Article open access publication

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

The BMJ, BMJ, ISSN 0959-8138

Volume 358, 2017

DOI:10.1136/bmj.j3677, Dimensions: pub.1091206638, PMC: PMC5558898, PMID: 28819030,

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  1. (1) Brigham and Women's Hospital, grid.62560.37
  2. (2) Harvard University, grid.38142.3c
  3. (3) International Rescue Committee, grid.420433.2
  4. (4) Johns Hopkins University, grid.21107.35
  5. (5) London School of Hygiene & Tropical Medicine, grid.8991.9
  6. (6) World Health Organization, grid.3575.4
  7. (7) Federal University of Pelotas, grid.411221.5
  8. (8) Columbia University, grid.21729.3f
  9. (9) University of Copenhagen, grid.5254.6, KU
  10. (10) University of North Carolina at Chapel Hill, grid.10698.36
  11. (11) Universidade Católica de Pelotas, grid.411965.e
  12. (12) Centre of Excellence in Women and Child Health, Aga Khan University, Stadium Road PO Box 3500, Karachi 74800, India.
  13. (13) Hospital for Sick Children, grid.42327.30
  14. (14) Bill & Melinda Gates Foundation, grid.418309.7
  15. (15) Clinica Santa Maria, grid.482859.a
  16. (16) Pontifical Catholic University of Chile, grid.7870.8
  17. (17) Zvitambo Institute for Maternal and Child Health Research, grid.493148.3
  18. (18) International Food Policy Research Institute, grid.419346.d
  19. (19) Ghent University, grid.5342.0
  20. (20) Centers for Disease Control and Prevention Kenya, Off Kisumu-Busia Highway, PO Box 1578-40100, Kisumu, Kenya.
  21. (21) Kenya Medical Research Institute, grid.33058.3d
  22. (22) National Institute for Medical Research, grid.416716.3
  23. (23) Mother and Infant Research Activities, grid.451043.7
  24. (24) Mahidol University, grid.10223.32
  25. (25) Ministry of Health, grid.415705.2
  26. (26) Fetal Maternal Medicine Unit, Clinica Davila, Avenida Recoleta 464, Santiago, Chile.
  27. (27) University of the Andes, grid.440627.3
  28. (28) Belgian Health Care Knowledge Centre, grid.414403.6
  29. (29) University College London, grid.83440.3b
  30. (30) Liverpool School of Tropical Medicine, grid.48004.38
  31. (31) Malawi-Liverpool-Wellcome Trust Clinical Research Programme, grid.419393.5
  32. (32) George Washington University, grid.253615.6
  33. (33) University of the Witwatersrand, grid.11951.3d
  34. (34) Imperial College London, grid.7445.2

Description

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.

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Times Cited: 91

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Relative Citation ratio (RCR): 8.59

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