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Kannane S, Touloun O, Boussaa S. The prevalence of neural tube defects and their prevention by folic acid supplementation. Clin Nutr ESPEN 2024; 63:57-67. [PMID: 38923466 DOI: 10.1016/j.clnesp.2024.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 05/17/2024] [Accepted: 06/04/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND & AIMS Folate is crucial for the development of the fetal neurological system. Moroccan Health authorities promote Folic acid (FA) supplementation, before and during pregnancy, as a significant protection against fetal neural tube defects (NTDs). Thus, the current study aims to investigate the effect of FA supplementation guidelines on NTDs prevalence and to assess the health professionals' (HPs) knowledge, attitude, and practice (KAP) regarding FA supplementation in Morocco. METHODS To assess the prevalence of NTDs, epidemiological data were collected from local and regional medical facilities and enhanced through a literature study. In addition, an auto-administered questionnaire was implemented to evaluate KAP among HPs on the FA supplementation national program. RESULTS The study results showed that from 2017 to 2023, the national prevalence rate of NTDs ranged from 4.26 to 21 per 10,000 live births, according to the region. Lack of information about FA supplementation is evident among HPs; while, 13.7% of the participants confused FA with vitamin B12; merely 50% recognized the significance of FA; and 11.9% had no idea which foods contained the most folate. Consequently, HPs' attitude and practice towards FA supplementation were deemed inadequate. Additionally, only 35.8% of respondents stated that they occasionally inquire about their patients' nutrition, 55.9% do not prescribe FA, and 44.1% are unwilling to report cases of NTDs. CONCLUSION NTDs remain a serious public health problem in Morocco. Despite the significant incidence of these diseases, HPs' knowledge, attitudes and practices in terms of prevention present gaps and inadequacies. According to the results of this study, the preparation of specific training sessions and the start of preconception consultations constitute an urgent and important issue.
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Affiliation(s)
- Soukaina Kannane
- Polydisciplinary Faculty, Sultan Moulay Slimane University, 23000, Beni Mellal, Morocco
| | - Oulaid Touloun
- Polydisciplinary Faculty, Sultan Moulay Slimane University, 23000, Beni Mellal, Morocco
| | - Samia Boussaa
- ISPITS- Higher Institute of Nursing and Health Techniques, Ministry of Health and Social Protection, 10000, Rabat, Morocco.
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2
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Kannane S, Boussaa S, Mendili JE, Touloun O. Congenital Malformations in the Moroccan Surveillance System: Contribution to Prevalence Estimation. Glob Health Epidemiol Genom 2024; 2024:9570798. [PMID: 38529480 PMCID: PMC10963113 DOI: 10.1155/2024/9570798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 02/05/2024] [Accepted: 03/07/2024] [Indexed: 03/27/2024] Open
Abstract
Background Congenital malformations (CMs) are a group of structural or functional anomalies present at birth. These anomalies result in a high rate of mortality, morbidity, and disability in children. CMs are a major public health problem and place a heavy burden on healthcare systems in both developed and developing countries including Morocco, which has had a CMs surveillance system in place since 2011. The aim of this study is to determine the prevalence of CMs in Morocco. Methods In this study, the epidemiology of CMs in Morocco was assessed retrospectively using the national surveillance system data gathered from case notification forms from 2017 to 2021. Results The main results showed that the prevalence of CMs in Morocco is 3.91/1000 live births (LBs), and the minimum annual prevalence of CMs was reached in 2017 (3.10/1000 LBs) while the maximum annual prevalence was recorded in 2018 (4.55/1000 LBs). The majority of CMs are unspecified CMs (68.55%), neural tube defects (NTDs) account for (21.13%), and orofacial clefts (OFCs) account for (10.32%). In addition, the majority of CMs (61.73%) were from rural areas. According to region, the Dakhla-Oued Eddahab region recorded the highest prevalence of CMs in Morocco, with 8.81/1000 LBs, while the lowest prevalence was recorded in the Rabat-Sale-Kenitra region, with 2.02/1000 LB. Conclusions This study reveals that the national prevalence of CMs is high and may be underestimated, as most of the CMS reported is unspecified. The use of a CM registry with detailed reporting of all CMs and the promotion of preventive measures are urgently recommended.
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Affiliation(s)
- Soukaina Kannane
- Polyvalent Team of Research and Development (PTRD), Polydisciplinary Faculty, Sultan Moulay Slimane University, 23000 Beni Mellal, Morocco
| | - Samia Boussaa
- Higher Institute of Nursing and Health Techniques, Ministry of Health and Social Protection, 10000 Rabat, Morocco
| | - Jamila El Mendili
- Health Studies and Information Unit, Planning and Studies, Division, Planning and Financial Resources Department, Ministry of Health and Social Protection, 10020 Rabat, Morocco
| | - Oulaid Touloun
- Polyvalent Team of Research and Development (PTRD), Polydisciplinary Faculty, Sultan Moulay Slimane University, 23000 Beni Mellal, Morocco
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Kalantar-Hormozi A, Chitsazan M, Davai NR, Eghbali Zarch A, Manafi A, Mozafari N, Saberi Ghouchani A, Azhdari K, Shahverdiani R, Ashabyamin M, Tarahomi M, Shams Hojjati Y, Sheikhi A, Kalantar-Hormozi H, Manafi N, Poudineh M. The Road Less Traveled: The Marham National Health Institute's Journey on Cleft Lip and Palate Surgery Missions. World J Plast Surg 2024; 13:3-15. [PMID: 38742029 PMCID: PMC11088737 DOI: 10.61186/wjps.13.1.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 11/26/2023] [Indexed: 05/16/2024] Open
Abstract
Congenital cleft lip and palate represent the prevailing craniofacial birth anomalies on a global scale. Notably, a substantial proportion of patients within remote regions of Iran defer corrective surgery until later stages of life, often in childhood or adulthood, primarily due to intricate financial and cultural constraints. In response to this pressing healthcare challenge, a dedicated collective of volunteer plastic surgeons was established in 2009 with the explicit aim of providing medical care to these underserved patients. Over the subsequent years, this compassionate team embarked on 31 meticulously planned missions to underprivileged areas scattered across the country. Through these organized endeavors, a remarkable total of 20,579 medical visits were conducted, coupled with the performance of 2,303 essential surgeries, thus offering a lifeline of healthcare to these disadvantaged individuals.
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Affiliation(s)
- Abdoljalil Kalantar-Hormozi
- Department of Plastic and Craniofacial Surgery, 15 Khordad Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | | | - Ahmad Eghbali Zarch
- Anesthesiology Research Center, Mofid Children Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Manafi
- Department of Plastic and Craniofacial Surgery, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Naser Mozafari
- Department of Plastic and Craniofacial Surgery, 15 Khordad Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Kamyar Azhdari
- Department of plastic surgery, Imam Reza Hospital, AJA University of Medical Sciences, Tehran, Iran
| | - Reza Shahverdiani
- Department of Tissue Engineering and Stem Cell, Georgetown Medical University, Washington DC, USA
| | - Mahmoudreza Ashabyamin
- Department of Plastic and Craniofacial Surgery, Kerman University of Medical Sciences, Kerman, Iran
| | | | | | - Abdolreza Sheikhi
- Department of Plastic Surgery, Taleqhani Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | | | - Navid Manafi
- David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA, USA
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Zhou Y, Yang D, Mao X, Zhou H, Wang L. Epidemiology of birth defects in a national hospital-based birth defect surveillance spot in Southern Jiangsu, China, 2014-2018. Front Med (Lausanne) 2023; 10:1138946. [PMID: 37766918 PMCID: PMC10520965 DOI: 10.3389/fmed.2023.1138946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 08/09/2023] [Indexed: 09/29/2023] Open
Abstract
Objective As the only hospital-based national surveillance spot of birth defects (BDs) in Changzhou city located in the economically developed eastern part of China, Changzhou Maternal and Child Health Care Hospital has encountered serious challenges in BD prevention. This study aimed to describe the epidemiology of total BDs born in the hospital from 2014 to 2018. Methods The data were collected from the national hospital-based birth defect surveillance system. BD prevalence was calculated by Poisson distribution. Trends of prevalence and the associations regarding information with BDs were analyzed by Poisson regression. Results The reported prevalence of total BDs was 313.92 (95% confidence interval [CI]: 299.59-328.76) per 10,000 perinatal infants (PIs), while the perinatal prevalence of BD was 160.19 (95% CI: 150.00-170.89) per 10,000 PIs. A remarkable uptrend in the prevalence of BDs was noticed with a prevalence rate ratio (PRR) of 1.09 (95% CI: 1.04-1.14) and 1.13 (95% CI: 1.09-1.16), respectively. Congenital heart disease (CHD), cleft lip with or without cleft palate (CL/P), congenital malformation of the kidney (CMK), polydactyly, Down syndrome (DS), cystic hygroma, neural tube defect (NTD), and congenital talipes equinovarus (CTE) were common types of total BDs. Mothers living in the urban area (PRR = 1.67, 95% CI:1.50-1.87), male fetuses (PRR = 1.16, 95% CI: 1.05-1.28), and maternal age younger than 20 (PRR = 2.28, 95% CI: 1.60-3.25) and 25 years (PRR = 1.41, 95% CI: 1.22-1.63) or older than 35 years (PRR = 1.18, 95% CI: 1.00-1.40) were risk factors for BD occurrence. Conclusion The reported prevalence of total BDs was nearly two times higher than the perinatal prevalence of BDs in PIs, and the ranks of total BDs and BDs in PIs were different. Mothers living in the urban area, male fetuses, and maternal ages younger than 25 or older than 35 years were risk factors for BD incidence. Thus, improving prenatal examination technology, expanding the surveillance time quantum of BDs, and keeping maternal health may be warranted.
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Affiliation(s)
- Ying Zhou
- Department of Health Emergency, Changzhou Center for Disease Control and Prevention, Changzhou, China
| | - Di Yang
- Department of Obstetrics and Gynecology, Changzhou Maternity and Child Health Care Hospital, Changzhou Medical Center, Nanjing Medical University, Nanjing, China
| | - Xueqin Mao
- Department of Obstetrics and Gynecology, Changzhou Maternity and Child Health Care Hospital, Changzhou Medical Center, Nanjing Medical University, Nanjing, China
| | - Hua Zhou
- Department of Obstetrics and Gynecology, Changzhou Maternity and Child Health Care Hospital, Changzhou Medical Center, Nanjing Medical University, Nanjing, China
| | - Li Wang
- Department of Obstetrics and Gynecology, Changzhou Maternity and Child Health Care Hospital, Changzhou Medical Center, Nanjing Medical University, Nanjing, China
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5
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Benavides-Lara A, Fernández-Sánchez O, Barboza-Argüello MDLP, Alfaro-Calvo T, Martínez H. Integrated surveillance strategy to support the prevention of neural tube defects through food fortification with folic acid: the experience of Costa Rica. Childs Nerv Syst 2023; 39:1743-1754. [PMID: 36790493 PMCID: PMC9930052 DOI: 10.1007/s00381-023-05837-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 01/06/2023] [Indexed: 02/16/2023]
Abstract
PURPOSE (1) To describe how Costa Rica implemented an integrated surveillance strategy of folate deficiency, neural tube defects (NTDs) prevalence, NTDs-associated infant mortality rate (NTDs-IMR), and folic acid food fortification (FAFF), to support with evidence NTDs prevention policies; (2) to disseminate updated data from monitoring programs. METHODS We performed a cross-sectional analysis, using the databases of national surveillance systems for NTDs outcomes to compare NTDs-prevalence and NTDs-IMR observed in the pre-fortification (1987-1998) and post-fortification (2010-2020) periods. In addition, using data from FAFF monitoring program (2010-2020), means of folic acid concentration (mg/kg) and folic acid daily intake (μg/day) were calculated for each fortified food (corn and wheat flour, rice and milk), as well as its contribution to folic acid estimated average requirement (EAR). RESULTS After FAFF Costa Rica showed a decrease of 84% in folic acid deficiency in women of childbearing age, as well as a 53% decrease in the prevalence of NTDs, falling from 11.82/10,000 to 5.52/10,000 livebirths. In addition, there was a 76% reduction in the NTDs-IMR from 77.01/100,000 to 18.66/100,000 livebirths. Between 2010 and 2020, all fortified foods provided an average contribution of 119% of the EAR of folic acid in the population. CONCLUSION To reduce NTD risk, an integrated surveillance strategy is essential not only to base prevention strategies on evidence, but also to demonstrate their impact and improve interventions over time. The experience in Costa Rica provides evidence that this type of surveillance is feasible to be implemented in developing countries.
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Affiliation(s)
- Adriana Benavides-Lara
- Costa Rican Birth Defects Register Center (CREC), Costa Rican Institute of Research and Education in Nutrition and Health (INCIENSA), Cartago, Costa Rica
| | - Oscar Fernández-Sánchez
- National Reference Center of Bromatology (CNRBro), Costa Rican Institute of Research and Education in Nutrition and Health (INCIENSA), Cartago, Costa Rica
| | - María de la Paz Barboza-Argüello
- Costa Rican Birth Defects Register Center (CREC), Costa Rican Institute of Research and Education in Nutrition and Health (INCIENSA), Cartago, Costa Rica
| | - Thelma Alfaro-Calvo
- National Reference Center of Bromatology (CNRBro), Costa Rican Institute of Research and Education in Nutrition and Health (INCIENSA), Cartago, Costa Rica
| | - Homero Martínez
- Global Technical Services, Nutrition International, Ottawa, ON Canada
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Kang L, Cao G, Jing W, Liu J, Liu M. Global, regional, and national incidence and mortality of congenital birth defects from 1990 to 2019. Eur J Pediatr 2023; 182:1781-1792. [PMID: 36781460 DOI: 10.1007/s00431-023-04865-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 02/01/2023] [Accepted: 02/04/2023] [Indexed: 02/15/2023]
Abstract
The study aims to estimate the trends in incidence and mortality of congenital birth defects at global, regional, and national levels from 1990 to 2019. Annual incident cases, age-standardized incidence rates (ASIRs), deaths, and age-standardized mortality rates (ASMRs) of congenital birth defects during 1990-2019 were collected from Global Burden of Diseases Study 2019. We calculated percentage of relative changes and estimated annual percentage changes (EAPCs) to quantify temporal trends, and explored potential influence factors of EAPCs using Pearson correlation. Globally, total incident cases and deaths of congenital birth defects were 8.52 million and 0.55 million in 2019. Congenital heart anomalies were the major category of congenital birth defects worldwide in 2019. From 1990 to 2019, the ASIR remained stable (EAPC=0.01, 95% CI -0.03 to 0.05), whereas the ASMR decreased (EAPC=-1.79, 95% CI -1.84 to -1.74). The most pronounced increase in ASIR occurred in low-middle socio-demographic index (SDI) regions (EAPC=0.03, 95% CI 0.01 to 0.06). The number of deaths increased by 14.49% in low SDI regions and the ASMR increased in Southern Sub-Saharan Africa (EAPC=0.17, 95% CI 0.02 to 0.33). Negative correlations of EAPCs in ASIRs and ASMRs with SDI and universal health coverage index values in 2019 were detected at national levels. Conclusions: Congenital birth defects are an important child health problem. There is urgent need to strengthen surveillance and detection of congenital birth defects, build and improve maternal and child healthcare capacity, and promote treatment and rehabilitation, especially in resource-limited countries. What is known: • Congenital birth defects were the fourth leading cause of death among children under 5 years in 2019, accounting for nearly 10% of deaths. What is new: • In this study using data from the Global Burden of Disease Study, global incident cases, deaths, and age-standardized mortality rate (ASMR) of congenital birth defects decreased, whereas age-standardized incidence rate (ASIR) remained stable from 1990 to 2019. • From 1990 to 2019, the most pronounced increase in ASIR occurred in Oceania, and the ASMR increased by an average of 0.17% per year in Southern Sub-Saharan Africa.
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Affiliation(s)
- Liangyu Kang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, No. 38, Xueyuan Road, Haidian District, Beijing, 100191, China
| | - Guiying Cao
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, No. 38, Xueyuan Road, Haidian District, Beijing, 100191, China
| | - Wenzhan Jing
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, No. 38, Xueyuan Road, Haidian District, Beijing, 100191, China
| | - Jue Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, No. 38, Xueyuan Road, Haidian District, Beijing, 100191, China
| | - Min Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, No. 38, Xueyuan Road, Haidian District, Beijing, 100191, China.
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Al-Dewik N, Samara M, Younes S, Al-Jurf R, Nasrallah G, Al-Obaidly S, Salama H, Olukade T, Hammuda S, Marlow N, Ismail M, Abu Nada T, Qoronfleh MW, Thomas B, Abdoh G, Abdulrouf PV, Farrell T, Al Qubaisi M, Al Rifai H. Prevalence, predictors, and outcomes of major congenital anomalies: A population-based register study. Sci Rep 2023; 13:2198. [PMID: 36750603 PMCID: PMC9905082 DOI: 10.1038/s41598-023-27935-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 01/10/2023] [Indexed: 02/09/2023] Open
Abstract
Congenital anomalies (CAs) are a leading cause of morbidity and mortality in early life. We aimed to assess the incidence, risk factors, and outcomes of major CAs in the State of Qatar. A population-based retrospective data analysis of registry data retrieved from the Perinatal Neonatal Outcomes Research Study in the Arabian Gulf (PEARL-Peristat Study) between April 2017 and March 2018. The sample included 25,204 newborn records, which were audited between April 2017 and March 2018, of which 25,073 live births were identified and included in the study. Maternal risk factors and neonatal outcomes were assessed for association with specific CAs, including chromosomal/genetic, central nervous system (CNS), cardiovascular system (CVS), facial, renal, multiple congenital anomalies (MCAs) using univariate and multivariate analyses. The incidence of any CA among live births was 1.3% (n = 332). The most common CAs were CVS (n = 117; 35%), MCAs (n = 69, 21%), chromosomal/genetic (51; 15%), renal (n = 39; 12%), CNS (n = 20; 6%), facial (14, 4%), and other (GIT, Resp, Urogenital, Skeletal) (n = 22, 7%) anomalies. Multivariable regression analysis showed that multiple pregnancies, parity ≥ 1, maternal BMI, and demographic factors (mother's age and ethnicity, and infant's gender) were associated with various specific CAs. In-hospital mortality rate due to CAs was estimated to be 15.4%. CAs were significantly associated with high rates of caesarean deliveries (aOR 1.51; 95% CI 1.04-2.19), Apgar < 7 at 1 min (aOR 5.44; 95% CI 3.10-9.55), Apgar < 7 at 5 min (aOR 17.26; 95% CI 6.31-47.18), in-hospital mortality (aOR 76.16; 37.96-152.8), admission to neonatal intensive care unit (NICU) or perinatal death of neonate in labor room (LR)/operation theatre (OT) (aOR 34.03; 95% CI 20.51-56.46), prematurity (aOR 4.17; 95% CI 2.75-6.32), and low birth weight (aOR 5.88; 95% CI 3.92-8.82) before and after adjustment for the significant risk factors. This is the first study to assess the incidence, maternal risk factors, and neonatal outcomes associated with CAs in the state of Qatar. Therefore, a specialized congenital anomaly data registry is needed to identify risk factors and outcomes. In addition, counselling of mothers and their families may help to identify specific needs for pregnant women and their babies.
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Affiliation(s)
- Nader Al-Dewik
- Department of Research, Women's Wellness and Research Center, Hamad Medical Corporation, P.O. Box 3050, Doha, Qatar. .,Translational Research Institute (TRI), Hamad Medical Corporation (HMC), Doha, Qatar. .,Genomics and Precision Medicine (GPM), College of Health and Life Science (CHLS), Hamad Bin Khalifa University (HBKU), 34110, Doha, Qatar. .,Faculty of Health and Social Care Sciences, Kingston University, St. George's University of London, London, UK. .,Department of Pediatrics and Neonatology, Neonatal Intensive Care Unit, Newborn Screening Unit, Women's Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar.
| | - Muthanna Samara
- Department of Psychology, Kingston University London, Kingston upon Thames, UK
| | - Salma Younes
- Department of Biomedical Science, College of Health Sciences, Member of QU Health, Qatar University, Doha, Qatar
| | - Rana Al-Jurf
- Department of Biomedical Science, College of Health Sciences, Member of QU Health, Qatar University, Doha, Qatar
| | - Gheyath Nasrallah
- Department of Biomedical Science, College of Health Sciences, Member of QU Health, Qatar University, Doha, Qatar
| | - Sawsan Al-Obaidly
- Obstetrics and Gynecology Department, Women's Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
| | - Husam Salama
- Department of Pediatrics and Neonatology, Neonatal Intensive Care Unit, Newborn Screening Unit, Women's Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
| | - Tawa Olukade
- Department of Pediatrics and Neonatology, Neonatal Intensive Care Unit, Newborn Screening Unit, Women's Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
| | - Sara Hammuda
- Department of Psychology, Kingston University London, Kingston upon Thames, UK
| | - Neil Marlow
- Institute for Women's Health, UCL, London, UK
| | - Mohamed Ismail
- Translational Research Institute (TRI), Hamad Medical Corporation (HMC), Doha, Qatar
| | - Taghreed Abu Nada
- Department of Biomedical Science, College of Health Sciences, Member of QU Health, Qatar University, Doha, Qatar
| | - M Walid Qoronfleh
- Q3CG Research Institute, Research & Policy Division, 7227 Rachel Drive, Ypsilanti, MI, 48917, USA
| | - Binny Thomas
- Department of Pharmacy, Women's Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
| | - Ghassan Abdoh
- Department of Pediatrics and Neonatology, Neonatal Intensive Care Unit, Newborn Screening Unit, Women's Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
| | - Palli Valapila Abdulrouf
- Department of Pharmacy, Women's Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
| | - Thomas Farrell
- Obstetrics and Gynecology Department, Women's Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
| | - Mai Al Qubaisi
- Department of Pediatrics and Neonatology, Neonatal Intensive Care Unit, Newborn Screening Unit, Women's Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
| | - Hilal Al Rifai
- Department of Pediatrics and Neonatology, Neonatal Intensive Care Unit, Newborn Screening Unit, Women's Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
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Paulson KR, Kamath AM, Alam T, Bienhoff K, Abady GG, Abbas J, Abbasi-Kangevari M, Abbastabar H, Abd-Allah F, Abd-Elsalam SM, Abdoli A, Abedi A, Abolhassani H, Abreu LG, Abu-Gharbieh E, Abu-Rmeileh NME, Abushouk AI, Adamu AL, Adebayo OM, Adegbosin AE, Adekanmbi V, Adetokunboh OO, Adeyinka DA, Adsuar JC, Afshari K, Aghaali M, Agudelo-Botero M, Ahinkorah BO, Ahmad T, Ahmadi K, Ahmed MB, Aji B, Akalu Y, Akinyemi OO, Aklilu A, Al-Aly Z, Alam K, Alanezi FM, Alanzi TM, Alcalde-Rabanal JE, Al-Eyadhy A, Ali T, Alicandro G, Alif SM, Alipour V, Alizade H, Aljunid SM, Almasi-Hashiani A, Almasri NA, Al-Mekhlafi HM, Alonso J, Al-Raddadi RM, Altirkawi KA, Alumran AK, Alvis-Guzman N, Alvis-Zakzuk NJ, Ameyaw EK, Amini S, Amini-Rarani M, Amit AML, Amugsi DA, Ancuceanu R, Anderlini D, Andrei CL, Ansari F, Ansari-Moghaddam A, Antonio CAT, Antriyandarti E, Anvari D, Anwer R, Aqeel M, Arabloo J, Arab-Zozani M, Aripov T, Ärnlöv J, Artanti KD, Arzani A, Asaad M, Asadi-Aliabadi M, Asadi-Pooya AA, Asghari Jafarabadi M, Athari SS, Athari SM, Atnafu DD, Atreya A, Atteraya MS, Ausloos M, Awan AT, Ayala Quintanilla BP, Ayano G, Ayanore MA, Aynalem YA, Azari S, Azarian G, Azene ZN, B DB, Babaee E, Badiye AD, Baig AA, Banach M, Banik PC, Barker-Collo SL, Barqawi HJ, Bassat Q, Basu S, Baune BT, Bayati M, Bedi N, Beghi E, Beghi M, Bell ML, Bendak S, Bennett DA, Bensenor IM, Berhe K, Berman AE, Bezabih YM, Bhagavathula AS, Bhandari D, Bhardwaj N, Bhardwaj P, Bhattacharyya K, Bhattarai S, Bhutta ZA, Bikbov B, Biondi A, Birihane BM, Biswas RK, Bohlouli S, Bragazzi NL, Breusov AV, Brunoni AR, Burkart K, Burugina Nagaraja S, Busse R, Butt ZA, Caetano dos Santos FL, Cahuana-Hurtado L, Camargos P, Cámera LA, Cárdenas R, Carreras G, Carrero JJ, Carvalho F, Castaldelli-Maia JM, Castañeda-Orjuela CA, Castelpietra G, Cerin E, Chang JC, Chanie WF, Charan J, Chatterjee S, Chattu SK, Chattu VK, Chaturvedi S, Chen S, Cho DY, Choi JYJ, Chu DT, Ciobanu LG, Cirillo M, Conde J, Costa VM, Couto RAS, Dachew BA, Dahlawi SMA, Dai H, Dai X, Dandona L, Dandona R, Daneshpajouhnejad P, Darmstadt GL, Das JK, Dávila-Cervantes CA, Davis AC, Davletov K, De la Hoz FP, De Leo D, Deeba F, Denova-Gutiérrez E, Dervenis N, Desalew A, Deuba K, Dey S, Dharmaratne SD, Dhingra S, Dhungana GP, Dias da Silva D, Diaz D, Dorostkar F, Doshmangir L, Dubljanin E, Duraes AR, Eagan AW, Edinur HA, Efendi F, Eftekharzadeh S, El Sayed I, El Tantawi M, Elbarazi I, Elgendy IY, El-Jaafary SI, Emami A, Enany S, Eyawo O, Ezzikouri S, Faris PS, Farzadfar F, Fattahi N, Fauk NK, Fazlzadeh M, Feigin VL, Ferede TY, Fereshtehnejad SM, Fernandes E, Ferrara P, Filip I, Fischer F, Fisher JL, Foigt NA, Folayan MO, Foroutan M, Franklin RC, Freitas M, Friedman SD, Fukumoto T, Gad MM, Gaidhane AM, Gaidhane S, Gaihre S, Gallus S, Garcia-Basteiro AL, Garcia-Gordillo MA, Gardner WM, Gaspar Fonseca M, Gebremedhin KB, Getacher L, Ghashghaee A, Gholamian A, Gilani SA, Gill TK, Giussani G, Gnedovskaya EV, Godinho MA, Goel A, Golechha M, Gona PN, Gopalani SV, Goudarzi H, Grivna M, Gugnani HC, Guido D, Guimarães RA, Gupta RD, Gupta R, Hafezi-Nejad N, Haider MR, Haj-Mirzaian A, Hamidi S, Hanif A, Hankey GJ, Hargono A, Hasaballah AI, Hasan MM, Hasan SS, Hassan A, Hassanipour S, Hassankhani H, Havmoeller RJ, Hayat K, Heidari-Soureshjani R, Henry NJ, Herteliu C, Hole MK, Holla R, Hossain N, Hosseini M, Hosseinzadeh M, Hostiuc M, Hostiuc S, Househ M, Huang J, Humayun A, Hwang BF, Iavicoli I, Ibitoye SE, Ikuta KS, Ilesanmi OS, Ilic IM, Ilic MD, Inamdar S, Inbaraj LR, Iqbal K, Iqbal U, Islam MM, Islam SMS, Iso H, Iwagami M, Iwu CCD, Jaafari J, Jacobsen KH, Jagnoor J, Jain V, Janodia MD, Javaheri T, Javanmardi F, Jayaram S, Jayatilleke AU, Jenabi E, Jha RP, Ji JS, John O, Jonas JB, Joo T, Joseph N, Joukar F, Jozwiak JJ, Jürisson M, Kabir A, Kabir Z, Kalankesh LR, Kamyari N, Kanchan T, Kapoor N, Karami Matin B, Karch A, Karimi SE, Kassahun G, Kayode GA, Kazemi Karyani A, Kemmer L, Khalid N, Khalilov R, Khammarnia M, Khan EA, Khan G, Khan M, Khan MN, Khang YH, Khatab K, Khater AM, Khater MM, Khayamzadeh M, Khosravi A, Kim D, Kim YE, Kim YJ, Kimokoti RW, Kisa A, Kisa S, Kissoon N, Kopec JA, Kosen S, Koul PA, Koulmane Laxminarayana SL, Koyanagi A, Krishan K, Krishnamoorthy V, Kuate Defo B, Kucuk Bicer B, Kulkarni V, Kumar GA, Kumar M, Kumar N, Kurmi OP, Kusuma D, La Vecchia C, Lacey B, Lalloo R, Lami FH, Landires I, Larsson AO, Lasrado S, Lassi ZS, Lauriola P, Lee PH, Lee SWH, Lee YH, Leigh J, Leonardi M, Lewycka S, Li B, Li S, Liang J, Lim LL, Limenih MA, Lin RT, Liu X, Lodha R, Lopez AD, Lozano R, Lugo A, Lunevicius R, Mackay MT, Madhava Kunjathur S, Magnani FG, Mahadeshwara Prasad DR, Maheri M, Mahmoudi M, Majeed A, Maled V, Maleki A, Maleki S, Malekzadeh R, Malik AA, Malta DC, Mamun AA, Mansouri B, Mansournia MA, Martinez G, Martini S, Martins-Melo FR, Masoumi SZ, Maulik PK, McAlinden C, McGrath JJ, Medina-Solís CE, Mehrabi Nasab E, Mejia-Rodriguez F, Memish ZA, Mendoza W, Menezes RG, Mengesha EW, Mensah GA, Meretoja A, Meretoja TJ, Mersha AM, Mestrovic T, Miazgowski B, Miazgowski T, Michalek IM, Miller TR, Mini GK, Miri M, Mirica A, Mirrakhimov EM, Mirzaei H, Mirzaei M, Moazen B, Moghadaszadeh M, Mohajer B, Mohamad O, Mohammad Y, Mohammadi SM, Mohammadian-Hafshejani A, Mohammed S, Mokdad AH, Molokhia M, Monasta L, Mondello S, Moni MA, Moore CE, Moradi G, Moradi M, Moradzadeh R, Moraga P, Morawska L, Morrison SD, Mosser JF, Mousavi Khaneghah A, Mustafa G, Naderi M, Nagarajan AJ, Nagaraju SP, Naghavi M, Naghshtabrizi B, Naimzada MD, Nangia V, Narasimha Swamy S, Nascimento BR, Naveed M, Nazari J, Ndejjo R, Negoi I, Negoi RI, Nena E, Nepal S, Netsere HB, Nguefack-Tsague G, Ngunjiri JW, Nguyen CTY, Nguyen CT, Nguyen HLT, Nigatu YT, Nigussie SN, Nixon MR, Nnaji CA, Nomura S, Noor NM, Noubiap JJ, Nuñez-Samudio V, Nwatah VE, Oancea B, Odukoya OO, Ogbo FA, Olusanya BO, Olusanya JO, Omar Bali A, Onwujekwe OE, Ortiz A, Otoiu A, Otstavnov N, Otstavnov SS, Owolabi MO, P A M, Padubidri JR, Pakhale S, Pakshir K, Pal PK, Palladino R, Pana A, Panda-Jonas S, Pandey A, Pandey A, Pandi-Perumal SR, Pangaribuan HU, Pardo-Montaño AM, Park EK, Patel SK, Patton GC, Pawar S, Pazoki Toroudi H, Peden AE, Pepito VCF, Peprah EK, Pereira J, Pérez-Gómez J, Perico N, Pesudovs K, Pilgrim T, Pinheiro M, Piradov MA, Pirsaheb M, Platts-Mills JA, Pokhrel KN, Postma MJ, Pourjafar H, Prada SI, Prakash S, Pupillo E, Quazi Syed Z, Rabiee N, Radfar A, Rafiee A, Rafiei A, Raggi A, Rahimzadeh S, Rahman MHU, Rahmani AM, Ramezanzadeh K, Rana J, Ranabhat CL, Rao SJ, Rasella D, Rastogi P, Rathi P, Rawaf DL, Rawaf S, Rawasia WF, Rawassizadeh R, Reiner Jr RC, Remuzzi G, Renzaho AMN, Reshmi B, Resnikoff S, Rezaei N, Rezaei N, Rezapour A, Riahi SM, Ribeiro D, Rickard J, Roever L, Ronfani L, Rothenbacher D, Rubagotti E, Rumisha SF, Ryan PM, Saddik B, Sadeghi E, Saeedi Moghaddam S, Sagar R, Sahebkar A, Salahshoor MR, Salehi S, Salem MR, Salimzadeh H, Salomon JA, Samodra YL, Samy AM, Sanabria J, Santric-Milicevic MM, Saraswathy SYI, Sarker AR, Sarrafzadegan N, Sarveazad A, Sathian B, Sathish T, Sattin D, Saxena S, Saya GK, Saylan M, Schiavolin S, Schlaich MP, Schwebel DC, Schwendicke F, Senthilkumaran S, Sepanlou SG, Serván-Mori E, Sha F, Shafaat O, Shahabi S, Shahbaz M, Shaheen AA, Shahid I, Shaikh MA, Shakiba S, Shalash AS, Shams-Beyranvand M, Shannawaz M, Sharafi K, Sheikh A, Sheikhbahaei S, Shiferaw WS, Shigematsu M, Shin JI, Shiri R, Shiue I, Shuval K, Siddiqi TJ, Sidemo NB, Sigfusdottir ID, Sigurvinsdottir R, Silva JP, Silverberg JIS, Simonetti B, Singh BB, Singh JA, Singhal D, Sinha DN, Skiadaresi E, Skryabin VY, Skryabina AA, Sleet DA, Sobaih BH, Sobhiyeh MR, Soltani S, Soriano JB, Spurlock EE, Sreeramareddy CT, Steiropoulos P, Stokes MA, Stortecky S, Sufiyan MB, Suliankatchi Abdulkader R, Sulo G, Swope CB, Sykes BL, Szeto MD, Szócska M, Tabarés-Seisdedos R, Tadesse EG, Taherkhani A, Tamiru AT, Tareque MI, Tehrani-Banihashemi A, Temsah MH, Tesfay FH, Tessema GA, Tessema ZT, Thankappan KR, Thapar R, Tolani MA, Tovani-Palone MR, Traini E, Tran BX, Tripathy JP, Tsapparellas G, Tsatsakis A, Tudor Car L, Uddin R, Ullah A, Umeokonkwo CD, Unim B, Unnikrishnan B, Upadhyay E, Usman MS, Vacante M, Vaezi M, Valadan Tahbaz S, Valdez PR, Vasankari TJ, Venketasubramanian N, Verma M, Violante FS, Vlassov V, Vo B, Vu GT, Wado YD, Waheed Y, Wamai RG, Wang Y, Wang Y, Wang YP, Ward P, Werdecker A, Westerman R, Wickramasinghe ND, Wilner LB, Wiysonge CS, Wu AM, Wu C, Xie Y, Yahyazadeh Jabbari SH, Yamagishi K, Yandrapalli S, Yaya S, Yazdi-Feyzabadi V, Yip P, Yonemoto N, Yoon SJ, Younis MZ, Yousefi Z, Yousefinezhadi T, Yu C, Yusuf SS, Zaidi SS, Zaman SB, Zamani M, Zamanian M, Zastrozhin MS, Zastrozhina A, Zhang Y, Zhang ZJ, Zhao XJG, Ziapour A, Hay SI, Murray CJL, Wang H, Kassebaum NJ. Global, regional, and national progress towards Sustainable Development Goal 3.2 for neonatal and child health: all-cause and cause-specific mortality findings from the Global Burden of Disease Study 2019. Lancet 2021; 398:870-905. [PMID: 34416195 PMCID: PMC8429803 DOI: 10.1016/s0140-6736(21)01207-1] [Citation(s) in RCA: 192] [Impact Index Per Article: 64.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 05/25/2021] [Accepted: 05/25/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Sustainable Development Goal 3.2 has targeted elimination of preventable child mortality, reduction of neonatal death to less than 12 per 1000 livebirths, and reduction of death of children younger than 5 years to less than 25 per 1000 livebirths, for each country by 2030. To understand current rates, recent trends, and potential trajectories of child mortality for the next decade, we present the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 findings for all-cause mortality and cause-specific mortality in children younger than 5 years of age, with multiple scenarios for child mortality in 2030 that include the consideration of potential effects of COVID-19, and a novel framework for quantifying optimal child survival. METHODS We completed all-cause mortality and cause-specific mortality analyses from 204 countries and territories for detailed age groups separately, with aggregated mortality probabilities per 1000 livebirths computed for neonatal mortality rate (NMR) and under-5 mortality rate (U5MR). Scenarios for 2030 represent different potential trajectories, notably including potential effects of the COVID-19 pandemic and the potential impact of improvements preferentially targeting neonatal survival. Optimal child survival metrics were developed by age, sex, and cause of death across all GBD location-years. The first metric is a global optimum and is based on the lowest observed mortality, and the second is a survival potential frontier that is based on stochastic frontier analysis of observed mortality and Healthcare Access and Quality Index. FINDINGS Global U5MR decreased from 71·2 deaths per 1000 livebirths (95% uncertainty interval [UI] 68·3-74·0) in 2000 to 37·1 (33·2-41·7) in 2019 while global NMR correspondingly declined more slowly from 28·0 deaths per 1000 live births (26·8-29·5) in 2000 to 17·9 (16·3-19·8) in 2019. In 2019, 136 (67%) of 204 countries had a U5MR at or below the SDG 3.2 threshold and 133 (65%) had an NMR at or below the SDG 3.2 threshold, and the reference scenario suggests that by 2030, 154 (75%) of all countries could meet the U5MR targets, and 139 (68%) could meet the NMR targets. Deaths of children younger than 5 years totalled 9·65 million (95% UI 9·05-10·30) in 2000 and 5·05 million (4·27-6·02) in 2019, with the neonatal fraction of these deaths increasing from 39% (3·76 million [95% UI 3·53-4·02]) in 2000 to 48% (2·42 million; 2·06-2·86) in 2019. NMR and U5MR were generally higher in males than in females, although there was no statistically significant difference at the global level. Neonatal disorders remained the leading cause of death in children younger than 5 years in 2019, followed by lower respiratory infections, diarrhoeal diseases, congenital birth defects, and malaria. The global optimum analysis suggests NMR could be reduced to as low as 0·80 (95% UI 0·71-0·86) deaths per 1000 livebirths and U5MR to 1·44 (95% UI 1·27-1·58) deaths per 1000 livebirths, and in 2019, there were as many as 1·87 million (95% UI 1·35-2·58; 37% [95% UI 32-43]) of 5·05 million more deaths of children younger than 5 years than the survival potential frontier. INTERPRETATION Global child mortality declined by almost half between 2000 and 2019, but progress remains slower in neonates and 65 (32%) of 204 countries, mostly in sub-Saharan Africa and south Asia, are not on track to meet either SDG 3.2 target by 2030. Focused improvements in perinatal and newborn care, continued and expanded delivery of essential interventions such as vaccination and infection prevention, an enhanced focus on equity, continued focus on poverty reduction and education, and investment in strengthening health systems across the development spectrum have the potential to substantially improve U5MR. Given the widespread effects of COVID-19, considerable effort will be required to maintain and accelerate progress. FUNDING Bill & Melinda Gates Foundation.
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Xu C, Cai X, Chen S, Luo Q, Xi H, Zhang D, Wang H, Wu Y, Huang HF, Zhang J. Comprehensive non-invasive prenatal screening for pregnancies with elevated risks of genetic disorders: protocol for a prospective, multicentre study. BMJ Open 2021; 11:e053617. [PMID: 34452972 PMCID: PMC8404451 DOI: 10.1136/bmjopen-2021-053617] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Chromosomal abnormalities and monogenic disorders account for ~15%-25% of recognisable birth defects. With limited treatment options, preconception and prenatal screening were developed to reduce the incidence of such disorders. Currently, non-invasive prenatal screening (NIPS) for common aneuploidies is implemented worldwide with superiority over conventional serum or sonographic screening approaches. However, the clinical validity for the screening of frequent chromosome segmental copy number variations and monogenic disorders still awaits to be proved. METHODS AND ANALYSIS This study is a multicentre, prospective study. The participants were recruited from three tertiary hospitals in China starting from 10 April 2021. The study is expected to conclude before 10 October 2022. Pregnant women with abnormal prenatal screening results indicated for invasive prenatal diagnosis or those who decide to terminate their pregnancies due to abnormal ultrasound findings will be evaluated for enrolment. Cell-free DNA extracted from the maternal plasma will be used for an analytically validated comprehensive NIPS test developed by Beijing BioBiggen Technology Co. (Beijing, China). The diagnostic results from prenatal or postnatal specimens as well as the pregnancy outcome data will be collected to examine the clinical sensitivity, specificity, positive and negative predictive values of the test. ETHICS AND DISSEMINATION This study was approved by the Obstetrics and Gynecology Hospital of Fudan University (2020-178). Results of this study will be disseminated to public through scientific conferences and a peer-reviewed journal. Written informed consents will be obtained from participants. TRIAL REGISTRATION NUMBER ChiCTR2100045739.
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Affiliation(s)
- Chenming Xu
- Obstetrics and Gynecology Hospital, Institute of Reproduction and Development, Fudan University, Shanghai, China
| | | | - Songchang Chen
- Obstetrics and Gynecology Hospital, Institute of Reproduction and Development, Fudan University, Shanghai, China
| | - Qiong Luo
- Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Hui Xi
- Center of Hunan Provincial Prenatal Diagnosis, Hunan Maternal and Child Health Hospital, Changsha, Hunan, China
| | - Dan Zhang
- Key Laboratory of Reproductive Genetics (Ministry of Education), Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Hua Wang
- Center of Hunan Provincial Prenatal Diagnosis, Hunan Maternal and Child Health Hospital, Changsha, Hunan, China
| | - Yanting Wu
- Obstetrics and Gynecology Hospital, Institute of Reproduction and Development, Fudan University, Shanghai, China
| | - He-Feng Huang
- Obstetrics and Gynecology Hospital, Institute of Reproduction and Development, Fudan University, Shanghai, China
- Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Jinglan Zhang
- Obstetrics and Gynecology Hospital, Institute of Reproduction and Development, Fudan University, Shanghai, China
- Beijing BioBiggen Technology Co, Beijing, China
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Dolk H, Leke AZ, Whitfield P, Moore R, Karnell K, Barišić I, Barlow-Mosha L, Botto LD, Garne E, Guatibonza P, Godfred-Cato S, Halleux CM, Holmes LB, Moore CA, Orioli I, Raina N, Valencia D. Global birth defects app: An innovative tool for describing and coding congenital anomalies at birth in low resource settings. Birth Defects Res 2021; 113:1057-1073. [PMID: 33949803 PMCID: PMC8349897 DOI: 10.1002/bdr2.1898] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 03/15/2021] [Accepted: 04/05/2021] [Indexed: 12/02/2022]
Abstract
Background: Surveillance programs in low- and middle-income countries (LMICs) have difficulty in obtaining accurate information about congenital anomalies. Methods: As part of the ZikaPLAN project, an International Committee developed an app for the description and coding of congenital anomalies that are externally visible at birth, for use in low resource settings. The “basic” version of the app was designed for a basic clinical setting and to overcome language and terminology barriers by providing diagrams and photos, sourced mainly from international Birth Defects Atlases. The “surveillance” version additionally allows recording of limited pseudonymized data relevant to diagnosis, which can be uploaded to a secure server, and downloaded by the surveillance program data center. Results: The app contains 98 (88 major and 10 minor) externally visible anomalies and 12 syndromes (including congenital Zika syndrome), with definitions and International Classification of Disease v10 -based code. It also contains newborn examination videos and links to further resources. The user taps a region of the body, then selects among a range of images to choose the congenital anomaly that best resembles what they observe, with guidance regarding similar congenital anomalies. The “basic” version of the app has been reviewed by experts and made available on the Apple and Google Play stores. Since its launch in November 2019, it has been downloaded in 39 countries. The "surveillance” version is currently being field-tested. Conclusion: The global birth defects app is a mHealth tool that can help in developing congenital anomaly surveillance in low resource settings to support prevention and care.
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Affiliation(s)
- Helen Dolk
- Centre for Maternal, Fetal and Infant Research, Institute for Nursing and Health Research, Ulster University, Newtownabbey, United Kingdom
| | - Aminkeng Zawuo Leke
- Centre for Maternal, Fetal and Infant Research, Institute for Nursing and Health Research, Ulster University, Newtownabbey, United Kingdom
| | | | - Rebecca Moore
- Centre for Maternal, Fetal and Infant Research, Institute for Nursing and Health Research, Ulster University, Newtownabbey, United Kingdom
| | - Katy Karnell
- Centre for Maternal, Fetal and Infant Research, Institute for Nursing and Health Research, Ulster University, Newtownabbey, United Kingdom
| | - Ingeborg Barišić
- Children's Hospital Zagreb, Centre of Excellence for Reproductive and Regenerative Medicine, Medical School University of Zagreb, Zagreb, Croatia
| | - Linda Barlow-Mosha
- The Makerere University-John Hopkins University Research Collaboration, Kampala, Uganda
| | - Lorenzo D Botto
- International Center on Birth Defects (ICBD) of the International Clearinghouse for Birth Defects Surveillance and Research (ICBDSR), and Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
| | - Ester Garne
- Pediatric Department, Hospital Lillebaelt Kolding, Kolding, Denmark
| | - Pilar Guatibonza
- Latin American Collaborative Study of Congenital Malformations (ECLAMC), Bogotá, Colombia
| | - Shana Godfred-Cato
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Christine M Halleux
- UNICEF/UNDP/WB/WHO Special Program for Research & Training in Tropical Diseases (TDR), World Health Organization, Geneva, Switzerland
| | - Lewis B Holmes
- Medical Genetics and Metabolism Unit, MassGeneral Hospital for Children, Boston, Massachusetts, USA
| | - Cynthia A Moore
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Ieda Orioli
- Latin American Collaborative Study of Congenital Malformations (ECLAMC), Rio de Janeiro, Brazil
| | - Neena Raina
- World Health Organization, Regional Office for South East Asia (WHO SEARO), New Delhi, India
| | - Diana Valencia
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
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11
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Morris J, Orioli IM, Benavides-Lara A, de la Paz Barboza-Arguello M, Tapia MAC, de França GVA, Groisman B, Holguin J, Hurtado-Villa PM, Ibarra Ramirez M, Mellado C, Pardo R, Pastora Bucardo DM, Rodríguez C, Zarante I, Limb E, Dolk H. Prevalence of microcephaly: the Latin American Network of Congenital Malformations 2010-2017. BMJ Paediatr Open 2021; 5:e001235. [PMID: 34901471 PMCID: PMC8611451 DOI: 10.1136/bmjpo-2021-001235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 10/25/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE The Latin American Network of Congenital Malformations: ReLAMC was established in 2017 to provide accurate congenital anomaly surveillance. This study used data from ReLAMC registries to quantify the prevalence of microcephaly from 2010 to 2017 (before, during and after the Zika virus epidemic). DESIGN Nine ReLAMC congenital anomaly registries provided case-level data or aggregate data for any live births, still births or terminations of pregnancy with microcephaly. Births to pregnant women infected with Zika virus first occurred in Brazil in 2015, and in the remaining registry areas in 2016 with the exception of Chile that did not experience Zika virus. Therefore the prevalence of microcephaly for 2010-2014 and individual years 2015, 2016 and 2017 was estimated using multilevel random effect Poisson models. Clinical classification and characteristics of the cases were compared pre and post Zika for all centres providing individual case-level data. RESULTS The prevalence of microcephaly for all registries excluding Brazil was 2.3 per 10 000 (95% CI 2.0 to 2.6) for 2010-2014 rising to 5.4 (95% CI 4.8 to 6.0) in 2016 and 5.9 (95% CI 5.3 to 6.6) in 2017. Brazil had a prevalence of 0.6 per 10 000 (95% CI 0.5 to 0.6) in 2010-2014, rising to 5.8 (95% CI 5.6 to 6.1) in 2015, 8.0 (95% CI 7.6 to 8.3) in 2016 and then falling in 2017. Only 29 out of 687 cases of microcephaly were reported as congenital Zika syndrome in countries excluding Brazil. CONCLUSIONS The prevalence of microcephaly was influenced both by Zika causing congenital Zika syndrome and by increased reporting awareness.
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Affiliation(s)
- Joan Morris
- Population Health Research Institute, St George's University of London, London, UK
| | - Ieda M Orioli
- ReLAMC (Latin American Network of Congenital Malformations) at Department of Genetics, Institute of Biology, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.,ECLAMC (Latin American Collaborative Study of Congenital Malformations), Instituto Nacional de Genética Médica Populacional INAGEMP, Porto Alegre, Brazil
| | - Adriana Benavides-Lara
- Centro de Registro de Enfermedades Congénitas (CREC), Unidad de Enfermedades Congénitas, Instituto Costarricense de Investigación y Enseñanza en Nutrición y Salud-INCIENSA, Cartago, Costa Rica
| | - María de la Paz Barboza-Arguello
- Centro de Registro de Enfermedades Congénitas (CREC), Unidad de Enfermedades Congénitas, Instituto Costarricense de Investigación y Enseñanza en Nutrición y Salud-INCIENSA, Cartago, Costa Rica
| | | | | | - Boris Groisman
- National Network of Congenital Anomalies of Argentina (RENAC), National Center of Medical Genetics (CNGM), National Administration of Laboratories and Health Institutes (ANLIS), National Ministry of Health, Buenos Aires, Argentina
| | - Jorge Holguin
- Secretaria de Salud Publica Municipal de Cali, Cali, Colombia
| | | | - Marisol Ibarra Ramirez
- Departamento de Genética, Universidad Autónoma de Nuevo León Facultad de Medicina, Monterrey, Nuevo León, Mexico
| | - Cecilia Mellado
- Genetics Unit, Division of Pediatrics, Pontificia Universidad Católica de Chile, Santiago, Chile.,Genetics Section, Department of Medicine, Servicio de Salud Metropolitano Sur Oriente, Santiago, Chile
| | - Rosa Pardo
- Genetics Section, Department of Medicine, Hospital Clinico Universidad de Chile, Santiago, Chile.,Complejo Asistencial Dr. Sótero del Río, Servicio de Salud Metropolitano Sur Oriente, Santiago, Chile
| | | | | | - Ignacio Zarante
- Instituto de Genetica Humana, Pontificia Universidad Javeriana Bogota, Bogota, Colombia
| | - Elizabeth Limb
- Population Health Research Institute, St George's University of London, London, UK
| | - Helen Dolk
- Maternal Fetal and Infant Research Centre, Institute of Nursing and Health Research, Ulster University, Newtownabbey, Northern Ireland, UK
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Zhou Y, Mao X, Zhou H, Wang L, Qin Z, Cai Z, Yu B. Birth Defects Data From Population-Based Birth Defects Surveillance System in a District of Southern Jiangsu, China, 2014-2018. Front Public Health 2020; 8:378. [PMID: 32850599 PMCID: PMC7423872 DOI: 10.3389/fpubh.2020.00378] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 06/30/2020] [Indexed: 01/24/2023] Open
Abstract
As a population-based national surveillance region, Tianning District confronts with great challenges in birth defects (BDs) prevention. We aimed to describe the epidemiology of BDs in infants (including dead fetus, stillbirth, or live birth between 28 weeks of gestation and 42 days after birth) in Tianning District from 2014 to 2018. The data was collected from the national birth defect surveillance system. The prevalence rates of BDs were calculated by poisson distribution. Trends of incidence and the associations of regarding perinatal characteristics with BDs were analyzed by poisson regression. During the study period, the prevalence of BD was 155.49 per 10,000 infants. The ten leading BDs were congenital heart defects (CHD), polydactyly, Congenital malformation of kidney (CMK), syndactyly, cleft palate, hypospadias, Congenital hypothyroidism (CH), congenital atresia of rectum and anus, congenital talipes equinovarus (CTE), and microtia. A significant increase in the prevalence of CHD was observed with a prevalence rate ratio (PRR) of 1.191. Gravidity ≥ 3 (PRR = 1.38) and multiple births (PRR = 2.88) were risk factors for BDs. Premature delivery (PRR = 4.29), fetal death or stillbirth (PRR = 24.79), and infant death (PRR = 43.19) were adverse consequences of BDs. Strengthening publicity and education, improving the ability of diagnosis and monitoring, expanding surveillance time quantum of BDs system may be warranted.
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Affiliation(s)
- Ying Zhou
- Changzhou Maternity and Child Health Care Hospital Affiliated to Nanjing Medical University, Changzhou, China
| | - Xueqin Mao
- Changzhou Maternity and Child Health Care Hospital Affiliated to Nanjing Medical University, Changzhou, China
| | - Hua Zhou
- Changzhou Maternity and Child Health Care Hospital Affiliated to Nanjing Medical University, Changzhou, China
| | - Li Wang
- Changzhou Maternity and Child Health Care Hospital Affiliated to Nanjing Medical University, Changzhou, China
| | - Zhiqiang Qin
- Changzhou Maternity and Child Health Care Hospital Affiliated to Nanjing Medical University, Changzhou, China
| | - Zhengmao Cai
- Changzhou Commission of Health, Changzhou, China
| | - Bin Yu
- Changzhou Maternity and Child Health Care Hospital Affiliated to Nanjing Medical University, Changzhou, China
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Kurdi AM, Majeed-Saidan MA, Al Rakaf MS, AlHashem AM, Botto LD, Baaqeel HS, Ammari AN. Congenital anomalies and associated risk factors in a Saudi population: a cohort study from pregnancy to age 2 years. BMJ Open 2019; 9:e026351. [PMID: 31492776 PMCID: PMC6731804 DOI: 10.1136/bmjopen-2018-026351] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE To assess the three key issues for congenital anomalies (CAs) prevention and care, namely, CA prevalence, risk factor prevalence and survival, in a longitudinal cohort in Riyadh, Saudi Arabia. SETTING Tertiary care centre, Riyadh, Saudi Arabia. PARTICIPANTS Saudi women enrolled during pregnancy over 3 years and their 28 646 eligible pregnancy outcomes (births, stillbirths and elective terminations of pregnancy for foetal anomalies). The nested case-control study evaluated the CA risk factor profile of the underlying cohort. All CA cases (1179) and unaffected controls (1262) were followed through age 2 years. Referred mothers because of foetal anomaly and mothers who delivered outside the study centre and their pregnancy outcome were excluded. PRIMARY OUTCOME MEASURES Prevalence and pattern of major CAs, frequency of CA-related risk factors and survival through age 2 years. RESULTS The birth prevalence of CAs was 412/10 000 births (95% CI 388.6 to 434.9), driven mainly by congenital heart disease (148 per 10 000) (95% CI 134 to 162), renal malformations (113, 95% CI 110 to 125), neural tube defects (19, 95% CI 25.3 to 38.3) and chromosomal anomalies (27, 95% CI 21 to 33). In this study, the burden of potentially modifiable risk factors included high rates of diabetes (7.3%, OR 1.98, 95% CI 1.04 to 2.12), maternal age >40 years (7.0%, OR 2.1, 95% CI 1.35 to 3.3), consanguinity (54.5%, OR 1.5, 95% CI 1.28 to 1.81). The mortality for live births with CAs at 2 years of age was 15.8%. CONCLUSIONS This study documented specific opportunities to improve primary prevention and care. Specifically, folic acid fortification (the neural tube defect prevalence was >3 times that theoretically achievable by optimal fortification), preconception diabetes screening and consanguinity-related counselling could have significant and broad health benefits in this cohort and arguably in the larger Saudi population.
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Affiliation(s)
- Ahmed M Kurdi
- Obstetrics & Gynecology, Prince Sultan Military Medical City, Riyadh, Al Riyadh, Saudi Arabia
| | | | - Maha S Al Rakaf
- Obstetrics & Gynecology, Prince Sultan Military Medical City, Riyadh, Al Riyadh, Saudi Arabia
| | - Amal M AlHashem
- Paediatrics, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Lorenzo D Botto
- Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
| | - Hassan S Baaqeel
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Amer N Ammari
- Paediatrics, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
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Botto LD, Mastroiacovo P. Triple surveillance: a proposal for an integrated strategy to support and accelerate birth defect prevention. Ann N Y Acad Sci 2019. [PMID: 29532515 PMCID: PMC5873412 DOI: 10.1111/nyas.13600] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Preventing neural tube defects (NTDs) easily qualifies as a high-value opportunity to improve childhood survival and health: the unmet need is significant (major preventable burden), the intervention is transformative (providing sufficient folic acid), and delivery strategies (e.g., fortification) are effective in low-resource countries. Yet, NTD prevention is lagging. Can public health surveillance help fix this problem? Critics contend that surveillance is largely unnecessary, that limited resources are best spent on interventions, and that surveillance is unrealistic in developing countries. The counterargument is twofold: (1) in the absence of surveillance, interventions will provide fewer benefits and cost more and (2) effective surveillance is likely possible nearly everywhere, with appropriate strategies. As a base strategy, we propose "triple surveillance:" integrating surveillance of cause (folate insufficiency), of disease occurrence (NTD prevalence), and of health outcomes (morbidity, mortality, and disability). For better sustainability and usefulness, it is crucial to refocus and streamline surveillance activities (no recreational data collection), weave surveillance into clinical care (integrate in clinical workflow), and, later, work on including additional risk factors and pediatric outcomes (increase benefits at low marginal cost). By doing so, surveillance becomes not a roadblock but a preferential path to prevention and better care.
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Affiliation(s)
- Lorenzo D Botto
- Division of Medical Genetics, Department of Pediatrics, University of Utah, Salt Lake City, Utah.,International Center on Birth Defects, International Clearinghouse for Birth Defects Surveillance and Research, Rome, Italy
| | - Pierpaolo Mastroiacovo
- International Center on Birth Defects, International Clearinghouse for Birth Defects Surveillance and Research, Rome, Italy
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Bekele KK, Ekanem PE, Meberate B. Anatomical patterns of cleft lip and palate deformities among neonates in Mekelle, Tigray, Ethiopia; implication of environmental impact. BMC Pediatr 2019; 19:254. [PMID: 31340768 PMCID: PMC6657112 DOI: 10.1186/s12887-019-1624-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 07/12/2019] [Indexed: 11/10/2022] Open
Abstract
Background Cleft lip and palate deformities are considered one of the most common birth defects of the head and neck that pose significant medical, psychosocial and financial burdens on the affected individuals and families, especially in low income communities. The etiology and pathogenesis of cleft lip and palate is complex and is known to involve genetic and/or environmental factors. Objective To assess the patterns of anatomical cleft lip and palate deformities among neonates in Mekelle and Ayder Comprehensive Specialized hospitals, Tigray, Northern Ethiopia. Methods A hospital-based retrospective study was conducted from May 2017 to June 2017 at Mekelle and Ayder Comprehensive Specialized hospitals, both in Mekelle city. Data was collected from all medical charts of neonates registered from 2011 to 2016 and analyzed using SPSS version 21.0 and OpenEpi software. Results were presented using tables and graphs; Chi-square test was used to look for an association between variables, odds ratio to determine the strength of association of selected variables using multinomial logistic regression model, while Fisher Exact (Clopper-Pearson) was used to compare yearly prevalence. Results Of 37,152 neonatal charts analyzed, 119 (0.32%) cases were identified as having cleft deformities. 38.7, 17.6, and 43.7% of this figure had cleft lips, cleft palates and both cleft lip and palate respectively. 46 (38.7%) neonates had lateral patterns of cleft lip deformities with 56.5% located unilaterally on the right and 43.5% unilaterally on the left. Of 52 (43.7%) neonates with cleft lip and palate deformities, 40.4% were located bilaterally while 38.5 and 21.2% were located unilaterally on the left and right, respectively. Associated malformations were: cardiac (3.4%), central nervous system (1.7%) and limb deformities (5.9%). The overall prevalence of cleft deformities was found to be 3.11 per 1000 live births. Conclusion The study showed a higher prevalence of cleft deformities than that reported in Addis Ababa and some other African countries. A higher occurrence of left unilateral pattern of cleft lip and palate was observed whereas a higher right unilateral pattern of cleft lip was identified. The higher prevalence of cleft lip and palate recorded in this region of Ethiopia may reflect an environmental impact.
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Affiliation(s)
- Konjit K Bekele
- Department of Anatomy, College of Health Sciences, Mekelle University, P.O. Box 1674, Mekelle, Ethiopia
| | - Peter E Ekanem
- Department of Anatomy, College of Health Sciences, Mekelle University, P.O. Box 1674, Mekelle, Ethiopia.
| | - Berhanu Meberate
- Department of Anatomy, College of Health Sciences, Mekelle University, P.O. Box 1674, Mekelle, Ethiopia
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Ayaz R, Asoglu MR. Neural tube defects in eastern Turkey; Is low folate status or vitamin B12 deficiency or both associated with a high rate of NTDs? J Matern Fetal Neonatal Med 2019; 33:3835-3840. [PMID: 31122096 DOI: 10.1080/14767058.2019.1623778] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Objective: The aim of this study was to compare the rates of low folate status and vitB12 deficiency between pregnancies with a NTD-affected fetus and those with a structurally normal fetus in a low-income population residing in eastern Turkey.Study design: It was a retrospective cohort study conducted in our perinatology unit in eastern Turkey between 2016 and 2018. The inclusion criterion for the study group was pregnancies with an NTD-affected fetus. The control group was pregnancies who met the following criteria; no prior history of pregnancy with a NTD-affected fetus, spontaneous abortion or stillbirth, no fetal growth problems or structural abnormality in the present pregnancy, and matching by gestational age. Venous blood samples of these women were obtained at the time of ultrasound examination and serum folate and vitB12 levels were measured by chemiluminescence method using ECLIA immunologic test (Roche, cobas e601/602 analyzers) at our laboratory.Results: The rate of NTDs was 130 per 10 000 (151/11 552). VitB12 deficiency was found in 62.9% of the study group and 36.4% of the control group (p < .001). The rate of low folate status was also different between the groups, with 42.3 and 15.2%, respectively (p < .001). Of the NTDs cases, 12.5% had only low folate status, 33.7% had only vitB12 deficiency, and 29.8% had both together. The rate of low folate status together with vitB12 deficiency was significantly different between the groups (p < .001).Conclusion: Low folate status coupled with B12 deficiency seems to be strongly associated with NTDs. Thus, simultaneous correction of their levels may be the best reasonable approach for the prevention of NTDs in low-income regions. This strategy can reduce the rate of NTDs in low-income regions, improve overall population health and mitigate the economic burden of NTDs on health care system.
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Affiliation(s)
- Reyhan Ayaz
- Division of Obstetrics and Gynecology, Van Regional Training and Research Hospital, Van, Turkey
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17
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Dinede G, Wondimagegnehu A, Enquselassie F. Rubella outbreak in the school children, Addis Ababa, Ethiopia: February-April 2018. BMC Infect Dis 2019; 19:267. [PMID: 30885148 PMCID: PMC6423871 DOI: 10.1186/s12879-019-3873-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 03/04/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Rubella is a vaccine-preventable contagious disease causing an estimated 100,000 children to be born with congenital rubella syndrome each year globally. Studies documented that 18 rubella outbreaks were occurred each year in Ethiopia. Yeka sub-city woreda 13 public health emergency management office reported two measles suspected cases on 8 February, 2018. We investigated this outbreak to identify its etiology, describe the outbreak and implement control measures. METHODS We described the outbreak using descriptive epidemiology. The study population was defined as students learning in the school where the outbreak occurred. Suspected rubella case was defined as student with generalized rash whereas confirmed case was suspected case tested positive for rubella IgM. Questionnaires, checklists and students record review were used to collect data. We searched for new cases in classes daily and excluded them from classes. The school environment was assessed and the outbreak was described in person and time. RESULTS We identified 58 cases (median age: 4.6 years; IQR: 4-5 years) with six of them rubella IgM positive and 52 epidemiologically linked. The outbreak began on 8 February 2018 having multiple intermittent peaks during its course reaching its highest peak at 2 April, 2018 and ended on 20 April, 2018. Index cases were reported from two classes; however, cases were occurred in 13/15(86.67%) of the classes during the entire outbreak. Fifty five percent (32/58) and 45/58(77.59%) of the cases were females and 3-5 years children, respectively. Overall attack rate was 58/531(4.05%). Attack rate was higher in females 32/252 (12.7%) than in males 26/279 (9.32%), and higher 45/275(16.36%) in 3-5 years than those in 5-8 years 13/256(5.08%) children. Case fatality ratio was zero. All cases were vaccinated against measles but unvaccinated against rubella. CONCLUSIONS Attack rate was higher in females than in males and higher in 3-5 years than 5-8 years children. We recommended establishing rubella surveillance system, conducting sero-prevalence of rubella among child bearing age females and establishing CRS surveillance among young infants to provide evidence-based information for RCV introduction. It was also recommended to develop a national rubella surveillance guideline which aid to exclude rubella cases from schools during outbreak.
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Affiliation(s)
- Getachew Dinede
- Epidemiology Directorate, Ministry of Agriculture, Addis Ababa, Ethiopia
| | - Abigiya Wondimagegnehu
- Epidemiology Unit, Department of Preventive Medicine, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Fikre Enquselassie
- Head of Department of Preventive Medicine, School Of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
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Larrandaburu M, Vianna FL, Griot K, Queijo C, Monzón G, Ugarte C, Nacul L, Schuler-Faccini L, Sanseverino MTV. Rare Diseases in Uruguay: Focus on Infants with Abnormal Newborn Screening. JOURNAL OF INBORN ERRORS OF METABOLISM AND SCREENING 2019. [DOI: 10.1590/2326-4594-jiems-2019-0002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Mariela Larrandaburu
- Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Ministerio de Salud, Uruguay
| | - Fernanda L.S Vianna
- Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Hospital de Clinicas de Porto Alegre, Brazil; Instituto Nacional de Genética Médica Populacional, Brazil
| | | | - Cecilia Queijo
- Laboratorio de Pesquisa Neonatal del Instituto de la Seguridad Social, Uruguay
| | | | | | - Luis Nacul
- London School of Hygiene and Tropical Medicine School, United Kindom
| | - Lavinia Schuler-Faccini
- Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Hospital de Clinicas de Porto Alegre, Brazil; Instituto Nacional de Genética Médica Populacional, Brazil
| | - Maria Teresa V. Sanseverino
- Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Hospital de Clinicas de Porto Alegre, Brazil; Instituto Nacional de Genética Médica Populacional, Brazil; Pontificia Universidade Catolica do Rio Grande do Sul, Brazil
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19
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Arinola GO, Dutta A, Oluwole O, Olopade CO. Household Air Pollution, Levels of Micronutrients and Heavy Metals in Cord and Maternal Blood, and Pregnancy Outcomes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15122891. [PMID: 30562990 PMCID: PMC6313792 DOI: 10.3390/ijerph15122891] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Revised: 12/03/2018] [Accepted: 12/04/2018] [Indexed: 12/02/2022]
Abstract
Cooking with kerosene emits toxic pollutants that may impact pregnancy outcomes. Sixty-eight women in their first trimester of pregnancy, kerosene users (n = 42) and liquefied natural gas (LNG) users (n = 26), were followed until birth. Maternal and cord blood were collected immediately after birth. Levels of micronutrients and heavy metals were quantified. Pregnancy outcomes (gestation age (GA), birth weight (BW), and chest and head circumference) were also measured. Mean (± standard deviation (SD)) age of mothers in kerosene and LNG groups were similar (p = 0.734). Mean (±SD) BW of newborns of LNG users was significantly higher compared to newborns of kerosene users (3.43 ± 0.32 vs. 3.02 ± 0.43, p < 0.001). Mean GA (in weeks) was similar between the two groups (p = 0.532). Women in the kerosene group had significantly higher cord blood levels of zinc, lead, mercury, iodine and vitamin B6 and lower levels of folic acid compared to LNG users (p < 0.05). Newborns of kerosene users had reduced levels of zinc, lead, mercury, iodine, vitamins B6 and B12, folic acid, and homocysteine compared with LNG users (p < 0.05). Also, cooking with kerosene was significantly associated with reduced birth weight after adjusting for potential confounders (β ± standard error (SE) = −0.326 ± 0.155; p = 0.040). Smoke from kerosene stove was associated with reduced birth weight and micronutrients imbalance in mothers and newborns.
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Affiliation(s)
| | - Anindita Dutta
- Department of Medicine and Center for Global Health, University of Chicago, 5841 S. Maryland Avenue, MC 2021 Chicago, IL 60637, USA.
| | - Oluwafemi Oluwole
- Department of Pediatrics and the Canadian Centre for Health and Safety in Agriculture, College of Medicine, University of Saskatchewan, Saskatoon, SK S7N 2Z4, Canada.
| | - Christopher O Olopade
- Department of Medicine and Center for Global Health, University of Chicago, 5841 S. Maryland Avenue, MC 2021 Chicago, IL 60637, USA.
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Boyle B, Addor MC, Arriola L, Barisic I, Bianchi F, Csáky-Szunyogh M, de Walle HEK, Dias CM, Draper E, Gatt M, Garne E, Haeusler M, Källén K, Latos-Bielenska A, McDonnell B, Mullaney C, Nelen V, Neville AJ, O’Mahony M, Queisser-Wahrendorf A, Randrianaivo H, Rankin J, Rissmann A, Ritvanen A, Rounding C, Tucker D, Verellen-Dumoulin C, Wellesley D, Wreyford B, Zymak-Zakutnia N, Dolk H. Estimating Global Burden of Disease due to congenital anomaly: an analysis of European data. Arch Dis Child Fetal Neonatal Ed 2018; 103:F22-F28. [PMID: 28667189 PMCID: PMC5750368 DOI: 10.1136/archdischild-2016-311845] [Citation(s) in RCA: 105] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 03/15/2017] [Accepted: 04/18/2017] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To validate the estimates of Global Burden of Disease (GBD) due to congenital anomaly for Europe by comparing infant mortality data collected by EUROCAT registries with the WHO Mortality Database, and by assessing the significance of stillbirths and terminations of pregnancy for fetal anomaly (TOPFA) in the interpretation of infant mortality statistics. DESIGN, SETTING AND OUTCOME MEASURES EUROCAT is a network of congenital anomaly registries collecting data on live births, fetal deaths from 20 weeks' gestation and TOPFA. Data from 29 registries in 19 countries were analysed for 2005-2009, and infant mortality (deaths of live births at age <1 year) compared with the WHO Mortality Database. Eight EUROCAT countries were excluded from further analysis on the basis that this comparison showed poor ascertainment of survival status. RESULTS According to WHO, 17%-42% of infant mortality was attributed to congenital anomaly. In 11 EUROCAT countries, average infant mortality with congenital anomaly was 1.1 per 1000 births, with higher rates where TOPFA is illegal (Malta 3.0, Ireland 2.1). The rate of stillbirths with congenital anomaly was 0.6 per 1000. The average TOPFA prevalence was 4.6 per 1000, nearly three times more prevalent than stillbirths and infant deaths combined. TOPFA also impacted on the prevalence of postneonatal survivors with non-lethal congenital anomaly. CONCLUSIONS By excluding TOPFA and stillbirths from GBD years of life lost (YLL) estimates, GBD underestimates the burden of disease due to congenital anomaly, and thus declining YLL over time may obscure lack of progress in primary, secondary and tertiary prevention.
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Affiliation(s)
- Breidge Boyle
- EUROCAT: WHO Collaborating Centre for the Surveillance of Congenital Anomalies, University of Ulster, Coleraine, UK,School of Nursing and Midwifery, Queens University Belfast, Belfast, UK
| | | | - Larraitz Arriola
- Registro Anomalías Congénitas CAV Subdirección de Salud Pública Av Navarra, San Sebastian, Spain
| | - Ingeborg Barisic
- Children’s Hospital Zagreb, School of Medicine, University of Zagreb, Zagreb, Croatia
| | | | - Melinda Csáky-Szunyogh
- Hungarian Congenital Abnormality Registry, National Public Health and Medical Officer Service, Budapest, Hungary
| | - Hermien E K de Walle
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Carlos Matias Dias
- Departamento de Epidemiologia, Registo Nacional de Anomalias Congénitas Av Padre Cruz, Lisbon, Portugal
| | - Elizabeth Draper
- Department of Epidemiology Public Health, East Midlands & South Yorkshire (EMSYCAR), University of Leicester, Leicester, UK
| | - Miriam Gatt
- Department of Health Information and Research, Guardamangia, Malta
| | - Ester Garne
- Department of Paediatric, Hospital Lillebaelt, Kolding, Denmark
| | - Martin Haeusler
- Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
| | - Karin Källén
- Swedish National Board of Health and Welfare and Department of Reproduction Epidemiology, Institution of Clinical Sciences, University of Lund, Lund, Sweden
| | | | | | | | - Vera Nelen
- Department of Environment, PIH, Province of Antwerp, Antwerp, Belgium
| | - Amanda J Neville
- Azienda Ospedaliero-Universitaria di Ferrara Corso Giovecca, Ferrara, Italy
| | | | - Annette Queisser-Wahrendorf
- Birth Registry Mainz Model, Children’s Hospital University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Hanitra Randrianaivo
- Register of Reunion Island, Centre Hospitalo-Universitaire, St Pierre La Reunion, Reunion, UK
| | - Judith Rankin
- Institute of Health and Society, Newcastle University, Newcastle, UK
| | - Anke Rissmann
- Malformation Monitoring Centre, Saxony-Anhalt, Medical Faculty Otto-von-Guericke University, Magdeburg, Germany
| | - Annukka Ritvanen
- National Institute for Welfare and Health (THL), Helsinki, Finland
| | | | - David Tucker
- Public Health Wales, Congenital Anomaly Register and Information Service for Wales (CARIS), Swansea, UK
| | - Christine Verellen-Dumoulin
- Centre de Génétique Humaine IPG Institut de Pathologie et de Génétique Avenue G Lemaître, Charleroi, Belgium
| | - Diana Wellesley
- Faculty of Medicine, University of Southampton and Wessex Clinical Genetics Service, Southampton, UK
| | - Ben Wreyford
- School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Natalia Zymak-Zakutnia
- Khmelnytsky Perinatal Center, OMNI-Net Ukraine Birth Defects Program, Khmelnytsky, Ukraine
| | - Helen Dolk
- EUROCAT: WHO Collaborating Centre for the Surveillance of Congenital Anomalies, University of Ulster, Coleraine, UK
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Abstract
PURPOSE OF REVIEW The aim of this paper is to evaluate recent literature on valproic acid (VPA) in women and girls of childbearing age and to emphasize new findings. RECENT FINDINGS Recent research confirms VPAs teratogenicity and risk of hormone disruption. VPA exposure in utero increases the risk for a variety of major congenital malformations (MCMs), reduced IQ and behavioral problems. In girls and women, VPA increases the risk of hormone abnormalities, obesity, and polycystic ovarian syndrome (PCOS). Despite guidelines recommending caution, VPA use continues to be prescribed to reproductive-aged women and girls. Despite significant and well-documented risk, adherence to guidelines in VPA use in reproductive-aged girls and women remains low.
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Affiliation(s)
- Dorothy Gotlib
- Michigan Medicine, Department of Psychiatry, Ann Arbor, MI, USA.
| | - Rachel Ramaswamy
- Department of Psychiatry and Behavioral Neurosciences, Loyola University, Tampa, FL, USA
| | | | - Alana DeRiggi
- Michigan Medicine, Department of Psychiatry, Ann Arbor, MI, USA
| | - Michelle Riba
- Michigan Medicine, Department of Psychiatry, Ann Arbor, MI, USA
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Xing J, Cao Y, Yu Y, Li H, Song Z, Yu H. In Vitro Micropatterned Human Pluripotent Stem Cell Test (µP-hPST) for Morphometric-Based Teratogen Screening. Sci Rep 2017; 7:8491. [PMID: 28819231 PMCID: PMC5561212 DOI: 10.1038/s41598-017-09178-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 07/21/2017] [Indexed: 01/13/2023] Open
Abstract
Exposure to teratogenic chemicals during pregnancy may cause severe birth defects. Due to high inter-species variation of drug responses as well as financial and ethical burdens, despite the widely use of in vivo animal tests, it’s crucial to develop highly predictive human pluripotent stem cell (hPSC)-based in vitro assays to identify potential teratogens. Previously we have shown that the morphological disruption of mesoendoderm patterns formed by geometrically-confined cell differentiation and migration using hPSCs could potentially serve as a sensitive morphological marker in teratogen detection. Here, a micropatterned human pluripotent stem cell test (µP-hPST) assay was developed using 30 pharmaceutical compounds. A simplified morphometric readout was developed to quantify the mesoendoderm pattern changes and a two-step classification rule was generated to identify teratogens. The optimized µP-hPST could classify the 30 compounds with 97% accuracy, 100% specificity and 93% sensitivity. Compared with metabolic biomarker-based hPSC assay by Stemina, the µP-hPST could successfully identify misclassified drugs Bosentan, Diphenylhydantoin and Lovastatin, and show a higher accuracy and sensitivity. This scalable µP-hPST may serve as either an independent assay or a complement assay for existing assays to reduce animal use, accelerate early discovery-phase drug screening and help general chemical screening of human teratogens.
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Affiliation(s)
- Jiangwa Xing
- Institute of Bioengineering and Nanotechnology, A*STAR, The Nanos, #04-01, 31 Biopolis Way, Singapore, 138669, Singapore.
| | - Yue Cao
- Institute of Bioengineering and Nanotechnology, A*STAR, The Nanos, #04-01, 31 Biopolis Way, Singapore, 138669, Singapore.,Mechanobiology Institute, National University of Singapore, T-Lab, #05-01, 5A Engineering Drive 1, Singapore, 117411, Singapore
| | - Yang Yu
- Institute of Bioengineering and Nanotechnology, A*STAR, The Nanos, #04-01, 31 Biopolis Way, Singapore, 138669, Singapore.,BioSyM, Singapore-MIT Alliance for Research and Technology, Enterprise Wing 04-13/14 and B1, 1 Create Way, Singapore, 138602, Singapore.,Department of Physiology, Yong Loo Lin School of Medicine, MD9-04-11, 2 Medical Drive, Singapore, 117597, Singapore
| | - Huan Li
- Institute of Bioengineering and Nanotechnology, A*STAR, The Nanos, #04-01, 31 Biopolis Way, Singapore, 138669, Singapore
| | - Ziwei Song
- Institute of Bioengineering and Nanotechnology, A*STAR, The Nanos, #04-01, 31 Biopolis Way, Singapore, 138669, Singapore.,Department of Physiology, Yong Loo Lin School of Medicine, MD9-04-11, 2 Medical Drive, Singapore, 117597, Singapore
| | - Hanry Yu
- Institute of Bioengineering and Nanotechnology, A*STAR, The Nanos, #04-01, 31 Biopolis Way, Singapore, 138669, Singapore. .,Mechanobiology Institute, National University of Singapore, T-Lab, #05-01, 5A Engineering Drive 1, Singapore, 117411, Singapore. .,BioSyM, Singapore-MIT Alliance for Research and Technology, Enterprise Wing 04-13/14 and B1, 1 Create Way, Singapore, 138602, Singapore. .,Department of Physiology, Yong Loo Lin School of Medicine, MD9-04-11, 2 Medical Drive, Singapore, 117597, Singapore. .,Gastroenterology Department, Southern Medical University, Guangzhou, 510515, China.
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Harris BS, Bishop KC, Kemeny HR, Walker JS, Rhee E, Kuller JA. Risk Factors for Birth Defects. Obstet Gynecol Surv 2017; 72:123-135. [PMID: 28218773 DOI: 10.1097/ogx.0000000000000405] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Importance Major congenital abnormalities, or birth defects, carry significant medical, surgical, cosmetic, or lifestyle consequences. Such abnormalities may be syndromic, involving multiple organ systems, or can be isolated. Overall, 2% to 4% of live births involve congenital abnormalities. Risk factors for birth defects are categorized as modifiable and nonmodifiable. Modifiable risk factors require thorough patient education/counseling. The strongest risk factors, such as age, family history, and a previously affected child, are usually nonmodifiable. Objective This review focuses on risk factors for birth defects including alcohol consumption, illicit drug use, smoking, obesity, pregestational diabetes, maternal phenylketonuria, multiple gestation, advanced maternal age, advanced paternal age, family history/consanguinity, folic acid deficiency, medication exposure, and radiation exposure. Evidence Acquisition Literature review via PubMed. Results There is a strong link between alcohol use, folic acid deficiency, obesity, uncontrolled maternal diabetes mellitus, uncontrolled maternal phenylketonuria, and monozygotic twins and an increased risk of congenital anomalies. Advanced maternal age confers an increased risk of aneuploidy, as well as nonchromosomal abnormalities. Some medications, including angiotensin converting enzyme inhibitors, retinoic acid, folic acid antagonists, and certain anticonvulsants, are associated with various birth defects. However, there are few proven links between illicit drug use, smoking, advanced paternal age, radiation exposure, and statins with specific birth defects. Conclusions and Relevance Birth defects are associated with multiple modifiable and nonmodifiable risk factors. Obstetrics providers should work with patients to minimize their risk of birth defects if modifiable risk factors are present and to appropriately counsel patients when nonmodifiable risk factors are present.
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Affiliation(s)
| | | | - Hanna R Kemeny
- Medical Student, Duke University School of Medicine, Durham
| | - Jennifer S Walker
- Research Librarian, Health Sciences Library, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | - Jeffrey A Kuller
- Professor, Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC
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24
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Njoh AA, Njoh SN, Abizou MB. Fetal malformation in maternal toxoplasma and rubella co-infection in Cameroon: a case report. J Med Case Rep 2016; 10:345. [PMID: 27912790 PMCID: PMC5135823 DOI: 10.1186/s13256-016-1133-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 11/04/2016] [Indexed: 11/28/2022] Open
Abstract
Background There has been a recent increase in the number of newborns with brain malformations due to congenital infections, but the impact of these diseases remains largely under ascertained in middle-income and low-income countries. This case report presents a fetal anencephaly following maternal toxoplasma and rubella co-infection in a resource-limited setting and the challenges faced by the patient and the health care provider in the management of the condition. Case presentation A 25-year-old black Cameroonian woman of Bakossi origin, gravida3 para1010, presented with a positive rubella and toxoplasma immunoglobulin G serologic test at 21 weeks of pregnancy; she could not benefit from a fetal morphologic ultrasound partly because there was none at the site of her antenatal clinic and because there were accessibility constraints getting to the nearest referral hospital approximately 100 km away. She returned to the hospital in labor pains 14 weeks later and, upon examination, she was observed to be at almost full cervical dilatation and had a stillbirth a few minutes later; a baby boy weighing 1600 g with anencephaly. The devastated parents of the baby were counseled and given psychological support. She was discharged from hospital 3 days later and now benefits from continual follow up as out-patient. She was advised to consult a gynecologist-obstetrician before her next pregnancy. Conclusion Much attention still has to be paid to ameliorate the health care in resource-limited settings where pregnant women generally obtain less than adequate care. Electronic supplementary material The online version of this article (doi:10.1186/s13256-016-1133-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Andreas Ateke Njoh
- Tombel District Hospital, Ministry of Public Health, Tombel, Republic of Cameroon. .,General Medicine, Faculty of Medicine and Biomedical Sciences, University of Yaounde 1, Yaounde, Republic of Cameroon.
| | - Sarah Namondo Njoh
- Educational Psychology/Special Education, Faculty of Education, University of Buea, Buea, Republic of Cameroon
| | - Messang Blandine Abizou
- General Medicine, Faculty of Medicine and Biomedical Sciences, University of Yaounde 1, Yaounde, Republic of Cameroon
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Cui H, He C, Kang L, Li Q, Miao L, Shen L, Zhu J, Li X, Wang Y. Under-5-Years Child Mortality Due to Congenital Anomalies: A Retrospective Study in Urban and Rural China in 1996-2013. Am J Prev Med 2016; 50:663-671. [PMID: 26895742 DOI: 10.1016/j.amepre.2015.12.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 11/22/2015] [Accepted: 12/17/2015] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Congenital anomalies (CAs) contribute significantly to under-5-years child mortality (U5M) throughout the world. This study analyzed trends in the CA-specific U5M rate in urban and rural China. METHODS This population-based epidemiologic study used data obtained by China's National U5M Surveillance System from 1996 to 2013. Data from national surveillance sites were used to examine CA-specific U5M rates by year, urban and rural habitation, and sex. Mixed effect negative binomial regression models were used to assess the trends in CA-specific U5M rates and differences in those trends between urban and rural areas. RESULTS The CA-specific U5M rate decreased from 407.7 per 100,000 live births in 1996 to 217.4 per 100,000 live births in 2013, with average annual decline rates of 6.4% (95% CI=5.6%, 7.1%) and 3.8% (95% CI=3.3%, 4.3%) in urban and rural areas, respectively. The CA-specific U5M rate was the same in both rural and urban areas in 1996, but the U5M rate of the rural areas was 1.621-fold of that of urban areas in 2013. In urban and rural China, cardiovascular anomalies were the most frequent CAs, accounting for 50.3% and 58.2% of U5M due to CA, respectively. CONCLUSIONS CAs have become one of the leading causes of U5M in both urban and rural China and the difference between the CA-specific U5M rates in two areas is gradually increasing. Reduction of child mortality due to CAs and elimination of the geographic disparity in child mortality rates should be major public health concerns in China.
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Affiliation(s)
- Hao Cui
- National Center for Birth Defects Monitoring of China, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China; West China School of Public Health, Sichuan University, Chengdu, Sichuan, China
| | - Chunhua He
- National Center for Birth Defects Monitoring of China, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Leni Kang
- National Center for Birth Defects Monitoring of China, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Qi Li
- National Center for Birth Defects Monitoring of China, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Lei Miao
- National Center for Birth Defects Monitoring of China, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Liqin Shen
- West China School of Public Health, Sichuan University, Chengdu, Sichuan, China
| | - Jun Zhu
- National Office for Maternal and Child Health Surveillance of China, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.
| | - Xiaohong Li
- National Center for Birth Defects Monitoring of China, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.
| | - Yanping Wang
- National Office for Maternal and Child Health Surveillance of China, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, China
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26
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Liu QG, Sun J, Xiao XW, Song GR. Birth defects data from surveillance hospitals in Dalian city, China, 2006-2010. J Matern Fetal Neonatal Med 2016; 29:3615-21. [PMID: 26768968 DOI: 10.3109/14767058.2016.1140136] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The objective of this study is to disclose characteristics of birth defects in perinatal infants in Dalian and provide an epidemiological basis for controlling birth defects. METHODS Data used in this study were collected from surveillance hospitals in Dalian during 2006-2010. Comparison analysis and trend analysis were conducted by performing Chi-square tests. RESULTS The perinatal prevalence of birth defects from 2006 to 2010 was 101.14 per 10 000 live births and was decreased by about 29% from 115.49 per 10 000 live births in 2006 to 81.16 per 10 000 live births in 2010. The prevalence in urban was higher than that in rural areas significantly. The three leading birth defects were congenital heart disease, cleft lip and/or palate, and polydactyly or syndactyly. About 572 cases identified by antenatal diagnosis were terminated pregnancy before 28 weeks of gestation, so the prevalence of birth defects would decrease from 126.29/10 000 to 101.14/10 000. CONCLUSIONS Dalian has experienced a decreasing temporal trend of birth defects' prevalence; however, it is still confronted with the challenge to reduce the prevalence of birth defects. Congenital heart diseases are the focus to prevent birth defects. It is necessary to keep the surveillance system function properly, provide preconception health care service extensively, and improve the ability of prenatal diagnosis.
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Affiliation(s)
- Qi-Gui Liu
- a School of Public Health, Dalian Medical University , Dalian , PR China and
| | - Jin Sun
- b Maternal and Children Health Care Hospital of Dalian City , Dalian , PR China
| | - Xu-Wu Xiao
- b Maternal and Children Health Care Hospital of Dalian City , Dalian , PR China
| | - Gui-Rong Song
- a School of Public Health, Dalian Medical University , Dalian , PR China and
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27
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Postoev VA, Grjibovski AM, Nieboer E, Odland JØ. Changes in detection of birth defects and perinatal mortality after introduction of prenatal ultrasound screening in the Kola Peninsula (North-West Russia): combination of two birth registries. BMC Pregnancy Childbirth 2015; 15:308. [PMID: 26596677 PMCID: PMC4657227 DOI: 10.1186/s12884-015-0747-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 11/18/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Prenatal diagnostics ultrasound was established in Russia in 2000 as a routine method of screening for birth defects. The aims of the current study were twofold: to assess changes in birth defects prevalence at birth and perinatal mortality after ultrasound screening was implemented and to estimate prenatal detection rates for congenital malformations in the city of Monchegorsk (Murmansk County, North-West Russia). METHODS The Murmansk County Birth Registry and the Kola Birth Registry were the primary sources of information, and include 30 448 pregnancy outcomes in Monchegorsk for the period 1973-2011. Data from these registries were supplemented with information derived from hospital records about pregnancy terminations for 2000-2007. RESULTS The total number of newborns with any kind of birth defects in Monchegorsk during 1973-2011 was 1099, of whom 816 were born in the 1973-2000 period. The prevalence of defects at birth increased from 34.2/1000 (95% CI = 31.9-36.5) to 42.8/1000 newborns (95% CI = 38.0-47.7) after prenatal ultrasound screening was formally implemented. We observed significant decreases (p < 0.05) in the birth prevalence of congenital malformations of the circulatory system, the musculoskeletal system (including deformations), and other (excluding multiple); those of the urinary system increased from 0.9/1000 to 17.1/1000 (p < 0.0001). The perinatal mortality among newborns with any kind of malformation decreased from 106.6 per 1000 newborns with birth defects (95% CI = 84.3-129.1) to 21.2 (95 % CI = 4.3-38.1). Mothers who had undergone at least one ultrasound examination during pregnancy (n = 9883) had a decreased risk of having a newborn die during the perinatal period [adjusted OR = 0.49 (95% CI = 0.27-0.89)]. The overall prenatal detection rate was 34.9% with the highest for malformations of the nervous system. CONCLUSION Improved detection of severe malformations with subsequent pregnancy termination was likely the main contributor to the observed decrease in perinatal mortality in Murmansk County, Russia.
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Affiliation(s)
- Vitaly A Postoev
- Department of Community Medicine, UiT- The Arctic University of Norway, Tromsø, Norway. .,International School of Public Health, Northern State Medical University, 163061 Troickij av, 51 NSMU, ISPHA, office 2519, Arkhangelsk, Russia.
| | - Andrej M Grjibovski
- International School of Public Health, Northern State Medical University, 163061 Troickij av, 51 NSMU, ISPHA, office 2519, Arkhangelsk, Russia.,Department of International Public Health, Norwegian Institute of Public Health, Oslo, Norway.,Department of Preventive Medicine, International Kazakh-Turkish University, Turkestan, Kazakhstan.,North-Eastern Federal University, Yakutsk, Russia
| | - Evert Nieboer
- Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, ON, Canada
| | - Jon Øyvind Odland
- Department of Community Medicine, UiT- The Arctic University of Norway, Tromsø, Norway.,Faculty of Health Sciences, School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
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Dante G, Morani L, Bronzetti D, Garutti P, Neri I, Calapai G, Facchinetti F. Poor Folate Intake in a North Italian Pregnant Population: an Epidemiological Survey. Paediatr Perinat Epidemiol 2015; 29:501-4. [PMID: 26367522 DOI: 10.1111/ppe.12226] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND The association between folic acid (FA) insufficiency and congenital malformations has been demonstrated in over the past two decades. The aim of the present study was to investigate the use and timing of folate intake among a large sample of pregnant women in a north Italian region. METHODS A multicentre prospective cohort study was conducted over a 14-month period in the maternity wards of five general hospitals (2301 women). Data were collected via a face-to-face interview. RESULTS Seven hundred sixty women (33%) took at least one product containing FA. Seven hundred thirty-three (31.8%) women consumed multivitamins containing 413 (17.9%) consumed products containing FA only and 17 (0.7%) 15 mg of levofolinic acid. Only 0.9% of all women took FA before pregnancy 72.5% of women who consumed FA started during the first trimester. The most common dosage was 0.4 mg (19.4%). CONCLUSIONS Very few women in the population are taking FA before pregnancy. Moreover, while most women consuming FA started in the first trimester, it is likely that they did so after closure of the neural tube. An important action is the recommendation that periconceptional supplementation programmes be promoted.
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Affiliation(s)
- Giulia Dante
- Mother-Infant Department, Obstetric Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Letizia Morani
- Mother-Infant Department, Obstetric Unit, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Paola Garutti
- Obstetrics and Gynecology Unit, Azienda Ospedaliero-Universitaria S.Anna, Ferrara, Italy
| | - Isabella Neri
- Mother-Infant Department, Obstetric Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Gioacchino Calapai
- School and Division of Allergology and Clinical Immunology, University of Messina, Messina, Italy
| | - Fabio Facchinetti
- Mother-Infant Department, Obstetric Unit, University of Modena and Reggio Emilia, Modena, Italy
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Lewis J, Gonzales M, Burnette C, Benally M, Seanez P, Shuey C, Nez H, Nez C, Nez S. Environmental exposures to metals in Native communities and implications for child development: basis for the Navajo birth cohort study. ACTA ACUST UNITED AC 2015; 14:245-69. [PMID: 26151586 DOI: 10.1080/1536710x.2015.1068261] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Two disparate statistics often cited for the Western United States raise concern about risks for developmental disabilities in Native American children. First, 13 of the states with the highest percentage of Native American population are located in the Western United States (U.S. Census Bureau, 2012 ). Second, more than 161,000 abandoned hard-rock mines are located in 12 Western states (General Accounting Office, 2014 ). Moreover, numerous studies have linked low-level metals exposure with birth defects and developmental delays. Concern has emerged among tribal populations that metals exposure from abandoned mines might threaten development of future generations.
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Affiliation(s)
- Johnnye Lewis
- a University of New Mexico Health Sciences Center , Albuquerque , New Mexico , USA
| | - Melissa Gonzales
- a University of New Mexico Health Sciences Center , Albuquerque , New Mexico , USA
| | - Courtney Burnette
- a University of New Mexico Health Sciences Center , Albuquerque , New Mexico , USA
| | - Malcolm Benally
- a University of New Mexico Health Sciences Center , Albuquerque , New Mexico , USA
| | - Paula Seanez
- b Growing in Beauty, Window Rock Agency , Navajo Nation Office of Special Education and Rehabilitation Services , Window Rock , Arizona , USA
| | - Christopher Shuey
- c Uranium Impact Assessment Program , Southwest Research and Information Center , Albuquerque , New Mexico , USA
| | - Helen Nez
- d Tachee Uranium Concerns Committee , Blue Gap , Arizona , USA
| | - Christopher Nez
- d Tachee Uranium Concerns Committee , Blue Gap , Arizona , USA
| | - Seraphina Nez
- d Tachee Uranium Concerns Committee , Blue Gap , Arizona , USA
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30
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Larrandaburu M, Matte U, Noble A, Olivera Z, Sanseverino MTV, Nacul L, Schuler-Faccini L. Ethics, genetics and public policies in Uruguay: newborn and infant screening as a paradigm. J Community Genet 2015; 6:241-9. [PMID: 26021874 PMCID: PMC4524831 DOI: 10.1007/s12687-015-0236-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 05/13/2015] [Indexed: 10/23/2022] Open
Abstract
Uruguay is a middle-income country and the smallest in South America. Its population is under 3.3 million. The demographic and epidemiological characteristics are similar to those of developed countries, with a high burden associated with congenital anomalies. Infant mortality rate (IMR) decreased from 37/1000 live births, in 1980, to 8.8/1000, in 2013. This is largely explained by medical and social policies. IMR related to congenital anomalies, however, remained unchanged for the last 30 years. Therefore, programmes for prevention of congenital disorders were developed, such as the National Newborn Screening Programme. Mandatory, universal, free infant screening was implemented two decades ago. The Ministry of Public Health created the Comprehensive Plan on Birth Defects and Rare Diseases (PIDCER), to develop a strategic public policy tool enabling comprehensive, universal, quality care during their entire lifetime. Recent national legislation created provisions for newborn and infant screening, including for congenital hypothyroidism, phenylketonuria, congenital adrenal hyperplasia, cystic fibrosis and medium-chain acyl-CoA dehydrogenase, via blood spot test, otoacoustic emissions, systematic physical examination and hip ultrasound. We discuss how this programme was implemented, the current situation of rare diseases, the institution managing disability in Uruguay and the development of new laws based on the MPH's PIDCER. It illustrates how Uruguay is developing public policies in the genomic era, based both on science and bioethics.
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Affiliation(s)
- Mariela Larrandaburu
- />Ministry of Public Health of Uruguay, 18 de Julio 1892, 11200 Montevideo, Uruguay
- />Post-Graduate Program in Genetics and Molecular Biology, Federal University of Rio Grande do Sul, Porto Alegre, RS Brazil
- />Born Healthy Program, National Institute of Population Medical Genetics - INAGEMP, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS Brazil
| | - Ursula Matte
- />Post-Graduate Program in Genetics and Molecular Biology, Federal University of Rio Grande do Sul, Porto Alegre, RS Brazil
| | - Ana Noble
- />Ministry of Public Health of Uruguay, 18 de Julio 1892, 11200 Montevideo, Uruguay
| | - Zully Olivera
- />Ministry of Public Health of Uruguay, 18 de Julio 1892, 11200 Montevideo, Uruguay
| | - Maria Teresa V. Sanseverino
- />Post-Graduate Program in Genetics and Molecular Biology, Federal University of Rio Grande do Sul, Porto Alegre, RS Brazil
- />Born Healthy Program, National Institute of Population Medical Genetics - INAGEMP, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS Brazil
| | | | - Lavinia Schuler-Faccini
- />Post-Graduate Program in Genetics and Molecular Biology, Federal University of Rio Grande do Sul, Porto Alegre, RS Brazil
- />Born Healthy Program, National Institute of Population Medical Genetics - INAGEMP, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS Brazil
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Njeru I, Onyango D, Ajack Y, Kiptoo E. Rubella outbreak in a Rural Kenyan District, 2014: documenting the need for routine rubella immunization in Kenya. BMC Infect Dis 2015; 15:245. [PMID: 26116437 PMCID: PMC4483200 DOI: 10.1186/s12879-015-0989-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Accepted: 06/18/2015] [Indexed: 11/20/2022] Open
Abstract
Background Rubella infection has been identified as a leading cause of birth defects commonly known as Congenital Rubella Syndrome (CRS). Kenya does not currently have a rubella immunization program nor a CRS surveillance system. In 2014, a rubella outbreak was reported in a rural district in Kenya. We investigated the outbreak to determine its magnitude and describe the outbreak in time, place and person. We also analyzed the laboratory-confirmed rubella cases from 2010 to 2014 to understand the burden of the disease in the country. Methods The Rubella outbreak was detected using the case-based measles surveillance system. A suspected case was a person with generalized rash and fever while a confirmed case was a person who tested positive for rubella IgM. All laboratory-confirmed and epidemiologically linked cases were line listed. The measles case-based surveillance database was used to identify rubella cases from 2010 to 2014. Results A total of 125 rubella cases were line listed. Fifty four percent of cases were female. Case age ranged from 3 months to 32 years with a median of 4 years. Fifty-one percent were aged less than 5 years, while 82 % were aged less than 10 years. Six percent of the cases were women of reproductive age. All cases were treated as outpatients and there were no deaths. The number of confirmed rubella cases was 473 in 2010, 604 in 2011, 300 in 2012, 336 in 2013 and 646 in 2014. Conclusions Analysis of Kenya rubella data shows that rubella is endemic throughout the country, and many outbreaks may be underestimated or undocumented. Six percent of all the cases in this outbreak were women of reproductive age indicating that the threat of CRS is real. The country should consider initiating a CRS surveillance system to quantify the burden with the goal of introducing rubella vaccine in the future.
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Affiliation(s)
- Ian Njeru
- Disease Surveillance and Response Unit, Ministry of Health, Nairobi, Kenya.
| | - Dickens Onyango
- Disease Surveillance and Response Unit, Ministry of Health, Nairobi, Kenya.
| | - Yusuf Ajack
- Disease Surveillance and Response Unit, Ministry of Health, Nairobi, Kenya.
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32
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Räisänen S, Kancherla V, Gissler M, Kramer MR, Heinonen S. Adverse perinatal outcomes associated with moderate or severe maternal anaemia based on parity in Finland during 2006-10. Paediatr Perinat Epidemiol 2014; 28:372-80. [PMID: 24938307 DOI: 10.1111/ppe.12134] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Anaemia during pregnancy is an important public health problem. We investigated whether the association between maternal anaemia during pregnancy and adverse perinatal outcomes differed between nulliparous and multiparous women. METHODS A retrospective population-based cohort study was conducted using data on all singleton births (n = 290 662) recorded in the Finnish Medical Birth Register during 2006-10. Maternal anaemia was defined as a maternal haemoglobin level of <100 g/L). Adverse perinatal outcomes that were examined included preterm delivery (<37 weeks), small-for-gestational age (SGA, <2 standard deviation), admission to neonatal intensive care, stillbirth, early neonatal death, and major congenital anomalies. An association between anaemia and adverse outcomes was assessed by logistic regression analysis. RESULTS The prevalence of anaemia during pregnancy was 2.5% among nulliparous women and 2.3% among multiparous women. Among nulliparous women, anaemia was not associated with adverse perinatal outcomes. Among multiparous women, anaemia was associated with preterm delivery (adjusted odds ratio [aOR] 1.32, [95% CI 1.14, 1.53]), SGA (aOR 1.27, [95% CI 1.04, 1.55]), and admission to neonatal intensive care (aOR 1.23, [95% CI 1.10, 1.38]); there was a trend towards increased odds of major congenital anomalies (aOR 1.15, [95% CI 0.99, 1.34]). CONCLUSIONS These data underscore that maternal anaemia is associated with several adverse perinatal outcomes. This association was, however, confined to multiparous women. Future research should explore in detail the timing of anaemia in these associations.
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Affiliation(s)
- Sari Räisänen
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA; Department of Obstetrics and Gynaecology, Kuopio University Hospital, Kuopio, Finland
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