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The global burden of preterm birth
Editorial
Hoffmanpr
The global burden of preterm birth
For the March of Dimes report see http://marchofdimes.com/ files/66423_MOD-Complete.pdf For The Lancet Preterm Birth Series see Series Lancet 2008; 371: 75–84 For The Lancet Neonatal Survival Series see Series Lancet 2005; 365: 891–900
Preterm birth (birth before 37 weeks’ gestation) has been an under-recognised and underfunded global health issue, partly because of a lack of data on the worldwide extent of the problem. Now a new report by the US March of Dimes Foundation, based on data from WHO, attempts to address this deficit. The report provides global and regional estimates of the prevalence of preterm birth. The figures are alarming. In 2005, 13 million preterm babies were born worldwide; 85% of these births (11 million births) occurred in Africa and Asia. Africa (11·9%), North America (10·6%), and Asia (9·1%) have the highest rates of preterm birth. Where good-quality trend data are available, preterm births also seem to be increasing in numbers. In the USA, for example, the rate of preterm birth has increased by 35% in the past 25 years, because of factors such as a rise in the use of assisted reproductive technologies. More than 1 million infants die every year because they are born preterm, according to the report. Those who survive have an increased risk of morbidities such as cerebral palsy, blindness, and hearing loss. Even late
preterm births (34–36 weeks’ gestation) have a higher rate of disabilities, jaundice, and delayed brain development. Although more research is needed to find the interventions that are effective at preventing preterm births, there is a lot that can be done now. For example, in high-income countries there needs to be more focus on preconception health. Women planning a pregnancy should be encouraged to adopt a healthy lifestyle (ie, giving up tobacco smoking if they smoke and losing weight if they are overweight). In developing countries, there are several simple low-cost interventions that can help promote a healthy pregnancy outcome, such as treating malnutrition in women before and during pregnancy, treating high blood pressure and diabetes, and monitoring pregnancies for problems. Care for preterm babies can also be low cost and effective, such as keeping the baby warm, treating infections, and providing adequate nutrition. Governments need to pay more attention to preterm birth as a serious health issue. The data and recommendations in the March of Dimes report should provide strong impetus for action. ■ The Lancet
The Work Foundation
Is Europe fit for work?
Fo more on Fit for work see http://www.theworkfoundation. com/research/publications/ publicationdetail.aspx?oItemId= 224&parentPageID=102&PubType=
1214
“A healthy workforce means a healthy economy”, so says Fit for work, a report published last week by the Work Foundation, a not-for-profit organisation in London, UK. The Foundation has an eye on the economic recession and the need to improve productivity when concluding that the European Union workforce might not be healthy enough to compete internationally. Fit for work found that sickness absence from work is caused more often by musculoskeletal disorders than by any other disease. The report concludes that up to 2% of gross domestic product is accounted for by the direct costs of such disorders every year, with a total cost due to sickness absence across Europe of £219 billion. But there is a human cost too, particularly in quality of life and limitations in the type of work that can be done, and in the effect on the family of having a breadwinner out of work. Additionally, having a musculoskeletal disorder can lead to depression and anxiety—Fit for work concludes that such comorbidity substantially inhibits an early return to work.
Clinically, one might wonder why Fit for work lumped conditions such as repetitive strain injury and low-back pain (which can be caused by working but are usually self-limiting) with chronic debilitating conditions, such as rheumatoid arthritis and spondyloarthropathy (the report was sponsored by Abbott, who market a monoclonal antibody for rheumatoid arthritis). These diseases require different treatment and rehabilitation approaches. Fit for work looked at a UK National Audit Office report which estimated that increasing the proportion of patients who access disease-modifying antirheumatic drugs within 3 months of diagnosis by 10% might increase costs to the health service by £11 million over 5 years, but lead to productivity gains of £31 million, with a 4% gain in quality of life. Musculoskeletal disorders are a major burden in general practice. But they are treatable, and the treatments are cost effective and boost quality of life. A win–win scenario for patients, doctors, and the European workforce. ■ The Lancet www.thelancet.com Vol 374 October 10, 2009
Hoffmanpr
The global burden of preterm birth
For the March of Dimes report see http://marchofdimes.com/ files/66423_MOD-Complete.pdf For The Lancet Preterm Birth Series see Series Lancet 2008; 371: 75–84 For The Lancet Neonatal Survival Series see Series Lancet 2005; 365: 891–900
Preterm birth (birth before 37 weeks’ gestation) has been an under-recognised and underfunded global health issue, partly because of a lack of data on the worldwide extent of the problem. Now a new report by the US March of Dimes Foundation, based on data from WHO, attempts to address this deficit. The report provides global and regional estimates of the prevalence of preterm birth. The figures are alarming. In 2005, 13 million preterm babies were born worldwide; 85% of these births (11 million births) occurred in Africa and Asia. Africa (11·9%), North America (10·6%), and Asia (9·1%) have the highest rates of preterm birth. Where good-quality trend data are available, preterm births also seem to be increasing in numbers. In the USA, for example, the rate of preterm birth has increased by 35% in the past 25 years, because of factors such as a rise in the use of assisted reproductive technologies. More than 1 million infants die every year because they are born preterm, according to the report. Those who survive have an increased risk of morbidities such as cerebral palsy, blindness, and hearing loss. Even late
preterm births (34–36 weeks’ gestation) have a higher rate of disabilities, jaundice, and delayed brain development. Although more research is needed to find the interventions that are effective at preventing preterm births, there is a lot that can be done now. For example, in high-income countries there needs to be more focus on preconception health. Women planning a pregnancy should be encouraged to adopt a healthy lifestyle (ie, giving up tobacco smoking if they smoke and losing weight if they are overweight). In developing countries, there are several simple low-cost interventions that can help promote a healthy pregnancy outcome, such as treating malnutrition in women before and during pregnancy, treating high blood pressure and diabetes, and monitoring pregnancies for problems. Care for preterm babies can also be low cost and effective, such as keeping the baby warm, treating infections, and providing adequate nutrition. Governments need to pay more attention to preterm birth as a serious health issue. The data and recommendations in the March of Dimes report should provide strong impetus for action. ■ The Lancet
The Work Foundation
Is Europe fit for work?
Fo more on Fit for work see http://www.theworkfoundation. com/research/publications/ publicationdetail.aspx?oItemId= 224&parentPageID=102&PubType=
1214
“A healthy workforce means a healthy economy”, so says Fit for work, a report published last week by the Work Foundation, a not-for-profit organisation in London, UK. The Foundation has an eye on the economic recession and the need to improve productivity when concluding that the European Union workforce might not be healthy enough to compete internationally. Fit for work found that sickness absence from work is caused more often by musculoskeletal disorders than by any other disease. The report concludes that up to 2% of gross domestic product is accounted for by the direct costs of such disorders every year, with a total cost due to sickness absence across Europe of £219 billion. But there is a human cost too, particularly in quality of life and limitations in the type of work that can be done, and in the effect on the family of having a breadwinner out of work. Additionally, having a musculoskeletal disorder can lead to depression and anxiety—Fit for work concludes that such comorbidity substantially inhibits an early return to work.
Clinically, one might wonder why Fit for work lumped conditions such as repetitive strain injury and low-back pain (which can be caused by working but are usually self-limiting) with chronic debilitating conditions, such as rheumatoid arthritis and spondyloarthropathy (the report was sponsored by Abbott, who market a monoclonal antibody for rheumatoid arthritis). These diseases require different treatment and rehabilitation approaches. Fit for work looked at a UK National Audit Office report which estimated that increasing the proportion of patients who access disease-modifying antirheumatic drugs within 3 months of diagnosis by 10% might increase costs to the health service by £11 million over 5 years, but lead to productivity gains of £31 million, with a 4% gain in quality of life. Musculoskeletal disorders are a major burden in general practice. But they are treatable, and the treatments are cost effective and boost quality of life. A win–win scenario for patients, doctors, and the European workforce. ■ The Lancet www.thelancet.com Vol 374 October 10, 2009