The prevalence and pattern of neural tube defects and other major congenital malformations of nervous system detected at birth in Barbados

Occipital encephalocele: Presentation of case

INTRODUCTION

Encephalocele is defined as the externalization of brain tissue and/or meninges from the skull through a congenital bony defect. It is one of the most severe neural tube defects.

CASE PRESENTATION

We report a female newborn, weighing 2800 g, APGAR score 8/10. At birth, the clinical examination revealed a weight of 2800 g, a head circumference of 33 cm with a non bulging anterior fontanel.

DISCUSSION

Prenatal diagnosis of encephalocele is made by maternal screening of serum alpha-fetoprotein levels and by ultrasound. On two-dimensional ultrasound, encephalocele appears as a cystic mass with heterogeneous contents in continuity with certain brain structures. 2D ultrasound detects about 80 % of encephaloceles. The diagnosis is easily and confidently made from the ultrasound findings in the second trimester and can also be made in the first trimester. The prognosis of newborns with encephalocele depends on the extent of neural tissue herniation in the sac and the presence of associated anomalies.

CONCLUSION

The purpose of this observation is to highlight the contribution of different antenatal imaging methods in the diagnosis of encephalocele.

Burden of Neural Tube Defects and Their Associated Factors in Africa: A Systematic Review and Meta-Analysis

Background

Neural tube defects are a type of congenital anomaly caused by an abnormality in the development of the brain and spinal cord during embryogenesis. They cause high rates of mortality, morbidity, and lifelong disability. There are several studies carried out worldwide reporting different findings on the burden and associated factors. The aim of this study is to carry out a systematic review and meta-analysis of the burden of neural tube defects and their associated factors in Africa.

Methods

A total of 58 eligible articles were identified systematically using databases such as PubMed, Embase, African Journal Online Library, ProQuest, Cochrane, Google Scopus, Google Scholar, and Grey literature. Extracted data were analyzed using STATA 16.0 statistical software. The heterogeneity of studies was determined using the Cochrane Q test statistic and I² test statistics with forest plots. A random effects model was used to examine the pooled burden of neural tube defects, subgroups of the region, subtypes of NTDs, sensitivity analysis, and publication bias. The association between NTDs and associated factors was studied using a fixed-effect model.

Results

Fifty-eight studies with a total of 7,150,654 participants in 16 African countries revealed that the pooled burden of neural tube defects was 32.95 per 10,000 births (95% CI: 29.77-36.13). The Eastern African region had the highest burden in the subgroup analysis, with 111.13 per 10,000 births (95% CI: 91.85-130.42). South African countries had the lowest burden, at 11.43 per 10,000 births (95% CI: 7.51-15.34). In subtype analysis, spina bifida had the highest pooled burden at 17.01 per 10,000 births (95 percent CI: 15.00-19.00), while encephalocele had the lowest at 1.66 per 10,000 births (95% CI: 1.12-2.20). Maternal folic acid supplementation (AOR: 0.38; 95% CI: 0.16-0.94), alcohol consumption (AOR: 2.54; 95% CI: 1.08-5.96), maternal age (AOR: 3.54; 95% CI: 1.67-7.47), pesticide exposure (AOR: 2.69; 95% CI: 1.62-4.46), X-ray radiation (AOR: 2.67; 95% CI: 1.05-6.78), and history of stillbirth (AOR: 3.18; 95% CI: 1.11-9.12) were significantly associated with NTDs.

Conclusion

The pooled burden of NTDs in Africa was found to be high. Maternal age, alcohol consumption, pesticide and X-ray radiation exposure, history of stillbirth, and folic acid supplementation were significantly associated with NTDs.