Vietnam had the lowest low birth weight rate in Southeast Asia & Oceania in 2015, at 8.2 per cent, according to the latest research from the London School of Hygiene & Tropical Medicine, UNICEF, and the World Health Organization (WHO), published in The Lancet Global Health journal.
“This figure is most encouraging,” said Ms. Rana Flowers, UNICEF Representative in Vietnam. “However, as a national average, it does not give us the complete picture and is likely to hide important disparities, for example among the poorest mothers, 28 per cent of whom do not have institutional deliveries and their newborn’s weight is not usually recorded.”
Data from the report shows that more than 20 million babies were born with a low birth weight (less than 2.5 kg, or 5.5 pounds) in 2015; around one in seven of all births worldwide.
Assessing birth weight in 148 countries and territories and reviewing 281 million births, the estimates, which are the first of their kind, found that worldwide low birth weight prevalence fell slightly, from 17.5 per cent in 2000 (22.9 million low birth weight live births) to 14.6 per cent in 2015 (20.5 million). A similar pattern can be seen in Vietnam, as the rate of low birth weight was reduced by 1 per cent from 9.2 per cent in 2000 to 8.2 per cent in 2015, and the number of babies with low birth weight stayed almost constant at 130,000 per year over this period.
Low birth weight is a significant contributor in more than 80 per cent of cases of newborn fatalities. Babies that survive are at a greater risk of stunting and developmental and physical ill health later in life. Calling for urgent attention to reduce the number of babies born with low birth weight, the research challenges governments in rich as well as poor countries to refocus and do more.
“Improved levels can be achieved, with a stronger focus on maternal nutrition delivered in quality ante-natal care, and institutional delivery services for all mothers, especially the poorest and those in remote and mountainous areas,” said Ms. Flowers. “Likewise, a scaling up of nationwide interventions for premature and low birth weight babies, such as Early Essential Newborn Care and Kangaroo Mother Care, would also secure stronger results.”
Furthermore, the study concluded that at the current rate of progress – with a 1.2 per cent yearly decline in low birth weight rates between 2000 and 2015 – the world will fall well short of the annual reduction rate of 2.7 per cent required to meet the WHO-agreed target of a 30 per cent reduction in prevalence between 2012 and 2025.
The study’s authors called for international action to ensure that all babies are weighed at birth, together with improved clinical care and the promotion of public health action on the causes of low birth weight. They point to an urgent need for more investment and action to tackle the key drivers of low birth weight throughout life. Such drivers include extremes of maternal age, multiple pregnancies, obstetric complications, chronic conditions (for e.g. hypertension), infections (for e.g. malaria), and maternal nutritional status, as well as exposure to environmental factors such as indoor air pollution and tobacco and drug use. In low-income countries, poor growth in the womb is a major cause of low birth weight. In more developed regions, low birth weight is often associated with premature birth (babies born before 37 weeks).
“Despite clear commitments, our estimates indicate that national governments are doing too little to reduce low birth weight,” said lead author Dr. Hannah Blencowe from the London School of Hygiene & Tropical Medicine. “We have seen very little change over 15 years, even in high-income settings where low birth weight is often due to prematurity as a result of high maternal age, smoking, medically unnecessary caesarean sections, and fertility treatments that increase the risk of multiple births. Meeting the global nutrition target of a 30 per cent reduction in low birth weight by 2025 will require more than doubling the pace of progress.”
In signaling concerns regarding a lack of data in low and middle-income countries, the report sounds a clear call to action to weigh every baby at birth. “Every newborn must be weighed, yet worldwide we don’t have a record for the birth weight of nearly one-third of all newborns,” said co-author Ms. Julia Krasevec, Statistics & Monitoring Specialist from UNICEF. “We cannot help babies born with low birth weight without improving the coverage and accuracy of the data we collect. With better weighing devices and stronger data systems, we can capture the true birth weight of every baby, including those born at home, and provide better quality care to these newborns and their mothers.”
Almost three-quarters of low birth weight babies were born in Southern Asia and sub-Saharan Africa, where data is more limited. However, researchers also noted a virtual lack of progress since 2000 in high-income countries in Europe and North America as well as Australia and New Zealand.
One of the lowest rates of low birth weight in 2015 was estimated to be in Sweden (2.4 per cent). This compares to around 7 per cent in high-income countries such as the US (8 per cent), the UK (7 per cent), Australia (6.5 per cent), and New Zealand (5.7 per cent). The regions making the fastest progress are those with the highest numbers of low birth weight babies – Southern Asia and Sub-Saharan Africa – with a yearly decline in low birth weight prevalence of 1.4 per cent and 1.1 per cent, respectively, between 2000 and 2015. Southern Asia still has almost half of the world’s low birth weight live births, with an estimated 9.8 million in 2015.
“Low birth weight is a complex clinical entity composed of intrauterine growth restriction and preterm birth,” said co-author Dr. Mercedes de Onis from the WHO. “This is why reducing low birth weight requires understanding of the underlying causes in a given country. For example, in Southern Asia a large proportion of low birth weight babies are born at term but with intrauterine growth restriction, which is associated with maternal under-nutrition, including maternal stunting. Conversely, preterm birth is the major contributor to low birth weight in settings with many adolescent pregnancies, a high prevalence of infection, or where pregnancy is associated with high levels of fertility treatment and caesarean sections (like in the US and Brazil). Understanding and tackling these underlying causes in high-burden countries should be a priority.”
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