Health facilities’ readiness to manage preterm labour using the new World Health Organisation guidelines for antenatal corticosteroids in Jinja Regional Referral Hospital catchment area, Uganda

Abstract

Preterm birth complications claim over 1 million neonates every year, with the biggest percentage occurring in developing countries. Antenatal corticosteroids (ACS) for women at high risk of preterm birth is a cost-effective and feasible intervention to reduce neonatal mortality among preterm babies; by helping with the rapid maturation of fetal lungs. However, during the recent Antenatal Corticosteroids Trial (ACT), African sites appeared to have increased neonatal mortality in the intervention clusters unlike other sites. As a consequence, WHO published new guidelines for the use of ACS when managing preterm labour but, it’s not clear whether facilities in Uganda are prepared for of ACS use. Objective: To assess preparedness of health facilities in Jinja Regional referral catchment area to manage preterm labour using Antenatal Corticosteroids (ACS) as per the new WHO guidelines

Methods: The study was conducted in 6 hospitals and 8 Health center IVs within the Jinja regional referral hospital catchment area. Prevalence of ACS use was determined using 354 medical records (November 2015 to March 2016) of mothers who delivered preterm babies after 24 and before 37 completed weeks of gestation. A readiness assessment tool, key informant interview guide, a pretested semi-structured questionnaire and a data extraction tool were used for data collection. Qualitative results were analyzed using thematic content analysis and quantitative results were analyzed using STATA (version 12) and Microsoft excel (2013).

Results: The overall readiness index was 82%. The hospitals were more prepared compared to HCIVs. The difference in the mean of overall readiness index of hospitals (90.3%) and HCIVs (75.8) was statistically significant with chi square of 4.817 (p-value 0.028). Prevalence of ACS use was 13.6% of which 9.3% was appropriate use. About three quarters (74%) of the health workers’ knowledge levels were low. The new WHO guidelines on ACS use for management of preterm labour were not available in any of the facilities.

Conclusion: The overall readiness index was good. Hospitals generally performed better than HCIV but, correct ACS use as per the new WHO guidelines for management of preterm birth was low. The low levels of knowledge and absence of the new WHO guidelines in the facilities indicated that there need for the Ministry of Health and partners to urgently introduce programs to improve awareness and use of ACS as well update the new guidelines of ACS use at all facility levels.