Providing antenatal corticosteroids for preterm birth: a quality improvement initiative in Cambodia and the Philippines.
OBJECTIVE
To determine whether a simple quality improvement initiative consisting of a technical update and regular audit and feedback sessions will result in increased use of antenatal corticosteroids among pregnant women at risk of imminent preterm birth delivering at health facilities in the Philippines and Cambodia.


METHODS
Non-randomized, observational study using a pre-/post-intervention design conducted between October 2013 and June 2014.


METHODS
A total of 12 high volume facilities providing Emergency Obstetric and Newborn Care services in Cambodia (6) and Philippines (6).


METHODS
A technical update on preterm birth and use of antenatal corticosteroids, followed by monthly audit and feedback sessions.


METHODS
The proportion of women at risk of imminent preterm birth who received at least one dose of dexamethasone.


RESULTS
Coverage of at least one dose of dexamethasone increased from 35% at baseline to 86% at endline in Cambodia (P < 0.0001) and from 34% at baseline to 56% at endline in the Philippines (P < 0.0001), among women who had births at 24-36 weeks. In both settings baseline coverage and magnitude of improvement varied notably by facility. Availability of dexamethasone, knowledge of use and cost were not major barriers to coverage.


CONCLUSIONS
A simple quality improvement strategy was feasible and effective in increasing use of dexamethasone in the management of preterm birth in 12 hospitals in Cambodia and Philippines.
Jhpiego, Maternal and Child Survival Program (MCSP), 1776 Massachusetts Avenue, NW, Suite 300, Washington, DC 20036, USA.
Jeffrey Michael
JM
Smith
Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD 21205, USA.
Shivam
S
Gupta
Jhpiego, 1615 Thames St, Baltimore, MD 21231, USA.
Emma
E
Williams
Jhpiego, Maternal and Child Survival Program (MCSP), 1776 Massachusetts Avenue, NW, Suite 300, Washington, DC 20036, USA.
Kate
K
Brickson
National Maternal and Child health Center (NMCHC) of Cambodia, No 31A Rue de France (French St), Sangkat Sras Chak, Khan Daun Penh, Phnom Penh, Cambodia.
Keth
K
Ly Sotha
Human Development Research Cambodia, #6Z1, Mao Tse Toung Boulevard, Sangkat Tonle, Bassac, KhanChamkarmon, Phnom Penh 12301, Cambodia.
Navuth
N
Tep
Family Health Office, Disease Prevention and Control Bureau, Department of Health, 2/F Building 14, San Lazaro Compound, Rizal Ave., Sta. Cruz, 1003, Manila.
Anthony
A
Calibo
Nutrition Center of the Philippines, 2332 Chino Roces Ave Ext, Taguig City, Manila, 1630 Metro Manila, Philippines.
Mary Christine
MC
Castro
Jhpiego, 1615 Thames St, Baltimore, MD 21231, USA.
Bernabe
B
Marinduque
Jhpiego, Maternal and Child Survival Program (MCSP), 1776 Massachusetts Avenue, NW, Suite 300, Washington, DC 20036, USA.
Mark
M
Hathaway
D002160:Cambodia; D003907:Dexamethasone / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D005865:Gestational Age; D005938:Glucocorticoids / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D010679:Philippines; D011247:Pregnancy; D047928:Premature Birth / Q000517:prevention & control*; D011295:Prenatal Care / Q000379:methods; D058996:Quality Improvement / Q000458:organization & administration* / Q000706:statistics & numerical data
D005938:Glucocorticoids; D003907:Dexamethasone
Cambodia; Philippines; dexamethasone; premature birth; quality improvement