In 2015 just under six million children under the age of five died across the globe. Of these, about 2.6 million died within the first month of being born. And more than 60% of these deaths took place in Africa and South Asia. Just over a third of these babies died as a result of complications because they were born premature.
Prematurity is the most common cause of neonatal deaths globally. Babies are considered premature if they are born before the mother reaches 37 weeks of pregnancy.
In developed countries, the main causes of preterm deaths are well known and studied. Some babies develop infections, others have breathing problems such as birth asphyxia or lung immaturity. They also have feeding problems or experience metabolic and electrolyte disturbances and congenital malformations.
But in low resource countries, the causes of preterm deaths is much less understood. Anecdotal evidence from experts and clinicians in neonatal intensive care units is that infections such as neonatal sepsis and asphyxia are common. But there is no data to back this up.
It is therefore critical to identify the most “treatable and preventable” causes of death in low resource settings. These findings would help inform the tools and interventions that must be developed and included in national programmes to reduce neonatal mortality in the developing world.
Approaches that work
Reducing the high rates of children under the age of five who die has been a global health priority since the early 1990s. At the time diarrhoea, pneumonia and malaria were the three leading killers of children under the age of five.
To tackle these several interventions were rolled out and since deaths of children under five has more than halved. The interventions were simple: oral rehydration solutions and zinc for diarrhoea, a pneumococcal vaccine and antibiotics for pneumonia and antimalarial medicines and long-lasting insecticide treated nets for malaria.
But these reductions has meant that the proportion of deaths in the neonatal age group has increased. Just under half of all the under-five deaths are due to neonatal mortality.
The thinking behind these interventions is based on the principles of precision medicine where the right solution is delivered to the right population at the right time.