Complications from preterm births now outrank all other causes of death for young children. Of the more than 6.3 million deaths of kids under age five in 2013, more than one million resulted from preterm problems.
The new study was released November 17, World Prematurity Day, and appears in The Lancet medical journal. It’s a collaborative effort by researchers from the Johns Hopkins Bloomberg School of Public Health, the London School of Hygiene and Tropical Medicine and the World Health Organization.
The vast majority the deaths from direct complications of preterm births occurred within the first 28 days of life – with an additional 125,000 deaths occurring between one month and five years.
Dr. Andres de Francisco, interim executive director of the Geneva-based Partnership for Maternal Newborn and Child Health, said, “Over the last few years the proportion of deaths due to preterm births has been increasing. The reason for this is that we do not really have major interventions in place to avoid premature births -- and second, to manage them in most communities where they occur.”
He said preterm birth complications are a worldwide problem.
“We have countries in Africa, for example – Nigeria – or in Asia -- India and Pakistan -- that have extremely high numbers of kids that are dying related to preterm births. But this is not only a problem in developing countries," de Francisco said. "This is also a problem that affects developed countries, as well.”
India actually tops the list, followed by Nigeria, Pakistan, the DRC, China, Bangladesh, Indonesia, Ethiopia, Angola and Kenya. Researchers warn the Ebola outbreak in West Africa raises the risk of preterm complications in the affected countries.
The rise in deaths from preterm birth complications actually coincides with a dramatic decline in the worldwide mortality rate of children under five.
“Mortality has been reducing by about 3.9 percent per year, which is a very impressive reduction of mortality -- and is due to a lot of interventions that we have in stock, including decreasing the mortality due to infectious diseases, such as pneumonia and diarrhea, malaria, among others,” de Francisco said.
Some of the interventions credited for the mortality rate decline include vaccines, bed nets, antibiotics, anti-malarial and HIV treatments.
But de Francisco said the mortality rate for premature babies has decreased by a much smaller rate of 2 percent a year. A big part of the reason, he says, is a lack of adequate interventions. And, right now, it’s not clear what the best interventions are, aside from addressing obesity and high blood pressure or hypertension.
The study said for the most part it’s not fully known what triggers pre-term labor – and about half of pre-term births occur spontaneously.
“This cause of mortality needs to be studied much more specifically and in a much more focused way. Because if we don’t have the causes – if we don’t have the factors – pregnancy is going to end in a premature birth. And this needs to be the focus of intensive research,” de Francisco said.
Some $250 million worth of intensive research is getting underway through four major initiatives: the Global Coalition to Advance Preterm Birth Research; the March of Dimes; the University of California at San Francisco’s Preterm Birth Initiative; and the Global Alliance to Prevent Prematurity and Stillbirth.
“If we are able to support these research programs, within the next five years or so, we will be able to have interventions that are going to contribute to the reduction of mortality in these very small babies,” he said.
Researchers also will study poverty, nutrition, pollution and stress. And they’ll try to solve a mystery: why do Somali women living in the United States have “very low rates of premature births, while most black women in the U.S. have very high rates.”