TY - JOUR
T1 - Use of antenatal corticosteroids at health facilities and communities in low-and-middle income countries
AU - Berrueta, Mabel
AU - Hemingway-Foday, Jennifer
AU - Thorsten, Vanessa R.
AU - Goldenberg, Robert L.
AU - Carlo, Waldemar A.
AU - Garces, Ana
AU - Patel, Archana
AU - Saleem, Sarah
AU - Pasha, Omrana
AU - Chomba, Elwyn
AU - Hibberd, Patricia L.
AU - Krebs, Nancy F.
AU - Goudar, Shivaprasad
AU - Derman, Richard J.
AU - Esamai, Fabian
AU - Liechty, Edward A.
AU - Moore, Janet L.
AU - McClure, Elizabeth M.
AU - Koso-Thomas, Marion
AU - Buekens, Pierre M.
AU - Belizán, José M.
AU - Althabe, Fernando
N1 - Funding Information:
This study was funded by grants from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (grant number U01 HD058322, U01 HD040477, U01 HD043464, U01 HD040657, U01 HD042372, U01 HD040607, U01 HD058326, U01 HD040636). Additional support was provided to FA and JB from Bill & Melinda Gates Foundation grant OPP1132907.
Publisher Copyright:
© 2016 Berrueta et al.
PY - 2016/5/27
Y1 - 2016/5/27
N2 - Background: Antenatal corticosteroids (ACS) for women at high risk of preterm birth is an effective intervention to reduce neonatal mortality among preterm babies delivered in hospital settings, but has not been widely used in low-middle resource settings. We sought to assess the rates of ACS use at all levels of health care in low and middle income countries (LMIC). Methods: We assessed rates of ACS in 7 sites in 6 LMIC participating in the Eunice Kennedy Shriver National Institute of Child Health and Human Development's Global Network for Women and Children's Health Research Antenatal Corticosteroids Trial (ACT), a cluster-randomized trial to assess the feasibility, effectiveness, and safety of a multifaceted intervention designed to increase the use of ACS. We conducted this analysis using data from the control clusters, which did not receive any components of the intervention and intended to follow usual care. We included women who delivered an infant with a birth weight <5th percentile, a proxy for preterm birth, and were enrolled in the Maternal Newborn Health (MNH) Registry between October 2011 and March 2014 in all clusters. A survey of the site investigators regarding existing policies on ACS in health facilities and for health workers in the community was part of pre-trial activities. Results: Overall, of 51,523 women delivered in control clusters across all sites, the percentage of <5th percentile babies ranged from 3.5 % in Kenya to 10.7 % in Pakistan. There was variation among the sites in the use of ACS at all hospitals and among those hospitals having cesarean section and neonatal care capabilities (bag and mask and oxygen or mechanical ventilation). Rates of ACS use for <5th percentile babies in all hospitals ranged from 3.8 % in the Kenya sites to 44.5 % in the Argentina site, and in hospitals with cesarean section and neonatal care capabilities from 0 % in Zambia to 43.5 % in Argentina. ACS were rarely used in clinic or home deliveries at any site. Guidelines for ACS use at all levels of the health system were available for most of the sites. Conclusion: Our study reports an overall low utilization of ACS among mothers of <5th percentile infants in hospital and clinic deliveries in LMIC. Trial Registration: clinicaltrials.gov
AB - Background: Antenatal corticosteroids (ACS) for women at high risk of preterm birth is an effective intervention to reduce neonatal mortality among preterm babies delivered in hospital settings, but has not been widely used in low-middle resource settings. We sought to assess the rates of ACS use at all levels of health care in low and middle income countries (LMIC). Methods: We assessed rates of ACS in 7 sites in 6 LMIC participating in the Eunice Kennedy Shriver National Institute of Child Health and Human Development's Global Network for Women and Children's Health Research Antenatal Corticosteroids Trial (ACT), a cluster-randomized trial to assess the feasibility, effectiveness, and safety of a multifaceted intervention designed to increase the use of ACS. We conducted this analysis using data from the control clusters, which did not receive any components of the intervention and intended to follow usual care. We included women who delivered an infant with a birth weight <5th percentile, a proxy for preterm birth, and were enrolled in the Maternal Newborn Health (MNH) Registry between October 2011 and March 2014 in all clusters. A survey of the site investigators regarding existing policies on ACS in health facilities and for health workers in the community was part of pre-trial activities. Results: Overall, of 51,523 women delivered in control clusters across all sites, the percentage of <5th percentile babies ranged from 3.5 % in Kenya to 10.7 % in Pakistan. There was variation among the sites in the use of ACS at all hospitals and among those hospitals having cesarean section and neonatal care capabilities (bag and mask and oxygen or mechanical ventilation). Rates of ACS use for <5th percentile babies in all hospitals ranged from 3.8 % in the Kenya sites to 44.5 % in the Argentina site, and in hospitals with cesarean section and neonatal care capabilities from 0 % in Zambia to 43.5 % in Argentina. ACS were rarely used in clinic or home deliveries at any site. Guidelines for ACS use at all levels of the health system were available for most of the sites. Conclusion: Our study reports an overall low utilization of ACS among mothers of <5th percentile infants in hospital and clinic deliveries in LMIC. Trial Registration: clinicaltrials.gov
UR - http://www.scopus.com/inward/record.url?scp=84971223681&partnerID=8YFLogxK
U2 - 10.1186/s12978-016-0176-2
DO - 10.1186/s12978-016-0176-2
M3 - Article
C2 - 27228986
AN - SCOPUS:84971223681
SN - 1742-4755
VL - 13
JO - Reproductive Health
JF - Reproductive Health
IS - 1
M1 - 66
ER -
