Maternal Adolescent Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK.
Data and Analytics, Division of Data, Research and Policy, UNICEF, NY, USA.
Lancet Glob Health. 2019 Jul;7(7):e849-e860. doi: 10.1016/S2214-109X(18)30565-5. Epub 2019 May 15.
BACKGROUND: Low birthweight (LBW) of less than 2500 g is an important marker of maternal and fetal health, predicting mortality, stunting, and adult-onset chronic conditions. Global nutrition targets set at the World Health Assembly in 2012 include an ambitious 30% reduction in LBW prevalence between 2012 and 2025. Estimates to track progress towards this target are lacking; with this analysis, we aim to assist in setting a baseline against which to assess progress towards the achievement of the World Health Assembly targets. METHODS: We sought to identify all available LBW input data for livebirths for the years 2000-16. We considered population-based national or nationally representative datasets for inclusion if they contained information on birthweight or LBW prevalence for livebirths. A new method for survey adjustment was developed and used. For 57 countries with higher quality time-series data, we smoothed country-reported trends in birthweight data by use of B-spline regression. For all other countries, we estimated LBW prevalence and trends by use of a restricted maximum likelihood approach with country-level random effects. Uncertainty ranges were obtained through bootstrapping. Results were summed at the regional and worldwide level. FINDINGS: We collated 1447 country-years of birthweight data (281 million births) for 148 countries of 195 UN member states (47 countries had no data meeting inclusion criteria). The estimated worldwide LBW prevalence in 2015 was 14·6% (uncertainty range [UR] 12·4-17·1) compared with 17·5% (14·1-21·3) in 2000 (average annual reduction rate [AARR] 1·23%). In 2015, an estimated 20·5 million (UR 17·4-24·0 million) livebirths were LBW, 91% from low-and-middle income countries, mainly southern Asia (48%) and sub-Saharan Africa (24%). INTERPRETATION: Although 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. FUNDING: Bill & Melinda Gates Foundation, The Children's Investment Fund Foundation, United Nations Children's Fund (UNICEF), and WHO.
背景：出生体重低于 2500 克的低体重儿（LBW）是母婴健康的重要指标，可预测死亡率、发育迟缓以及成年后慢性疾病。2012 年世界卫生大会制定的全球营养目标包括到 2025 年将 LBW 患病率降低 30%。目前缺乏评估这一目标进展的相关数据；本分析旨在为评估实现世界卫生大会目标的进展情况提供一个基线。
方法：我们试图找出 2000 年至 2016 年所有可用的活产 LBW 输入数据。如果包含活产儿出生体重或 LBW 患病率的信息，我们将考虑纳入基于人群的国家或全国代表性数据集。我们开发了一种新的调查调整方法并加以应用。对于具有高质量时间序列数据的 57 个国家，我们使用 B 样条回归对国家报告的出生体重数据趋势进行平滑处理。对于所有其他国家，我们使用具有国家层面随机效应的受限最大似然方法估计 LBW 患病率和趋势。通过自举法获得不确定性范围。在区域和全球层面汇总结果。
结果：我们整理了来自 195 个联合国会员国中 148 个国家的 1447 个国家年的出生体重数据（2.81 亿例分娩）（47 个国家没有符合纳入标准的数据）。2015 年全球 LBW 患病率估计为 14.6%（95%置信区间[CI]：12.4-17.1），而 2000 年为 17.5%（14.1-21.3）（平均年降低率[AARR]：1.23%）。2015 年，估计有 2050 万（95%CI：1740-2400 万）活产儿为 LBW，91%来自中低收入国家，主要来自南亚（48%）和撒哈拉以南非洲（24%）。
解释：尽管这些估计表明 2000 年至 2015 年间在降低 LBW 方面取得了一些进展，但要实现 2012 年至 2025 年全球营养目标要求的 2.74%的 AARR，需要将进展提高一倍以上，这既需要改善测量方法，也需要为解决整个生命周期 LBW 原因进行方案投资。
资金来源：比尔及梅琳达·盖茨基金会、儿童投资基金会、联合国儿童基金会（UNICEF）和世卫组织。
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