article · PLOS Global Public Health
Antenatal corticosteroids significantly benefit preterm newborns, yet their administration remains disproportionately low in low- and middle-income countries. This research examined facility-level factors influencing recent corticosteroid administration, defined as use within the prior three months, across 6,183 delivery facilities in nine countries. In the eight countries with nationally representative data, only a median of 22.7 percent of delivery facilities had recently administered antenatal corticosteroids. Urban facilities demonstrated a 21 percent higher likelihood of recent use compared to rural counterparts. The availability of injectable corticosteroids increased the likelihood of use by 14 percent, while facilities with the highest structural readiness were almost twice as likely to administer them compared to those in the lowest tier. Eight of nine emergency obstetric and newborn care functions correlated with increased corticosteroid use, with neonatal resuscitation exhibiting the strongest link.
Preterm infants in lower-income regions face severe health risks that antenatal corticosteroids can help mitigate. Identifying structural deficits, rural disparities, and supply gaps enables health systems to direct investments precisely where maternal and newborn care capabilities are lagging, ensuring life-saving interventions actually reach patients in need.
The findings can inform public health planners, hospital administrators, and international development funders designing facility readiness initiatives or procurement programmes for maternal and neonatal care. This research represents applied health systems analysis, providing observational data rather than a commercial product, meaning direct commercialisation pathways are not indicated by the abstract.
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Antenatal corticosteroids (ACS) utilization is disproportionately limited in low- and middle-income countries where most global preterm newborns who could benefit from this intervention are born. Understanding the factors affecting ACS use is crucial for improving its uptake. This study aimed to investigate facility-level factors associated with ACS use in low-resource countries. We used data from ten Service Provision Assessment surveys across nine countries. We restricted the sample to facilities that provided delivery services. Our primary outcome was recent ACS use, defined as having administered ACS within the past three months before the survey. We conducted mixed-effect log binomial regressions, with country as a fixed effect and sub-national regions as random intercepts, to explore the association between recent ACS use and facility characteristics, injectable corticosteroids and ultrasound availability, facility structural readiness, and past performance of nine Comprehensive Emergency Obstetric and Newborn Care (CEmONC) signal functions. A sensitivity analysis excluding the Afghanistan data was performed since the country adopted a different sampling strategy that mainly sampled urban facilities. This study included 6183 facilities from nine countries. Across eight countries with nationally representative data, only 22.7% (median, range 4.0% to 27.4%) of facilities that provided delivery services had used ACS recently, compared to 59.4% in the Afghanistan survey. Urban facilities had a 21% higher likelihood of recent ACS use (95% CI 6%-38%) than rural facilities. Corticosteroid availability was associated with a 14% higher likelihood of recent ACS use (95% CI 1%-29%). Facilities in the highest readiness tertile were more likely to have recent ACS use than those in the lowest (RR 1.91, 95% CI 1.58-2.30). Each CEmONC signal function, except assisted vaginal deliveries, was significantly associated with recent ACS use, with neonatal resuscitation having the largest effect (RR 2.62, 95% CI 1.93-3.55). In conclusion, facilities that had performed CEmONC services were more likely to administer ACS, highlighting the importance of provider knowledge, skills, and competence in managing obstetric and newborn emergencies for effective ACS provision.
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DOI: 10.1371/journal.pgph.0003989
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