Addressing Critical Knowledge Gaps in Newborn Health

Blog

By Natasha Salaria on November 26, 2014
Africa, Asia

This blog was originally published by BioMed Central. Written by Natasha Salaria.

This year 15 million babies will be born prematurely, with 1 million a year – or 3000 a day – dying as a result of premature birth. And for the first time in history, preterm birth has overtaken pneumonia as the leading cause of death in young children.

Today marks the 4th World Prematurity Day, a global effort to raise awareness of preterm birth and its prevention, involving over 200 countries, NGOs and relevant organizations.

What are the problems?

Preterm birth is now the leading global killer of young children with more than 3,000 children dying daily from preterm birth complications as outlined in a recent Lancet special issue.

Across the world, the top 5 countries with the highest numbers of babies dying from preterm birth complications each year are: India (361,600), Nigeria (98,300), Pakistan (75,000), Democratic Republic of the Congo (40,600) and China (37,200). West Africa is currently seeing some of the highest rates, which will no doubt be on the increase in those countries suffering from the Ebola outbreak.

What is being done about it?

According to this press release, out today, $250 million has been provided to carry out revolutionary research into the cause of preterm birth and prevention/delay and will involve more than 200 researchers. Key messages this year

This press release, released at 0:00 GMT today provides vital information and statistics on the causes and effects of preterm birth. Key messages are outlined below.

There are many known preventions to reduce the risk of preterm birth and complications, including family planning, decreasing embryo transfer numbers when using assisted reproductive techniques, and eliminating C-sections that are elective before 39 weeks.

Since 2000, we have seen an annual reduction of 3.9% in under-five deaths. This can, at least in part, be put down to the great advances made against deaths from pneumonia, diarrhea, measles and HIV. In comparison, preterm births have seen an annual reduction of 2.0%.

Dr José M. Belizán, who is Editor-in-Chief of Reproductive Health and also the chosen spokesperson of the press release for South America, reflects on how the journal is contributing to the effort to reduce pretem births:

“Through the journal Reproductive Health we have made many relevant contributions. Initially with the Born Too Soon supplement and the corresponding infographic and consequently with three further supplements giving the basis for interventions that could ameliorate the problem of preterm births.”

How is research contributing to these advancements?

Research is fundamental to ensuring the continued reduction of preterm births. Reproductive Health has published several important supplements in 2014 as part of this work as well as the Born Too Soon supplement published last World Prematurity Day in 2013.

Our first supplement on Essential interventions for Maternal, Newborn and Child Health addressed essential key steps to take in order to improve maternal, newborn and child health and survival in a series of freely available review articles. This includes family planning, corticosteroid use and management of preterm, premature rupture of membranes, kangaroo mother care for preterm babies as well as continuous positive airway pressure to manage preterm babies with respiratory distress syndrome.

We then looked at Quality of Care for Maternal and Child Health in a series of five papers that assessed and summarized information from relevant systematic reviews on the impact of various approaches to improve the quality of care for women and newborns. This included outreach services for women at a high risk for preterm birth.

Most recently, we looked at Preconception interventions addressing pre-pregnancy health risks and health problems that could have negative maternal and fetal consequences, including factors associated with preterm birth and proposed interventions.

It has potential to further reduce global maternal and child mortality and morbidity, particularly in low-income countries where the highest burden of pregnancy-related deaths and disability occurs. You can also see a visual summary of these supplements in our infographic.

What can you do to participate?

  • Visit facebook.com/worldprematurityday to read stories from around the world
  • Show your support on Twitter using the hashtag #worldprematurityday
  • Share this blog/these infographics and the information within them
     

Dr José M. Belizán is a medical doctor, with a PhD in Reproductive Health Sciences, Superior Researcher of his country’s National Board of Science and Technology and the Editor-in-Chief of Reproductive Health

Natasha Salaria is the Journal Development Editor of Reproductive Health at BioMed Central

By Eve Lackritz on November 25, 2014


A nurse helps a new mother breastfeed her newborn at a clinic in Accra, Ghana. © Bill & Melinda Gates Foundation/Olivier Asselin

This blog was originally published in Impatient Optimists. Written by Eve Lackritz. 

The global burden of preterm birth represents a large and complex public health challenge that no single intervention or organization can solve alone. Each year, 15 million infants are born preterm, and more than one million will not survive their first month of life, making preterm birth the leading cause of death for all children up to age 5 worldwide. To tackle a health problem of that magnitude, a new coalition of leading health institutions is banding together to find new solutions for the prevention and care of preterm birth and its associated morbidity and mortality worldwide.

The Global Coalition to Advance Preterm birth Research (GCAPR) is a partnership initiated by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), the March of Dimes Foundation, the Bill & Melinda Gates Foundation, and the Global Alliance to Prevent Prematurity and Stillbirth (GAPPS), an initiative of Seattle Children’s.

Sixteen organizations from around the world have already signed on as members of the organization, expressing their desire to increase collaboration, efficiency, and funding of preterm birth research.

Infants who are born preterm face the risk of death or potentially lifelong complications including respiratory and vision disorders and developmental delays, affecting families and increasing demands on resources for health care, education, and social services. The Institute of Medicine estimated in 2007 that the costs associated with preterm birth were $26.2 billion each year in the U.S. alone. While organizations exist to fund research to decrease risks of preterm birth, GCAPR was formed to coordinate those efforts, accelerate discovery of new solutions, and leverage new and existing investments to achieve global change.

The Coalition has outlined some priority activities, which include:

  • Improve coordination, comparability, and harmonization of research. A subcommittee will review materials from several existing research programs and recommend steps to make methods and definitions more compatible. Materials will include questionnaires, standard operating procedures, protocols and definitions. When pregnancy researchers use similar definitions and methods across research projects, results can be compared, evaluated, and analyzed more effectively.
     
  • Evaluate evidence-based strategies to improve survival and health. One area of implementation research that is ripe for attention is the evaluation of interventions and treatments that are delivered in combination. It is common for individual interventions to be evaluated separately, but delivered in conjunction with others. Careful analysis of outcomes will allow researchers to identify the role that each intervention plays in improving infant survival.
     
  • Accelerate moving discoveries into practice. New scientific advancements need a more rapid path from discovery to development of diagnostic or therapeutic products to improve health outcomes. GCAPR members will share expertise to advance strategies and research needed to move results down the pipeline to the mothers and infants who need them.
  • Ensure global applicability of products. Through collaboration and partnership, GCAPR will seek opportunities to conduct clinical trials across populations so that the resulting products and interventions can have broad applicability around the world.

Preterm birth is not a problem that will be solved easily, as there are many pathways and causes. We know that uniting organizations with similar goals will give us the best opportunities to make measurable progress toward reducing the global burden. We are very excited about the momentum that has been building around preterm birth funding and research. We hope that additional organizations and agencies from both the public and private sector will continue to join this effort as we focus attention on preterm birth and strive to find solutions.

By Denise Raquel Dunning on November 24, 2014
Nigeria
Africa


Photo: Mark Tuschman

This blog was originally published in Impatient Optimists. Written by Dr. Denise Raquel Dunning

Nigeria, one of the richest countries in Africa, also boasts one of the world’s highest rates of maternal, newborn, and child death. One in 13 Nigerian women dies during pregnancy or childbirth, and one in 8 Nigerian children dies before their fifth birthday.

And Nigeria is not alone. The global realities are equally devastating – nearly three million newborn babies die annually, and 800 women die in childbirth every single day. That means that two women will die by the time you finish reading this article – assuming you read fast.

While the numbers are shocking, it’s even more horrifying to realize that nearly 90% of these deaths are avoidable: women, newborns, and young children die from preventable conditions like hemorrhage, premature birth, malnutrition, and malaria.

Simply put, here’s what these statistics mean – Aisha didn’t have to bleed to death during childbirth. Baby Efe didn’t have to asphyxiate in his first minutes of life. Two year old Tosin didn’t have to die from diarrhea.

All of these lives could have been saved – easily and inexpensively. But in an age of unprecedented medical innovation, we are still failing to save the lives of poor women and their children.

The challenges may appear intractable, but the solution is simpler than you think.

The international community needs to invest in the country-based leaders who have the power to transform the health of their own communities. We need to invest in the civil society leaders and organizations who fight every day to save the lives of women and children.

This strategy lies at the core of Champions for Change, a new initiative supported by the Bill and Melinda Gates Foundation in Nigeria. Champions for Change empowers strong local leaders and organizations to advocate for the laws, policies, programs, and funding needed to improve reproductive, maternal, newborn, and child health (RMNCH) outcomes in Nigeria.

Champions for Change invests in the talent, vision, and potential of the Nigerian civil society leaders. These Champions ensure that Nigeria’s policies, systems, and services advance the health and rights of women and children. Champions for Change leverages the tested model of its sister initiative, Let Girls Lead, which has contributed to improved health, education, livelihoods, and rights for more than 3 million girls globally, as demonstrated by an external evaluation commissioned by the UN Foundation.

Following a highly competitive process, Champions for Change selected Nigeria’s best and brightest civil society leaders working across sectors – reproductive health, child nutrition, family planning, girls’ education, women’s rights, poverty reduction, HIV/AIDS prevention, media, and youth development – to scale up their innovative approaches to reduce maternal and child deaths in Nigeria.

The civil society leaders participating in Champions for Change know best the challenges facing their communities, and how to create scalable impact. These Champions bring the experience, cultural fluency, and vision needed to ensure that policies, programs, services, and funding respond to the realities of women and their children across Nigeria.

This week in Lagos, we are hosting the inaugural Champions for Change convening, launching a two-year process that integrates state of the art leadership development and organizational strengthening. An elite cohort of 24 leaders from 12 Nigerian organizations will participate in intensive advocacy capacity building, executive coaching, and organizational development.

These leaders will learn strategies to engage policymakers, traditional and religious leaders, and medical providers to create sustainable change, and how to empower women and communities to raise their voices for their own priorities.These Champions will also receive grant funding and technical assistance to develop scalable new strategies that sustainably improve the health and wellbeing of Nigerian women and children.

Saving the lives of women and children takes financial resources, political will, and savvy advocates who are undaunted by the enormity of the challenges they face. Investing in visionary local leaders and organizations is the most promising strategy to ensure that policies, systems, and services improve health outcomes. Nigeria’s women and children deserve no less.

By Kathryn Millar on November 21, 2014


Photo: Loulou d'Aki/Save the Children

This blog was originally published by the Maternal Health Task Force. Written by Kathryn Millar

As the world recognizes World Prematurity Day today, the Maternal Health Task Force is ever mindful of the key role a woman’s and mother’s health plays in the prevention of premature birth. While improving neonatal care and promoting interventions—such as kangaroo care are important—the rising rate of preterm births suggests prevention is key for decreasing neonatal mortality rates. And what would prevention be without ensuring the health of the woman before and during pregnancy?

The health of a pregnant woman is paramount, not only for her own survival and health, but also to prevent the number one killer of neonates: prematurity. While it is true that a large percentage of preterm births are iatrogenic, meaning the cause is unknown, there are several preventable factors that increase a woman’s risk of delivering prematurely. Ensuring women’s rights; preventing and treating infectious and non-communicable diseases; providing quality preconception and antenatal care; and promoting facility delivery to prevent maternal death will not only improve the lives of mothers, but also aid in preventing prematurity and neonatal death.

Women’s Rights

Respecting a women’s right to live a violence-free life and plan her family is basic and essential, yet women around the world still suffer violence, often in their own homes, and many are not given the choice to plan their families. Domestic violence plays a significant role at putting a woman at risk for delivering prematurely. Family planning also plays a key role in decreasing premature birth; meeting the unmet need for family planning is estimated to decrease the number of premature births and neonatal mortality. In addition, appropriate birth spacing decreases a woman’s odds of giving birth prematurely by 16 percent.

Preventing and treating infectious and chronic disease

While the prevention and treatment of infectious diseases has long been a focus of antenatal care, more recently the importance of mitigating the effects of non-communicable diseases (NCDs) through preconception care has been realized as key for decreasing prematurity and birth complications.

Providing a women with the education and means to prevent sexually transmitted infections (STIs) and treatment if needed is not only key for her health, but can significantly decrease birth complications and prematurity. In addition to STIs, rubella—a vaccine-preventable disease—and malaria significantly increase the risk of preterm birth. Providing methods of prevention and appropriate treatment for these infections will have a significant impact on the rate of prematurity and the health of women and their children.

A life course approach to preventing prematurity necessitates the need for ensuring the overall health of women prior to pregnancy. Non-communicable diseases—such as low BMI, high BMI, high blood pressure, asthma, diabetes, and thyroid and heart disease—are significant contributors to prematurity. Providing regular care before conception and antenatal care during pregnancy to address chronic health problems will improve the chances for a healthy pregnancy for both the mother and her newborn.

Antenatal Care and Facility Births

Skilled care is a key intervention for the health of the mother and the prevention of birth complications, including prematurity. Regular antenatal care visits allow complications to be addressed, familiarization with the health sector, and increased chance of delivering in a facility. Since not all preterm births can be prevented, a facility birth, which has an incredible positive impact on maternal mortality, also situates the premature infant in a setting where emergency services may be provided. Given that 36% of neonatal deaths occur in the first 24 hours of life, this indicates indicates the need for immediate emergency and supportive facility-based care, such as resuscitation, treatment of sepsis, and thermoregulation.

The rate of preterm birth—the number one cause of death in children under-five—can be reduced through integrated maternal and neonatal health. By addressing the health of both the mother and the newborn, complications can be mitigated and lives saved.

For more information on preventing and mitigating the effects of preterm birth, access our Preterm Birth Topic Page and the recently published standards on pregnancy dating.

By Casey Calamusa on November 20, 2014
Uganda
Africa, North America

This blog was originally published in Seattle Children's On the Pulse blog. Written by Casey Calamusa.  

When you see pictures of tiny preterm babies, you likely marvel at how they fit in the palm of a hand, or how a wedding ring can slide up their arm and reach their elbow. What you may not consider is the lifelong toll premature birth can have on a person – if they survive it at all.

New research shows that for the first time ever, preterm birth is now the leading cause of death for all children under age 5 around the world.

More than 15 million babies are born too soon every year, and nearly one million of them don’t survive infancy. Those who do survive are often faced with lasting health issues such as cerebral palsy, developmental delays, or respiratory, vision and hearing problems. The burden is magnified in many developing countries, where world-class neonatal intensive care units, let alone a basic level of healthcare, are not available.

Dr. Craig Rubens, executive director of the Global Alliance to Prevent Prematurity and Stillbirth (GAPPS), an initiative of Seattle Children’s, says a larger, coordinated research effort is critical to lowering the number of babies born preterm.

“It’s easy to look at preterm birth and view it as a single endpoint,” Rubens said. “In reality, preterm birth can have many causes and pathways. Although the end result is the same, we need more research to understand the different pathways so we can develop ways to prevent them.”

In conjunction with World Prematurity Day today, Rubens and his team have published a state-of-the-art review in Science Translational Medicine, providing a central analysis of preterm birth research. The findings, Rubens said, leave a lot to be desired.

“There are not enough resources dedicated to researching the complex problem of preterm birth and its prevention,” he said. “Our paper is a clarion call to the scientific community, that investing in preterm birth research will pay dividends with millions of lives saved and also save billions of dollars in healthcare expenses associated with preterm birth.”

In 2007, the Institute of Medicine estimated the annual costs associated with preterm birth to be $26 billion in the U.S. alone, and those numbers have surely increased since.

In the paper, Rubens and his co-authors note that there are many factors that can increase a woman’s likelihood of preterm birth – including genetics, stress and poor pregnancy weight gain – however, there is very little known about why those factors increase risk and what can be done to prevent them.

There are also discrepancies in preterm birth rates that are poorly understood. For example, in the United States, babies of non-Hispanic black women have preterm birth rates that are 40% greater than those of Hispanic and non-Hispanic white women, and this difference persists even after adjustment for maternal socioeconomic status and education. Unfortunately, even less is understood about the risk factors, disparities and causes of preterm birth in high-burden, low-resource countries.

Despite the sobering statistics, Rubens is optimistic that preterm birth will be recognized as a global issue that needs to be prioritized.

“As more people learn that preterm birth is the leading cause of death for children under age 5 around the world – and that it happens to moms and babies from the U.S. to Uganda – we are hopeful that scientists, policymakers and funders will prioritize preterm birth research so that every birth can be a healthy birth.”

Resources

Above photo courtesy of Paul Joseph Brown/GAPPS