Suchergebnisse

BACKGROUND:Antenatal corticosteroids (ACS) for women at high risk of preterm birth is an effective intervention to reduce neonatal mortality among preterm babies delivered in hospital settings, but has not been widely used in low-middle resource settings. We sought to assess the rates of ACS use at all levels of health care in low and middle income countries (LMIC).METHODS:We assessed rates of ACS in 7 sites in 6 LMIC participating in the Eunice Kennedy Shriver National Institute of Child Health and Human Development´s Global Network for Women and Children´s Health Research Antenatal Corticosteroids Trial (ACT), a cluster-randomized trial to assess the feasibility, effectiveness, and safety of a multifaceted intervention designed to increase the use of ACS. We conducted this analysis using data from the control clusters, which did not receive any components of the intervention and intended to follow usual care. We included women who delivered an infant with a birth weight <5th percentile, a proxy for preterm birth, and were enrolled in the Maternal Newborn Health (MNH) Registry between October 2011 and March 2014 in all clusters. A survey of the site investigators regarding existing policies on ACS in health facilities and for health workers in the community was part of pre-trial activities.RESULTS:Overall, of 51,523 women delivered in control clusters across all sites, the percentage of <5th percentile babies ranged from 3.5 % in Kenya to 10.7 % in Pakistan. There was variation among the sites in the use of ACS at all hospitals and among those hospitals having cesarean section and neonatal care capabilities (bag and mask and oxygen or mechanical ventilation). Rates of ACS use for <5th percentile babies in all hospitals ranged from 3.8 % in the Kenya sites to 44.5 % in the Argentina site, and in hospitals with cesarean section and neonatal care capabilities from 0 % in Zambia to 43.5 % in Argentina. ACS were rarely used in clinic or home deliveries at any site. Guidelines for ACS use at all levels of the health system were available for most of the sites.CONCLUSION:Our study reports an overall low utilization of ACS among mothers of <5th percentile infants in hospital and clinic deliveries in LMIC. ; Fil: Berrueta, Amanda Mabel. Instituto de Efectividad Clínica y Sanitaria; Argentina ; Fil: Hemingway Foday, Jennifer. University Of Durham; Reino Unido ; Fil: Thorsten, Vanessa R. University Of Durham; Reino Unido ; Fil: Goldenberg, Robert L. Columbia University; Estados Unidos ; Fil: Carlo, Waldemar A. University of Alabama at Birmingahm; Estados Unidos ; Fil: Garces, Ana. Fundación para la Alimentación y Nutrición de Centro América y Panamá; Guatemala ; Fil: Patel, Archana. Lata Medical Research Foundation, Indira Gandhi Government Medical College; India ; Fil: Saleem, Sarah. Aga Khan University. Department of Community Health Sciences, ; Pakistán ; Fil: Pasha, Omrana. Aga Khan University. Department of Community Health Sciences, ; Pakistán ; Fil: Chomba, Elwyn. University Teaching Hospital; Zambia ; Fil: Hibberd, Patricia L. Massachusetts General Hospital; Estados Unidos ; Fil: Krebs, Nancy F. 0University of Colorado School of Medicine; Estados Unidos ; Fil: Goudar, Shivaprasad. KLE University's Jawaharlal Nehru Medical College,; India ; Fil: Derman, Richard J. 2Christiana Health Care; Estados Unidos ; Fil: Esamai, Fabian. Moi University School of Medicine; Kenia ; Fil: Liechty, Edward A. Indiana University; Estados Unidos ; Fil: Moore, Janet L. University Of Durham; Reino Unido ; Fil: McClure, Elizabeth M. University Of Durham; Reino Unido ; Fil: Koso Thomas, Marion. Eunice Kennedy Shriver National Institute of Child Health and Human Development; Estados Unidos ; Fil: Buekens, Pierre. Tulane School of Public Health & Tropical Medicine; Estados Unidos ; Fil: Belizan, Jose. Instituto de Efectividad Clínica y Sanitaria; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina ; Fil: Althabe, Fernando. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Instituto de Efectividad Clínica y Sanitaria; Argentina

Introduction: Neonatal mortality associated with preterm birth can be reduced with antenatal corticosteroids (ACS), yet 36.0 weeks GA. In phase 1, UH measurements were collected prospectively in the Democratic Republic of Congo, India and Pakistan, using distinct tapes to address variation across regions and ethnicities. In phase 2, we tested accuracy in 250 pregnant women with known GA from early ultrasound enrolled at prenatal clinics in Argentina, India, Pakistan and Zambia. Providers masked to the ultrasound GA measured UH. Receiver operating characteristics (ROC) analysis was conducted. Results: 1,029 pregnant women were enrolled. In all countries the tapes were most effective identifying pregnancies between 20.0-35.6 weeks, compared to the other GAs. The ROC areas under the curves and 95% confidence intervals were: Argentina 0.69 (0.63, 0.74); Zambia 0.72 (0.66, 0.78), India 0.84 (0.80, 0.89), and Pakistan 0.83 (0.78, 0.87). The sensitivity and specificity (and 95% confidence intervals) for identifying pregnancies between 20.0-35.6 weeks, respectively, were: Argentina 87% (82%-92%) and 51% (42%-61%); Zambia 91% (86%-95%) and 50% (40%-60%); India 78% (71%-85%) and 89% (83%-94%); Pakistan 63% (55%-70%) and 94% (89% -99%). Conclusions: We observed moderate-good accuracy identifying pregnancies ≤35.6 weeks gestation, with potential usefulness at the community level in low-middle income countries to facilitate the preterm identification and interventions to reduce preterm neonatal mortality. Further research is needed to validate these findings on a population basis. ; Fil: Althabe, Fernando. Instituto de Efectividad Clínica y Sanitaria; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina ; Fil: Berrueta, Amanda Mabel. Instituto de Efectividad Clínica y Sanitaria; Argentina ; Fil: Hemingway Foday, Jennifer. Rti International; Estados Unidos ; Fil: Mazzoni, Agustina. Instituto de Efectividad Clínica y Sanitaria; Argentina ; Fil: Bonorino, Carolina Astoul. Instituto de Efectividad Clínica y Sanitaria; Argentina ; Fil: Gowdak, Andrea. Instituto de Efectividad Clínica y Sanitaria; Argentina ; Fil: Gibbons, Luz. Instituto de Efectividad Clínica y Sanitaria; Argentina ; Fil: Bellad, M. B. Jawaharlal Nehru Medical College Belgaum; India ; Fil: Metgud, M. C. Jawaharlal Nehru Medical College Belgaum; India ; Fil: Goudar, Shivaprasad. Jawaharlal Nehru Medical College Belgaum; India ; Fil: Kodkany, Bhalchandra S. Jawaharlal Nehru Medical College Belgaum; India ; Fil: Derman, Richard J. Christiana Care Health System; Estados Unidos ; Fil: Saleem, Sarah. The Aga Khan University; Pakistán ; Fil: Iqbal, Samina. Sobhraj Maternity Hospital; Pakistán ; Fil: Ala, Syed Hasan. Sindh Government Qatar Hospital; Pakistán ; Fil: Goldenberg, Robert L. Columbia University; Estados Unidos ; Fil: Chomba, Elwyn. University Teaching Hospital Lusaka; Zambia ; Fil: Manasyan, Albert. University of North Carolina; Estados Unidos. Centre For Infectious Disease Research In Zambia; Zambia ; Fil: Chiwila, Melody. University Teaching Hospital Lusaka; Zambia ; Fil: Imenda, Edna. University Teaching Hospital Lusaka; Zambia ; Fil: Mbewe, Florence. University Teaching Hospital Lusaka; Zambia ; Fil: Tshefu, Antoinette. Kinshasa School Of Public Health; República Democrática del Congo ; Fil: Lokomba, Victor. Kinshasa School Of Public Health; República Democrática del Congo ; Fil: Bose, Carl L. University of North Carolina; Estados Unidos ; Fil: Moore, Janet. Rti International; Estados Unidos ; Fil: Meleth, Sreelatha. Rti International; Estados Unidos ; Fil: McClure, Elizabeth M. Rti International; Estados Unidos ; Fil: Koso Thomas, Marion. Eunice Kennedy Shriver NICHD; Estados Unidos ; Fil: Buekens, Pierre. University of Tulane; Estados Unidos ; Fil: Belizan, Jose. Instituto de Efectividad Clínica y Sanitaria; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina