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Preterm Births In Low-And Middle-Income Nations: Interventions Needed To Tackle This Serious Issue

Preterm Births In Low-And Middle-Income Nations: Interventions Needed To Tackle This Serious Issue

Preterm birth is a global problem, but a far greater number of preterm babies born in low-income countries die than in high-income settings.

Written by Longjam Dineshwori |Updated : November 26, 2022 11:40 AM IST

According to the World Health Organization (WHO) estimates, globally 15 million babies are born preterm every year and approximately 1 million of these children die due to complications. Prematurity is also a major factor for death in children below 5 years.

The terms premature and preterm both refer to being early. Preterm labour is defined as labour that starts earlier than 37 weeks into a pregnancy. Your body goes through labour to give birth to your child. Premature birth can result from preterm labour. When your baby is born before 37 weeks of pregnancy, it is known as a premature birth. Before birth, your baby requires roughly 40 weeks to grow and develop in the womb.

Preterm birth is a global issue but there is a striking difference when it comes to survival rate of premature babies around the world. WHO says over 90 per cent of extremely preterm babies born in low-income countries die within the first few days of life, compared to less than 10 per cent in high-income settings. Extremely preterm babies are born are less than 28 weeks of pregnancy. While half of very preterm babies (born at or below 32 weeks) die in low-income settings, almost all these babies survive in high-income countries.

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WHO cites "lack of feasible, cost-effective care such as warmth, breastfeeding support and basic care for infections and breathing difficulties" behind death of preterm babies in low-income counties. In middle-income countries, suboptimal use of technology is leading to an increased burden of disability among preterm babies who survive the neonatal period, according to the UN health agency.

Preterm delivery is a serious health issue

In many low- and middle-income nations, preterm delivery has not been given great priority as a health issue until recently, says Dr Padma Srivastava, Consultant Obstetrician & Gynaecologist, Motherhood Hospitals, Lullanagar, Pune.

However, changes are happening and efforts are being made to address preterm birth issue in low- and middle-income nations. Dr Padma states, "Solutions for both preventing and caring for preterm newborns have been identified, and next steps have been suggested. More information and evidence-based solutions have increased global partner participation and national action."

Many expensive, high-tech therapies that are standard in high-income nations are out of reach for low- and middle-income countries' national health budgets. But effective treatment for high-risk mothers and preterm babies can be attained with cost-effective measures too.

Dr Padma says, "There are a variety of tried-and-true, low-tech, low-cost therapies that, if completely adopted, may drastically lower prematurity-related mortality and disability in high-burden nations. Therefore, with similar cost-effective measures and enhanced public health services, quick and considerable progress may be made in decreasing fatalities linked to complications from premature delivery."

Causes of preterm birth

Often the cause of preterm birth is not known, and mostly it happens spontaneously. Preterm birth may occur due to a variety of reasons such as multiple pregnancies, infections and chronic medical conditions such as diabetes and high blood pressure, or a genetic factor.

Dr Padma, "Preterm labour and premature delivery can sometimes have unknown causes. On occasion, labour might begin on its own with no prior notice. Even if you follow all pregnancy guidelines, you still run the risk of giving birth too soon."

"We are aware that some factors may increase your risk of preterm labour and early delivery. They are referred to as risk factors. Even if you have a risk factor, it doesn't guarantee preterm labour or an early delivery. However, it can raise your chances," she adds.

What you can do to help lower your risk should be discussed with your healthcare professional, as the WHO says, "preventing deaths and complications from preterm birth starts with a healthy pregnancy."

Key interventions needed to prevent preterm births

To prevent preterm births and complications from preterm birth, the WHO's antenatal care guidelines suggest key interventions which include:

  • Healthy diet and optimal nutrition
  • Counselling on tobacco and substance use
  • Fetal measurements to determine gestational age and detect multiple pregnancies
  • A minimum of 8 prenatal visits throughout pregnancy starting before 12 weeks to identify and manage risk factors.

This year, the organization also issued new recommendations on the care of the preterm infant. It suggested some simple interventions to reduce mortality in preterm and low birthweight babies. These include kangaroo mother care immediately after birth, early initiation of breastfeeding, use of continuous positive airway pressure (CPAP) and medicines such as caffeine for breathing problems.