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Lancet Glob Health. 2013 Jul;1(1):e26-36. doi: 10.1016/S2214-109X(13)70006-8. Epub 2013 Jun 25.

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

Author information

1
Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Newborn Medicine, Brigham and Women's Hospital, Boston, MA, USA. Electronic address: alee6@partners.org.
2
Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
3
Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
4
School of Population Health, Faculty of Medicine, Dentistry and Health Sciences, University of Western Australia, Crawley, WA, Australia; 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.
5
University of North Carolina School of Public Health, Chapel Hill, NC, USA.
6
Division of Women and Child Health, Aga Khan University, Karachi, Pakistan.
7
Faculty of Infectious Disease and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK; Malaria Centre, London School of Hygiene and Tropical Medicine, London, UK.
8
MRC-HPA Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.
9
Department of Nutrition, Harvard School of Public Health, Boston, MA, USA; Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA; Department of Global Health and Population, Harvard School of Public Health, Boston, MA, USA.
10
Pontificia Universidad Católica de Chile, School of Medicine, and Clínica Santa María, Santiago, Chile.
11
Department of Food Safety and Food Quality, Ghent University, Ghent, Belgium; Woman and Child Health Research Center, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.
12
Kenya Medical Research Institute, Center for Global Health Research, and Centers for Disease Control and Prevention Kenya, Kisumu, Kenya.
13
National Institute Medical Research, Tanga, Tanzania.
14
Faculty of Infectious Disease and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK; Malaria Centre, London School of Hygiene and Tropical Medicine, London, UK; Maternal Reproductive and Child Health Centre, London School of Hygiene and Tropical Medicine, London, UK.
15
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.
16
ASEAN Institute for Health Development, Mahidol University, Nakhon Pathom, Thailand.
17
Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Kwa-Zulu Natal, South Africa.
18
Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Kwa-Zulu Natal, South Africa; Centre for Paediatric Epidemiology and Biostatistics, University College London Institute of Child Health, London, UK.
19
Fetal Maternal Medicine Unit, Clinica Davila, and Faculty of Medicine, Universidad de Los Andes, Santiago, Chile.
20
Institute for Global Health, University College London Institute of Child Health, London, UK.
21
Woman and Child Health Research Center, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.
22
Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA.
23
Programa de Pósgraduacao em Epidemiologia, Universidade Federal de Pelotas, Pelotas, RS, Brazil.
24
Department of Global Health, George Washington University School of Public Health and Health Services, Washington, DC, USA.
25
Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK; Malaria Centre, London School of Hygiene and Tropical Medicine, London, UK; Maternal Reproductive and Child Health Centre, London School of Hygiene and Tropical Medicine, London, UK.
26
Maternal Reproductive and Child Health Centre, London School of Hygiene and Tropical Medicine, London, UK; Saving Newborn Lives/Save the Children USA, Washington, DC, USA.

Erratum in

  • Lancet Glob Health. 2013 Aug;1(2):e76.

Abstract

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-SGA. 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).

Comment in

PMID:
25103583
PMCID:
PMC4221634
DOI:
10.1016/S2214-109X(13)70006-8
[Indexed for MEDLINE]
Free PMC Article

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