Antenatal corticosteroids for pregnant women at risk of preterm labor in low- and middle-income countries: utilization and facility readiness

Background Antenatal corticosteroids (ACS) use among pregnant women with a high likelihood of preterm labor improves newborn survival. ACS adoption in low- and middle-income countries (LMICs) remains limited. Giving ACS in inadequately equipped settings could be harmful to mothers and newborns. Thus, health facilities have to demontrate readiness to administer ACS. However, the degree to which health systems are ready is unknown. Objective We assessed facility readiness to administer ACS based on the 2022 WHO recommendations on ACS use and ACS utilization. Methods The study used Service Provision Assessment surveys administered between 2013 and 2022 in nine LMICs. The primary outcome was whether facilities had ever provided ACS. We also assessed injectable corticosteroid (dexamethasone or betamethasone) availability and facility readiness to administer ACS. We used a total of 35 indicators, grouped into four readiness categories based on the WHO recommendations, to measure facility readiness. Findings Across eight countries with comparable sampling strategies, only 10.7% (median, range 6.7% - 35.2%) of facilities had ever provided ACS; one-fourth (median 25.3%, range 4.6% - 61.5%) of facilities had injectable corticosteroids available at the time of the survey; overall readiness indices were low ranging from 8.1% for Bangladesh to 32.9% for Senegal. Across four readiness categories, the readiness index was the lowest for criterion 1 (ability to assess gestational age accurately and identify a high likelihood of preterm birth) (7.3%), followed by criterion 2 (ability to identify maternal infections) (24.8%), criterion 4 (ability to provide adequate preterm care) (31.3%), and criterion 3 (ability to provide adequate childbirth care) (32.9%). Conclusion We proposed a strategy for measuring facility readiness to implement one of the most effective interventions to improve neonatal survival. Countries should operationalize readiness measurement, improve facilities readiness to deliver this life-saving intervention, and encourage ACS uptake by targeting facilities that are well-equipped.