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Antenatal corticosteroids for management of preterm birth: a multi-country analysis of health system bottlenecks and potential solutions

Journal Article
(Published September, 2015)
Liu G. (Author),
Segrè J. (Author),
Gülmezoglu AM (Author),
Mathai M. (Author),
Smith JM (Author),
Hermida J (Author),
Simen-Kapeu A (Author),
Barker P (Author)
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The Working Group for the UN Commission of Life Saving Commodities Antenatal Corticosteroids applied their bottleneck analysis tool in 12 countries in Africa and Asia as part of the Every Newborn Action Plan process. 9 or more countries (>75%) reported very major or significant bottlenecks included absence of coverage data, poor gestational age metrics, lack of national essential medicines listing, discrepancies between prescribing authority and provider cadres managing care, delays due to referral, and lack of supervision, mentoring and quality improvement systems. Recommendations included improving HIS gestational age assessment and tracking ACS coverage, use and outcomes. Better health service delivery requires clarified policy assigning roles by level of care and cadre of provider, dependent on capability to assess gestational age and risk of preterm birth, and the implementation of guidelines with adequate supervision, mentoring and quality improvement systems, including audit and feedback. National essential medicines lists should include dexamethasone for antenatal use, and dexamethasone should be integrated into supply logistics

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Citation: 
Liu G, Segre J, Gulmezoglu A, Mathai M, Smith JM, Hermida J, et al. Antenatal corticosteroids for management of preterm birth: a multi-country analysis of health system bottlenecks and potential solutions. BMC pregnancy and childbirth. 2015;15 Suppl 2:S3