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

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Lee, Anne Cc, Kozuki, Naoko, Cousens, Simon, Stevens, Gretchen A, Blencowe, Hannah, Silveira, Mariangela F, Sania, Ayesha, Rosen, Heather E, Schmiegelow, Christentze, Adair, Linda S, Baqui, Abdullah H, Barros, Fernando C, Bhutta, Zulfiqar A, Caulfield, Laura E, Christian, Parul, Clarke, Siân E, Fawzi, Wafaie, Gonzalez, Rogelio, Humphrey, Jean, Huybregts, Lieven, Kariuki, Simon, Kolsteren, Patrick, Lusingu, John, Manandhar, Dharma, Mongkolchati, Aroonsri, Mullany, Luke C, Ndyomugyenyi, Richard, Nien, Jyh Kae, Roberfroid, Dominique, Saville, Naomi, Terlouw, Anja, Tielsch, James M, Victora, Cesar G, Velaphi, Sithembiso C, Watson-Jones, Deborah, Willey, Barbara A, Ezzati, Majid, Lawn, Joy E, Black, Robert E and Katz, Joanne (2017) 'Estimates of burden and consequences of infants born small for gestational age in low and middle income countries with INTERGROWTH-21(st) standard: analysis of CHERG datasets.'. British Medical Journal (BMJ), Vol 358, j3677.

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Abstract

Objectives
To estimate small for gestational age birth prevalence and attributable neonatal mortality in low and middle income countries with the INTERGROWTH-21(st) 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-21(st) 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.

Item Type: Article
Subjects: WA Public Health > WA 30 Socioeconomic factors in public health (General)
WA Public Health > Statistics. Surveys > WA 900 Public health statistics
WS Pediatrics > WS 20 Research (General)
WS Pediatrics > By Age Groups > WS 420 Newborn infants. Neonatology
WS Pediatrics > By Age Groups > WS 430 Infancy
Faculty: Department: Clinical Sciences & International Health > Malawi-Liverpool-Wellcome Programme (MLW)
Digital Object Identifer (DOI): https://doi.org/10.1136/bmj.j3677
SWORD Depositor: JISC Pubrouter
Depositing User: Stacy Murtagh
Date Deposited: 12 Sep 2017 10:49
Last Modified: 14 Sep 2017 09:35
URI: http://archive.lstmed.ac.uk/id/eprint/7535

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