Post Graduate Institute of Medical Education and Research Chandigarh, India.
All India Institute of Medical Sciences, Bathinda, Punjab, India.
Glob Health Sci Pract. 2021 Sep 30;9(3):575-589. doi: 10.9745/GHSP-D-20-00716.
In 2014, the Government of India (GOI) released operational guidelines on the use of antenatal corticosteroids (ACS) in preterm labor. However, without ensuring the quality of childbirth and newborn care at facilities, the use of ACS in low- and middle-income countries is potentially harmful. This study assessed the readiness to provide ACS at primary and secondary care public health facilities in northern India.
A cross-sectional study was conducted in 37 public health facilities in 2 districts of Haryana, India. Facility processes and program implementation for ACS delivery were assessed using pretested study tools developed from the World Health Organization (WHO) quality of care standards and WHO guidelines for threatened preterm birth.
Key gaps in public health facilities' process of care to provide ACS for threatened preterm birth were identified, particularly concerning evidence-based practices, competent workforce, and actionable health information system. Emphasis on accurate gestational age estimation, quality of childbirth care, and quality of preterm care were inadequate. Shortage of trained staff was widespread, and a disconnect was found between knowledge and attitudes regarding ACS use. ACS administration was provided only at district or subdistrict hospitals, and these facilities did not uniformly record ACS-specific indicators. All levels lacked a comprehensive protocol and job aids for identifying and managing threatened preterm birth.
ACS operational guidelines were not widely disseminated or uniformly implemented. Facilities require strengthened supervision and standardization of threatened preterm birth care. Facilities need greater readiness to meet required conditions for ACS use. Increasing uptake of a single intervention without supporting it with adequate quality of maternal and newborn care will jeopardize improvement in preterm birth outcomes. We recommend updating and expanding the existing GOI ACS operational guidelines to include specific actions for the safe and effective use of ACS in line with recent scientific evidence.
2014 年，印度政府发布了产前皮质类固醇（ACS）在早产中的使用操作指南。然而，如果不能确保分娩和新生儿护理设施的质量，在中低收入国家使用 ACS 可能会造成危害。本研究评估了印度北部初级和二级保健公共卫生机构提供 ACS 的准备情况。
在印度哈里亚纳邦的 2 个区的 37 个公共卫生机构进行了横断面研究。使用根据世界卫生组织（WHO）护理质量标准和 WHO 有威胁早产的 ACS 指南制定的经过预测试的研究工具评估 ACS 分娩的设施流程和方案实施情况。
确定了公共卫生设施提供 ACS 以治疗有威胁早产的护理过程中的关键差距，特别是在循证实践、合格的劳动力和可操作的卫生信息系统方面。强调准确估计胎龄、分娩护理质量和早产儿护理质量不足。训练有素的工作人员普遍短缺，并且发现 ACS 使用方面的知识和态度之间存在脱节。ACS 管理仅在地区或分区医院提供，并且这些设施没有统一记录 ACS 特定指标。所有级别都缺乏全面的协议和工作辅助工具，用于识别和管理有威胁早产。
ACS 操作指南没有得到广泛传播或统一实施。设施需要加强监督和标准化有威胁早产的护理。设施需要更好地准备满足 ACS 使用所需的条件。仅增加单一干预措施的使用率而不支持足够的母婴保健质量，将危及早产结局的改善。我们建议更新和扩大现有的印度政府 ACS 操作指南，以包括根据最新科学证据安全有效地使用 ACS 的具体行动。
