Barriers to improving preterm newborn outcomes through effective antenatal corticosteroid use in Ethiopia

Authors

Wen-Chien Yang, Department of Global Health, The George Washington University Milken Institute School of Public Health, Washington, District of Columbia, USA.
Theodros Getachew, Health System and Reproductive Health Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia.
Emily R. Smith, Department of Global Health, The George Washington University Milken Institute School of Public Health, Washington, District of Columbia, USA.
Delayehu Bekele, Department of Obstetrics and Gynecology, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia.
Sofanit Haile, Department of Obstetrics and Gynecology, Addis Ababa University, Addis Ababa, Ethiopia.
Gesit Metaferia, Pediatric and Child Health Department, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia.
Zelalem Birhan Tilahun, Sister Aklesia Memorial Hospital, Adama, Ethiopia.
Catherine Arsenault, Department of Global Health, The George Washington University Milken Institute School of Public Health, Washington, District of Columbia, USA catherine.arsenault@gwu.edu.

Document Type

Journal Article

Publication Date

9-16-2025

Journal

BMJ global health

Volume

10

Issue

9

DOI

10.1136/bmjgh-2025-019102

Keywords

Global Health; Health systems; Maternal health

Abstract

Ethiopia has prioritised high-impact interventions to reduce neonatal deaths, including antenatal corticosteroids (ACS) utilisation. However, effective ACS use has faced various challenges. We used multiple data sources to examine the current landscape of ACS use in Ethiopia and to elucidate barriers to effective ACS utilisation, including a review of national obstetric guidelines over the past decade, a review of literature, and a descriptive analysis of health facility data.National obstetric protocols recommend administering ACS in both hospitals and health centres. However, ACS remains substantially underused. The 2016 Ethiopian Emergency Obstetric and Newborn Care Assessment reported that only 5% of preterm infants were born to women who had received corticosteroids before delivery. At the health facility level, the 2021 Ethiopian Service Provision Assessment survey showed that only 22.1% of facilities providing antenatal care and delivery services had administered ACS in the past 3 months, and 44.7% of facilities had injectable corticosteroids in stock at the time of the survey. Notably, private clinics had both the lowest corticosteroid availability (16.9%) and utilisation rate (2.8%).We identified several barriers to effective ACS use, including healthcare service delivery organisation, gaps in healthcare providers' knowledge and skills (particularly at the primary healthcare level and in private facilities), challenges in accurate gestational age assessment resulting from limited access to early ultrasound and late initiation of antenatal care, and insufficient corticosteroid availability. Increasing ACS uptake alone is unlikely to have the desired population benefits without considering health service delivery redesign and integration with other life-saving maternal and newborn health interventions.

APA Citation

Yang, Wen-Chien; Getachew, Theodros; Smith, Emily R.; Bekele, Delayehu; Haile, Sofanit; Metaferia, Gesit; Tilahun, Zelalem Birhan; and Arsenault, Catherine, "Barriers to improving preterm newborn outcomes through effective antenatal corticosteroid use in Ethiopia" (2025). GW Authored Works. Paper 7943.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/7943

Department

Global Health