**2. The exaggerated risk of death for the preterm newborns at the community level**

Birth and the succeeding few days present the highest risk of death to any newborn in the human lifespan because of the delicate needs of body temperature regulation, glycemic control, and a clean environment to prevent infection. Preterm infants, however, are at an exaggerated risk of dying compared to their full-term counterparts as they are not able to adequately regulate their body temperature, have poor suckling reflex for adequate feeding, and also have poor lung maturity for adequate lung expansion and are therefore, prone to respiratory distress syndrome and infection [5, 6]. These medical complications may be managed with relative ease in the health care facility setting and this makes the difference in survival for the preterm newborns in the different economies.

Most health facilities in the developing world still lack the appropriate technology and skills to save preterm neonates, and it is worse at the community level where the health systems lack community structures for continued care at home after hospital discharge or to access care for those delivered from home. The death of a preterm baby is thus, considered inevitable by both the healthcare system and the families in these economies, yet many of them could be saved with simple interventions that can be rendered and/or continued at the community level [7]. The majority (>80%) of preterm babies are born between 32–37 weeks of gestation and can survive without the need for sophisticated medical care [8]. This chapter aims to highlight the key medical needs of the preterm neonates and how community health structures can be re-aligned to offer simple interventions to support their survival at home in developing countries. It is an attempt to contribute to the efforts towards achieving SDG goal 3 target of reducing neonatal mortality to at least 12 per 1,000 live births [9].

### **3. The rationale for a community approach in the developing economies**

The risk factors for preterm births are ripe in the developing economies where access to health care is poor. Young and advanced maternal age, low maternal body *Approaches at Community Level for Care of the Preterm Neonates in Low-Income Countries DOI: http://dx.doi.org/10.5772/intechopen.96920*

mass, short inter-pregnancy intervals, gender-based violence, infections such as urinary tract infections, malaria, bacterial vaginosis, HIV, and syphilis are still very common in these countries and are associated with preterm births. Lifestyle behaviors such as excessive physical work, smoking and excessive alcohol consumption have also been associated with preterm births and are common practices in these developing countries [10].

The numbers of preterm births are therefore, higher in these countries and yet survival is poor, as most of these births take place at home, some of the traditional practices of neonatal care simply heighten neonatal infection rates such as application of substances on the cord, the knowledge to detect danger signs is limited and referral pathways are also limited. Well planned and coordinated interventions at community level would argument health system programs to reduce neonatal mortalities in these countries. However, before such interventions are designed and implemented, there is need to assess the contextual newborn care practices at the household level and understand the beliefs attached to these practices. This helps to inform the cultural feasibility and therefore, acceptability of the intervention as well as to define the delivery platform within the local health system.
