Babies Born ‘Born Too Small’ Or ‘Born Too Soon’ Accounting For 1.9 Million Stillbirths

Lancet Series on small vulnerable newborns calls for standardization of data, technology, and quality pre-natal information as national preventive measures to curb the high rate of newborns born too small or too soon which currently stands at the highest rate at 20% in Sub-Saharan Africa. 

Globally, one in every four babies in the world is either ‘born too small’ or ‘born too soon’ accounting for 1.9 million stillbirths and 1.4 million newborn deaths annually. The small vulnerable newborn survivors are vulnerable to health problems throughout their life course, affecting human capital, economic productivity, and healthcare costs. Furthermore, while the situation is the most challenging in Sub-Saharan Africa and Southern Asia, rates of data availability are also the lowest in these regions, making it difficult for decision-makers to meaningfully address this issue.

The Series, created through an international collaboration of a group of scientists, presents a new conceptual framework that brings preterm birth, small for gestational age (SGA), and low birth weight (LBW) together under the umbrella term “small vulnerable newborns” (SVN). This new terminology and framework gives global and local actors a shared terminology and framing of the issue, allowing them to work together to implement change.

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The Series estimates that 566,000 stillbirths and 5.2 million preterm or underweight births could be prevented each year by implementing eight accessible and cost-effective pregnancy interventions in low- and middle-income countries. the estimated cost of implementing these measures stands at $1.1 billion by the year 2030.

The Series provides low-cost, evidence-based pregnancy interventions for the prevention of small vulnerable newborns and stillbirths. These interventions include multiple micronutrient supplements, treatment of syphilis, and treatment of asymptomatic bacteriuria (a bacterial infection of the urine) for all women. The targeted interventions provided include low-dose aspirin, balanced protein energy supplements, prevention of malaria in pregnancy, progesterone provided vaginally, and smoking cessation. In addition, implementing girls’ and women’s reproductive rights is key to preventing pregnancy complications and poor pregnancy outcomes.

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Speaking during the launch of the Lancet series in Kenya, Ministry of Health Acting Head, Division of Health Informatics Dr. Job Nyangena reiterated the government’s commitment to implementing these preventive measures.

“As a government and especially with the devolution of health services, we are developing technological specifications to ensure standardization of operating procedures and training manuals,” he said.

Although addressing the issue of small vulnerable newborns has been on the global agenda for years, global trends show that the situation has not improved. This indicates a pressing need for national actors, along with global partners, to commit to providing high-quality care for all women during pregnancy and at birth. This includes implementing the World Health Organization (WHO) antenatal care guidelines that include a screening ultrasound for all pregnant women.

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Prof Marleen Temmerman, Director of Aga Khan University’s Centre of Excellence in Women and Child Health, East Africa (CoEWCH EA) says, “One out of 4 babies is born too early, too small, or stillborn. It is our moral duty to invest in the prevention of small vulnerable newborns through early and high quality antenatal and childbirth care and girls’ and women’s reproductive rights.”

As part of the advocacy efforts to prevent small vulnerable newborns, Aga Khan University’s Centre of Excellence in Women and Child Health, East Africa (CoEWCH EA) in collaboration with the Small Vulnerable Newborn Consortium is hosting the regional launch of the Lancet Series on Small Vulnerable Newborns in Nairobi. The launch will bring together academics, healthcare professionals, policy experts, and parents of SVNs to share findings from the Lancet small vulnerable newborns series, advocate for small vulnerable newborns prevention, and discuss local opportunities and priorities to catalyze a movement for change.

The launch calls for relevant actors to urgently prioritize action, advocate for, and invest in the prevention of small vulnerable newborns to reverse the current trend, reduce small vulnerable newborns outcomes, and ultimately save the lives of millions of babies. “20% of babies born in Sub-Saharan Africa are small vulnerable newborns, yet prevention is possible. This is the challenge we all need to tackle, the Nairobi launch aims to help us do this,” says Dr Abdu Mohiddin, Physician Scientist and Assistant Professor at the Aga Khan University.

The five-paper Series and the regional launches were funded by the Children’s Investment Fund Foundation (CIFF) and the Bill and Melinda Gates Foundation (BMGF) and involved experts from the Aga Khan University, Tampere University, Johns Hopkins University, London School of Hygiene & Tropical Medicine, University College London, and the University of Botswana.

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