{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,18]],"date-time":"2025-09-18T10:13:07Z","timestamp":1758190387157,"version":"3.44.0"},"reference-count":52,"publisher":"BMJ","issue":"9","license":[{"start":{"date-parts":[[2025,9,16]],"date-time":"2025-09-16T00:00:00Z","timestamp":1757980800000},"content-version":"unspecified","delay-in-days":15,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Glob Health"],"accepted":{"date-parts":[[2025,7,18]]},"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:p>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.<\/jats:p>\n               <jats:p>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%).<\/jats:p>\n               <jats:p>We identified several barriers to effective ACS use, including healthcare service delivery organisation, gaps in healthcare providers\u2019 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.<\/jats:p>","DOI":"10.1136\/bmjgh-2025-019102","type":"journal-article","created":{"date-parts":[[2025,9,17]],"date-time":"2025-09-17T05:05:20Z","timestamp":1758085520000},"page":"e019102","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Barriers to improving preterm newborn outcomes through effective antenatal corticosteroid use in Ethiopia"],"prefix":"10.1136","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8206-1496","authenticated-orcid":false,"given":"Wen-Chien","family":"Yang","sequence":"first","affiliation":[{"name":"Department of Global Health, The George Washington University Milken Institute School of Public Health, Washington, District of Columbia, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6486-0531","authenticated-orcid":false,"given":"Theodros","family":"Getachew","sequence":"additional","affiliation":[{"name":"Health System and Reproductive Health Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia"},{"name":"Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5715-9459","authenticated-orcid":false,"given":"Emily R","family":"Smith","sequence":"additional","affiliation":[{"name":"Department of Global Health, The George Washington University Milken Institute School of Public Health, Washington, District of Columbia, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9243-2622","authenticated-orcid":false,"given":"Delayehu","family":"Bekele","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, St. Paul\u2019s Hospital Millennium Medical College, Addis Ababa, Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sofanit","family":"Haile","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Addis Ababa University, Addis Ababa, Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gesit","family":"Metaferia","sequence":"additional","affiliation":[{"name":"Pediatric and Child Health Department, St. Paul\u2019s Hospital Millennium Medical College, Addis Ababa, Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-6112-684X","authenticated-orcid":false,"given":"Zelalem Birhan","family":"Tilahun","sequence":"additional","affiliation":[{"name":"Sister Aklesia Memorial Hospital, Adama, Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2410-3015","authenticated-orcid":false,"given":"Catherine","family":"Arsenault","sequence":"additional","affiliation":[{"name":"Department of Global Health, The George Washington University Milken Institute School of Public Health, Washington, District of Columbia, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,9,16]]},"reference":[{"key":"2025091622050741000_10.9.e019102.1","doi-asserted-by":"crossref","first-page":"1261","DOI":"10.1016\/S0140-6736(23)00878-4","article-title":"National, regional, and global estimates of preterm birth in 2020, with trends from 2010: a systematic analysis","volume":"402","author":"Ohuma","year":"2023","journal-title":"The Lancet"},{"key":"2025091622050741000_10.9.e019102.2","doi-asserted-by":"crossref","DOI":"10.1186\/s40748-016-0035-8","article-title":"Neonatal mortality and causes of death in Kersa Health and Demographic Surveillance System (Kersa HDSS), Ethiopia, 2008-2013","volume":"2","author":"Assefa","year":"2016","journal-title":"Matern Health Neonatol Perinatol"},{"key":"2025091622050741000_10.9.e019102.3","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pgph.0001471","article-title":"National and subnational burden of under-5, infant, and neonatal mortality in Ethiopia, 1990-2019: Findings from the Global Burden of Disease Study 2019","volume":"3","author":"Tessema","year":"2023","journal-title":"PLOS Glob Public Health"},{"key":"2025091622050741000_10.9.e019102.4","doi-asserted-by":"crossref","DOI":"10.1186\/s13104-019-4668-3","article-title":"Factors affecting neonatal mortality in the general population: evidence from the 2016 Ethiopian Demographic and Health Survey (EDHS)-multilevel analysis","volume":"12","author":"Wolde","year":"2019","journal-title":"BMC Res Notes"},{"key":"2025091622050741000_10.9.e019102.5","doi-asserted-by":"crossref","first-page":"e1130","DOI":"10.1016\/S2214-109X(19)30220-7","article-title":"Major causes of death in preterm infants in selected hospitals in Ethiopia (SIP): a prospective, cross-sectional, observational study","volume":"7","author":"Muhe","year":"2019","journal-title":"Lancet Glob Health"},{"key":"2025091622050741000_10.9.e019102.6","unstructured":"The World Bank . 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