This opinion piece was first published in Jornal de Angola, a copy of which can be found here: https://www.jornaldeangola.ao/noticias/9/opini%C3%A3o/652265/prematuridade:-um-desafio-silencioso-que-angola-precisa-de-vencer 

By Dr Natércia de Almeida, WHO Maternal and Child Health Officer  

World Prematurity Day, celebrated on November 17 and recently recognized by the World Health Assembly, has this year’s theme: ‘Giving premature babies a strong start for a promising future.’ More than a symbolic date, it is a call to urgent action.

In Angola, despite the progress made, neonatal, infant, and maternal mortality rates remain above the global average. Data from the Multiple Indicator Cluster Survey (MICS) show that between 2015/16 and 2023/24, the rates decreased from 24 to 16 neonatal deaths per 1,000 live births, from 44 to 32 infant deaths, and from 239 to 170 maternal deaths per 100,000 births. These are significant advances, but will they be enough to achieve the Sustainable Development Goals (SDGs) by 2030?

Neonatal mortality accounts for the majority of infant deaths, especially in the first 28 days of life. In 2015/2016, about 25% of deaths of children under five were associated with complications during delivery and prematurity, i.e., birth before 37 weeks of gestation.  Although rates have declined, current figures are likely to be underestimated, given that half of all births still occur outside health facilities, making proper registration difficult.

Prematurity is a silent emergency. Worldwide, one in ten babies is born prematurely, facing a high risk of respiratory complications, infections, hypothermia, and developmental delays. Without proper care, these conditions can be fatal. The disparity in response is striking in low-income countries, where only 10% of extremely premature babies survive, compared to 90% in rich countries. What message does this difference send us about the urgency of action? Each death represents an irreparable loss — and perhaps we are losing future geniuses like Albert Einstein, Isaac Newton, Charles Darwin, or Pablo Picasso who were born prematurely.

The World Health Organisation (WHO) and the United Nations Children’s Fund (UNICEF) warn of the need to invest in high-impact, low-cost interventions, especially in resource-limited settings. 

Among the recommended strategies, the following stand out: a) Strengthen maternal health services to prevent premature births and detect conditions such as hypertension and infections promptly; b) Ensure specialised care for small and sick newborns, including neonatal units, the kangaroo mother care method, and trained professionals; c) Supporting families with emotional and practical resources to care for their babies; and d) Promoting equity by ensuring that survival does not depend on geography or income.

In Angola, it is essential to invest in cost-effective solutions. The widespread implementation of the Kangaroo Mother Care method can save thousands of lives, while the creation of neonatal intensive care units remains a significant challenge. Training health professionals to provide quality antenatal care is equally crucial. Furthermore, regular check-ups for pregnant women allow for the identification and treatment of conditions that often lead to premature birth, such as vaginal infections and high blood pressure. 

For this approach to be successful, it is necessary to ensure access to basic materials, such as vaginal speculums and sphygmomanometers, as well as to raise awareness among communities about the importance of early and regular prenatal care. Another essential step is to invest in the continuous training of doctors and nurses in obstetrics, neonatology, and paediatrics. These professionals need adequate conditions to apply the knowledge they have acquired, which means improving infrastructure and ensuring essential equipment is available. Are we ready to take this leap?

Premature birth should not be synonymous with a death sentence. All babies deserve not only to survive, but also to thrive. Honouring this promise means investing in Angola’s future. 

The fight against prematurity requires a strong political commitment, adequate resources, and active community involvement. Everyone’s support is needed: families, civil society, politicians, and the private sector. It is time to make prematurity, this silent challenge, a national priority and to protect our beautiful children.