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BMJ. 2017 Aug 17;358:j3677. doi: 10.1136/bmj.j3677.

Estimates of burden and consequences of infants born small for gestational age in low and middle income countries with INTERGROWTH-21st standard: analysis of CHERG datasets.

Author information

1
Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA alee6@bwh.harvard.edu.
2
Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA.
3
International Rescue Committee, 1730 M Street NW, Suite 505, Washington, DC 20036, USA.
4
Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD 21205, USA.
5
Facuty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.
6
Maternal, Adolescent, Reproductive, and Child Health (MARCH) Centre, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.
7
Department of Information, Evidence and Research, World Health Organization (WHO), Geneva, Switzerland, CH-1211.
8
Programa de Pós-graduacao em Epidemiologia, Universidade Federal de Pelotas, Rua Marechal Deodoro 1160, 30 piso, Centro, CEP 96020-220, Pelotas, RS, Brazil.
9
Mailman School of Public Health, Columbia University, 722 W 168th St, New York, NY 10032.
10
Centre for Medical Parasitology, Department of Immunology and Microbiology, University of Copenhagen, Oester Farimagsgade 5, 1014 Copenhagen K, Denmark.
11
Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, NC 27599, USA.
12
Carolina Population Center, University of North Carolina at Chapel Hill, 137 E. Franklin, Chapel Hill, NC 27516, USA.
13
Programa de Pós-graduação em Saúde e Comportamento, Universidade Católica de Pelotas, Félix da Cunha, 412, CEP 96010-000, Centro, Pelotas, RS, Brazil.
14
Center for Global Child Health, Hospital for Sick Children, 686 Bay Street, Toronto, ON, M5G A04, Canada.
15
Centre of Excellence in Women and Child Health, Aga Khan University, Stadium Road PO Box 3500, Karachi 74800, India.
16
Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, W2041, Baltimore, MD 21205 USA.
17
Women's Nutrition, Bill and Melinda Gates Foundation, Seattle, WA 98102, USA.
18
Faculty of Infectious Disease and Tropical Diseases, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.
19
Malaria Centre, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.
20
Department of Global Health and Population, Harvard School of Public Health, 677 Huntington Ave, Boston, MA 02115, USA.
21
Department of Nutrition, Harvard School of Public Health, 677 Huntington Ave, Boston, MA 02115, USA.
22
Department of Epidemiology, Harvard School of Public Health, 677 Huntington Ave, Boston, MA 02115, USA.
23
Pontificia Universidad Católica de Chile, School of Medicine, Avenida Libertador General Bernardo O'Higgins #340, Santiago, Chile.
24
Clínica Santa María, Avenida Santa María 0410 Providencia, Santiago, Chile.
25
Zvitambo Institute for Maternal and Child Health Research, 16 Lauchlan Road, Meyrick Park, Harare, Zimbabwe.
26
Department of Food Safety and Food Quality, Ghent University, Coupure Links 653 - 9000 Ghent, Belgium.
27
Poverty, Health and Nutrition Division, International Food Policy Research Institute, 2033 K St, NW Washington, DC 20006-1002, USA.
28
Kenya Medical Research Institute, Centre for Global Health Research, PO Box 1578-40100, Kisumu, Kenya.
29
Centers for Disease Control and Prevention Kenya, Off Kisumu-Busia Highway, PO Box 1578-40100, Kisumu, Kenya.
30
National Institute for Medical Research, PO Box 5004, Tanga, Tanzania.
31
University of Copenhagen, Denmark.
32
Mother and Infant Research Activities (MIRA), YB Bhawan, Thapathali, Kathmandu 921, Nepal.
33
ASEAN Institute for Health Development, Mahidol University, 999 Phuttamonthon 4 Rd, Salaya, Nakhon Pathom 73170, Thailand.
34
Vector Control Division, Ministry of Health, Uganda, Plot 6 Lourdel Rd, Nakasero, Kampala, Uganda.
35
Fetal Maternal Medicine Unit, Clinica Davila, Avenida Recoleta 464, Santiago, Chile.
36
Faculty of Medicine, Universidad de Los Andes, Avda San Carlos De Apoquindo 2200, Santiago, Chile.
37
Belgian Health Care Knowledge Centre, Boulevard du Jardin Botanique 55, Brussels, Belgium.
38
Institute for Global Health, University College London Institute of Child Health, London WC1N 1EH, UK.
39
Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK.
40
Malawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, University of Malawi, PO Box 30096, Chichiri, Blantyre 3, Malawi.
41
Department of Global Health, Milken Institute School of Public Health, George Washington University, 950 New Hampshire Ave, NW, Suite 400, Washington, DC 20052, USA.
42
Department of Paediatrics, Chris Hani Baragwaneth Hospital, Faculty of Health Sciences, University of Witwatersrand, Soweto, Johannesburg, South Africa.
43
Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK.
44
Mwanza Intervention Trial Unit, National Institute for Medical Research, Mwanza, Tanzania.
45
MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College, London, London W2 1PG, UK.
46
Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.

Abstract

Objectives To estimate small for gestational age birth prevalence and attributable neonatal mortality in low and middle income countries with the INTERGROWTH-21st birth weight standard.Design Secondary analysis of data from the Child Health Epidemiology Reference Group (CHERG), including 14 birth cohorts with gestational age, birth weight, and neonatal follow-up. Small for gestational age was defined as infants weighing less than the 10th centile birth weight for gestational age and sex with the multiethnic, INTERGROWTH-21st birth weight standard. Prevalence of small for gestational age and neonatal mortality risk ratios were calculated and pooled among these datasets at the regional level. With available national level data, prevalence of small for gestational age and population attributable fractions of neonatal mortality attributable to small for gestational age were estimated.Setting CHERG birth cohorts from 14 population based sites in low and middle income countries.Main outcome measures In low and middle income countries in the year 2012, the number and proportion of infants born small for gestational age; number and proportion of neonatal deaths attributable to small for gestational age; the number and proportion of neonatal deaths that could be prevented by reducing the prevalence of small for gestational age to 10%.Results In 2012, an estimated 23.3 million infants (uncertainty range 17.6 to 31.9; 19.3% of live births) were born small for gestational age in low and middle income countries. Among these, 11.2 million (0.8 to 15.8) were term and not low birth weight (≥2500 g), 10.7 million (7.6 to 15.0) were term and low birth weight (<2500 g) and 1.5 million (0.9 to 2.6) were preterm. In low and middle income countries, an estimated 606 500 (495 000 to 773 000) neonatal deaths were attributable to infants born small for gestational age, 21.9% of all neonatal deaths. The largest burden was in South Asia, where the prevalence was the highest (34%); about 26% of neonatal deaths were attributable to infants born small for gestational age. Reduction of the prevalence of small for gestational age from 19.3% to 10.0% in these countries could reduce neonatal deaths by 9.2% (254 600 neonatal deaths; 164 800 to 449 700).Conclusions In low and middle income countries, about one in five infants are born small for gestational age, and one in four neonatal deaths are among such infants. Increased efforts are required to improve the quality of care for and survival of these high risk infants in low and middle income countries.

PMID:
28819030
PMCID:
PMC5558898
DOI:
10.1136/bmj.j3677
[Indexed for MEDLINE]
Free PMC Article

Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: financial support for the submitted work from the Bill and Melinda Gates Foundation by a grant to the US Fund for UNICEF; no financial relationships with any organizations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

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