Preterm birth complications highest under-five killer

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Complications linked to preterm births are the highest killer of under-fives in the world. It is responsible for 40% of children in the UK.

According to new findings which have been published in The Lancet, complications from premature births were responsible for almost 1.1 million of the 6.3 million global deaths of children under the age of five during 2013.

The UK has one of the highest premature birth death rates in Western Europe, along with Poland, Switzerland, Denmark, Slovenia and Serbia.

The country with the lowest rate is Iceland at 2.4 deaths per 1000 children. In the UK the mortality rate was 4.9 deaths per 1000 children during 2013.

Child death rates have been declining globally since 1990. However, in the UK, the rate has slowed down and the decline from 2000 to 2013 was 50% of the figure from 1990 to 2000.

During last year, around 3800 under-fives dies in Britain, of which 1400 were premature.

It is believed that the preference for women to give birth in their late 30s and early 40s is responsible for the rise in deaths. In England and Wales, 9.5% of all premature births are to women over the age of 40, compared to 6.9% to those between the ages of 20 and 24. Smoking during pregnancy and poverty increases the risk dramatically.

A member of the research team, Dr Joy Lawn, from the London School of Hygiene & Tropical Medicine and a long-term advisor to Save the Children, said these figures indicates a move from infection to neonatal conditions, particularly those linked to preterm births, and this require a very different public health and medical approach.

She said the success they have experienced in their fight against infectious diseases shows that they can be successful in preventing preterm birth, if there was investment.

The global rate of death for children under the age of five has fallen drastically from 76 to 46 deaths for every 1000 live births during 2013. This is an annual reduction of 3.9%.

Most progress has been achieved by the prevention of deaths from tetanus, HIV, measles, diarrhoea and pneumonia. By contrast, the mortality rates linked to preterm have only dropped by 2% per year globally and have increased slightly in the UK, from 36% to 38.7%.

This is the first time in history that the complications linked to preterm birth has surpassed all other causes as the global cause of death among young children.

Countries that are currently suffering from the outbreak of Ebola, such as Liberia and Sierra Leone, experience some of the highest rates of death from preterm complications. Four huge research projects have been launched to try and find out the reasons for preterm births and to determine ways of preventing or delaying these births.

It is not known what triggers the commencement of labour before full-term as more than 50% of preterm births are spontaneous.

One group is working on the identification of the source of the signals which promote labour and discover if the process is initiated by the foetus or the mother.

Researchers are also looking at how stress, pollution, nutrition and poverty affects birth and will look at limiting the number of females under the age of 17 and over the age of 40 giving birth.

Other risk factors linked to preterm births include high blood pressure and obesity, which are also risk factors for birth defects and stillbirths.

Image Credit: Joshua Smith

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