Preterm birth is the world's largest killer of babies, causing more than 1 million deaths each year, yet 75% could be saved without high technology care. In South Africa, more than 8 out of 100 babies are premature (before 37 weeks of pregnancy) and we rank 24 out of 184 countries for number of newborn deaths due to complications from preterm birth.
World Prematurity Day, November 17 2012, is part of a global effort to raise awareness of the deaths and disabilities due to prematurity and the simple, proven cost-effective measures that could prevent them. World Prematurity Day is building momentum by showing how countries can reduce preterm births and better care for babies born too soon. Countries in every part of the world will take action on World Prematurity Day including South Africa.
"People think that preterm babies need intensive, high-tech care, but we have simple methods that really work and would save hundreds of thousands of lives," says Joy Lawn, MD, PhD, of Save the Children, a neonatal physician. “We need urgent action on two gaps – the knowledge gap for preventing preterm birth, and the action gap to save newborn babies’ lives now by getting frontline workers and essential medicines to the mothers and babies who need care the most.”
Essential newborn care
“Essential newborn care is especially important for babies born preterm,” said Elizabeth Mason, MD, Director of WHO’s Department of Maternal, Newborn, Child and Adolescent Health. “This means keeping them warm, clean, and well-fed, and ensuring that babies who have difficulty breathing get immediate attention.”
Basic life-saving interventions can dramatically accelerate reduction of newborn deaths, particularly for preterm babies. These interventions include providing regular checkups for pregnant mothers, ensuring that births take place in the hands of skilled health workers; helping babies breathe at birth; breastfeeding, keeping babies warm and ensuring hygienic umbilical cord care.
In addition, there are three low-cost interventions that are especially effective for preterm babies, but are not commonly used despite documented success:
- Steroid injections. When given to mothers in preterm labour, dexamethosone, a steroid used to treat asthma, helps speed up the development of the baby’s lungs. At a cost of about US$1, two shots stop premature babies from going into respiratory distress when they are born and, in many cases, prevent death.
- Kangaroo Mother Care. Using this technique, the tiny infant is placed skin-to-skin upright between the mother’s breasts and then tied to the mother's chest with a cloth. This keeps the preterm baby warm and facilitates breastfeeding. Keeping preterm babies warm is especially important because their tiny bodies lose heat rapidly, making them highly vulnerable to illness, infection and even death.
- In addition, while all newborns are more vulnerable to life-threatening infection than older infants and children, preterm babies are especially at risk. Good hygiene and care can help prevent these infections, and basic antibiotics to fight infections when they occur, can save lives.
South Africa was one of the first countries to adopt the Kangaroo method and currently we believe that other countries could learn from us.
“Out of the 15-million total number of babies born preterm (2011), 84 000 occur in our country. Sadly, about 10% of these babies do not survive despite most births occurring at health-care facilities. Cost effective and proven interventions, such as Kangaroo Mother Care, bring hope for change and could save many lives,” remarks Ruth Davidge, NELS Coordinator, President of the Neonatal Nurses Association of South Africa, and Director of the Council of International Neonatal Nurses.
While Carole Presern, PhD, head of the Partnership for Maternal, Newborn & Child Health (PMNCH) and a midwife says, “Using an essential package of pregnancy, childbirth and postnatal care that includes these interventions will save more than three quarters of preterm babies without intensive care. Most of these infants can grow up healthy and without lifelong disabilities.”
Prevention is the next frontier
For countries with very high burdens of preterm births, 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. “We know that poverty, lack of women’s education, malaria and HIV all have an impact on the pregnancy and the health of the baby,” says Christopher Howson, Ph.D, Vice President of Global Programs for the March of Dimes and an epidemiologist. “However, little is known about the interplay of these and other environmental and social factors in increasing the risk of preterm birth. We need to know more. Prevention is the next frontier.”
Committing to prevention of and care for preterm birth
Today in South Africa, 41% of children who die under the age of 5 years are newborns, and this is a rising proportion. Complications from prematurity are the leading cause of newborn mortality. Having committed to the Millennium Development Goal for child survival and pledging support to A Promise Renewed, South Africa is using World Prematurity Day to take actions to address preterm birth, in hopes of taking a step forward in achieving these goals for child survival.
(Press release, November 2012)