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A New Global Focus on Preterm Births


World Prematurity Day highlights effective, low-cost care

New commitments to address the problem



Contacts:
Marshall Hoffman, H&H, +1 703 533-3535, +1 703 801-8602 (mob); This e-mail address is being protected from spambots. You need JavaScript enabled to view it
Nils Hoffman, H&H Video, +1 703 967-1490; This e-mail address is being protected from spambots. You need JavaScript enabled to view it
Michele Kling, MoD, +1 914 997-4613, +1 914 843-9487 (mob); This e-mail address is being protected from spambots. You need JavaScript enabled to view it
Fadéla Chaib, WHO,  +41 22 791 32 28, +41 79 475 55 56 (mob); This e-mail address is being protected from spambots. You need JavaScript enabled to view it
Mike Kiernan, Save The Children, +1 202 640 6664 , +1 202 412 7579 (mob); This e-mail address is being protected from spambots. You need JavaScript enabled to view it

Additional Background and Resources:

Background materials on Born Too Soon report and preterm birth: http://everywomaneverychild.org/borntoosoon
Every Woman Every Child commitments to preterm birth: http://everywomaneverychild.org/commitments (search by "issue area")
For TV Producers: B-roll on the Hoffman & Hoffman website: www.hoffmanpr.com/world/preterm/B-roll
Facebook for parent stories and an interactive map of preterm births: www.facebook.com/WorldPrematurityDay


Preterm birth is the world's largest killer of newborn babies, causing more than 1 million deaths each year, yet 75 percent could be saved without expensive, high technology care.

That's the primary message and motivating theme of World Prematurity Day, November 17, a global effort to raise awareness of the deaths and disabilities due to prematurity and the simple, proven, cost-effective measures that could prevent them.

On World Prematurity Day, countries in nearly every part of the world will take action to raise awareness of what can be done to reduce preterm births and better care for babies born too soon.

Families affected by premature birth can share stories, photos, and videos, and identify their locations on an interactive world map on facebook.com/WorldPrematurityDay. More than 700,000 visited this website in 2011.

"People think that preterm babies need intensive, high-tech care, but we have simple methods that really work and would save hundreds of thousands of lives," says Joy Lawn, M.D., Ph.D., of Save the Children, a neonatal physician.

12.6 million moderate to late preterm births

Babies born between 32 and less than 37 completed weeks of pregnancy make up 85 percent of the 15 million preterm babies born annually –12.6 million.

“These babies are born too soon, but they are not born to die,” says Dr. Lawn. “Their deaths are utterly preventable.”

“We know what it takes to address the challenge of prematurity and we are committed to bringing partners together behind proven, affordable solutions,” says UN Secretary-General Ban Ki-moon who launched The Global Strategy for Women’s and Children's Health in 2010. The Global Strategy is supported by Every Woman Every Child, an umbrella movement that has already leveraged more than $20 billion in new money and aims to save the lives of 16 million by 2015.

The countries with the greatest numbers of moderate to late preterm births annually are:

India –2,959,300; China –981,050; Nigeria –665,080; Pakistan –633,640; Indonesia –564,350; United States –438,410; Bangladesh –355,030; Philippines –295,780; Democratic Republic of Congo –291,750; and Brazil –233,320.

Essential newborn care

“Essential newborn care is especially important for babies born preterm,” said Elizabeth Mason, M.D., Director of WHO’s Department of Maternal, Newborn, Child and Adolescent Health. “This means keeping them warm, clean, and well-fed, and ensuring that babies who have difficulty breathing get immediate attention.”

Three low-cost interventions that are very effective, but are not commonly used, are:

·         Steroid injections. When given to mothers in preterm labor, dexamethosone, a steroid used to treat asthma, helps speed up the development of the baby’s lungs. At a cost of about US$1, two shots can stop premature babies from going into respiratory distress when they are born. This can prevent 400,000 deaths annually.

·         Kangaroo Mother Care. Using this technique, the tiny infant is held skin-to-skin on the mother's chest. This keeps the baby warm and facilitates breastfeeding. Keeping preterm babies warm is especially important because their tiny bodies lose heat rapidly, making them highly vulnerable to illness, infection and death. This could prevent 450,000 deaths annually.

·         In addition, basic antibiotics can save lives, such as amoxicillin to treat pneumonia and injection antibiotics to fight serious infections.

“Using an essential package of pregnancy, childbirth and postnatal care that includes these interventions will save more than three quarters of preterm babies without intensive care,” says Carole Presern, Ph.D., head of The Partnership for Maternal, Newborn & Child Health (PMNCH) and a midwife. “Most of these infants can grow up healthy and without lifelong disabilities.”

Prevention is the next frontier

A key way to reduce the burden of preterm birth is to find ways to help pregnancies go to full term, or at least 39 weeks.

"Prevention is the next frontier,” says Christopher Howson, Ph.D.,Vice President of Global Programs for the March of Dimes and an epidemiologist. “We are looking closely at what can be done before a woman gets pregnant to help her have an optimal outcome."

A number of risk factors for mothers to deliver prematurely have been identified, including a prior history of preterm birth, underweight, obesity, diabetes, high blood pressure, smoking, infection, age (either under 17 or over 40), genetics, multiple pregnancy (twins, triplets, and more) and pregnancies spaced too closely together.

“We also know that poverty, lack of women’s education, malaria and HIV all have an impact on the pregnancy and the health of the baby,” says Dr. Howson. “However, little is known about the interplay of these and other environmental and social factors in increasing the risk of preterm birth. We need to know more and this knowledge could have a big impact in the lowest income countries.”

Documented success for steroid use and Kangaroo Mother Care

In high-income countries, steroids have been widely used for women in preterm labor since the 1990s and an estimated 95 percent of women in preterm labor before 34 weeks of pregnancy now receive steroid injections prior to delivery.

By comparison, in low- and middle-income countries, only an estimated 5 percent of women receive these steroid injections.

Dr. Lawn says that these medicines are rarely used in the developing world, despite the low cost and proven effectiveness, because health care professionals do not know about this life-saving use. In fact, antenatal steroids are now identified by a new UN-led Commission on Life-Saving Commodities for Women and Children as an essential medicine that should be available everywhere.

"The use of steroids should be part of the ‘to do’ list of everyone looking after women in pregnancy. It should be written on hospital walls," says Dr. Lawn. “In America or Europe, if a woman in preterm labor were not given steroid injections, the doctor could be sued for malpractice, as this is the standard of care. Why should a woman in Africa or Asia not get the same care, especially given the low cost?”

Kangaroo Mother Care started as a solution for overcrowded nurseries in Colombia where tiny infants were forced to share what incubators were available. The technique works well for both mothers and babies. Studies show that the mortality rate for babies who benefit from Kangaroo Mother Care can be the same or better than that for babies in incubators.

Though Kangaroo Mother Care was developed in 1967, the spread has been slow despite the well-documented effectiveness and its benefits for child development.

“One reason for the slow spread in some areas could simply be a lack of information about what works,” says Dr. Presern. “Another may be that many obstetricians, midwives and nurses find it hard to accept that such a natural approach could be superior to expensive high technology equipment.”

Countries make new commitments

On World Prematurity Day, a number of countries will announce major commitments to reduce preterm mortality. These countries have each adopted packages of interventions to care for premature babies and are championing initiatives in their countries and others. For example:

·         Malawi has the world's highest preterm birth rate, a statistic that led the Vice President Khumbo Kachali and the country's health leaders to prioritize care for preterm babies, instituting Kangaroo Mother Care and providing steroid injections in almost all hospitals.

·         India—with nearly 3 million moderate to late preterm births, the largest number in the world, and 304,000 preterm deaths per year—has been working with support from UNICEF to outfit 100 district hospitals to care for preterm babies.

·        Uganda has committed to speeding access to steroid injections for all women in preterm labor.

 Born Too Soon report stimulates activity

Publication of the Born Too Soon report in May 2012 by the March of Dimes, PMNCH, the World Health Organization and Save the Children drew global attention to what many consider one of the world’s most overlooked public health problems. The report included the first country-by-country statistics for both absolute numbers and rates of preterm birth, documenting the extent and severity of the problem, also published in The Lancet.

The report showed that preterm births are not solely a problem of the developing world, but that wealthy countries, including the United States and Brazil, were also in the top 10, in terms of absolute numbers. To mark the publication of the report, more than 30 organizations made new or enhanced commitments in support of the Every Woman Every Child effort launched by the United Nations Secretary General Ban Ki-moon.

About World Prematurity Day
Started last year by the March of Dimes and founding parent groups –European Foundation for the Care of Newborn Infants (EFCNI), Africa-based Little Big Souls International Foundation and the National Premmie Foundation of Australia— World Prematurity Day will this year spread throughout the world, now involving more than 50 countries and groups globally.

Events are planned in many countries, including the United States, China, Indonesia, Malaysia, Malawi, Uganda and Argentina, to draw public attention to the problem of preterm birth and the simple care that can save many of these babies.

*           *          *

 

Born Too Soon Supporters: Governments, United Nations agencies, development partners, foundations, civil society, parents’ organizations, health professional associations, academia, and the private sector.

 

The Aga Khan University, American Academy of Pediatrics, American University of Beirut Medical Center, Association of Women’s Health, Obstetric and Neonatal Nurses, Australian Aid, Bliss UK, Bill & Melinda Gates Foundation, Canadian International Development Agency, Centers for Disease Control and Prevention, Countdown to 2015, European Foundation for Care of Newborn Infants, Family Care International, Flour Fortification Initiative, GAVI Alliance, General Electric, Global Alliance to Prevent Prematurity and Stillbirth, Home for Premature Babies (China), Institute for Clinical Effectiveness for Health Policy, International Federation of Gynecology and Obstetrics, International Confederation of Midwives, International Pediatric Association, International Preterm Birth Collaborative, Japan International Cooperation Agency, Johns Hopkins Bloomberg School of Public Health, Ecole de Santé Publique, Université de Kinshasa, Little Big Souls International Foundation Africa and UK, London School of Hygiene & Tropical Medicine, National Premmie Foundation Australia, Nationwide Children’s, National Collaborative Perinatal Neonatal Network, Norwegian Agency for International Development, Peking University Center of Medical Genetics, Swedish International Development Cooperation Agency, Tommy’s, UK Department for International Development, UNICEF, United Nations Foundation, United Nations Population Fund, United States Agency for International Development, University College London, University of Malawi, University of Texas Medical Branch, Institute of Human Genetics (University of the Philippines), Women Deliver.

 

 


Countries and territories

 

Number of moderate to late preterm births

(32 to <37 completed weeks) (2011)

Number of deaths due to preterm birth complications (2011)

India

2,959,300

          304,050

China

                981,050

            34,560

Nigeria

                665,080

            83,510

Pakistan

                633,640

            62,800

Indonesia

                564,350

            29,220

United States

                438,410

             6,400

Bangladesh

                355,030

            35,490

Philippines

                295,780

            11,290

Democratic Republic of the Congo

                291,750

            43,600

Brazil

                233,320

             9,480

Ethiopia

                222,110

            29,100

United Republic of Tanzania

                184,560

            16,930

Uganda

                176,770

            16,090

Kenya

                161,690

            14,320

Afghanistan

                137,010

            17,520

Iran (Islamic Republic of)

                136,950

             7,740

Mexico

                135,820

             5,280

Turkey

                130,000

             4,470

Sudan

                123,760

            12,310

Mozambique

                123,000

             9,790

Viet Nam

                115,870

             5,660

Egypt

                115,700

             6,300

Malawi

                104,450

             6,680

Yemen

                104,390

            10,270

Russian Federation

                  99,730

             4,150

Ghana

                  94,780

             8,270

Madagascar

                  89,460

             6,080

Myanmar

                  85,990

            11,550

Nepal

                  85,460

            10,140

Angola

                  84,320

            11,380

Thailand

                  83,470

             2,340

Côte d'Ivoire

                  80,230

             9,250

Cameroon

                  75,800

             8,120

South Africa

                  71,000

             8,320

Mali

                  70,980

            11,800

Zambia

                  67,930

             6,320

Colombia

                  67,820

             3,290

Burkina Faso

                  66,980

             8,280

Iraq

                  63,100

             7,140

Niger

                  61,680

             9,770

Malaysia

                  60,080

                740

Chad

                  56,210

             7,440

Germany

                  54,510

                630

Japan

                  53,370

                210

Zimbabwe

                  52,560

             4,110

United Kingdom

                  50,280

             1,200

Argentina

                  46,680

             2,180

Guinea

                  46,310

             5,120

France

                  44,750

                300

Algeria

                  44,370

             4,940

Uzbekistan

                  43,080

             3,390

Syrian Arab Republic

                  42,630

             1,880

Somalia

                  41,880

             6,490

Venezuela (Bolivarian Republic of)

                  41,010

             2,020

Senegal

                  38,650

             4,250

Republic of Korea

                  37,140

                500

Peru

                  36,560

             2,170

Rwanda

                  36,040

             3,270

Morocco

                  34,850

             5,230

Sri Lanka

                  33,760

                470

Benin

                  31,650

             3,690

Haiti

                  31,630

             2,550

Democratic People's Republic of Korea

                  31,470

             2,700

Spain

                  31,340

                310

Guatemala

                  30,740

             2,430

Saudi Arabia

                  30,590

             1,630

Italy

                  30,540

                420

Cambodia

                  28,210

             2,680

Burundi

                  27,600

             4,270

Ukraine

                  27,240

                750

Kazakhstan

                  25,680

             1,810

Canada

                  25,440

                510

Poland

                  23,250

                700

Togo

                  21,790

             2,490

Honduras

                  20,950

                920

Congo

                  20,380

             1,570

Bolivia (Plurinational State of)

                  20,080

             2,210

Eritrea

                  19,880

             1,520

Australia

                  19,800

                260

Dominican Republic

                  19,570

             1,110

Sierra Leone

                  19,130

             3,540

Jordan

                  18,660

                940

Liberia

                  18,340

             1,450

Tajikistan

                  17,510

             1,650

Central African Republic

                  16,560

             2,340

Mauritania

                  15,340

             1,570

Chile

                  14,710

                420

El Salvador

                  13,600

                290

Romania

                  13,540

                420

Tunisia

                  13,430

                700

Azerbaijan

                  13,130

             1,460

Lao People's Democratic Republic

                  12,750

                890

Ecuador

                  12,750

             1,070

Netherlands

                  12,250

                100

Kyrgyzstan

                  11,540

                730

Papua New Guinea

                  11,500

             1,740

Nicaragua

                  10,850

                690

Israel

                  10,570

                110

Paraguay

                  10,330

                870

Libyan Arab Jamahiriya

                  10,070

                630

Turkmenistan

                    9,080

                910

Costa Rica

                    8,440

                130

Belgium

                    8,190

                  70

Gambia

                    7,880

                790

Mongolia

                    7,400

                300

Namibia

                    7,310

                410

Hungary

                    7,210

                140

Czech Republic

                    7,110

                  60

Austria

                    6,740

                  70

Greece

                    6,520

                210

Portugal

                    6,240

                  50

Serbia

                    6,160

                270

Lesotho

                    6,070

                860

United Arab Emirates

                    6,010

                170

Botswana

                    6,000

                210

Oman

                    5,960

                110

Cuba

                    5,870

                  50

Gabon

                    5,720

                380

Sweden

                    5,660

                  30

Guinea-Bissau

                    5,560

                850

Switzerland

                    4,800

                  80

Panama

                    4,790

                190

Bulgaria

                    4,730

                190

Singapore

                    4,570

                  20

Timor-Leste

                    4,520

                370

Kuwait

                    4,480

                  90

Republic of Moldova

                    4,380

                  50

Armenia

                    4,360

                200

Jamaica

                    4,320

                230

Lebanon

                    4,290

                140

Uruguay

                    4,230

                  80

New Zealand

                    4,100

                  60

Swaziland

                    4,080

                460

Comoros

                    3,900

                290

Ireland

                    3,870

                  50

Georgia

                    3,780

                270

Belarus

                    3,730

                  90

Equatorial Guinea

                    3,650

                310

Denmark

                    3,590

                  70

Albania

                    3,120

                110

Norway

                    3,080

                  20

Slovakia

                    3,070

                110

Finland

                    2,850

                  30

Bahrain

                    2,770

                  30

Djibouti

                    2,620

                300

Bosnia and Herzegovina

                    2,110

                  50

Croatia

                    2,000

                  20

Qatar

                    1,890

                  40

Solomon Islands

                    1,810

                  60

Mauritius

                    1,740

                  60

Lithuania

                    1,680

                  20

Cyprus

                    1,600

                  10

Fiji

                    1,530

                  60

Guyana

                    1,500

                  90

Trinidad and Tobago

                    1,350

                  90

Slovenia

                    1,280

                  10

Bhutan

                    1,270

                150

Former Yugoslav Republic of Macedonia  

                    1,250

                  80

Latvia

                    1,090

                  10

Cape Verde

                        960

                  40

Estonia

                        790

                  -  

Brunei Darussalam

                        780

                  10

Vanuatu

                        780

                  10

Suriname

                        710

                  70

Belize

                        680

                  -  

Montenegro

                        590

                  10

Sao Tome and Principe

                        460

                  50

Bahamas

                        430

                  10

Luxembourg

                        410

                  -  

Other

2,920

110

World

12,592,050

 

1,032,710

 

 

Born Too Soon: The Global Action Report on Preterm Birth – Updated for 2011with live births and neonatal mortality estimates for 2011 from The UN Interagency Group for Child Mortality Estimation.

Data sources:
Numbers of babies with moderate to late preterm birth: Blencowe H, Cousens S, Oestergaard M, Chou D, Moller AB, Narwal R, Adler A, Garcia CV, Rohde S, Say L, Lawn JE. National, regional and worldwide estimates of preterm birth, The Lancet, June 2012.

Deaths due to preterm birth complications data: Liu L, Johnson HL, Cousens S, Lawn JE et al. 2012. Global, regional, and national causes of child mortality in 2000–2010: an updated systematic analysis. The Lancet, June 2012. doi:10.1016/S0140-6736(12)60560-1.

Preterm birth prevention analysis: Hannah H. Chang, Jim Larson, Hannah Blencowe, Catherine Y. Spong, Christopher P. Howson, Sarah Cairns-Smith, Eve M. Lackritz, Shoo K. Lee, Elizabeth Mason, Andrew C. Serazin, Salimah Walani, Joe Leigh Simpson, Joy E. Lawn. Preventing preterm births: trends and potential reductions with current interventions in 39 very high human development index countries. The Lancet in press.