Events: Preterm deaths are still a challenge that the health sector in the country faces today.

Thirty-seven percent of preterm deaths contribute to neonatal mortality in the country, which is more than the global trend of 28 percent, according to the findings of the annual national maternal and neonatal death review.

Bhutan is one of the countries in South Asia that has a huge burden of preterm births, health minister Tandin Wangchuk said during an event to observe the fifth World Prematurity Day yesterday.

The World Health Organisation (WHO) estimates the number of preterm births for Bhutan at 1,380 each year, which translates to one preterm birth per 10 live births.

“As any country in the world, premature births are the number one killer of babies in Bhutan,” Lyonpo said.

Premature babies who survive find it difficult to live a normal life due to serious health challenges including life long disabilities such as cerebral palsy, lung problems, and vision and hearing loss, among others.

Therefore, Lyonpo said that prematurity birth is an important public health concern, which should be addressed both at the community and institutional levels.

Neonatologist with the national referral hospital, Dr Yoriko Nishizawa, said that a premature baby is usually not fully developed and some vital organs might not be functioning at optimal levels. While, some may not be ready to operate at all, which is why these babies are placed in the Neonatal Intensive Care Unit (NICU) and cared for by specialists.

Of 169 preterm newborns admitted in NICU last year, some 41 did not survive.

Dr Yoriko said that preterm birth rates in the country are rising and prevention of preterm birth must be accelerated.

“Premature babies can be saved with feasible, cost-effective care. Everyone has a role to play to meet the targets set,” Dr Yoriko said. “Bhutan needs to commit to end preventable newborn death and child disability.”

Hypertension, recurrent urinary tract infection (UTI), sexually transmitted infection, inadequate prenatal care, anemia and multiple pregnancy are some of the risk factors of preterm delivery in current pregnancy.

Occupational activity, smoking and substance use are some of the behavioral risk factors while maternal age that is below 18 and more than 40 years, poor nutrition, low socioeconomic factors are the other risk factors.

However, gynecologist with the national referral hospital, Dr Pema Choden Bhutia said that two thirds of preterm births occur among women with no risk factors.

How to improve the neonatal outcome in preterm birth is still a question, Dr Pema Choden said.

Treatment of chronic hypertension and prevention of preeclampsia is an important intervention to prevent indicated preterm birth.

Consideration of progesterone use and its feasibility in women with prior preterm delivery and prevention of potential most common indication of indicated preterm delivery such as preeclampsia is the way forward for Bhutan to prevent preterm birth, Dr Pema Choden said.

Globally, of about 15 million estimated preterm births every year, more than a million preterm babies die due to complications before attaining their first birthday.

Among the regions, countries in South Asia and Sub-Saharan Africa contribute over 60 percent of the global preterm burden.

Lyonpo said that preterm birth is at least in part preventable in nature and therefore provides an opportunity to focus on changing our outlook and behaviors to reverse the increasing burden of preterm births in the country.

It is important to sensitise the public to undertake preventative measures such as avoiding early age marriage, teenage pregnancy, smoking and alcohol abuse, and improve adolescent and maternal malnutrition to reduce the burden of preterm births in the country.

The health ministry accords priority to prevention and management of preterm births in the country.

Some of the initiatives include the implementation of Every Newborn Action Plan (2016 – 2023) in collaboration with the Jigme Dorji Wangchuck National Referral Hospital, Khesar Gyalpo University of Medical Sciences of Bhutan, UNICEF and WHO.

“This strategy aspires to achieve the target of neonatal mortality rate of 13.2 per 1000 live births by 2023 from 21 per 1000 live births at present.”

As a part of this plan, healthcare providers will be trained on Early Essential Newborn Care and Kangaroo Mother Care (KMC) and will be expanded in a phased manner to referral hospitals and dzongkhag hospitals in the country.

KMC is a standardised, protocol-based care system for preterm and low birth weight infants and is based on skin-to-skin contact between baby and mother.

“I am hopeful that these initiatives would go a long way in reduction of neonatal mortality in the country,” Lyonpo said.

Lyonpo urged all health professionals to work hard for the noble cause of improving quality care for preterm births in the country. “We need to create awareness and educate the public and communities on the issue and garner their support to prevent the problem.”

Dechen Tshomo