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Prof. Elwyn Chomba, MBChB, DCH, MRCP Permanent Secretary Ministry of Community Health, Mother and Child Health,ZM Global Network for Womens and Childrens Health Research
Background
Global health perspective
Preterm birth (PTB) is the second leading cause of Under-5 mortality, after pneumonia 1.1 million children die from direct complications of preterm birth
Background
Key evidence-based interventions during pregnancy and childbirth?
Understand the gestational clock triggering the onset of labour Identify the causal pathways leading to preterm labour and delivery
Background
However, until there is better understanding of the onset of labor and the causal pathways, improved management of preterm birth can reduce mortality and major morbidities
Roberts & Dalziel, 2006; Kenyon et al, 2010; Doyle LW et al, 2010; Lawn et al, 2010
80%
30%
4% - 71%
10%
5%
LMIC
N=42
HIC
LMIC
N=75 Jones et al 2003 Darmstadt et al 2005 Born Too Soon report 2012
Latin America
N=6
Why is such an effective, safe, easy to administer, and inexpensive intervention is still underused in lowand middle-income countries?
Antenatal Corticosteroids Trial in Preterm Births to Increase Neonatal Survival in Developing Countries (ACT Trial)
ACT Trial
Cluster Randomized Controlled Trial
102 health regions (Home, Primary Health Centre, and Hospital births)
6 countries Argentina, Guatemala, India, Kenya, Pakistan, and Zambia
OR REFER
Obstetric Disk
TBA 37%
Nurse/ midwife 28%
Three Key Messages From the Born Too Soon Care Group on Antenatal Corticosteroids
1
Focus on dexamethasone for now Both betamethasone and dexamethasone are effective, but dexamethasone is less expensive and more commonly available
ANCS may be beneficial in many contexts, but current data supports hospital usage
The balance of risks is in favor of treatment side effects are minimal while potential benefit is substantial
Conclusions
1. ACS administration is the most effective intervention during pregnancy to reduce neonatal mortality
2. ACS administration is safe for the mothers and babies 3. Use of ACS is low in developing countries
200,000 deaths per year may be averted if antenatal corticosteroids use is increased to 50% during preterm labour
Incorporate updated ACS guidelines into preservice education for healthcare providers who administer ACS.
Engage professional associations of healthcare cadres.
USAID and MCHIP
THANKS!