Increasing Adoption of Antenatal Magnesium Sulfate for Fetal Neuroprotection in Imminent Preterm Deliveries: A Stepped-Wedge Cluster-Randomised Trial in Lagos
Description
Hypothesis and Research Overview This dataset stems from a stepped-wedge cluster randomized implementation trial conducted across six secondary healthcare facilities in Lagos, Nigeria. The central hypothesis was that a structured implementation package—comprising provider training and facility-level advocacy—would significantly increase the administration of antenatal magnesium sulphate (MgSO₄) for fetal neuroprotection among women presenting with imminent preterm delivery. Data Scope and Gathering The data encompasses 364 clinical records (190 pre-intervention; 174 post-intervention) where all captured cases are treated as imminent preterm deliveries. Data were gathered using standardized clinical proformas, monthly facility service statistics, and caregiver surveys. Key variables include maternal demographics, gestational age at delivery, eligibility markers (specifically thresholds of ≤32 and ≤34 weeks), and the primary outcome: MgSO₄ administration. Caregiver data (N=179) provides context on provider knowledge, training gaps, and systemic barriers such as facility protocols and drug availability. Notable Findings Preliminary analysis indicates a substantial improvement in clinical practice following the intervention. Specifically, for the primary analytic population, MgSO₄ administration increased from the pre-intervention phase to the post-intervention phase in women delivering before 34 completed weeks by an absolute increase of 36.9 percentage points. While 95.5% of caregivers were aware of MgSO₄ use in pregnancy generally, only 34.1% initially utilized it for fetal neuroprotection, highlighting a "knowledge-to-action" gap that the intervention successfully addressed. Interpretation and Use The data allows for evaluation of implementation success in resource-constrained settings. When interpreting the results, users must account for the stepped-wedge design where facilities transitioned at different times (July–December 2025). The Group variable identifies the study phase relative to these dates. Researchers can utilize this data to model longitudinal changes in provider behavior, analyze neonatal outcomes associated with MgSO₄ uptake, and identify persisting barriers to evidence-based obstetric care.