Use of antenatal corticosteroids at health facilities and communities in low-and-middle income countries

Mabel Berrueta, Jennifer Hemingway-Foday, Vanessa R. Thorsten, Robert L. Goldenberg, Waldemar A. Carlo, Ana Garces, Archana Patel, Sarah Saleem, Omrana Pasha, Elwyn Chomba, Patricia L. Hibberd, Nancy F. Krebs, Shivaprasad Goudar, Richard J. Derman, Fabian Esamai, Edward A. Liechty, Janet L. Moore, Elizabeth M. McClure, Marion Koso-Thomas, Pierre M. BuekensJosé M. Belizán, Fernando Althabe

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

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 (NCT01084096)

Original languageEnglish (US)
Article number66
JournalReproductive Health
Volume13
Issue number1
DOIs
StatePublished - May 27 2016

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Health Facilities
Adrenal Cortex Hormones
Kenya
Argentina
Premature Birth
Cesarean Section
Health Status
National Institute of Child Health and Human Development (U.S.)
Zambia
Pakistan
Infant Mortality
Proxy
Women's Health
Masks
Artificial Respiration
Birth Weight
Registries
Mothers
Research Personnel
Guidelines

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Reproductive Medicine

Cite this

Berrueta, M., Hemingway-Foday, J., Thorsten, V. R., Goldenberg, R. L., Carlo, W. A., Garces, A., ... Althabe, F. (2016). Use of antenatal corticosteroids at health facilities and communities in low-and-middle income countries. Reproductive Health, 13(1), [66]. https://doi.org/10.1186/s12978-016-0176-2

Use of antenatal corticosteroids at health facilities and communities in low-and-middle income countries. / Berrueta, Mabel; Hemingway-Foday, Jennifer; Thorsten, Vanessa R.; Goldenberg, Robert L.; Carlo, Waldemar A.; Garces, Ana; Patel, Archana; Saleem, Sarah; Pasha, Omrana; Chomba, Elwyn; Hibberd, Patricia L.; Krebs, Nancy F.; Goudar, Shivaprasad; Derman, Richard J.; Esamai, Fabian; Liechty, Edward A.; Moore, Janet L.; McClure, Elizabeth M.; Koso-Thomas, Marion; Buekens, Pierre M.; Belizán, José M.; Althabe, Fernando.

In: Reproductive Health, Vol. 13, No. 1, 66, 27.05.2016.

Research output: Contribution to journalArticle

Berrueta, M, Hemingway-Foday, J, Thorsten, VR, Goldenberg, RL, Carlo, WA, Garces, A, Patel, A, Saleem, S, Pasha, O, Chomba, E, Hibberd, PL, Krebs, NF, Goudar, S, Derman, RJ, Esamai, F, Liechty, EA, Moore, JL, McClure, EM, Koso-Thomas, M, Buekens, PM, Belizán, JM & Althabe, F 2016, 'Use of antenatal corticosteroids at health facilities and communities in low-and-middle income countries', Reproductive Health, vol. 13, no. 1, 66. https://doi.org/10.1186/s12978-016-0176-2
Berrueta M, Hemingway-Foday J, Thorsten VR, Goldenberg RL, Carlo WA, Garces A et al. Use of antenatal corticosteroids at health facilities and communities in low-and-middle income countries. Reproductive Health. 2016 May 27;13(1). 66. https://doi.org/10.1186/s12978-016-0176-2
Berrueta, Mabel ; Hemingway-Foday, Jennifer ; Thorsten, Vanessa R. ; Goldenberg, Robert L. ; Carlo, Waldemar A. ; Garces, Ana ; Patel, Archana ; Saleem, Sarah ; Pasha, Omrana ; Chomba, Elwyn ; Hibberd, Patricia L. ; Krebs, Nancy F. ; Goudar, Shivaprasad ; Derman, Richard J. ; Esamai, Fabian ; Liechty, Edward A. ; Moore, Janet L. ; McClure, Elizabeth M. ; Koso-Thomas, Marion ; Buekens, Pierre M. ; Belizán, José M. ; Althabe, Fernando. / Use of antenatal corticosteroids at health facilities and communities in low-and-middle income countries. In: Reproductive Health. 2016 ; Vol. 13, No. 1.
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abstract = "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 (NCT01084096)",
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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

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 (NCT01084096)

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 (NCT01084096)

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