Scaling up safe use of antenatal corticosteroids and small/sick newborn care interventions to improve preterm birth outcomes in Bangladesh, Pakistan, Ethiopia and Nigeria - a parallel with baseline cluster randomised trial
Preterm birth
Intervention arm ACS & Co-Interventions Antenatal corticosteroids (ACS) for preterm birth, tocolysis & magnesium sulphate for neuroprotection. Intervention includes training on: Right Woman: Identification and management of women at high risk of preterm birth, Right Treatment: ACS administration according to WHO guidelines Clinical protocols/job aids, diagnosis and treatment of women at high risk of preterm birth and administration of cointerventions (tocolysis & magnesium sulphate) according to clinical guidelines & Right Place: Promoting in-utero referral of preterm deliveries to high-level facilities. Adequate childbirth care Training of healthcare workers on appropriate monitoring of women during preterm labour and birth and strengthen recording practices, including introduction of the WHO labour care guide (LCG) adapted for preterm labour/birth. Adequate preterm newborn care (Small/sick newborn care) Training of healthcare workers on Essential newborn care at birth, KMC & breastfeeding (All facilities) and the eight domains of small and sick newborn care (SSNC) (Facilities with a SNCU/NICU). Provision of CPAP machines & pulse oximeters (SNCU/NICU). Provision of clinical protocols/job aids in Essential newborn care, Respiratory Support (CPAP), KMC, breastfeeding, alternative methods of feeding, hand hygiene, common problems, developmentally supportive care (DSC). Clinical onsite mentorship by experienced neonatologists in the SNCU in high level facilities including monthly observations of clinical practice using the SSNC strengthening tool. Monthly audit and feedback meetings to facilitate feedback on progress based on tracking indicators within the eight domains of SSNC. Community level intervention Community level engagement with community health workers (CHWs) on the signs of preterm labour and importance of referring women to a high-level facility for delivery. Distribution of IEC materials for women & their families via CHWs on signs of preterm labour
All women and her newborn(s) that are delivered within the network of health facilities
A woman who does not consent to routine clinical data sharing or a neonatal and maternal follow-up on day 28 of life.