By P.K.Balachandran/Daily Mirror
Colombo, May 19: The World Health Organization (WHO), UNICEF and UN Population Fund have together called for urgent global attention to preterm births or births before 37 months of pregnancy. Preterm babies could die or have a deep and lasting impact on the child’s health, the surrounding society and the country’s economy.
In a publication entitled: “Born too soon: Decade of action on preterm birth” released on May 9, EHO, UNICEF and UNFPA point out that 152 million babies were born preterm in the last ten years. In 2020, an estimated 13.4 million babies were born pre-term, with nearly one million of these dying from preterm complications (equivalent to around 1 in 10 babies born too soon).
Worldwide, one in 10 babies is born preterm or one baby every two seconds. A related fact of concern is that the rates of preterm birth have barely changed in the past decade. In some places, the rates have risen.
Preterm babies that survive, do so with disabilities which affect them lifelong. Additionally, their families get adversely affected as a result of these disabilities.
Preterm birth is the single largest killer of children under 5 years of age, accounting for more than one in three of all neonatal deaths (ie: deaths in the first month of life).
There is a rich-poor divide in this sphere. For obvious reasons, preterm babies in advanced countries have a greater chance of survival than those born in Third World counties. The difference is staggering. Nine out of 10 extremely preterm babies (born in less than 28 weeks of gestation) survive in high-income countries while only 1 in 10 such babies survives in low-income countries.
Obviously, women, babies and their families do not get uniformly high-quality, “respectful care” that they need, in poor countries. With the result, babies in poor countries have a poor chance of survival.
Preterm labor can result in stillbirth Three quarters of stillbirths are preterm. Intrauterine fetal death (babies with no signs of life in utero) can result in preterm labor. The vulnerability pathways that lead to stillbirth and neonatal deaths are similar, the report says.
Sadly, rates of preterm birth barely changed between 2010 and 2020. Despite some improvements in care, there are still more than 4.5 million deaths of women and babies every year, including more than 2.3 million neonatal deaths, 1.9 million stillbirths and 287 000 maternal deaths.
Every preterm death is a tragedy, but a great majority are preventable with high-quality care during pregnancy and birth and for newborns. However, with less than seven years to realize the Sustainable Development Goals (SDG) rates of progress are slower than a decade ago, and in some cases are even reversing, WHO notes.
The SDG goal is to end, by 2030, preventable deaths of newborns and children under 5 years of age. All countries should aim to reduce neonatal mortality and under‑5 mortality.
But the following data shows that the road ahead is hard: 65 countries will fall short of the SDG newborn mortality target without immediate course correction, and 55 need to more than double their current rate of improvement to meet the 2030 target.
New and intensified challenges loom large. The “four Cs” – conflict, climate change, COVID-19 and the cost-of-living crisis – pose distinct but overlapping challenges, and compound existing inequities, especially in places where health systems are already weak.
By the end of 2022, over 100 million people worldwide had been driven from their homes by war, violence, persecution and human rights abuses. Collapsing health systems and restricted access which result from these disturbances have devastating effects on pregnancies.
Eleven of the 16 countries with the highest newborn mortality rates have experienced a recent humanitarian crisis. Worldwide, a staggering 61% of maternal deaths, 51% of stillbirths and 50% of newborn deaths occurred in countries with a 2023 UN Humanitarian Appeal. Small and vulnerable newborns are especially at risk in conflict situations.
It is estimated that, in 2019, air pollution contributed to 6 million preterm births and almost 3 million low-birth-weight babies. A 2020 global report estimated that air pollution accounts for 20% of newborn deaths worldwide, mostly as a result of preterm birth and low birth weight.
Disruptions to supply chains, caused by COVID-19, conflicts and the climate crisis, have dramatically pushed up the cost of living for millions of people. Global inflation rose from 4.7% in 2021 to 8.8% in 2022, and there is double digit inflation in nearly half the world. This is more than a temporary economic squeeze: it is a global public health crisis in its own right, WHO says.
This crisis deepens the vulnerability of preterm babies and their families. There are reports of discharged babies returning to intensive care because families could not afford heating and oxygen at home and, in a recent survey, 84% of parents with a baby in neonatal care said the rising cost of living curtailed their ability to travel to and from hospital.
High Return on Investment
Money committed to maternal and newborn health is an effective investment, WHO says.
In South Asia, scaling up an evidence-based package of interventions to save the lives of newborns, including small and vulnerable newborns, has been calculated to return US$ 2-17 for every US$ 1 invested.
Globally, breastfeeding is one of the most cost-effective interventions in the whole spectrum of women’s, children’s and adolescents’ health care, returning US$ 35 for each US$ 1 invested in its promotion and protection.
More and better targeted investment is urgently needed. Investment must come from domestic resources as well as donors. Between 2010 and 2019, there was less investment in maternal than in child health, very much less for newborns, and almost no mention of stillbirths.
In Sri Lanka, about 24,500 babies are born preterm annually. Despite fairly good obstetric care island-wide, the preterm birth rate in Sri Lanka still ranges from 10 to 15 per 1000 live births.
A study on health-related quality of life of preterm born children at their third year in Gampaha district in Sri Lanka done by Himali Jayakodi and her colleagues shows that preterm children are prone to both short and long-term illnesses.
“Short-term medical complications of prematurity include respiratory distress, intraventricular hemorrhage and infections. Some children end up with chronic problems such as learning disabilities, speech and language disorders, visual disturbances, neurological and behvioral disorders,” the study says.
However, the good news is that in Sri Lanka, the number of preterm born children surviving beyond their infancy is increasing due to improved medical care.
A study done at the Jaffna Teaching Hospital done by S.Sathees and colleagues found that preterm birth was not related to the socio-economic background of the mothers and that the facilities and expertise provided by the government had been of great help to the mothers. Support from families had also been a helpful factor. But still there is vast scope for improvement in bringing baby deaths down.
With effective community-based interventions, the health status of preschool aged preterm born children can be improved. However, the field health sector in Sri Lanka still lacks organized interventions targeting preterm children at the community level. Provision of quality child care programs and stimulation for the child at the household level are needed, says the study done in Gampaha district.
WHO says that the motto should be “every baby, everywhere has a chance to be born alive, at the right time, and the right size” and to achieve these aims and build momentum, “pressure is needed, not just from the top down (from governments and donors) but also from the bottom up, from families and communities, including health-care providers and civil society.”
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