Barriers to improving preterm newborn outcomes through effective antenatal corticosteroid use in Ethiopia
Bibliographic Data
| ID | 21881554 |
|---|---|
| Authors | Wen-Chien Yang (0000-0001-8206-1496, Milken Institute), Theodros Getachew Zemedu (0000-0002-6486-0531, Ethiopian Public Health Institute), Emily R Smith (0000-0001-5715-9459, Milken Institute), Delayehu Bekele (0000-0002-9243-2622, St. Paul's Hospital Millennium Medical College), Sofanit Haile (Addis Ababa University), Gesit Metaferia (St. Paul's Hospital Millennium Medical College), Zelalem Birhan Tilahun (0009-0009-6112-684X, Sister Aklesia Memorial Hospital, Adama, Ethiopia), Zelalem Tilahun (Adama Science and Technology University), Catherine Arsenault (0000-0003-2410-3015, Milken Institute) |
| Year | 2025 |
| Volume | 10 |
| Issue | 9 |
| Pages | e019102 |
| Publication date | 2025-09-01 |
| Peer Reviewed | Yes |
| Open Access | Yes |
| Type | ARTICLE |
| Venue | BMJ Global Health (JOURNAL) |
| Journal identifiers | ISSN: 2059-7908 • E-ISSN: 2059-7908 |
| Publisher | BMJ (PUBLISHER • GB) |
| DOI | 10.1136/bmjgh-2025-019102 |
| PMID | 40962363 |
| OpenAlex | W4414311505 |
| Language | EN |
| References cited | 31 |
Ethiopia has prioritised high-impact interventions to reduce neonatal deaths, including antenatal corticosteroids (ACS) utilisation. However, effective ACS use has faced various challenges. We used multiple data sources to examine the current landscape of ACS use in Ethiopia and to elucidate barriers to effective ACS utilisation, including a review of national obstetric guidelines over the past decade, a review of literature, and a descriptive analysis of health facility data. National obstetric protocols recommend administering ACS in both hospitals and health centres. However, ACS remains substantially underused. The 2016 Ethiopian Emergency Obstetric and Newborn Care Assessment reported that only 5% of preterm infants were born to women who had received corticosteroids before delivery. At the health facility level, the 2021 Ethiopian Service Provision Assessment survey showed that only 22.1% of facilities providing antenatal care and delivery services had administered ACS in the past 3 months, and 44.7% of facilities had injectable corticosteroids in stock at the time of the survey. Notably, private clinics had both the lowest corticosteroid availability (16.9%) and utilisation rate (2.8%). We identified several barriers to effective ACS use, including healthcare service delivery organisation, gaps in healthcare providers’ knowledge and skills (particularly at the primary healthcare level and in private facilities), challenges in accurate gestational age assessment resulting from limited access to early ultrasound and late initiation of antenatal care, and insufficient corticosteroid availability. Increasing ACS uptake alone is unlikely to have the desired population benefits without considering health service delivery redesign and integration with other life-saving maternal and newborn health interventions
Gestational age · Health care · Population · Pregnancy · Premature birth · Psychological intervention · Public health · Service delivery framework · Global Maternal and Child Health · Infant Development and Preterm Care · Neonatal Respiratory Health Research
National, regional, and global estimates of preterm birth in 2020, with trends from 2010
Health system redesign for maternal and newborn survival
Factors affecting antenatal corticosteroid use in low- and middle-income countries
The burden and trends of child and maternal malnutrition across the regions in Ethiopia, 1990–2019
National and subnational burden of under-5, infant, and neonatal mortality in Ethiopia, 1990–2019
Antenatal corticosteroids for pregnant women at risk of preterm labour in low- and middle-income countries
| Citation velocity | historical |
|---|---|
| Highly cited | No |