A description of congenital anomalies among infants in Entebbe, Uganda

A retrospective study of congenital anomalies and associated risk factors among children admitted at a tertiary hospital in northwestern Tanzania

Congenital anomalies in Sub-Sahara Africa (SSA) are understudied despite the significant pediatric health burden. This retrospective longitudinal hospital-based study evaluated the records of 326 inpatient children under the age of two years with congenital anomalies at Bugando Medical Centre, a tertiary referral hospital in northwestern Tanzania. Classical logistic regression was used in the analysis of congenital malformation of muscles, gastrointestinal malformation, oral facial clefts, neural tube defects, and skeletal malformations. A modified poisson regression was used to model risk factors for Central Nervous System (CNS) hydrocephalus and congenital heart disease (CHD). A majority (78.8%) of children included in the study were less than six months of age. Nearly half (48.8%) were diagnosed with CHD followed by CNS hydrocephalus (10.4%) and congenital malformation of muscles (8.9%). Babies whose mothers missed periconceptual folic acid supplementation had 83% higher risk of hydrocephalus (aPR = 1.83, 95% CI = 1.11-1.96) and 78% higher for CHD (aPR = 1.78, 95% CI = 1.31-1.94). Male children had 1.67 higher odds of muscular congenital malformations (aOR = 1.67, 95% CI = 1.23-1.89). Less than 37 gestational age had a 1.86 higher odds of muscular congenital malformations (aOR = 1.86, 95% CI = 1.53-3.66). Our study highlights the critical need for folic acid supplementation and establishes a need for a registry and the potential for mapping.

Adherence to iron and folate supplementation and associated factors among women attending antenatal care in public health facilities at Covid-19 pandemic in Ethiopia

Adhesion is the degree to which a patient complies with treatment recommendations made by a health care professional. The majority of pregnant women worldwide don't get the recommended amounts of iron and folic acid (30 to 60 mg of iron and 400 g of folic acid/day for 6 months) pregnant women are more likely to develop iron- and folic acid deficiency anemia. For iron and folate supplementation programs to be effective in Ethiopia, adherence is a significant issue. So, this study aimed to evaluate the level and barriers preventing women receiving antenatal care from taking iron and folate supplements. A phenomenological qualitative study design was added to a facility-based cross-sectional study. The sample was established using a double population proportion formula. For the quantitative and qualitative study, 308 pregnant women and the focal points for the health facilities were chosen at random, using systematic random sampling and purposive sampling techniques. For the quantitative study, a face-to-face interviewer-guided, pre-tested structured questionnaire was used; for the qualitative study, a semi-structured questionnaire was used. Data was entered twice, cross-checked by comparing the two separate entries in Epi Data version 7.2.2.6, and exported to SPSS version 25 for analysis. COR and AOR with 95% CI are used to evaluate the relationship between variables and control for confounding factors. Statistical significance was declared at a p-value < 0.05. All, 308 (100%) participants were involved. 56.5% of pregnant women attending an ANC clinic (95% CI: 51%-62.2%) adhered to Iron and folate supplementation. Mothers with primary education], Urban residents mothers, Mother who had four or more ANC visits, mothers who had registered for their first ANC at early gestational age, mothers who had good awareness about birth defects were independent predictors of adherence to Iron and folate supplementation. In our study, adherence to iron and folate supplementation was low relative to previous research findings. Promoting early and frequent ANC visits and improving pregnant women's awareness of anemia and birth defects through education is necessary to increase the adherence status.

Proportion of Chromosomal Disorders and Their Patterns among Births with Congenital Anomalies in Africa: A Systematic Review and Meta-Analyses

Introduction

Worldwide, surveys have shown that the frequency of chromosomal disorders among births with congenital anomalies varies greatly from country to country. It is well known that chromosomal disorders are an important cause of premature death or life-long disability; however, the absence of local epidemiological data on their birth prevalence and outcomes impedes policy and service development in many countries and continents. Therefore, the current systematic review and meta-analysis intend to show the pooled proportion of chromosomal disorders among births with congenital anomalies in Africa.

Methods

From PubMed, Cochrane Library, and Google Scholar, we systematically reviewed and meta-analyzed the studies that examined the incidence, prevalence, and types of chromosomal disorders using PRISMA guidelines. A weighted inverse variance random-effects model was used to estimate the pooled proportion of chromosomal disorders among births with congenital anomalies.

Results

From the total of 3,569 studies identified, 1,442 were from PubMed, 108 were from Cochrane Library, 1,830 were from Google Scholar, and 189 were from other sources. After duplication was removed, a total of 844 articles remained (2725 were removed by duplication). Finally, 144 full-text studies were reviewed and 60 articles with 52,569 births having congenital anomalies met the inclusion criteria and were selected for this meta-analysis. The pooled proportion of chromosomal disorders among births with congenital anomalies was 8.94% (95% CI; 7.02, 10.86; I ² = 98.8%; p < 0.001). Conclusions and Future Implications. In the current systematic review and meta-analysis, the pooled proportion of chromosomal disorders among births with congenital anomalies in Africa was small. Down syndrome (trisomy 21) accounted for more than 80% of chromosomal disorders. The pooled proportion of chromosome disorders was the highest in North African regions and countries compared to other regions of the continent. Healthcare managers should focus on establishing proper cytogenetic diagnostic facilities in collaboration with well-trained genetic counseling services in the continent.

Changing the outcomes of newborns with surgical conditions at a tertiary-level hospital in Kenya: a cluster randomized trial

Background

Globally, 10% of neonatal mortality in low-/middle-income countries (L/MIC) is directly attributed to surgical conditions, and appropriate referral and transport of newborns to tertiary-level hospitals for surgical care often underlie their survival. This study aimed at evaluating the outcomes of newborns with surgical conditions in a low-resource setting, in the context of a structured standard operating procedure (SOP) for newborn transport. 

Methods

A cluster randomized controlled trial was conducted. Ten county hospitals that refer newborns with surgical conditions to the Moi Teaching and Referral Hospital (MTRH) were selected and randomized into intervention group (A) and control group (B). A structured standard operating procedure (SOP) for transport of newborns was introduced in the hospitals in group A via an education module. Thereafter, 126 newborns (63 in group A and 63 in group B) were enrolled, upon their admission to the MTRH. All the newborns from both groups of referring hospitals were given standard surgical care upon admission. Data on study variables was collected and analyzed, and the outcomes of the newborns in the two groups were compared to assess the effect of the structured SOP.

Results

The median age at admission was 4.1 days in group A and 4.6 days in group B. The top 4 surgical conditions were gastroschisis, hydrocephalus, Hirschsprung’s disease, and anorectal malformations. There was a statistically significant difference (p < .05) in all parameters that measured the clinical status of the newborns at admission, in the two groups. Mortality rate was 3.2% in group A and 28.6% in group B (p < .001), and hospital stay was 11 days in group A and 18 days in group B.

Conclusion

Appropriate transport of newborns with surgical conditions significantly improved their outcomes at the MTRH.

Level of evidence

II

Congenital anomalies during the 2015–2018 Zika virus epidemic: a population-based cross-sectional study

Background

Congenital anomalies are associated with several clinical and epidemiological complications. Following the Zika epidemic onset in Latin America, the incidence of congenital anomalies increased in Brazil. This study aimed to determine the frequency of congenital anomalies in one Brazilian state and assess potential factors associated with them.

Methods

This cross-sectional descriptive study was based on data concerning congenital anomalies recorded in the Brazilian Live-Born Information System during the Zika epidemic in Mato Grosso do Sul state from 2015 to 2018. Congenital anomalies were stratified according to year of birth and classified using ICD-10 categories.

Results

In total, 1,473 (0.85%) anomalies were registered. Within the number of cases recorded, microcephaly showed the greatest frequency and variations, with a 420% increase observed in the number of cases from 2015 to 2016. We identified an increase in the incidence of central nervous system anomalies, with the highest peak observed in 2016 followed by a subsequent decrease. Musculoskeletal, nervous, and cardiovascular system anomalies, and eye, ear, face, and neck anomalies represented 73.9% of all recorded anomalies. There was an increased chance of congenital anomalies in uneducated (odds ratio [OR] 5.56, 95% confidence interval [CI] 2.61–11.84) and Indigenous (OR 1.32, 95% CI 1.03–1.69) women, as well as among premature births (OR 2.74, 95% CI 2.39–3.13).

Conclusions

We estimated the incidence of congenital anomalies during the Zika epidemic. Our findings could help to support future research and intervention strategies in health facilities to better identify and assist children born with congenital anomalies.

Birth prevalence of neural tube defects in eastern Africa: a systematic review and meta-analysis

BACKGROUND

Neural tube defects (NTDs) are associated with high rates of neonatal mortality and morbidity worldwide. The promotion of folic acid fortification and supplementation in pregnant women by the Food and Drug Administration significantly decreased the incidence of NTDs in the United States. This practice is not widely adopted in Eastern Africa countries. We hypothesized that these countries experience a higher burden of NTDs than countries that promote the use of folic acid. We aimed to estimate the birth prevalence of NTDs in the United Nations (UN) Eastern African region.

METHODS

PubMed (Medline), Embase, and Cochrane Library databases were systematically searched from inception to December 17, 2021. We included randomized controlled trials or observational studies that reported the prevalence estimates of NTDs in Eastern Africa. Random effects model was used to pool the effect estimates. The GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach was used to assess the certainty of the evidence. Outcome measures were overall and specific (spina bifida, anencephaly, encephalocele) rates of NTDs per 10,000 births, including live and stillborn cases.

RESULTS

The meta-analysis included 20 studies consisting of 752,936 individuals. The pooled prevalence of all NTDs per 10,000 births in Eastern Africa was 33.30 (95% CI: 21.58 to 51.34). Between-study heterogeneity was high (I² = 97%, p < 0.0001), The rate was highest in Ethiopia (60 per 10,000). Birth prevalence of spina bifida (20 per 10,000) was higher than anencephaly (9 per 10,000) and encephalocele (2.33 per 10,000). No studies on NTDs were identified in 70% of the UN Eastern Africa region. Birth prevalence increased by 4% per year from 1983 to 2018. The level of evidence as qualified with GRADE was moderate.

CONCLUSION

The birth prevalence of NTDs in the United Nations region of Eastern Africa is 5 times as high as observed in Western countries with mandatory folic acid supplementation in place. Therefore, mandatory folic acid supplementation of stable foods may decrease the risk of NTDs in Eastern Africa.

Trends of Hospital Admissions Due to Congenital Anomalies in England and Wales between 1999 and 2019: An Ecological Study

Objectives: To investigate the trends in congenital anomalies-related hospital admissions in England and Wales. Methods: This was an ecological study that was conducted using hospital admission data taken from the Hospital Episode Statistics database in England and the Patient Episode Database for Wales. Congenital malformations, deformations and chromosomal abnormalities hospital admissions data were extracted for the period between April 1999 and March 2019. Results: Hospital admission rate increased by 4.9% [from 198.74 (95% CI 197.53–199.94) in 1999 to 208.55 (95% CI 207.39–209.71) in 2019 per 100,000 persons, trend test, p < 0.01]. The most common hospital admissions causes were congenital malformations of the circulatory system, the musculoskeletal system, genital organs, and the digestive system. The most notable increase in hospital admissions rate was observed in congenital malformations of the respiratory system (1.01-fold). The age group below 15 years accounted for 75.1% of the total number of hospital admissions. Males contributed to 57.5% of the whole number of hospital admission. Hospital admission rate between females was increased by 6.4% [from 162.63 (95% CI 161.10–164.16) in 1999 to 173.05 (95% CI 171.57–174.54) in 2019 per 100,000 persons]. Hospital admission rate between males was increased by 3.4% [from 236.61 (95% CI 234.72–238.50) in 1999 to 244.70 (95% CI 242.92–246.49) in 2019 per 100,000 persons]. Conclusions: Males had a higher percentage of hospitalisation compared to females. Further studies to investigate the factors associated with higher hospitalisation rate among males are needed.

Prevalence of neural tube defects, maternal HIV status, and antiretroviral therapy from a hospital-based birth defect surveillance in Kampala, Uganda

BACKGROUND

The estimated prevalence of neural tube defects (NTDs) in Africa is 11.7 per 10,000 live births; however, data on the impact of antiretroviral therapy (ART) during pregnancy and the risk for birth defects in Africa are limited.

METHODS

Data from a hospital-based surveillance program at four hospitals in Kampala, Uganda were used to estimate the baseline prevalence of NTDs and assess potential associations with HIV status and ART use. All live births, stillbirths, and spontaneous abortions delivered at the participating hospitals affected with selected birth defects between August 2015 and December 2018 were included. Trained midwives collected data from hospital records, maternal interviews, photographs, and narrative descriptions of birth defects. We estimated NTD prevalence per 10,000 births (live, stillbirths, spontaneous abortions), prevalence ratios, and 95% confidence intervals (CIs).

RESULTS

A total of 110,752 births from 107,133 women were included in the analysis; 9,394 (8.8%) women were HIV-infected and among those with HIV infection, 95.6% (n = 8,977) were on ART at delivery. Overall, 109 births were affected with NTDs, giving a prevalence of 9.8 (95% CI [8.2, 11.9]). Spina bifida (n = 63) was the most common type of NTD, with a prevalence of 5.7 (95% CI [4.4, 7.3]), followed by anencephaly (n = 31), with a prevalence of 2.8 (95% CI [2.0, 4.0]).

CONCLUSION

The prevalence of NTDs among births in Kampala, Uganda is consistent with current estimates for Africa. With the continued introduction of new medications that may be taken during pregnancy, sustainable birth defect surveillance systems and pharmacovigilance are indicated.

Knowledge, attitudes, and decision making towards prenatal testing among antenatal clinic attendees in Lagos University Teaching Hospital: an institution-based cross-sectional study

Introduction

in Africa, genetic diseases and congenital anomalies remain a significant source of morbidity and mortality. Existing data suggests a gap in the use of prenatal tests among pregnant women to better inform decision making. We examined relationships of socio-demographic factors with willingness to terminate affected pregnancies, and the use of, knowledge of, and attitudes towards prenatal screening/diagnostic tests.

Methods

this was a cross-sectional descriptive study of pregnant women who attended antenatal clinics at the Lagos University Teaching Hospital (N = 422) selected by convenience sampling. Responses were obtained with assisted self-administered structured questionnaires.

Results

mean ± S.D. age of the respondents was 32.5 ± 5.3 years. The majority of the participants (92.2%) had at least a secondary education. Ultrasound scans in the second trimester were the most frequently used test (39.1%). Only 77 (18.2%) of the respondents indicated willingness to terminate affected pregnancies. The majority of the respondents had fair knowledge and good attitude scores. Knowledge and attitude scores were significantly correlated (r = 0.25, p < 0.001). Compared to married women, being single was associated with a 2.62-point lower knowledge score (95% CI: -4.63, -0.62, p = 0.01). Compared to women who responded “no” when asked if they were willing to terminate an affected pregnancy, women who responded “maybe” had a 0.81-point lower attitude score (95% CI: -1.45, -0.17, p = 0.01).

Conclusion

our results suggest important socio-demographic differences in women´s knowledge/ behaviours towards prenatal diagnostic tests. Further research is needed to explore these relationships and broader pregnancy-related ethical beliefs among pregnant women in Lagos.

Congenital anomalies among newborn babies in Felege-Hiwot Comprehensive Specialized Referral Hospital, Bahir Dar, Ethiopia

Congenital anomaly is a structural or functional defect which could occur in any organ system. The aim of this study was to determine the prevalence and associated factors of congenital anomalies among newborn babies delivered at Felege-Hiwot Comprehensive Specialized Referral Hospital, Bahir Dar, Ethiopia. A cross-sectional study design was used to review medical records/charts of 11,177 new born babies born at the delivery ward of Felege-Hiwot Comprehensive Specialized Referral Hospital, Ethiopia. The data were collected using an abstraction form. A bivariate analysis was done to assess factors associated with congenital anomalies. Variables whose p-value < 0.2 were included in the multivariable analysis to identify the effects of confounders. P-values < 0.05 were considered statistically significant. A total of 11,177 newborn babies and their mothers were included in the study and the proportion of congenital anomalies was found to be 0.62%. The most (46.4%) prevalent congenital anomaly was neural tube defects. Newborn birth weight < 1.25 kg [AOR, 32.6, 95% CI 11.9-89.0], and newborn weight < 2.5 kg [AOR, 2.67, 95% CI 1.54-4.65], antenatal visits [AOR, 4.0, 95% CI 2.39-6.69] and urban residence [AOR, 2.1, 95% CI 1.28-3.55] were statistically significant factors. In conclusion, neural tube defects were anomalies prevalent in this study. Antenatal visits, birth weight and residence were factors associated with congenital anomalies.

The prevalence and patterns of chromosome abnormalities in newborns with major congenital anomalies: A retrospective study from Saudi Arabia

Congenital anomalies are a worldwide health problem that places a burden on the family and society. Chromosome abnormalities are one of the leading causes for congenital anomalies in newborns. Despite the remarkable development in cytogenetic services in the past years, still there are limited data from Middle East countries. The current study aimed to evaluate the prevalence and patterns of chromosomal aberrations in newborns admitted to the neonatal intensive care unit (NICU) with major congenital anomalies at Medina province in the western region of Saudi Arabia. Out of 2,541 live births, 150 newborns were selected based on the presence of major birth defects. Demographic and clinical data were collected from hospital medical records and statistically analyzed. The prevalence of major congenital anomalies was 10.7/1,000 live births (95% CI: 9.076- 12.583). The most common congenital anomalies in descending order were congenital heart disease, musculoskeletal and chromosome abnormalities. The birth prevalence of chromosome abnormalities was 4.22/1,000 live births (95% CI: 3.211-5.441). The most common chromosome abnormality was Down syndrome-nondisjunction type (66%). Advanced parental age was strongly associated with chromosome aberrations (p < 0.001) while consanguinity was evident in cases with normal karyotype (p < 0.001). High birth prevalence of chromosome abnormalities in newborns with congenital anomalies in Al Madinah was evident and advanced parental age is a potential risk factor. A local registry system for congenital anomalies is highly recommended to provide proper health services to high risk families.

Congenital malformations in neonates admitted to a neonatal intensive care unit in a low-resource setting

INTRODUCTION

Congenital malformations (CMs) are among the major causes of infant mortality in middle- and low-resource countries. This is the first study describing CMs in neonates admitted to the Neonatal Intensive Care Unit (NICU) of a referral hospital in Mozambique.

METHODS

We included all neonates with CMs admitted to the NICU of Beira Central Hospital from January 2015 to December 2016. CMs were classified according to the International Classification of Disease (ICD-10). All data were retrieved from medical charts.

RESULTS

CMs were found in 143/4767 (3%) neonates admitted to the NICU. The most frequent CMs were musculoskeletal (31%), neurological (18%), multiple congenital anomalies (12%), chromosomopathies (11%), cardiovascular (10%), and gastrointestinal (8%). Forty-three patients (30%) underwent corrective surgery. Overall mortality rate was 50%.

CONCLUSIONS

The prevalence of CMs was 3%, with a mortality rate of 50%. Alongside implementation of antenatal screening programs, improvement on expertise and postnatal care of CMs are warranted.

Comparative analysis of perinatal outcomes and birth defects amongst adolescent and older Ugandan mothers: evidence from a hospital-based surveillance database

Background

Uganda has one of the highest adolescent pregnancy rates in sub-Saharan Africa. We compared the risk of adverse birth outcomes between adolescents (age 12–19 years) and mothers (age 20–34 years) in four urban hospitals.

Methods

Maternal demographics, HIV status, and birth outcomes of all live births, stillbirths, and spontaneous abortions delivered from August 2015 to December 2018 were extracted from a hospital-based birth defects surveillance database. Differences in the distributions of maternal and infant characteristics by maternal age groups were tested with Pearson’s chi-square. Adjusted odds ratios (aORs) and 95% confidence intervals (CI) were calculated using logistic regression to compare the prevalence of adverse birth outcomes among adolescents to mothers 20–34 years.

Results

A total of 100,189 births were analyzed, with 11.1% among adolescent mothers and 89.0% among older mothers. Adolescent mothers had an increased risk of preterm delivery (aOR: 1.14; CI 1.06–1.23), low birth weight (aOR: 1.46; CI 1.34–1.59), and early neonatal deaths (aOR: 1.58; CI 1.23–2.02). Newborns of adolescent mothers had an increased risk of major external birth defects (aOR: 1.33; CI 1.02–1.76), specifically, gastroschisis (aOR: 3.20; CI 1.12–9.13) compared to mothers 20–34 years. The difference between the prevalence of gastroschisis among adolescent mothers (7.3 per 10,000 births; 95% CI 3.7–14.3) was statistically significant when compared to mothers 20–34 years (1.6 per 10,000 births; 95% CI 0.9–2.6).

Conclusions

This study found that adolescent mothers had an increased risk for several adverse birth outcomes compared to mothers 20–34 years, similar to findings in the region and globally. Interventions are needed to improve birth outcomes in this vulnerable population.

Adolescent pregnancies are a global problem occurring in high-, middle-, and low-income countries with Uganda having one of the highest adolescent pregnancy rates in sub-Saharan Africa. We compared the risk of adverse birth outcomes, including major external birth defects, between adolescents, (age 12–19 years) and mothers (age 20–34 years) in four urban hospitals.

All informative births, including live births, stillbirths, and spontaneous abortions; regardless of gestational age, delivered at four selected hospitals in Kampala from August 2015 to December 2018 were examined. Demographic data were obtained by midwives through maternal interviews and review of hospital patient notes.

Of the 100,189 births, 11.0% were among adolescent mothers and 89.0% among mothers (20–34 years). Adolescent mothers were more likely than mothers (20–34 years) to have an infant with preterm delivery, low birth weight, early neonatal death, and major external birth defects. Adolescent pregnancies were also associated with an increased risk of gastroschisis when compared to mothers (20–34 years).

In conclusion, this study found that adolescent mothers had an increased risk for several adverse birth outcomes compared to mothers 20–34 years. Research on the potential underlying causes or mechanisms for these adverse outcomes among adolescent births is necessary to identify possible interventions.

Burden and consequence of birth defects in Nepal-evidence from prospective cohort study

Background

Every year an estimated 7.9 million babies are born with birth defect. Of these babies, more than 3 million die and 3.2 million have disability. Improving nationwide information on prevalence of birth defect, risk factor and consequence is required for better resource allocation for prevention, management and rehabilitation. In this study, we assess the prevalence of birth defect, associated risk factors and consequences in Nepal.

Method

This is a prospective cohort study conducted in 12 hospitals of Nepal for 18 months. All the women who delivered in the hospitals during the study period was enrolled. Independent researchers collected data on the social and demographic information using semi-structured questionnaire at the time of discharge and clinical events and birth outcome information from the clinical case note. Data were analyzed on the prevalence and type of birth defect. Logistic regression was done to assess the risk factor and consequences for birth defect.

Results

Among the total 87,242 livebirths, the prevalence of birth defects was found to be 5.8 per 1000 live births. The commonly occurring birth defects were anencephaly (3.95%), cleft lip (2.77%), cleft lip and palate (6.13%), clubfeet (3.95%), eye abnormalities (3.95%) and meningomyelocele (3.36%). The odds of birth defect was higher among mothers with age < 20 years (adjusted Odds ratio (aOR) 1.64; 95% CI, 1.18–2.28) and disadvantaged ethnicity (aOR 1.78; 95% CI, 1.46–2.18). The odds of birth asphyxia was twice fold higher among babies with birth defect (aOR 1.88; 95% CI, 1.41–2.51) in reference with babies without birth defect. The odds of neonatal infection was twice fold higher among babies with birth defect (aOR 1.82; 95% CI, 1.12–2.96) in reference with babies without birth defect. Babies with birth defect had three-fold risk of pre-discharge mortality (aOR 3.00; 95% CI, 1.93–4.69).

Conclusion

Maternal age younger than 20 years and advantaged ethnicity were risk factors of birth defects. Babies with birth defect have high risk for birth asphyxia, neonatal infection and pre-discharge mortality at birth. Further evaluation on the care provided to babies who have birth defect is warranted.

Funding

Swedish Research Council (VR).

Prevalence of Absence of Function of the Flexor Digitorum Superficialis Muscle Tendons in the Fourth and Fifth Fingers of the Hand in the Brazilian Population

Objectives  To evaluate the prevalence of absence of flexor digitorum superficialis muscle tendons function of the fourth and fifth fingers of the hand in the Brazilian population

Methods  Prospective study performed at the orthopedics and traumatology department of a university hospital. The study was conducted from October 2017 to April 2018. The sample consisted of volunteers with no history of upper limb trauma, surgery or any other condition. This study included both male and female individuals over 18 years old. The flexor digitorum superficialis muscle tendons of the fourth and fifth fingers were evaluated through clinical tests by three independent examiners. The data were analyzed using GraphPad Prism 5.0 (GraphPad Software, San Diego, CA, USA).

Results  A total of 2,016 hands from 1,008 volunteers were analyzed. The prevalence of absence of flexor digitorum superficialis muscle tendon function of the fourth finger was 0.56% at the right hand and 0.99% at the left hand. At the right hand, this prevalence was higher in females compared to males ( p  = 0.0328). No difference between genders was noted in the left hand ( p  = 0.7562). The prevalence of absence of flexor digitorum superficialis muscle tendon function of the fifth finger was 34.53% in the right hand and 30.06% in the left hand. This prevalence was higher in females compared to males, both at the right hand ( p  = 0.0001) and the left hand ( p  = 0.0003).

Conclusion  Even though there are studies performed separately in different ethnic groups, there were no data in the literature regarding the prevalence of absence of flexor digitorum superficialis muscle tendons function of the fourth and fifth fingers of the hand in a multiethnic population such as the Brazilian one.

Prevalence and associated factors of birth defects among newborns in sub-Saharan African countries: a systematic review and meta-analysis

Introduction

Birth defects are the most serious causes of infant mortality and disability in sub-Saharan African countries with variable magnitude. Hence, this study was aimed to determine the pooled prevalence of birth defects and its associated risk factors among newborn infants in sub-Saharan African countries.

Methods

A total of 43 eligible studies were identified through literature search from Medline (PubMed), EMBASE, HINARI, Google scholar, Science Direct, Cochrane Library and other sources. Extracted data were analyzed using STATA 15.0 statistical software. A random effect meta-analysis model was used.

Results

Twenty-five studies in 9 countries showed that the pooled prevalence of birth defects was 20.40 per 1,000 births (95% CI: 17.04, 23.77). In the sub-group analysis, the highest prevalence was observed in southern Africa region with a prevalence of 43 per 1000 (95% CI: 14.89, 71.10). The most prevalent types of birth defects were musculo-skeletal system defects with a pooled prevalence of 3.90 per 1000 (95% CI: 3.11, 4.70) while the least was Down syndrome 0.62 per 1000 (95% CI: 0.40, 0.84). Lack of folic acid supplementation (95% CI: 1.95, 7.88), presence of chronic disease (95% CI: 2.00, 6.07) and intake of drugs (95% CI: 3.88, 14.66) during pregnancy were significantly associated with the birth defects.

Conclusion

The prevalence of birth defects is relatively high with high degree of regional variabilities. The most common types of birth defects were musculoskeletal defects. Lack of folic acid supplementation, presence of chronic disease and intake of drugs during pregnancy were significantly associated with birth defects.

Congenital malformations among newborns in Morocco: A retrospective study

Congenital malformations are one of the leading causes of neonates and infants' mortality and morbidity. The frequency of these congenital malformations varies in different populations. The objective of this study was to find out the prevalence and pattern of congenital malformations in a tertiary teaching hospital in Rabat, Morocco. This four-year retrospective descriptive study was conducted from January 2011 to December 2014. All newborns with congenital malformations diagnosed at birth were included. Mothers and newborn characteristics were analyzed using SPSS 13.0. A total of 706 newborns were noted to have congenital malformation. The prevalence rate was 1.02%. The mean maternal age was 28.8±7.2 years. The mean maternal body mass index was 28.1±6.9 kg/m². 13.3% of the mothers had a history of abortion. The nervous system was the most affected system (19.4%) followed by the musculoskeletal system (14.2%), the chromosomal abnormalities (12.3%) and the genito-urinary system (10.8%). Males newborns (57.9%) had more congenital malformations than females (40.5%). The rates for live-births, fetal asphyxia and stillbirths were 75.2%, 7.2% and 17.3%, respectively. This retrospective study provides recent and detailed data about congenital malformations in a Moroccan region. The result from this study will contribute to the knowledge of congenital malformations in this particular area and hence the supportive preventive policy.

A hospital-based birth defects surveillance system in Kampala, Uganda

Background

In 2010, the World Health Assembly passed a resolution calling upon countries to prevent birth defects where possible. Though birth defects surveillance programs are an important source of information to guide implementation and evaluation of preventive interventions, many countries that shoulder the largest burden of birth defects do not have surveillance programs. This paper shares the results of a hospital-based birth defects surveillance program in Uganda which, can be adopted by similar resource-limited countries.

Methods

All informative births, including live births, stillbirths and spontaneous abortions; regardless of gestational age, delivered at four selected hospitals in Kampala from August 2015 to December 2017 were examined for birth defects. Demographic data were obtained by midwives through maternal interviews and review of hospital patient notes and entered in an electronic data collection tool. Identified birth defects were confirmed through bedside examination by a physician and review of photographs and a narrative description by a birth defects expert. Informative births (live, still and spontaneous abortions) with a confirmed birth defect were included in the numerator, while the total informative births (live, still and spontaneous abortions) were included in the denominator to estimate the prevalence of birth defects per 10,000 births.

Results

The overall prevalence of birth defects was 66.2/10,000 births (95% CI 60.5–72.5). The most prevalent birth defects (per 10,000 births) were: Hypospadias, 23.4/10,000 (95% CI 18.9–28.9); Talipes equinovarus, 14.0/10,000 (95% CI 11.5–17.1) and Neural tube defects, 10.3/10,000 (95% CI 8.2–13.0). The least prevalent were: Microcephaly, 1.6/10,000 (95% CI 0.9–2.8); Microtia and Anotia, 1.6/10,000 (95% CI 0.9–2.8) and Imperforate anus, 2.0/10,000 (95% CI 1.2–3.4).

Conclusion

A hospital-based surveillance project with active case ascertainment can generate reliable epidemiologic data about birth defects prevalence and can inform prevention policies and service provision needs in low and middle-income countries.

Prevalence, risk factors and outcome of congenital anomalies among neonatal admissions in OGBOMOSO, Nigeria

BACKGROUND

Congenital anomalies (CA) are a major cause of neonatal morbidity and mortality, especially in developing countries. Data on these anomalies are still poorly collated in developing countries. We aimed to assess the prevalence, pattern, risk factors and outcome of congenital anomalies among neonatal admissions in Ogbomoso Town, Nigeria.

METHODS

A cross-sectional retrospective study in which a review of the records of all neonates admitted in the neonatal unit of the Bowen University Teaching Hospital, Ogbomoso over a five-year period (January 2012-December 2016) was undertaken. The occurrence rate and pattern of anomalies were determined, while factors associated with the occurrence and outcome of anomalies were calculated with the odds ratio and 95% confidence interval. Data entry and analysis were performed using SPSS version 21.

RESULTS

CA were found in 67 of the 1057 neonatal admissions, giving a prevalence rate of 6.3%. Anomalies of the cardiovascular and digestive systems were the most common. A higher proportion of babies referred from other facilities had CA, and this was found statistically significant. There was no significant association between CA and low birth weight, sex, maternal age or parity. The mortality rate among neonates with CA was 10.4%. Although, CA was associated with reduced risk of neonatal mortality compared to those with other acute conditions, this was not statistically significantly.

CONCLUSION

CA is a major indication for neonatal admissions in Ogbomoso. There is the need to establish a surveillance system for CA and efforts should be made to raise awareness of the occurrence and risk factors of CA in developing countries.

Pattern and risk factors of congenital anomalies in a pediatric university hospital, Alexandria, Egypt

Background

Congenital anomalies (CAs) are structural, functional, or metabolic anomalies that originate during intrauterine life and can interfere with the body functions. In Egypt, the prevalence of CAs is increasing. The study aimed to estimate the frequency, describe the types, and identify the possible risk factors of CAs among infants attending the Pediatric University Hospital, Alexandria, Egypt.

Methods

A retrospective case series and a case-control study were conducted. Patients’ records for the years 2010–2015 were reviewed, and a sample of 200 infants (100 cases and 100 controls) was taken from infants presented to Pediatrics, Pediatric Surgery, and Genetics Clinics of the hospital. Data were collected using a record review checklist and a predesigned interviewing questionnaire.

Results

The study revealed that congenital anomalies of the digestive system (38.0%), musculoskeletal system (32.9%), and circulatory system (11.0%) were the most common types of CAs. Males were more affected with CAs than females (63% versus 37%). The major risk factors for CAs were old-aged parents, complications during pregnancy, unprescribed medications and excessive vitamin A intake during pregnancy, exposure to chemicals and pesticides during pregnancy, and living near mobile strengthening stations.

Conclusion

Congenital malformations of the digestive, musculoskeletal, and circulatory systems were the most common types of CAs in the Pediatric Hospital. To prevent CAs, there is a need to restrict the prescription of medications that may have a teratogenic effect.

Adverse pregnancy outcomes among pregnant women with acute Rubella infections in Mwanza city, Tanzania

OBJECTIVE

This study investigated the adverse pregnancy outcomes among pregnant women with acute Rubella infections in the city of Mwanza, Tanzania.

METHODS

A longitudinal study was conducted between 2014 and 2016 among pregnant women attending antenatal clinics. Women were screened for Rubella IgG and IgM antibodies using enzyme immunoassay (EIA). IgM seropositive pregnant women were followed up until the end of the pregnancy to determine Congenital Rubella Syndrome, congenital infections and other pregnancy outcomes.

RESULTS

The median age of 685 enrolled pregnant women was 23 (IQR: 19-27) years. A total of 629(91.8%) were Rubella IgG seropositive while 61 (8.9%) were IgM seropositive. The IgM seropositivity was found to decrease significantly from first trimester to third trimester, p<0.001. Forty six (83.6%) of 55 Rubella IgM seropositive women had adverse pregnancy outcomes and 6 (10.9%) delivered neonates with CRS, making the overall incidence of CRS to be 6/685 (0.87%). First trimester IgM seropositive women had significantly higher adverse pregnancy outcomes than those in second/third trimesters (70.4% vs. 35.7, p=0.01).

CONCLUSION

There is one case of CRS in every 100 pregnancies necessitating additional strategies to reach a goal of elimination of CRS in developing countries.

Estimating the need for inpatient neonatal services: an iterative approach employing evidence and expert consensus to guide local policy in Kenya

Universal access to quality newborn health services will be essential to meeting specific Sustainable Development Goals to reduce neonatal and overall child mortality. Data for decision making are crucial for planning services and monitoring progress in these endeavours. However, gaps in local population-level and facility-based data hinder estimation of health service requirements for effective planning in many low-income and middle-income settings.

We worked with local policy makers and experts in Nairobi City County, an area with a population of four million and the highest neonatal mortality rate amongst counties in Kenya, to address this gap, and developed a systematic approach to use available data to support policy and planning. We developed a framework to identify major neonatal conditions likely to require inpatient neonatal care and identified estimates of incidence through literature review and expert consultation, to give an overall estimate for the year 2017 of the need for inpatient neonatal care, taking account of potential comorbidities.

Our estimates suggest that almost 1 in 5 newborns (183/1000 live births) in Nairobi City County may need inpatient care, resulting in an estimated 24 161 newborns expected to require care in 2017. Our approach has been well received by local experts, who showed a willingness to work together and engage in the use of evidence in healthcare planning. The process highlighted the need for co-ordinated thinking on admission policy and referral care especially in a pluralistic provider environment helping build further appetite for data-informed decision making.

Prevalence of Congenital Anomalies in Iran: A Review Article

BACKGROUND

Congenital anomalies are considered as main causes of disability and mortality among children in developing and developed countries. Expenditures of hospitalization and treatment procedures for these children impose a large burden on health system and their families. This study aimed to review the prevalence of congenital anomalies among infants in Iran.

METHODS

The review of studies was conducted through searching databases including IranMedex, SID, Magiran, Scopus, and PubMed. Descriptive and cross-sectional studies investigating on the prevalence of congenital anomalies among infants were included into the study. Hand search for some related journals and websites was done. The list of studies' references was reviewed. The data were analyzed using the CMA 2 software.

RESULTS

Of 455 studies, 27 studies were included into the meta-analysis study. The studies were conducted between 1992 and 2014.The overall prevalence of congenital anomalies among infants was estimated to be 2.3%. The overall prevalence rates, in terms of gender, were estimated to be 3% in boys and 2% in girls. While the highest prevalence rates were related to musculoskeletal anomalies (27.5%), skin anomalies (19.7%) and genitourinary system anomalies (15.8%), the lowest prevalence rate was related to respiratory system (1.82%).

CONCLUSION

The prevalence of congenital anomalies among infants in Iran is high. In order to reduce the rates of these anomalies and complications resulted from them, coping and preventive strategies such as the necessity of genetic counseling particularly in consanguineous marriages seem to be appropriate solutions.

[Prevalence of birth defects in Risaralda, 2010-2013]

INTRODUCTION

The data regarding birth defects at local levels in developing countries like Colombia are scarce.

OBJECTIVE

To describe the profile of congenital abnormalities in the province of Risaralda, Colombia.

MATERIALS AND METHODS

We included the information on infants with structural and functional abnormalities at birth between June, 2010, and December, 2013, from records of the Instituto Nacional de Salud, and compared it with those of children born in the same period in a local clinic participating in the Collaborative Study of Congenital Malformations. We analyzed the data using Stata 10®.

RESULTS

We found a prevalence of nine defects per 1,000 newborns from the total live births in Risaralda. The local clinic registered in the Collaborative Study of Congenital Malformations registered a prevalence of 34 defects per 1,000 births. Most frequent defects were heart defects, followed by cleft lip and palate, abdominal wall defects, skeletal dysplasia, hydrocephalus, polydactyly and Down syndrome.

CONCLUSIONS

Having a baseline on the prevalence of congenital defects in Risaralda is very useful in the design of prevention policies oriented to decrease congenital defects incidence and severity. Inclusion of maternity hospitals in the Collaborative Study of Congenital Malformations strengthens national recording and reporting of birth defects.

Magnitude of Birth Defects in Central and Northwest Ethiopia from 2010-2014: A Descriptive Retrospective Study

BACKGROUND

Birth defects are defined as structural and functional defects that develop during the organogenesis period and present at birth or detected later in life. They are one of the leading causes of infant and child mortality, morbidity, and long term disability. The magnitude of birth defects varies from country to country and from race/ethnicity to race/ethnicity, and about 40-60% of their causes are unknown. The known causes of birth defects are genetic and environmental factors which may be prevented. For various reasons, there is lack of data and research on birth defects in Ethiopia.

OBJECTIVE

The major objective of this study is to estimate the magnitude of birth defects in Ethiopia.

SUBJECT AND METHODS

A hospital based, retrospective, cross sectional, descriptive study was conducted. The subjects were babies/children aged 0-17years who visited selected hospitals between 2010 and 2014. Fourteen hospitals (8 in Addis Ababa, 6 in Amhara Region) were selected purposively based on case load. A data retrieving form was developed to extract relevant information from record books.

RESULTS

In the hospitals mentioned, 319,776 various medical records of children aged 0-17years were found. Of these, 6,076 (1.9% with 95% CI: 1.85%-1.95%) children were diagnosed as having birth defects. The majority (58.5%) of the children were male and 41.5% female. A slightly more than half (51.1%) of the children were urban dwellers, while 48.9% were from rural areas. Among the participants of the study the proportion of birth defects ranged as follows: orofacial (34.2%), neural tube (30.8%), upper and lower limb (12.8%), cardiovascular system (10.3%), digestive system and abdominal wall (4.8%), unspecified congenital malformations (2.5%), Down syndrome (2%), genitourinary system (2%), head, face, and neck defects (0.4%), and others (0.3%). The trend of birth defects increased linearly over time [Extended Mantel-Haenszel chi square for linear trend = 356.7 (P<0.0001)]. About 275 (4.5%) of the cases had multiple (associated) birth defects and 5,801 (95.5%) isolated (single) birth defects. Out of the total birth defects, 6,018 (99%) were major and 58 (1%) minor.

CONCLUSION

The magnitude of birth defects increased from 2010-2014. Orofacial and neural tube defects contributed about two thirds of the birth defects. There is an urgent need for registry and surveillance system strategies for intervention and control of birth defects in Ethiopia.

Frequency of congenital malformations and chromosomal disorders in Bacau and Vaslui counties (Romania)

This paper presents the state of genetic health of the human populations in two Romanian counties, Bacau and Vaslui, as they are different in area, number of inhabitants, level of economic and social development, etc. The data presented in this paper is from the Public Health Directions of the two counties, reflecting the situation recorded during 2006-2013. In the 8 years study, 1894 cases of congenital and chromosomal disorders were recorded in the newborns from the populations in the two counties. The identified cases were distributed based on years, categories of disorders and sexes. The average frequency of congenital disorders in the two populations over the investigated period was about 1.65 in Bacau county and 1.83% in Vaslui counties. In the population of Bacau county, these disorders affect in the same number in both the sexes (49.62% female cases and 50.38% male cases), while in Vaslui, the male cases are more than the females (53.92 and 46.08%, respectively). The main congenital disorders observed were: cardiovascular system anomalies, musculoskeletal system, urogenital system, etc. During the investigation period, in the human population of Bacau county, 97 cases of newborns with chromosomal disorders were diagnosed (0.16% of the living newborns), while in Vaslui county there were 106 cases (0.26% of the living newborns). Among these disorders, the Down's syndrome was the most frequent one, representing 83.5 and 85.8% of cases in the population of Bacau county, and Vaslui counties.

Birth prevalence of selected external structural birth defects at four hospitals in Dar es Salaam, Tanzania, 2011-2012

BACKGROUND

94% of all birth defects (BD) and 95% of deaths due to the BD occur in low and middle income countries, many of which are preventable. In Tanzania, there is currently a paucity of BD data necessary to develop data informed prevention activities.

METHODS

A cross-sectional analysis was conducted of deliveries identified with BD in the labor ward registers at four Dar es Salaam hospitals between October, 2011 and February, 2012. The birth prevalence of structural BD, case fatality proportion, and the distribution of structural defects associated deaths within total deaths were calculated.

RESULTS

A total of 28 217 resident births were encountered during the study period. Overall birth prevalence of selected defects was 28.3/10 000 live births. Neural tube defects and indeterminate sex were the most and least common defects at birth (9.9 and 1.1/10 000 live births, respectively). Among stillbirths (66.7%) and deaths that occurred within less than 5 days of an affected live birth (18.5%), neural tube defects were the most frequently associated structural defect.

CONCLUSION

Structural BD is common and contributes to perinatal mortality in Dar es Salaam. More than half of perinatal deaths encountered among the studied selected external structural BD are associated with neural tube defects, a birth defect with well-established evidence based prevention interventions. By establishing a population-based BD surveillance program, Tanzania would have the information about neural tube defects and other major structural BD needed to develop and monitor prevention activities.

Birth weight by gestational age and congenital malformations in Northern Ethiopia

BACKGROUND

Studies on birth weight and congenital anomalies in sub-Saharan regions are scarce.

METHODS

Data on child variables (gestational age, birth weight, sex, and congenital malformations) and maternal variables (gravidity, parity, antenatal care, previous abortions, maternal illness, age, medication, and malformation history) were collected for all neonates delivered at Ayder referral and Mekelle hospitals (Northern Ehthiopia) in a prospective study between 01-12-2011 and 01-05-2012.

RESULTS

The total number of deliveries was 1516. More female (54%) than male neonates were born. Birth weights were 700-1,000 grams between 26 and 36 weeks of pregnancy and then increased linearly to 3,500-4,000 grams at 40 weeks. Thirty-five and 54% of neonates were very-low and low birth weight, respectively, without sex difference. Very-low birth-weight prevalence was not affected by parity. Male and female neonates from parity-2 and parity-2-4 mothers, respectively, were least frequently under weight. Sixty percent of newborns to parity -3 mothers weighed less than 2,500 grams, without sex difference. The percentage male neonates dropped from ~50% in parity-1-3 mothers to ~20% in parity-6 mothers. Diagnosed congenital malformations (~2%) were 2-fold more frequent in boys than girls. The commonest malformations were in the central nervous system (CNS; ~1.5% of newborns). Parity, low birth weight, gestational age less than 35 weeks, male sex, and lack of antenatal care were the most significant risk factors for congenital anomalies.

CONCLUSION

The high prevalence of neonates with low birth weight and CNS anomalies in Northern Ethiopia was very high. The findings may reflect the harsh conditions in the past 2 decades and suggest environmental and/or nutritional causes. Male sex and parity affected the outcome of pregnancy negatively.

Pattern and factors associated with congenital anomalies among young infants admitted at Bugando medical centre, Mwanza, Tanzania

BACKGROUND

Congenital anomalies or birth defects are among the leading causes of infant mortality and morbidity around the world. The impact of congenital anomalies is particularly severe in middle- and low-income countries where health care resources are limited. The prevalence of congenital anomalies varies in different parts of the world, which could reflect different aetiological factors in different geographical regions.

METHODS

Between October 2012 and January 2013, a cross-sectional study was conducted involving young infants below 2 months of age, admitted at a university teaching hospital in Tanzania. Face-to-face interviews with parents/caretakers of young infants were carried out to collect socio-demographic and clinical information. Physical examinations were performed on all young infants. Echocardiography, X-ray, cranial as well as abdominal ultrasonographies were performed when indicated.

RESULTS

Analysis of the data showed that among 445 young infants enrolled in the study, the prevalence of congenital anomalies was 29%, with the Central Nervous System (CNS) as the most commonly affected organ system. Maternal factors that were significantly associated with congenital anomalies included the lack of peri-conceptional use of folic acid (OR = 3.1; 95% CI = 1.4-6.7; p = 0.005), a maternal age of above 35 years (OR = 2.2; 95% CI = 1.1-4.3; p = 0.024) and an inadequate attendance to antenatal clinic (OR = 2.1; 95% CI = 1.4-3.3; p < 0.001). Infant factors that were significantly associated with congenital anomalies were female sex, a birth weight of 2.5 kg or more, singleton pregnancy and a birth order above 4.

CONCLUSIONS

Due to the high prevalence of congenital anomalies observed in this particular context, the hospital should mobilize additional resources for an optimal and timely management of the patients with congenital anomalies. In this study, the proportion of women taking folic acid supplements during early pregnancy was very low. Efforts should be made to ensure that more women use folic acid during the peri-conceptional period, as the use of folic acid supplement has been linked by several authors to a reduced occurrence of some congenital anomalies.

Impact of anthelminthic treatment in pregnancy and childhood on immunisations, infections and eczema in childhood: a randomised controlled trial

Background

Helminth infections may modulate immune responses to unrelated pathogens and allergens; these effects may commence prenatally. We addressed the hypothesis that anthelminthic treatment in pregnancy and early childhood would improve responses to immunisation and modulate disease incidence in early childhood with both beneficial and detrimental effects.

Methods and Findings

A randomised, double-blind, placebo-controlled trial was conducted in Entebbe, Uganda [ISRCTN32849447]. In three independent randomisations, 2507 pregnant women were allocated to receive single-dose albendazole or placebo, and praziquantel or placebo; 2016 of their offspring were randomised to receive quarterly single-dose albendazole or placebo from age 15 months to 5 years. Primary outcomes were post-immunisation recall responses to BCG and tetanus antigens, and incidence of malaria, diarrhoea, and pneumonia; incidence of eczema was an important secondary outcome. Analysis was by intention-to-treat. Of 2345 live births, 1622 (69%) children remained in follow-up at age 5 years. 68% of mothers at enrolment, and 11% of five-year-olds, had helminth infections. Maternal hookworm and Schistosoma mansoni were effectively treated by albendazole and praziquantel, respectively; and childhood hookworm and Ascaris by quarterly albendazole. Incidence rates of malaria, diarrhoea, pneumonia, and eczema were 34, 65, 10 and 5 per 100 py, respectively. Albendazole during pregnancy caused an increased rate of eczema in the children (HR 1.58 (95% CI 1.15–2.17), p = 0.005). Quarterly albendazole during childhood was associated with reduced incidence of clinical malaria (HR 0.85 (95% CI 0.73–0.98), p = 0.03). There were no consistent effects of the interventions on any other outcome.

Conclusions

Routine use of albendazole in pregnancy may not always be beneficial, even in tropical developing countries. By contrast, regular albendazole treatment in preschool children may have an additional benefit for malaria control where helminths and malaria are co-endemic. Given the low helminth prevalence in our children, the effect of albendazole on malaria is likely to be direct.

Trial registration

Current Controlled Trials ISRCTN32849447