Readiness to Provide Antenatal Corticosteroids for Threatened Preterm Birth in Public Health Facilities in Northern India

Ankita Kankaria; Mona Duggal; Anshul Chauhan; Debarati Sarkar; Suresh Dalpath; Akash Kumar; Gursharan Singh Dhanjal; Vijay Kumar; Vanita Suri; Rajesh Kumar; Praveen Kumar; James A. Litch

doi:10.9745/GHSP-D-20-00716

Key Findings

Most of the 37 public health facilities in northern India that we assessed were not readied for providing quality care for threatened preterm birth and ensuring the safe use of antenatal corticosteroids (ACS).
Deficiencies were identified in areas of evidence-based practices, competent workforce, actionable health information system, physical resources, and communication.
The existing ACS guidelines were not up-to-date with current evidence and were not disseminated or implemented uniformly across facilities.
Attention to accurate gestational age estimation and the quality of childbirth and preterm care were inadequate in all the facilities.

Key Implications

Increasing uptake of ACS for threatened preterm birth without providing adequate-quality maternal and newborn care and meeting essential preconditions outlined by World Health Organization recommendations will not improve preterm outcomes.
Facility-level actions are needed for the safe and effective use of ACS in support of the delivery of quality care.

ABSTRACT

Introduction:

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.

Methods:

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.

Results:

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.

Conclusions:

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.

Received: November 24, 2020.
Accepted: May 13, 2021.
Published: September 30, 2021.

This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly cited. To view a copy of the license, visit https://creativecommons.org/licenses/by/4.0/. When linking to this article, please use the following permanent link: https://doi.org/10.9745/GHSP-D-20-00716

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