In 2010, almost 15 million infants were born prematurely worldwide. That is over one in ten babies born. Whilst the USA and Brazil are placed amongst the top ten countries with the highest premature birth rate with 517,000 and 279,300,Sub-Saharan Africa and the South Asia account for 60% of premature births, in 2010.
According to the first ever national level estimates and time series in this week’s Lancet, only three countries managed to reduce preterm birth rates within the past two decades.
Worldwide, preterm birth, i.e. births before week 37 of gestation, is still the single biggest cause of neonatal death and ranks in second place as the most common cause of mortality in children below the age of 5 years, claiming the lives of 1.1 million infants every year.
Joy Lawn from Save the Children in South Africa, who was team leader producing the estimates for the World Health Organization published in Born Too Soon, says: “Our estimates highlight a fact that has received little attention. Most European countries have about half the preterm birth rate of the USA, but whilst the US rate has leveled off, European rates, even in Scandinavian countries, are increasing.”
In order to estimate preterm birth rates for 2010 by country, region, and worldwide, Lawn and her team utilized data from various sources, such as National Registries and Reproductive Health Surveys, using statistical models to evaluate data for 184 countries. In addition, they also calculated time trends for 65 countries, including Latin America and the Caribbean from 1990 onwards.
They established that in the majority of the 65 countries premature birth rates increased, with a decrease of preterm birth rates being observed only in Croatia, Ecuador and Estonia between 1990 and 2010. Premature birth rates in the fourteen other countries remained more or less stable with an annual change of less than 0.5%.
On average, the preterm birth rate increased from 7.5% in 1990 with a total preterm birth rate of 2 million in the 65 countries to 8.6% in 2010 with a total of 2.2 million preterm births. The largest average rise in preterm birth rates in Europe per year since 1990 was registered in Cyprus (2.8%); Slovenia (2.6%); Belgium (2.5%); Austria (2.3%); Spain (2.2%); Ireland (2.1%); Portugal (1.9%); Greece (1.9%), France (1.6%), the UK (1.5%), and Bosnia (1.5%), whilst the average increase in the U.S. was just 0.7%.
“The countries with the fastest increases include many European countries, and in many cases the reasons are not clear although the effects on families and the health system are very apparent. Urgent attention is needed to better understand and reduce these rates of preterm birth. At the same time we are very clear what can be done to save the lives of babies born preterm and urgent action to provide feasible, lifesaving care in African and South Asian countries would result in rapid decreases in deaths.”
With regard to the economic burden due to preterm births, Nils-Halvdan Morken from Norway’s University of Bergen and Haukeland University Hospital writes in a linked comment:
“In the USA, the Institute of Medicine estimated that preterm birth costs the country at least US$26.2 billion a year or $51 600 per preterm infant. This group of infants accounts for 12% of US live births per year, but their care consumes close to 60% (or $6 billion) of total spending on initial neonatal care. The expenses are clearly related to gestational age; an infant born at 38 weeks incurs a tenth of the expense of one born at 35 weeks ($441 vs $4733). Therefore, even a modest reduction in preterm birth would lead to substantially reduced costs. Worldwide investment in maternal health and pregnancy will reduce suffering and probably save life years at a scale never before seen in the history of public health.”
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