Peer-reviewed article
Barriers to improving preterm newborn outcomes through effective antenatal corticosteroid use in Ethiopia.
Yang WC, Getachew T, Smith ER, Bekele D, Haile S et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study examines why antenatal corticosteroids (a proven treatment to improve preterm infant survival) are underused in Ethiopia despite being recommended in national guidelines. Researchers found that only 5% of preterm infants were born to mothers who received this treatment, and only 22% of health facilities had given it in the past three months. The main barriers identified include lack of provider knowledge, poor access to ultrasound for dating pregnancies, stock-outs of the medication, and weaknesses in how health services are organized, particularly in private clinics.
Key points
- Only 5% of preterm infants in Ethiopia were born to women who received antenatal corticosteroids, despite national guidelines recommending the intervention
- Only 22.1% of facilities providing antenatal care and delivery had administered corticosteroids in the past 3 months
- 44.7% of facilities had injectable corticosteroids in stock at the time of survey
- Private clinics had the lowest corticosteroid availability (16.9%) and use (2.8%)
- Key barriers include provider knowledge gaps, limited ultrasound access for gestational age assessment, late antenatal care initiation, and inadequate medication availability
Limitations
This is a descriptive analysis of barriers rather than an evaluation of an intervention to increase ACS use, so it cannot demonstrate what solutions would be effective. The study relies on facility-level data and does not provide individual-level information about maternal or newborn outcomes.
Abstract
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.