Yang Wen-Chien, Arsenault Catherine, Fan Victoria Y, Leslie Hannah H, Farooq Fouzia, Pembe Andrea B, Getachew Theodros, Smith Emily R
Department of Global Health, Milken Institute School of Public Health, The George Washington University, Washington, D.C., USA.
Center for Global Development, Washington, D.C., USA.
J Glob Health. 2025 May 23;15:04149. doi: 10.7189/jogh.15.04149.
Administering antenatal corticosteroids (ACS) to pregnant women at risk of imminent preterm labour improves newborn survival. However, ACS remains substantially underused in low- and middle-income countries (LMICs), where most preterm births occur globally. Providing ACS in inadequately equipped settings can be harmful. Health facilities must demonstrate readiness to ensure safe and effective ACS use. We aimed to assess ACS utilisation and facility readiness to administer ACS based on the World Health Organization (WHO) recommendations.
We used data from Service Provision Assessments in nine LMICs. The primary outcome was ACS utilisation, which was defined as having ever provided ACS in a health facility. We assessed the availability of injectable corticosteroids (dexamethasone or betamethasone) and facility readiness to administer ACS appropriately. To measure readiness, we developed an overall readiness index based on 35 indicators, grouped into four categories based on WHO recommendations. The results were stratified by facility level.
Across eight countries with comparable sampling strategies, only a median of 10.7% (range = 6.7-35.2%) of facilities had provided ACS, one-fourth (median = 25.3%; range = 4.6-61.5%) had injectable corticosteroids available at the time of the survey. Significant gaps were observed between corticosteroid availability and ACS use. We found low overall readiness indices, ranging from 8.1% for Bangladesh to 32.9% for Senegal. Across four readiness categories, the readiness index was the lowest for criterion one (i.e. ability to assess gestational age accurately) (7.3%), followed by criterion two (i.e. ability to identify maternal infections) (24.8%), criterion four (i.e. ability to provide adequate preterm newborn care) (31.3%), and criterion three (i.e. ability to provide adequate childbirth care) (32.9%).
We proposed a strategy for measuring facility readiness to implement one of the most effective interventions to improve neonatal survival. Countries should operationalise readiness measurement, improve facility readiness to provide ACS appropriately, and encourage ACS uptake in well-equipped facilities.
对有即将早产风险的孕妇使用产前糖皮质激素（ACS）可提高新生儿存活率。然而，在全球大多数早产发生的低收入和中等收入国家（LMICs），ACS的使用仍然严重不足。在设备不完善的环境中提供ACS可能有害。卫生设施必须表明有准备确保安全有效地使用ACS。我们旨在根据世界卫生组织（WHO）的建议，评估ACS的使用情况以及医疗机构使用ACS的准备情况。
我们使用了九个低收入和中等收入国家服务提供评估的数据。主要结果是ACS的使用情况，定义为医疗机构曾经提供过ACS。我们评估了注射用糖皮质激素（地塞米松或倍他米松）的可用性以及医疗机构适当使用ACS的准备情况。为了衡量准备情况，我们根据35项指标制定了一个总体准备指数，根据WHO的建议分为四类。结果按医疗机构级别进行分层。
在采用可比抽样策略的八个国家中，只有中位数为10.7%（范围=6.7-35.2%）的医疗机构提供过ACS，四分之一（中位数=25.3%；范围=4.6-61.5%）的医疗机构在调查时备有注射用糖皮质激素。在糖皮质激素可用性和ACS使用之间观察到显著差距。我们发现总体准备指数较低，从孟加拉国的8.1%到塞内加尔的32.9%不等。在四个准备类别中，准备指数在标准一（即准确评估胎龄的能力）方面最低（7.3%），其次是标准二（即识别母体感染的能力）（24.8%）、标准四（即提供足够的早产新生儿护理的能力）（31.3%）和标准三（即提供足够的分娩护理的能力）（32.9%）。
我们提出了一种策略，用于衡量医疗机构实施改善新生儿存活率最有效干预措施之一的准备情况。各国应实施准备情况衡量，提高医疗机构适当提供ACS的准备情况，并鼓励在设备完善的医疗机构中使用ACS。
