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      National and regional estimates of term and preterm babies born small for gestational age in 138 low-income and middle-income countries in 2010

      research-article
      Author(s): , Dr, MD a , b , * , , ScD a , , MRCPCH c , , DipMathStat c , , MSPH a , , MBBS g , h , , PhD i , , DrPH a , , PhD j , , PhD a , , DrPH a , , PhD d , e , , PhD k , , DrPH l , m , n , , PhD o , , PhD p , q , , PhD r , , PhD p , q , , PhD s , , PhD d , e , f , , MD h , , PhD t , , PhD a , , MSc u , , PhD u , v , , MD x , , PhD w , , PhD q , , MPP a , , PhD m , , PhD y , , PhD z , , PhD w , , PhD c , e , f , , PhD f , aa , , MD a , for the CHERG SGA-Preterm Birth Working Group †
      Publication date (Electronic):
      Journal: The Lancet. Global Health
      Publisher: Elsevier Ltd

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          Summary

          Background

          National estimates for the numbers of babies born small for gestational age and the comorbidity with preterm birth are unavailable. We aimed to estimate the prevalence of term and preterm babies born small for gestational age (term-SGA and preterm-SGA), and the relation to low birthweight (<2500 g), in 138 countries of low and middle income in 2010.

          Methods

          Small for gestational age was defined as lower than the 10th centile for fetal growth from the 1991 US national reference population. Data from 22 birth cohort studies (14 low-income and middle-income countries) and from the WHO Global Survey on Maternal and Perinatal Health (23 countries) were used to model the prevalence of term-SGA births. Prevalence of preterm-SGA infants was calculated from meta-analyses.

          Findings

          In 2010, an estimated 32·4 million infants were born small for gestational age in low-income and middle-income countries (27% of livebirths), of whom 10·6 million infants were born at term and low birthweight. The prevalence of term-SGA babies ranged from 5·3% of livebirths in east Asia to 41·5% in south Asia, and the prevalence of preterm-SGA infants ranged from 1·2% in north Africa to 3·0% in southeast Asia. Of 18 million low-birthweight babies, 59% were term-SGA and 41% were preterm. Two-thirds of small-for-gestational-age infants were born in Asia (17·4 million in south Asia). Preterm-SGA babies totalled 2·8 million births in low-income and middle-income countries. Most small-for-gestational-age infants were born in India, Pakistan, Nigeria, and Bangladesh.

          Interpretation

          The burden of small-for-gestational-age births is very high in countries of low and middle income and is concentrated in south Asia. Implementation of effective interventions for babies born too small or too soon is an urgent priority to increase survival and reduce disability, stunting, and non-communicable diseases.

          Funding

          Bill & Melinda Gates Foundation by a grant to the US Fund for UNICEF to support the activities of the Child Health Epidemiology Reference Group (CHERG).

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          Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010.

          Christopher J L Murray, Theo Vos, Rafael Lozano … (2013)
          Measuring disease and injury burden in populations requires a composite metric that captures both premature mortality and the prevalence and severity of ill-health. The 1990 Global Burden of Disease study proposed disability-adjusted life years (DALYs) to measure disease burden. No comprehensive update of disease burden worldwide incorporating a systematic reassessment of disease and injury-specific epidemiology has been done since the 1990 study. We aimed to calculate disease burden worldwide and for 21 regions for 1990, 2005, and 2010 with methods to enable meaningful comparisons over time. We calculated DALYs as the sum of years of life lost (YLLs) and years lived with disability (YLDs). DALYs were calculated for 291 causes, 20 age groups, both sexes, and for 187 countries, and aggregated to regional and global estimates of disease burden for three points in time with strictly comparable definitions and methods. YLLs were calculated from age-sex-country-time-specific estimates of mortality by cause, with death by standardised lost life expectancy at each age. YLDs were calculated as prevalence of 1160 disabling sequelae, by age, sex, and cause, and weighted by new disability weights for each health state. Neither YLLs nor YLDs were age-weighted or discounted. Uncertainty around cause-specific DALYs was calculated incorporating uncertainty in levels of all-cause mortality, cause-specific mortality, prevalence, and disability weights. Global DALYs remained stable from 1990 (2·503 billion) to 2010 (2·490 billion). Crude DALYs per 1000 decreased by 23% (472 per 1000 to 361 per 1000). An important shift has occurred in DALY composition with the contribution of deaths and disability among children (younger than 5 years of age) declining from 41% of global DALYs in 1990 to 25% in 2010. YLLs typically account for about half of disease burden in more developed regions (high-income Asia Pacific, western Europe, high-income North America, and Australasia), rising to over 80% of DALYs in sub-Saharan Africa. In 1990, 47% of DALYs worldwide were from communicable, maternal, neonatal, and nutritional disorders, 43% from non-communicable diseases, and 10% from injuries. By 2010, this had shifted to 35%, 54%, and 11%, respectively. Ischaemic heart disease was the leading cause of DALYs worldwide in 2010 (up from fourth rank in 1990, increasing by 29%), followed by lower respiratory infections (top rank in 1990; 44% decline in DALYs), stroke (fifth in 1990; 19% increase), diarrhoeal diseases (second in 1990; 51% decrease), and HIV/AIDS (33rd in 1990; 351% increase). Major depressive disorder increased from 15th to 11th rank (37% increase) and road injury from 12th to 10th rank (34% increase). Substantial heterogeneity exists in rankings of leading causes of disease burden among regions. Global disease burden has continued to shift away from communicable to non-communicable diseases and from premature death to years lived with disability. In sub-Saharan Africa, however, many communicable, maternal, neonatal, and nutritional disorders remain the dominant causes of disease burden. The rising burden from mental and behavioural disorders, musculoskeletal disorders, and diabetes will impose new challenges on health systems. Regional heterogeneity highlights the importance of understanding local burden of disease and setting goals and targets for the post-2015 agenda taking such patterns into account. Because of improved definitions, methods, and data, these results for 1990 and 2010 supersede all previously published Global Burden of Disease results. Bill & Melinda Gates Foundation. Copyright © 2012 Elsevier Ltd. All rights reserved.
          Article 0 comments Cited 1033 times – based on 0 reviews     Review now
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            National, regional, and worldwide estimates of preterm birth rates in the year 2010 with time trends since 1990 for selected countries: a systematic analysis and implications.

            Hannah Blencowe, Simon Cousens, Mikkel Z Oestergaard … (2012)
            Preterm birth is the second largest direct cause of child deaths in children younger than 5 years. Yet, data regarding preterm birth (<37 completed weeks of gestation) are not routinely collected by UN agencies, and no systematic country estimates nor time trend analyses have been done. We report worldwide, regional, and national estimates of preterm birth rates for 184 countries in 2010 with time trends for selected countries, and provide a quantitative assessment of the uncertainty surrounding these estimates. We assessed various data sources according to prespecified inclusion criteria. National Registries (563 datapoints, 51 countries), Reproductive Health Surveys (13 datapoints, eight countries), and studies identified through systematic searches and unpublished data (162 datapoints, 40 countries) were included. 55 countries submitted additional data during WHO's country consultation process. For 13 countries with adequate quality and quantity of data, we estimated preterm birth rates using country-level loess regression for 2010. For 171 countries, two regional multilevel statistical models were developed to estimate preterm birth rates for 2010. We estimated time trends from 1990 to 2010 for 65 countries with reliable time trend data and more than 10,000 livebirths per year. We calculated uncertainty ranges for all countries. In 2010, an estimated 14·9 million babies (uncertainty range 12·3-18·1 million) were born preterm, 11·1% of all livebirths worldwide, ranging from about 5% in several European countries to 18% in some African countries. More than 60% of preterm babies were born in south Asia and sub-Saharan Africa, where 52% of the global livebirths occur. Preterm birth also affects rich countries, for example, USA has high rates and is one of the ten countries with the highest numbers of preterm births. Of the 65 countries with estimated time trends, only three (Croatia, Ecuador, and Estonia), had reduced preterm birth rates 1990-2010. The burden of preterm birth is substantial and is increasing in those regions with reliable data. Improved recording of all pregnancy outcomes and standard application of preterm definitions is important. We recommend the addition of a data-quality indicator of the per cent of all live preterm births that are under 28 weeks' gestation. Distinguishing preterm births that are spontaneous from those that are provider-initiated is important to monitor trends associated with increased caesarean sections. Rapid scale up of basic interventions could accelerate progress towards Millennium Development Goal 4 for child survival and beyond. Bill & Melinda Gates Foundation through grants to Child Health Epidemiology Reference Group (CHERG) and Save the Children's Saving Newborn Lives programme; March of Dimes; the Partnership for Maternal Newborn and Childe Health; and WHO, Department of Reproductive Health and Research. Copyright © 2012 Elsevier Ltd. All rights reserved.
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              Multiple Imputation after 18+ Years

              Donald B Rubin (1996)
              Article 0 comments Cited 580 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Anne CC Lee
                Journal
                Journal ID (nlm-ta): Lancet Glob Health
                Journal ID (iso-abbrev): Lancet Glob Health
                Title: The Lancet. Global Health
                Publisher: Elsevier Ltd
                ISSN (Electronic): 2214-109X
                Publication date PMC-release: 1 July 2013
                Publication date (Electronic): July 2013
                Volume: 1
                Issue: 1
                Pages: e26-e36
                Affiliations
                [a ]Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
                [b ]Department of Newborn Medicine, Brigham and Women's Hospital, Boston, MA, USA
                [c ]Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
                [d ]Faculty of Infectious Disease and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
                [e ]Malaria Centre, London School of Hygiene and Tropical Medicine, London, UK
                [f ]Maternal Reproductive and Child Health Centre, London School of Hygiene and Tropical Medicine, London, UK
                [g ]School of Population Health, Faculty of Medicine, Dentistry and Health Sciences, University of Western Australia, Crawley, WA, Australia
                [h ]UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
                [i ]University of North Carolina School of Public Health, Chapel Hill, NC, USA
                [j ]Division of Women and Child Health, Aga Khan University, Karachi, Pakistan
                [k ]MRC-HPA Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
                [l ]Department of Nutrition, Harvard School of Public Health, Boston, MA, USA
                [m ]Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
                [n ]Department of Global Health and Population, Harvard School of Public Health, Boston, MA, USA
                [o ]Pontificia Universidad Católica de Chile, School of Medicine, and Clínica Santa María, Santiago, Chile
                [p ]Department of Food Safety and Food Quality, Ghent University, Ghent, Belgium
                [q ]Woman and Child Health Research Center, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
                [r ]Kenya Medical Research Institute, Center for Global Health Research, and Centers for Disease Control and Prevention Kenya, Kisumu, Kenya
                [s ]National Institute Medical Research, Tanga, Tanzania
                [t ]ASEAN Institute for Health Development, Mahidol University, Nakhon Pathom, Thailand
                [u ]Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Kwa-Zulu Natal, South Africa
                [v ]Centre for Paediatric Epidemiology and Biostatistics, University College London Institute of Child Health, London, UK
                [w ]Institute for Global Health, University College London Institute of Child Health, London, UK
                [x ]Fetal Maternal Medicine Unit, Clinica Davila, and Faculty of Medicine, Universidad de Los Andes, Santiago, Chile
                [y ]Programa de Pósgraduacao em Epidemiologia, Universidade Federal de Pelotas, Pelotas, RS, Brazil
                [z ]Department of Global Health, George Washington University School of Public Health and Health Services, Washington, DC, USA
                [aa ]Saving Newborn Lives/Save the Children USA, Washington, DC, USA
                Author notes
                [* ]Correspondence to: Dr Anne C Lee, Department of Newborn Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA alee6@ 123456partners.org
                [†]

                Members listed at end of report

                Article
                Publisher ID: S2214-109X(13)70006-8
                DOI: 10.1016/S2214-109X(13)70006-8
                PMC ID: 4221634
                PubMed ID: 25103583
                SO-VID: 6708bdea-2217-469a-aefc-36cf5f73fc5e
                Copyright © © 2013 Lee et al. Open Access article distributed under the terms of CC BY-NC-ND
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                This document may be redistributed and reused, subject to certain conditions.

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