Association between antenatal corticosteroid use and perinatal mortality among preterm births in hospitals in Tanzania.

Stanley Mwita,Benjamin Kamala,Karol J Marwa,Mary Jande,Andrew Kigombola,Semvua Kilonzo,Angelina Izina,Deborah Dewey,Eveline Konje,Andrew Sharp

doi:10.1371/journal.pone.0254916

Abstract

The primary aims of this study were to investigate if exposure to antenatal corticosteroids (ACS) was associated with lower rates of perinatal mortality (primary outcome) and other adverse perinatal outcomes (i.e., stillbirth, early neonatal mortality, APGAR score of < 7 at 5 mins, neonatal sepsis and respiratory distress syndrome) in preterm infants in hospitals in Tanzania. We also examine factors associated with administration of ACS among women at risk of preterm delivery. A hospital-based prospective chart review study was undertaken in four hospitals located in Nyamagana and Sengerema districts, Tanzania. The study population included all stillborn and live born preterm infants delivered between 24 to 34 weeks of gestation between July 2019 to February 2020. A total 1125 preterm infants were delivered by 1008 women (895 singletons, 230 multiple). Sociodemographic and medical data were recorded from participants' medical records. Three hundred and fifty-six (35.3%) women were administered at least one dose of ACS between 24 to 34 weeks' gestation and 385 (34.2%) infants were exposed to ACS. Infants exposed to ACS had a lower rate of perinatal mortality (13.77%) compared to those who were not exposed (28.38%). Multivariate analysis indicated that infants exposed to ACS were less likely to die during perinatal period, aRR 0.34 (95%CI 0.26-0.44). Only one-third of the sample was provided with ACS. Administration of ACS was associated with maternal education, attending antenatal care more than 3 times, method used to assess gestational age, maternal infection, exposure to maternal antibiotics, delivery mode and level of health facility. ACS significantly reduced the risk in perinatal mortality among infants born preterm in a limited resource setting. However, only about one-third of eligible women were provided with ACS, indicating low usage of ACS. Numerous factors were associated with low usage of ACS in this setting.

Highlights

Perinatal mortality refers to stillbirths and neonatal death during the first week of life
One-third of the sample was provided with antenatal corticosteroids (ACS)
Only about one-third of eligible women were provided with ACS, indicating low usage of ACS

Summary

Introduction

Perinatal mortality refers to stillbirths and neonatal death during the first week of life. Preterm birth is one of the leading causes of perinatal mortality [1, 2]. Stillbirths and early neonatal mortality remain remarkably high [3, 4]. In Tanzania, in 2018, approximately 45,000 deaths occurred during the neonatal period, which accounted for 40% of under-five deaths [5]. In 2015, ten countries accounted for 65% of stillbirths globally. Tanzania ranked 9th among these countries [6]

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