Health

Thousands of adverse birth outcomes in England down to ‘alarming’ inequality

Thousands of babies in England are being born prematurely, smaller than expected or stillborn because of “alarming” and “devastating” socioeconomic and racial inequality across the country, a landmark study has suggested.

Both are known risk factors for poor pregnancy outcomes. However, until now, little has been known about the scale of their “heartbreaking” impact on women and babies.

Now research involving more than 1m births suggests socioeconomic inequalities account for a quarter of all stillbirths, a fifth of preterm births, and a third of cases of foetal growth restriction (FGR), a condition in which babies are smaller than expected for their gestational age.

At the same time, one in 10 stillbirths and almost one in five FGR cases are due to racial inequalities, the study suggests. The findings, which have prompted calls for urgent action, were published in the medical journal the Lancet.

Dr Jennifer Jardine of the Royal College of Obstetrics and Gynaecologists (RCOG), one of the study’s co-lead authors, said: “I think that people will be shocked. The stark reality is that across England, women’s socioeconomic and ethnic background are still strongly related to their likelihood of experiencing serious adverse outcomes for their baby.”

The review, which was conducted by a team from the National Maternity and Perinatal Audit, analysed 1,155,981 birth records between April 2015 and March 2017 in NHS hospitals in England.

The analysis estimates that 24% of stillbirths, 19% of preterm births, and 31% of FGR cases were attributed to socioeconomic inequality and would not have occurred if all women had the same risk of adverse pregnancy outcomes as women in the least-deprived group.

Adjusting for ethnicity, maternal smoking and body mass index (BMI) substantially reduced these inequalities. That suggests that these characteristics can explain a considerable part of the socioeconomic inequalities in pregnancy outcomes.

Pregnancy complications disproportionately affected Black and minority-ethnic women: 12% of all stillbirths, 1% of preterm births, and 17% of FGR cases were attributed to ethnic inequality.

Prof Jan van der Meulen of the London School of Hygiene & Tropical Medicine, another co-lead author, told the Guardian the disparities were unacceptable but said there were no quick fixes that could immediately solve the problem.

The NHS has set a target of halving stillbirth and neonatal death rates and reducing levels of preterm birth by 25% by 2025.

However, the study findings suggest that current national programmes to make pregnancy safer, which focus on an individual woman’s risk and behaviour and their antenatal care, will not be enough to improve outcomes for babies born in England.

To reduce disparities in birth outcomes at a national level, Van der Meulen said, politicians, public health professionals and healthcare providers must work together to tackle racism and discrimination and improve women’s social circumstances, social support and health throughout their lives.

“National targets to make pregnancy safer will only be achieved if there is a concerted effort by midwives, obstetricians, public health professionals and politicians to tackle the broader socioeconomic and ethnic inequalities,” he said.

The largest increases in excess risk of complications among the most socioeconomically disadvantaged Black and south Asian and women.

Half of stillbirths (53.5%) and seven in 10 FGR cases (71.7%) among south Asian women living in the most deprived fifth of neighbourhoods in England could be avoidable if they had the same risks as white women in the most affluent fifth, the study suggests.

This was similarly the case for nearly two-thirds of stillbirths (63.7%) and half of FGR cases (55%) among Black women from the most deprived neighbourhoods.

“There are many possible reasons for these disparities,” said Van der Meulen. “Women from deprived neighbourhoods and Black and minority ethnic groups may be at a disadvantage because of their environment, for example, because of pollution, poor housing, social isolation, limited access to maternity and health care, insecure employment, poor working conditions, and stressful life events.”

Dr Edward Morris, the president of the RCOG, said the findings of the study were alarming, adding: “They provide more evidence that poverty, racism and discrimination can affect women throughout their lives and ultimately lead to devastating incidences of pregnancy complications and baby loss.”

Dr Christine Ekechi, a consultant obstetrician and gynaecologist and co-chair of RCOG’s race equality taskforce, said the disparities were heartbreaking.

“These women are being let down by a healthcare system that is supposed to protect them. Reducing the occurrence of potentially avoidable adverse pregnancy outcomes needs to be a national priority,” she said.

Health

Sierra Leone reports first case of monkeypox

Sierra Leone has reported its first confirmed case of mpox since the World Health Organization (WHO) raised its highest alert level for the potentially deadly viral disease last year.

According to the National Public Health Agency, the patient is a 27-year-old man from the rural district of the Western Zone, near the capital Freetown.

“Health teams are actively tracing and investigating to identify potentially exposed persons and to prevent further spread,” the agency announced in a social media post.

The confirmed case was detected on January 10, though health officials have not specified the variant affecting the patient.

Mpox, caused by a virus from the same family as smallpox, presents with high fever and skin lesions known as vesicles.

The disease was first identified in the Democratic Republic of Congo in 1970 and had mainly been limited to a dozen African countries before spreading more widely in 2022, including to regions where the virus had not previously circulated. The WHO declared its highest alert level for the disease in 2024.

In response, Sierra Leonean health authorities have swiftly activated containment measures. The infected patient has been placed in isolation while contacts will be monitored for 21 days. Surveillance efforts have been increased in all areas visited by the patient.

A public awareness campaign has been launched, and health workers are being equipped with protective gear and trained in prevention techniques to curb further spread.

Sierra Leone was previously one of the hardest-hit countries during the Ebola epidemic, which claimed around 4,000 lives, including nearly seven percent of the nation’s health workers, between 2014 and 2016.

Health

Risk of HMPV infection in Nigeria moderate- NCDC

The Nigeria Centre for Disease Control (NCDC) says the risk of the human metapneumovirus (HMPV) in the country is moderate.

HMPV, which was first reported in 2001 in the Netherlands, is a single-stranded ribonucleic acid (RNA) virus that causes symptoms similar to the common cold and influenza including cough, fever, nasal congestion, and fatigue, with an incubation period of three to six days.

It causes severe complications like pneumonia in infants, the elderly, and those with weakened immune systems and spreads through respiratory droplets or contact with contaminated surfaces.

China is currently experiencing an outbreak of the virus, sparking global concern. India has also reported at least two cases of the virus.

In an advisory issued, the NCDC said the agency, in collaboration with the ministry of health, is closely monitoring global developments. The agency said as of January 6, 2025, data from surveillance does not indicate any unusual increase in respiratory infections, including those caused by HMPV.

“However, given the global trends in HMPV cases, the Nigeria Centre for Disease Control and Prevention (NCDC) is proactively implementing measures to strengthen the country’s preparedness and response capacity.

In collaboration with the Federal Ministry of Health and partners such as the World Health Organization (WHO), the U.S. Centers for Disease Control and Prevention (USCDC), and the UK Health Security Agency (UKHSA), conducted a dynamic risk assessment for Human Metapneumovirus (HMPV).

The assessment classified the risk of HMPV for Nigeria as moderate. This evaluation will inform and guide preparedness efforts, decision-making, and response strategies to mitigate potential impacts.”

The NCDC said it is also collaborating with port health authorities to ensure robust preparedness at all international points of entry (PoEs).

“In addition, quarantine facilities are being identified and prepared to manage any suspected or confirmed cases if required. Infection Prevention and Control (IPC) materials are being deployed to PoEs to ensure adherence to hygiene and safety protocols. Information, Education, and Communication (IEC) materials are being developed and distributed to raise awareness and provide clear guidelines for frontline staff and travelers at PoEs.

The National Influenza Sentinel Surveillance (NISS) sites across the six geopolitical zones monitor Influenza-like Illness (ILI) and Severe Acute Respiratory Infections (SARI) which is already testing for COVID-19, will now also start testing for HMPV. Provisions will be made to increase the number of tests conducted. Additionally, laboratories in states with international airports will be supported to enable them to test for HMPV.”

Health

WHO declares new COVID outbreak in China global health emergency

The World Health Organization, WHO, has declared the outbreak of a new coronavirus in China, a global health emergency.

The WHO Director-General Tedros Ghebreyesus made the announcement at a press conference in Geneva.

WHO’s emergency committee on the epidemic had reportedly met Thursday afternoon and recommended designating the outbreak a Public Health Emergency of International Concern, PHEIC.

The decision had been “almost unanimous,” Didier Houssin, chair of the emergency committee, said at the press conference.

“The main reason for this declaration is not because of what is happening in China, but because of what is happening in other countries,” Tedros said at the press conference.

“Our greatest concern is the potential for the virus to spread to countries with weaker health systems and which are ill-prepared to deal with it. Let me be clear, this declaration is not a vote of no confidence in China. On the contrary, WHO continues to have confidence in China’s capacity to control the outbreak.”

Tedros also outlined recommendations made by the emergency committee to control the outbreak, including accelerating the development of vaccines and drugs and combatting the spread of misinformation.

This is the sixth time WHO has used that label, Public Health Emergency of International Concern, PHEIC. since the designation was introduced 15 years ago.