What do babies die of in resource poor countries?

Two very recent publications about neonatal mortality in resource poor countries. The first is from 6 different low resource countries and one medium resource country (Argentina) the authors presented the birth weight, gestational age and age at death of babies who died (Belizán JM, McClure EM, Goudar SS, Pasha O, Esamai F, Patel A, Chomba E, Garces A, Wright LL, Koso-Thomas M et al: Neonatal Death in Low- to Middle-Income Countries: A Global Network Study. Amer J Perinatol 2012(EFirst) https://www.thieme-connect.de/DOI/DOI?10.1055/s-0032-1314885). They show that around half of the deaths are of low birth weight infants, around a third of those being very low birth weight (less than 1500g), the remaining 46% of the deaths are of course normal birth weight (over 2500 g), gestational age at birth was also important, but a slightly higher percentage were considered term, 54%. The majority of babies who died did so early, 52% on the first day of life, followed by another third by the end of the first week.

The cause of death was not reported in that publication, but we know from other sources that the term babies will have died primarily of asphyxia followed by, as a second most frequent cause, by infection, the preterm infants will have died of complications of prematurity. I know that isn’t very specific, but prematurity is often listed as the cause of death in studies from low income countries, presumably a combination of hypothermia, hypoglycemia, respiratory distress, asphyxia and infections are involved in those babies.

Another study from North-East Vietnam had an very similar age at death and distribution of birth weights, and they did attempt to determine the cause of death (Nga NT, Hoa DTP, Målqvist M, Persson L-Å, Ewald U: Causes of neonatal death: results from NeoKIP community-based trial in Quang Ninh province, Vietnam. Acta Paediatrica 2012, 101(4):368-373 http://onlinelibrary.wiley.com/doi/10.1111/j.1651-2227.2011.02513.x/abstract). Causes of death were determined from post death interviews with the mother. The most frequent cause was prematurity/low birth weight, closely followed by birth asphyxia and then infections.

These studies confirm the necessity of resuscitation training, (check out http://helpingbabiesbreathe.org/ ) and basic neonatal care, (check out http://www.healthynewbornnetwork.org/) to improve global neonatal survival. These programs could make an enormous difference for neonatal mortality in the world.

Survival of premature babies in low resource countries could be dramatically improved by the use of antenatal steroids, hand washing, cord care with chlorhexidine, kangaroo care. All of which are cheap and the main pre-requisite is education.

Currently the Millennium Development Goal 4, a reduction in child mortality by 2 thirds, is behind schedule. Although mortality has decreased, it is not sufficient to achieve the goal. Neonatal deaths are currently 41% of all the deaths below 5 years. The only way to make progress in reducing child mortality and approach MDG 4 is by reducing neonatal mortality.

About Keith Barrington

I am a neonatologist and clinical researcher at Sainte Justine University Health Center in Montréal
This entry was posted in Neonatal Research and tagged , . Bookmark the permalink.

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