Enhancing Maternal and Newborn Health in Low- and Middle-Income Countries: Assessment of Antenatal Care Quality and Utilization of Antenatal Corticosteroids
Open Access DepositedThe world has seen a significant reduction in child mortality, made possible by tremendous global efforts. Despite this process, the burden of maternal and neonatal death globally remains high, with the majority of mortality happening in low-resource countries. More and more pregnant women in low- and middle-income countries (LMICs) have attended antenatal care visits; however, the quality of antenatal care (ANC) remains insufficient, meaning pregnant women do not always receive the essential care they need during those visits. To enhance maternal and newborn health in LMICs, high-quality care in pregnancy is crucial, which should include essential care components to monitor maternal and fetal health and evidence-based intervention to prevent illness and improve outcomes. To assess whether healthcare of good quality is provided to people who need it in settings that can optimize the benefits of care, this dissertation aimed to 1) examine the landscape of antenatal corticosteroid (ACS) utilization, one of the most effective interventions to improve preterm outcome, aiming to identify priority policy directions for ACS scale-up, and 2) investigate the quality of antenatal care, focusing on key care components essential to reduce adverse perinatal outcomes in low-resource countries. Three papers in this dissertation focused on antenatal corticosteroids in LMICs. The first two studies using health facility survey data from nine countries found low ACS utilization, limited corticosteroid availability, and inadequate facility readiness, with huge gaps between drug availability and actual utilization. To encourage ACS uptake and ensure its safe and effective provision, our findings suggested that policymakers should equip facilities for proper ACS use and target well-equipped facilities for ACS scale-up. The third study on ACS identified barriers to effective ACS utilization in Ethiopia. The country’s health service delivery structure strongly affects the effectiveness of ACS. Simply increasing ACS uptake without taking into account how high-risk pregnancies are managed and referred within a particular health system is unlikely to improve neonatal survival significantly. In addition, knowledge gaps in ACS use and identifying eligible women hinder providers from implementing this intervention appropriately. These three papers on ACS concluded that the benefits of ACS can only be realized in reasonably equipped facilities with competent providers who adhere to guidelines under a country’s service delivery structure that can effectively manage labor of varied risks in appropriate settings. Lastly, the fourth paper on the assessment of antenatal care quality found that pregnant women received antenatal care of suboptimal quality in Ethiopia, Kenya, and South Africa; suboptimal ANC quality was significantly associated with an increased risk of late miscarriage and stillbirth. Our findings also suggested the importance of ultrasound examination in antenatal care. As more and more pregnant women in LMICs have access to antenatal care, improving the quality of antenatal care becomes enormously crucial. The ongoing global efforts should focus on ensuring the provision of essential care components to every pregnant woman and evidence-based interventions to eligible women in settings that can optimize the benefits of healthcare services.
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