Complications from preterm births now the main killer of under-fives

Complications associated with preterm births have become the leading single killer of children under five, outpacing pneumonia and claiming 3 000 lives every day in what has been described as “one of the greatest health challenges of the 21st century”, a study published in the medical journal the Lancet said.

“Globally, this is a wake-up call,” said Dr Joy Lawn of the London School of Hygiene & Tropical Medicine , who is a member of the research team and a long-term adviser to Save the Children.

“This marks a turning of the tide, a transition from infections to neonatal conditions, especially those related to premature births, and this will require entirely different medical and public health approaches … the success we’ve seen in the ongoing fight against infectious diseases demonstrates that we can also be successful if we invest in prevention and care for preterm birth,” she added.

Some of the highest rates of preterm deaths are in west Africa, particularly in Liberia, Sierra Leone and Guinea, where the Ebola virus is straining underfunded and ill-equipped health services. One in seven women in these countries, which already have some of the highest maternal mortality rates, could die in pregnancy or childbirth because hospital services are overwhelmed, NGOs recently warned .

“The highest risk in the world (for preterm births) is in Sierra Leone,” said Lawn, adding that newborn death rates were the most sensitive indicator of the state of a country’s health system.

Complications from preterm births, defined as babies born alive before 37 weeks of pregnancy , accounted for nearly 1.1 million of the estimated 6.3 million deaths of children under five last year, according to research by the Johns Hopkins Bloomberg School of Public Health , alongside the World Health Organisation and the London School of Hygiene & Tropical Medicine.

The study, published to mark World Prematurity Day on November 17, showed that direct complications from preterm births accounted for 965 000 deaths during the first 28 days of life, with an additional 125 000 deaths between the ages of one month and five years. Other main causes of young children’s deaths include pneumonia, which killed 935 000 children under-five, and childbirth complications, which caused 720 000 deaths.

The five countries with the highest percentage of deaths of under-fives directly resulting from preterm birth complications are Macedonia (51%), Slovenia (48%), Denmark (43%), Serbia (40%) and the UK (39%). All of these exceed the global average of 17% of under-five deaths, partly because of success in reducing infectious diseases.

India has the highest number of children dying from preterm birth complications each year, at 361 600, followed by Nigeria (98 300), then Pakistan (75 000).

“Two-thirds of the 1.1 million babies who die could be saved without intensive care,” said Lawn. “It’s things like wrapping the baby, keeping it warm, breastfeeding and kangaroo mother care (holding the infant, skin to skin, on the mother’s chest to keep the baby warm and make breastfeeding easier)”.

“We have an epidemic of preterm and newborn deaths that represents one of the greatest health challenges of the 21st century,” said Andres de Francisco of the Partnership for Maternal, Newborn & Child Health, a coalition of more than 600 partners. “Two-thirds of these deaths could be prevented without intensive care.”

Campaigners say $250 million of new funding, announced on Monday, will be dedicated to studies, involving more than 200 researchers, into why preterm births occur and how to prevent them. Four initiatives are under way to investigate why preterm births occur and how to prevent them. They will investigate what triggers the start of labour, either at full term or preterm.

One research group is working to identify a pacemaker in the uterus that initiates labour, while another seeks to discover the source of the electrical signals that trigger labour and discover whether the process is set off by mother or foetus. Another research team is investigating why Somali women living in the US have very low rates of premature births, while other black women in the US have very high rates.

The worldwide mortality rate of children under five has declined from 76 deaths per 1 000 live births in 2000 to 46 deaths. Almost half of the overall reduction is a result of progress in tackling pneumonia, diarrhoea, measles, HIV and tetanus, thanks to investment in bed nets, vaccines, and antimalarial and HIV treatment. – Clar Ni Chonghaile

Image – A Colombian mother holds a premature baby after feeding him donated milk at Medellín’s General Hospital on August 20, 2014 in Medellin, Colombia. The region’s first Human Milk Bank opened recently, with the aim of reducing the mortality rate in premature infants, preventing disease and promoting breastfeeding. (AFP)