KARACHI: Registering about 750,000 preterm births in 2010, Pakistan has ranked fourth in the latest global listing in terms of the number of preterm births, with India on the top, followed by China and Nigeria as third and fourth, respectively.

However, the percentage wise ranking put Pakistan on the eighth position in the world with the annual average of 15.8 per cent preterm births. The world rate of preterm births is over 10 per cent.

The latest findings of the ‘Born too soon: the global action report on preterm birth’, which was authored by a group of international multidisciplinary experts, were made public globally on Wednesday evening.

The report quoted the standard WHO definition for the preterm as up to 37 weeks of completed gestation.

It described premature or preterm births as the leading cause of newborn deaths (babies in the first four weeks of life) and second leading cause of death after pneumonia in children under the age of five years.

Globally about 15 million babies were born too soon every year, while over one million children died each year due to preterm birth complications, the report stated. Many survivors faced a lifetime of disability, including learning disabilities and visual and hearing problems, it added.

Of the total preterm births across the globe, about 60 per cent occur in South Asia and sub-Saharan Africa every year.

Pakistan with 748,100 such births annually has the fourth highest number after India, which has 3,519,100 preterm births, China (1,172,300) and Nigeria (773,600). With a rate of 15.8 preterm births per 100 live births in 2010, Pakistan remained eight in the world and first among Asian countries registering preterm births.

Malawi had the highest (18.1 per cent) preterm birthrate in the world, while Belarus had the lowest preterm birth rate of 4.1 pc, the report stated.

The countries preceding Pakistan in the preterm birth list were Malawi — 18.1 per 100 births; Comoros and Congo — 16.7 each; Zimbabwe — 16.6; Equatorial Guinea — 16.5; Mozambique — 16.4; Gabon — 16.3 and countries that followed Pakistan were Indonesia — 15.5; Mauritania — 15.4 and Botswana — 15.1. Among others Nepal and Bangladesh had the rate of 14.0 each, India 13.0, Iran — 12.9, Afghanistan — 11.5 and Sri Lanka — 10.7.

Estimated three-quarters of those preterm babies who die could survive without expensive care if a few proven and inexpensive treatments and preventions were available worldwide, according to experts who contributed to the report, representing almost 40 UN agencies, universities, including the Aga Khan University, Pakistan, and organisations.

The report explained what was known about preterm birth, its causes, and the kinds of care needed. The lead authors of the report from The March of Dimes Foundation, The Partnership for Maternal, Newborn & Child Health, Save the Children and The World Health Organisation, offered a detailed plan for actions needed to reduce both the death toll and the numbers of preterm births.

“All newborns are vulnerable, but preterm babies are acutely so,” said UN Secretary General Ban Ki-moon, who wrote the foreword to the report.

“Being born too soon is an unrecognised killer,” said Dr Joy Lawn, co-editor of the report and director, Global Evidence and Policy for Save the Children.

“The numbers of preterm births are increasing. In all but three countries, preterm birth rates increased in the last 20 years,” said Dr Lawn.

“Worldwide, 50 million births still happen at home and many babies die without birth or death certificates,” added the expert.

According to the report, the problem of preterm births is not confined to low-income countries. The United States and Brazil both rank among the top 10 countries with the highest number of preterm births.

Replying to Dawn queries related to the magnitude of the problem in Pakistan, Dr Zulfiqar Bhutta of the AKU, one of the authors of the report, said the problem could be solved through improving care of serious complications like infections and respiratory distress.

He said Pakistan had made very slow progress in maternal and child health. Once again in terms of global figures, the country had come out with very poor statistics for preterm births and survival, he added.

He attributed poor maternal nutrition, health care, young age at marriage and high burden of infections behind the high preterm births or premature labour.

He said most poor women at risk and receiving poor health care in Pakistan were in rural areas and urban slums, which were difficult to access. Chronic infections, diabetes and hypertension were major risk factors, he said.

Dr Bhutta said that under-nutrition and deficiencies made the matters worse.

Responding to another question, he said that healthcare providers could have a way to know which women would experience preterm labour.

“We can have training for appropriate care and support of salvageable preterm infants to reduce death and disability among premature babies,” he said. Preterm deliveries were equally common at hospitals and homes but were preventable, he added.