This blog was written by Leith Greenslade of the MDG Health Alliance and Dr. Christopher Howson of the March of Dimes.
Every major killer of children under five years of age has a well-defined and resourced prevention agenda that engages the public and private sectors in partnership, except the #1 killer of children under 5 – preterm birth. If this doesn’t change within the next five years, the world will struggle to achieve the goal of ending preventable newborn deaths by 2030.
Pneumonia and diarrhea have vaccines, the Hib, pneumococcal and rotavirus, which are currently being introduced in low-income countries by GAVI, The Vaccine Alliance, in partnership with leading vaccine manufacturers Crucell, GlaxoSmithKline, Merck, and Pfizer. Malaria has the insecticide-treated bed net, with hundreds of millions delivered, often door-to-door, across sub-Saharan Africa by the Global Fund to Fight AIDS, TB and Malaria, in partnership with Vestergaard Frandsen and Sumitomo Chemical and many other partners.
But when it comes to preventing prematurity, the leading cause of child mortality and the cause of an estimated 965,000 or 15% of all child deaths in 2013, we don’t have highly effective interventions like vaccines or bed nets; we dont have a public-private partnership focused on prevention; and we don’t have a robust, evidence-based understanding of the causes of preterm birth and how to prevent it.
What the world needs to do now is to take a bold step forward and commit to developing a Public-Private Partnership to Prevent Preterm Birth. The partnership should set an ambitious goal – to halve preterm birth rates – with an initial strategic geographic focus on the countries with the largest numbers of preterm deaths, including India (253,000 deaths), Nigeria (88,000 deaths) and Pakistan (71,000 deaths). Together, these three countries account for an estimated one-third of all preterm births globally and an astounding 44% of all deaths from preterm birth complications.
The Partnership would target the leading risk factors for preterm birth based on the landmark 2012 Born Too Soon report, which highlighted age of pregnancy; pregnancy spacing; multiple pregnancy; infection; underlying maternal conditions, including non-communicable diseases like high blood pressure and pre-gestational and gestational diabetes; nutrition; lifestyle; occupational risks and psychological and genetic factors as major contributors to the rate of spontaneous preterm birth.
The Public-Private Partnership to Prevent Preterm Birth would target four areas we call the LINC factors (a) Lifestyle, (b) Infection, (c) Nutrition and (d) Contraception, and work in close partnership with governments, non-government organizations, the private sector, the research community and parent groups to reduce the risk factors among the target populations in India, Pakistan and Nigeria. Through working alliances, the Partnership would improve access to preterm prevention programs where at-risk girls and women before, during and between pregnancy could receive lifestyle education, testing and treatment of infections and non-communicable diseases; nutrition support; and access to modern contraception. Interventions would preferably be provided at one location and fully integrated with mainstream maternal and child health services.
Lifestyle services will need to focus on the prevention, diagnosis and treatment of risk factors like tobacco smoking, alcohol use and exposure to indoor air pollution. At the very minimum, pregnant women in the target populations should be tested for syphilis, urinary-tract infections, malaria, and HIV-AIDS. Nutrition interventions need to target both underweight and overweight, addressing iron, calcium, protein and energy deficiencies. Modern contraception that is easily accessible, especially to adolescent girls to delay pregnancy and to women who have just had babies to delay subsequent pregnancies and improve birth spacing, is absolutely critical.
Not all risk factors will apply equally to all populations. A recent study on risk factors for preterm birth in twenty-two countries found that the greatest risk factors in Asia were maternal malnutrition, preeclampsia, urinary tract infections, and diabetes, while diabetes, malaria, preeclampsia, malnutrition and HIV-AIDS played a more important role in increasing risk in sub-Saharan populations. It will be very important that the Partnership tailor program interventions to address the leading preterm birth risk factors by target populations.
To be effective, the Partnership should actively engage priority stakeholders in a number of key sectors, including relevant government agencies active in the target populations; non-government organizations with a major track record in adolescent, maternal and newborn health, survival and development; and major manufacturers of relevant services and products, including diagnostic tests and medicines for diabetes, high blood pressure, urinary tract infections, syphilis, malaria and HIV-AIDS; macro- and micronutrient supplements and fortified foods; and contraception. Supply-side private sector expertise will not be enough. We need the expertise of the leading private sector experts in behavior change, social media and telecommunications to design and deliver programs that inspire women and girls to take the actions necessary to reduce their risk of preterm birth.
Critically, we need research and development experts working alongside the Partnership to improve our knowledge and understanding of how to prevent preterm birth. The Every Newborn Action Plan argues strongly that “”much more knowledge is needed to address the solution and reach a point where preterm birth is prevented,and it calls for more research to discover new ways of preventing preterm birth by providing a better ing of the biological bases and causal pathways of preterm labour and for the development of new treatments, including tocolytics to delay preterm birth.
Child deaths have been halved since 1990 and the contribution of prevention technologies like vaccines and bed nets to this dramatic reduction cannot be underestimated. While care for any mother or baby struggling to survive and thrive is an imperative, prevention is the most critical tool in our arsenal to fight the leading threats to maternal and child health and development. With just 400 days until we usher in the new era of the Sustainable Development Goals, it is more important than ever that we have a robust global strategy to fight the leading cause of child death – preterm birth. To do so, it will be essential that the strategy includes a powerful prevention agenda. Prevention is an absolutely urgent priority for the mothers and families of the almost one million preterm babies who will lose their lives in 2015 and for the many millions more preterm babies who survive birth but who continue to struggle with life-long disabilities as a result.
Leith Greenslade is Vice-Chair at the MDG Health Alliance , a special initiative of the Office of the United Nations Special Envoy for Financing the Health Millennium Development Goals in support of Every Woman, Every Child, an unprecedented movement spearheaded by the United Nations Secretary-General to advance the health of women and children. Dr. Christopher Howson is Vice-President for Global Programs at the March of Dimes Foundation, a global leader in the fight to prevent preterm birth.