Prematurity

Globally 2.4 million children died in the first month of life in 2020. There are approximately 6700 newborn deaths every day, amounting to 47% of all child deaths under the age of 5 years, up from 40% in 1990. Most neonatal deaths (75%) occur during the first week of life, and in 2019, about 1 million newborns died within the first 24 hours. Preterm birth and childbirth-related complications were the cause of most neonatal deaths in 2019.

Preterm infants are at higher risk of dying due to complications such as respiratory problems, feeding difficulties, poor regulation of body temperature and recurrent infections. The burden of morbidity and mortality resulting from prematurity could be reduced by adopting and implementing priority evidence-based interventions such as:

ensuring antenatal care for all pregnant women, including screening for, and diagnosis and treatment of infections, such as HIV and sexually transmitted infections, nutritional support and counselling;

providing screening and management of pregnant women at higher risk of preterm birth – multiple pregnancies, diabetes, high blood pressure, or with a history of previous preterm birth;

managing effectively preterm labour, especially provision of antenatal corticosteroids to reduce the risk of breathing difficulties in premature babies. This intervention alone could save around 370 000 lives each year;

promoting behavioural and community interventions to reduce smoking, secondhand smoke exposure, and other pollutants; and preventing violence against women by intimate partners;

reducing non-medically indicated inductions of labour and caesarean births, especially before 39 completed weeks of gestation.

In the Eastern Mediterranean Region, given the notable reduction in number of deaths due to pneumonia and diarrhoea, preterm birth complications have become the leading cause of death among children under-5 in the Region. It is estimated that around 160 000 babies die due to preterm birth complications, comprising nearly 20% of under-5 deaths.

Data from countries show significant variations on the contribution of prematurity to 0-4 years deaths. In Bahrain and Kuwait, for instance, 35% are attributed to preterm complications while in a country like Somalia – where post-neonatal causes of death are more prevalent – this figure goes down to 8.5%. However, it is important to highlight that prematurity represents a public health problem in all Member States in the Region.

Table 1. Deaths due to preterm birth complications as percentage of all under-5 deaths

*Figure is for West Bank only and reflects percentage of premature deaths among infant deaths, 2016 data