obare et al 2016).

To reduce preventable deaths from PE/E, the World Health Organization recommends use of magnesium sulphate (MgSO4) as the most effective and safest drug (WHO, 2011)…

Kenya adopted the use of MgSO4 for management of severe PE/E in 2002, but women still face challenges in accessing pre-eclampsia services (Population Council, 2005; Warren et al, 2015; MOH 2016). In two counties – Kitui and Kakamega – Ending Eclampsia sought to find out. Our research aimed to examine the gaps between national and county policies and procedures, including observations of supply chain mechanisms, free maternity services, linkages between the quality of ANC and PNC, underutilization of EmONC, and health systems challenges…

Some providers lack knowledge and competency on key components of managing PE/E, such as measuring blood pressure and the dosage and administration of MgSO4. They also expressed a lack of confidence or fear of its toxicity, two barriers that limit its use by providers in dispensaries and health centers. These providers prefer to use other anticonvulsant drugs, such as valium, even when MgSO4 is available.

Overall, there was low community awareness of danger signs in pregnancy. This led to delays in seeking care, along with lack of support from spouses, birth partners, and mothers-in-law for ANC and PNC visits and the purchase of antihypertensive drugs when required…
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Best wishes, Neil

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