Ann. Pak. Inst. Med. Sci. 2012; 8(3): 159-160
Preterm birth is a live birth before 37 weeks of pregnancy are completed. Every year, about 10% of all births comprising of 15 million babies are born too soon, while over 1 million die annually due to complications of preterm birth. Many survivors may face a lifetime of disability, including learning disabilities as well as visual and hearing problems. Prematurity is the leading cause of newborn deaths (babies in the first 4 weeks of life) and preterm birth rates are rising. There are sub-categories of preterm birth based on gestational age including extremely preterm at <28 weeks, very preterm between 28 to <32 weeks and moderate to late preterm between 32 to 37 weeks gestation. Babies born between 32 and less than 37 completed weeks of pregnancy make up 85% preterm babies born every year.
Worldwide, more than 95% of all the maternal and child deaths occur in 75 countries including Pakistan. Despite some reduction in recent years, the current maternal mortality ratio (MMR) of Pakistan at 276 per 100,000 live births1,/ is still far from achieving MDG 5. The less than five mortality rate and neonatal mortality rate stands at 94 and 54 per 1000 live births, respectively, far above the MDG 4 target.2
In May 2012, the World Health Organization published "Born Too Soon: The Global Action Report on Preterm Birth".3 In this report, Pakistan is included in countries with a current high neonatal mortality rate of more than or equal to 5 per 1,000 live births. “Born Too Soon” aims for the reduction of deaths due to complications of preterm birth by 50% between 2010 and 2025. The 17th of November has been designated as World Prematurity Day with focus on equitable and quality of care to the neonates to minimize long-term impairment. Indeed 75% of the preterm neonates could be saved without expensive, high technology care if evidence-based interventions for preventing preterm birth are implemented. This Global Strategy on Women and Children Health is supported by many international organizations including DFID, Save the Children, JICA, UNICEF and ICM to advance the cause of prevention and care of preterm birth.
Prevention of preterm birth must be accelerated. Family planning and increased empowerment of women, especially adolescents, plus improved quality of care before, between and during pregnancy can help to reduce preterm birth rates. Parents affected by a preterm birth are a powerful advocacy force around the world. Increasingly, parents are organizing among themselves to raise awareness of the problem, facilitating public education, and improvement of quality of care for premature babies. Global progress in child survival and health to 2015 (MDG 4) and beyond cannot be achieved without addressing preterm birth. Investment in women’s and maternal health and care at birth will reduce stillbirth rates and improve outcomes for women (MDG 5) and newborn babies, especially those who are premature. According to the Economic Survey of Pakistan (2005-06), the government spent only 0.75% of GDP on health sector.4
Ensuring antenatal care for all pregnant women is an important intervention. During antenatal care nutritional support, counseling, screening, diagnosis and treatment of infections including HIV and STIs, screening and management of pregnant women at higher risk of preterm birth, e.g., multiple pregnancies, diabetes, high blood pressure, or with a history of previous preterm birth is important. Promotion of behavioral and community interventions to reduce smoking, secondhand smoke exposure and other pollutants and prevention of violence against women by intimate partners and reducing non-medically indicated inductions of labor and cesarean births especially before 39 completed weeks of gestation can all reduce preterm births.
Effectively managing preterm labor by tocolysis to slow down labor and gain time to administer antenatal corticosteroids for reducing the risk of breathing difficulties in premature babies and administration of antibiotics for premature pre labor rupture of membranes could save around 370,000 lives each year.
Historical data and new analyses show that deaths from preterm birth complications can be reduced by over three-quarters even without the availability of neonatal intensive care. Feasible, cost-effective care including warmth as with Kangaroo Mother Care, breastfeeding support, and basic care of infections and breathing difficulties can save lives. Over the last decade, some countries have halved deaths due to preterm birth by ensuring frontline workers are skilled in the care of premature babies and improving supplies of life-saving commodities and equipment for management of premature babies with complications, especially respiratory distress syndrome and infection. Comprehensive neonatal intensive care, where capacity allows can further improve outcomes.
In summary, a three pronged strategy of preventing preterm births, appropriate management of preterm labor and improved care of the premature newborn needs to be in place to save newborn lives and assist in achieving MDG 4.
References
1. Pakistan Demographic Health Survey 2006-7, National Institute of population studies, Pakistan.
2. The Millennium Development Goals report, June 2011, United Nations.
3. Born too soon: The Global Action Report on Preterm Birth .WHO 2012
4. Health Care Services and Government Spending in Pakistan. Akram M, Khan F. J. PIDE Working Papers. 2007:32.
