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dc.contributor.author
Althabe, Fernando
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Belizan, Jose
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McClure, Elizabeth M.
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Hemingway Foday, Jennifer
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Berrueta, Amanda Mabel
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Mazzoni, Agustina
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Ciganda, Alvaro
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Goudar, Shivaprasad S.
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Kodkany, Bhalachandra S.
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Mahantshetti, Niranjana S.
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Dhaded, Sangappa M.
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Katageri, Geetanjali M.
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Metgud, Mrityunjay C.
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Joshi, Anjali M.
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Bellad, Mrutyunjaya B.
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Honnungar, Narayan V.
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Derman, Richard J.
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Saleem, Sarah
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Pasha, Omrana
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Ali, Sumera
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Hasnain, Farid
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Goldenberg, Robert L
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Esamai, Fabian
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Nyongesa, Paul
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Ayunga, Silas
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Liechty, Edward A
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Garces, Ana L
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Figueroa, Lester
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Hambidge, K Michael
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Krebs, Nancy F
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Patel, Archana
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Bhandarkar, Anjali
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Waikar, Manjushri
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Hibberd, Patricia L
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Chomba, Elwyn
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Carlo, Waldemar A
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Mwiche, Angel
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Chiwila, Melody
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Manasyan, Albert
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Pineda, Sayury
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Meleth, Sreelatha
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Thorsten, Vanessa
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Stolka, Kristen
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Wallace, Dennis D
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Koso-Thomas, Marion
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Jobe, Alan H
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Buekens, Pierre M
dc.date.available
2018-03-08T20:07:27Z
dc.date.issued
2015-02
dc.identifier.citation
Althabe, Fernando; Belizan, Jose; McClure, Elizabeth M.; Hemingway Foday, Jennifer; Berrueta, Amanda Mabel; et al.; A population-based, multifaceted strategy to implement antenatal corticosteroid treatment versus standard care for the reduction of neonatal mortality due to preterm birth in low-income and middle-income countries: The ACT cluster-randomised trial; Elsevier Science Inc; Lancet; 385; 9968; 2-2015; 629-639
dc.identifier.issn
0140-6736
dc.identifier.uri
http://hdl.handle.net/11336/38318
dc.description.abstract
Background Antenatal corticosteroids for pregnant women at risk of preterm birth are among the most effective hospital-based interventions to reduce neonatal mortality. We aimed to assess the feasibility, effectiveness, and safety of a multifaceted intervention designed to increase the use of antenatal corticosteroids at all levels of health care in low-income and middle-income countries. Methods In this 18-month, cluster-randomised trial, we randomly assigned (1:1) rural and semi-urban clusters within six countries (Argentina, Guatemala, India, Kenya, Pakistan, and Zambia) to standard care or a multifaceted intervention including components to improve identification of women at risk of preterm birth and to facilitate appropriate use of antenatal corticosteroids. The primary outcome was 28-day neonatal mortality among infants less than the 5th percentile for birthweight (a proxy for preterm birth) across the clusters. Use of antenatal corticosteroids and suspected maternal infection were additional main outcomes. This trial is registered with ClinicalTrials.gov, number NCT01084096. Findings The ACT trial took place between October, 2011, and March, 2014 (start dates varied by site). 51 intervention clusters with 47 394 livebirths (2520 [5%] less than 5th percentile for birthweight) and 50 control clusters with 50 743 livebirths (2258 [4%] less than 5th percentile) completed follow-up. 1052 (45%) of 2327 women in intervention clusters who delivered less-than-5th-percentile infants received antenatal corticosteroids, compared with 215 (10%) of 2062 in control clusters (p<0·0001). Among the less-than-5th-percentile infants, 28-day neonatal mortality was 225 per 1000 livebirths for the intervention group and 232 per 1000 livebirths for the control group (relative risk [RR] 0·96, 95% CI 0·87-1·06, p=0·65) and suspected maternal infection was reported in 236 (10%) of 2361 women in the intervention group and 133 (6%) of 2094 in the control group (odds ratio [OR] 1·67, 1·33-2·09, p<0·0001). Among the whole population, 28-day neonatal mortality was 27·4 per 1000 livebirths for the intervention group and 23·9 per 1000 livebirths for the control group (RR 1·12, 1·02-1·22, p=0·0127) and suspected maternal infection was reported in 1207 (3%) of 48 219 women in the intervention group and 867 (2%) of 51 523 in the control group (OR 1·45, 1·33-1·58, p<0·0001). Interpretation Despite increased use of antenatal corticosteroids in low-birthweight infants in the intervention groups, neonatal mortality did not decrease in this group, and increased in the population overall. For every 1000 women exposed to this strategy, an excess of 3·5 neonatal deaths occurred, and the risk of maternal infection seems to have been increased. Funding Eunice Kennedy Shriver National Institute of Child Health and Human Development.
dc.format
application/pdf
dc.language.iso
eng
dc.publisher
Elsevier Science Inc
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dc.rights
info:eu-repo/semantics/openAccess
dc.rights.uri
https://creativecommons.org/licenses/by-nc-sa/2.5/ar/
dc.subject
Neonatal Mortality
dc.subject.classification
Salud Ocupacional
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Ciencias de la Salud
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CIENCIAS MÉDICAS Y DE LA SALUD
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dc.title
A population-based, multifaceted strategy to implement antenatal corticosteroid treatment versus standard care for the reduction of neonatal mortality due to preterm birth in low-income and middle-income countries: The ACT cluster-randomised trial
dc.type
info:eu-repo/semantics/article
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info:ar-repo/semantics/artículo
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info:eu-repo/semantics/publishedVersion
dc.date.updated
2018-03-08T19:01:08Z
dc.journal.volume
385
dc.journal.number
9968
dc.journal.pagination
629-639
dc.journal.pais
Países Bajos
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dc.journal.ciudad
Amsterdam
dc.description.fil
Fil: Althabe, Fernando. Instituto de Efectividad Clínica y Sanitaria; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina
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Fil: Belizan, Jose. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Instituto de Efectividad Clínica y Sanitaria; Argentina
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Fil: McClure, Elizabeth M.. No especifíca;
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Fil: Hemingway Foday, Jennifer. No especifíca;
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Fil: Berrueta, Amanda Mabel. Instituto de Efectividad Clínica y Sanitaria; Argentina
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Fil: Mazzoni, Agustina. Instituto de Efectividad Clínica y Sanitaria; Argentina
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Fil: Ciganda, Alvaro. Instituto de Efectividad Clínica y Sanitaria; Argentina
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Fil: Goudar, Shivaprasad S.. Jawaharlal Nehru Medical College Belgaum; India
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Fil: Kodkany, Bhalachandra S.. Jawaharlal Nehru Medical College Belgaum; India
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Fil: Mahantshetti, Niranjana S.. Jawaharlal Nehru Medical College Belgaum; India
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Fil: Dhaded, Sangappa M.. Jawaharlal Nehru Medical College Belgaum; India
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Fil: Katageri, Geetanjali M.. S. Nijalingappa Medical College; India
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Fil: Metgud, Mrityunjay C.. Jawaharlal Nehru Medical College Belgaum; India
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Fil: Joshi, Anjali M.. Jawaharlal Nehru Medical College Belgaum; India
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Fil: Bellad, Mrutyunjaya B.. Jawaharlal Nehru Medical College Belgaum; India
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Fil: Honnungar, Narayan V.. Jawaharlal Nehru Medical College Belgaum; India
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Fil: Derman, Richard J.. Christiana Health Care Services; Estados Unidos
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Fil: Saleem, Sarah. The Aga Khan University; Pakistán
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Fil: Pasha, Omrana. The Aga Khan University; Pakistán
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Fil: Ali, Sumera. The Aga Khan University; Pakistán
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Fil: Hasnain, Farid. The Aga Khan University; Pakistán
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Fil: Goldenberg, Robert L. Columbia University; Estados Unidos
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Fil: Esamai, Fabian. Moi University; Kenia
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Fil: Nyongesa, Paul. Moi University; Kenia
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Fil: Ayunga, Silas. University of Alabama at Birmingahm; Estados Unidos
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Fil: Liechty, Edward A. Indiana University; Estados Unidos
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Fil: Garces, Ana L. Francisco Marroquin University; Guatemala. Fundacion Para la Alimentacion y Nutricion de Centro America y Panama; Guatemala
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Fil: Figueroa, Lester. Fundacion Para la Alimentacion y Nutricion de Centro America y Panama; Guatemala
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Fil: Hambidge, K Michael. State University of Colorado - Fort Collins; Estados Unidos
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Fil: Krebs, Nancy F. State University of Colorado - Fort Collins; Estados Unidos
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Fil: Patel, Archana. Government Medical College Nagpur; India. Lata Medical Research Foundation; India
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Fil: Bhandarkar, Anjali. Lata Medical Research Foundation; India
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Fil: Waikar, Manjushri. Lata Medical Research Foundation; India
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Fil: Hibberd, Patricia L. Massachusetts General Hospital; Estados Unidos
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Fil: Chomba, Elwyn. University Teaching Hospital Lusaka; Zambia
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Fil: Carlo, Waldemar A. University of Alabama at Birmingahm; Estados Unidos
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Fil: Mwiche, Angel. University Teaching Hospital Lusaka; Zambia
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Fil: Chiwila, Melody. Centre For Infectious Disease Research; Zambia
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Fil: Manasyan, Albert. University of Alabama at Birmingahm; Estados Unidos
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Fil: Pineda, Sayury. Fundacion Para la Alimentacion y Nutricion de Centro America y Panama; Guatemala
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Fil: Meleth, Sreelatha. Rti International; Estados Unidos
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Fil: Thorsten, Vanessa. Rti International; Estados Unidos
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Fil: Stolka, Kristen. Rti International; Estados Unidos
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Fil: Wallace, Dennis D. Rti International; Estados Unidos
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Fil: Koso-Thomas, Marion. National Instituto Of Child Health & Human Developm.; Estados Unidos
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Fil: Jobe, Alan H. Cincinnati Children's Hospital Medical Center; Estados Unidos
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Fil: Buekens, Pierre M. Tulane University School Of Public Health And Tropical Medicine; Estados Unidos
dc.journal.title
Lancet
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dc.relation.alternativeid
info:eu-repo/semantics/altIdentifier/doi/http://dx.doi.org/10.1016/S0140-6736(14)61651-2
dc.relation.alternativeid
info:eu-repo/semantics/altIdentifier/url/http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)61651-2/abstract
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