Low birthweight: will new estimates accelerate progress?
Authors: Tanya Doherty, Mary Kinney
Journal: The Lancet Global Health (2019)

Birthweight is an important gauge of maternal and fetal health as well as an important determinant of perinatal, neonatal, and postneonatal outcomes. Approximately 80% of newborns who die every year are low birthweight (LBW), under 2500 g, because they were either born preterm or small for gestational age or both.1Katz J Lee AC Kozuki N et al.Mortality risk in preterm and small-for-gestational-age infants in low-income and middle-income countries: a pooled country analysis.Lancet. 2013; 382: 417-425Summary Full Text Full Text PDF PubMed Scopus (498) Google Scholar, 2WHOUNICEFSurvive and thrive: transforming care for every small and sick newborn: key findings. World Health Organization, Geneva2018Google Scholar LBW newborns who survive have a greater risk of both short-term and long-term adverse health consequences. In 2012, countries committed to a 30% reduction of LBW by 2025 as one of the Global Nutrition targets.3World Health AssemblyResolution WHA65.6. Comprehensive implementation plan on maternal, infant and young child nutrition. Sixty-fifth World Health Assembly Geneva, May 21–26, 2012. World Health Organization, Geneva2012Google Scholar Monitoring trends within and across countries is necessary to track progress and crucial to achieving the Sustainable Development Goal for health. UN agencies have previously tracked LBW estimates by means of non-comparable, national data sources, making it difficult to interpret and respond to patterns.4UNICEFState of the World's Children: Low birthweight data.https://data.unicef.org/resources/dataset/low-birthweight-sowc/Date: 2017Date accessed: December 28, 2018Google Scholar In The Lancet Global Health, Hannah Blencowe and colleagues present the first systematic estimates of global, regional, and national LBW trends that incorporate new data sources and analytical approaches to adjust survey data for heaping and missing data.5Blencowe H Krasevec J de Onis M et al.National, regional, and worldwide estimates of low birthweight in 2015, with trends from 2000: a systematic analysis.Lancet Glob Health. 2019; (published online May 15.)http://dx.doi.org/10.1016/S2214-109X(18)30565-5Summary Full Text Full Text PDF PubMed Scopus (338) Google Scholar The authors collated data from national administrative sources and nationally representative surveys for 148 of 195 UN member states. They estimated a worldwide LBW prevalence in 2015 of 14·6%, resulting in 20·5 million LBW livebirths, with 91% from low-and-middle income countries. The global trend estimate presented shows an average annual rate of reduction in LBW of only 1·23% between 2000 and 2015, well short of the estimated 2·74% required to meet the target.6WHOGlobal nutrition targets 2025: low birth weight policy brief (WHO/NMH/NHD/14.5). World Health Organization, Geneva2014Google Scholar Their work brings to light the enormous inequities in data availability. Nearly half of all datapoints (48%) were from high-income countries. Only 13% of input data came from sub-Saharan Africa and south Asia, the regions with the highest LBW prevalence. National administrative data came predominantly from high-income (65%) or upper-middle-income (28%) settings whereas for low-income and lower-middle-income settings, 54% of LBW datapoints were from household surveys. Furthermore, 47 countries had insufficient data to generate a national estimate, 62% of these being low-income and lower-middle-income countries. Data on LBW prevalence is needed to assist countries in developing action plans and accountability measures and to monitor progress; yet many barriers prevent accurate LBW measurement. It is estimated that globally the birthweight of 48% of infants is not recorded,6WHOGlobal nutrition targets 2025: low birth weight policy brief (WHO/NMH/NHD/14.5). World Health Organization, Geneva2014Google Scholar either because they are born outside of health facilities, or in ill-equipped health facilities, or because of weak health information systems. Routine administrative data sources, such as the District Health Information System 2 and civil registration and vital statistics systems, should be capturing data on birthweight. Investments in strengthening these routine data systems could provide disaggregated information to enable greater local and national use of data for action. In settings where routine information systems remain weak, surveys continue to be an important source for LBW data; and this paper has shown that analytical methods can be used to adjust for methodological biases. The authors present an urgent and practical call to action to greatly improve the coverage of weighing at birth, including the need to count and weigh all babies (livebirths and stillbirths), strengthen existing data and health systems, and innovate better weighing devices. Yet achieving this practically, especially in emergency settings or weak health systems, remains a challenge. Although the paper calls for accurate gestational age measurement, which is a desperately needed component of high-quality antenatal care, birthweight remains a highly important and relevant indicator since accurate gestational age measurement is unlikely to be done systematically in the immediate future in many settings where the burden is greatest. Alongside improving measurement, multidimensional, context-specific national action plans are needed to achieve the Global Nutrition targets with support from funders and implementation partners. These should include improving nutritional status of women and girls, before and during pregnancy; treating pregnancy-associated conditions such as pre- eclampsia; and providing quality antenatal care. Furthermore, feasible, cost-effective interventions exist to reduce adverse outcomes amongst LBW newborns, such as kangaroo mother care7Conde-Agudelo A Diaz-Rossello JL Kangaroo mother care to reduce morbidity and mortality in low birthweight infants.Cochrane Database Syst Rev. 2016; 8 (CD002771.)PubMed Google Scholar and household interventions such as early stimulation.2WHOUNICEFSurvive and thrive: transforming care for every small and sick newborn: key findings. World Health Organization, Geneva2018Google Scholar Strong community-facility linkages are also required to identify and refer pregnant women at high risk of newborn or to address behavioural and social norms that negatively affect the care and survival of these babies.8Kinney MV Smith JM Doherty T Hermida J Daniels K Belizan JM Feasibility of community level interventions for pre-eclampsia: perspectives, knowledge and task-sharing from Nigeria, Mozambique, Pakistan and India.Reprod Health. 2016; 13: 125Crossref PubMed Scopus (3) Google Scholar, 9Banda G Guenther T Chavula K et al."Khanda ndi Mphatso" (A baby is a gift): evaluation of a comprehensive social behavior change communication campaign to shift social norms and support for preterm babies in Malawi.J Dev Commun. 2018; 29: 111-136Google Scholar Digital health approaches, such as MomConnect in South Africa, also show promise.10Coleman J Xiong K Gauging the impact of MomConnect on maternal health service utilisation by women and their infants in Johannesburg, South Africa. MEASURE Evaluation SIFSA, Johannesburg2017Google Scholar With continued momentum on child survival and health, including early childhood development,2WHOUNICEFSurvive and thrive: transforming care for every small and sick newborn: key findings. World Health Organization, Geneva2018Google Scholar, 11WHOUNICEFWorld Bank GroupNurturing care for early childhood development: a framework for helping children survive and thrive to transform health and human potential. World Health Organization, Geneva2018Google Scholar, 12WHOEvery Newborn: An action plan to end preventable newborn deaths. World Health Organization, Geneva2014Google Scholar these new LBW estimates provide an opportunity to advance the agenda and call on all stakeholders to take concerted action in the effort to ensure that every newborn is weighed at birth, and that the information is collated and used for local action and accountability at the household, community, district, national, and global levels. At the same time, we must improve care for the 20·5 million LBW infants and their families each year. We declare no competing interests. National, regional, and worldwide estimates of low birthweight in 2015, with trends from 2000: a systematic analysisAlthough these estimates suggest some progress in reducing LBW between 2000 and 2015, achieving the 2·74% AARR required between 2012 and 2025 to meet the global nutrition target will require more than doubling progress, involving both improved measurement and programme investments to address the causes of LBW throughout the lifecycle. Full-Text PDF Open Access