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Smythe T, Freeze L, Cuthel A, Flowers M, Seghers F, Zia N, Bachani AM. Provision of rehabilitation for congenital conditions. Bull World Health Organ 2022; 100:717-725. [PMID: 36324557 PMCID: PMC9589394 DOI: 10.2471/blt.22.288147] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 07/07/2022] [Accepted: 07/07/2022] [Indexed: 11/17/2022] Open
Abstract
Considerable progress has been made in saving the lives of children younger than 5 years. Nevertheless, these advances have failed to help all children thrive, particularly children with disabilities. We describe the increasing prevalence of disability among children and adolescents. We evaluate the current situation regarding children with disabilities and rehabilitation in the context of health systems, particularly those in low- and middle-income countries. Within the newborn health agenda, congenital anomalies often require early intervention and rehabilitation. We provide Argentina as an example of a country where rehabilitation for congenital anomalies is integrated into the health system. We argue that congenital anomalies that require rehabilitation have the potential to strengthen rehabilitation systems and policies by: strengthening coordination between primary care and rehabilitation; identifying and understanding pathways that allow families to engage with services; providing human resources for rehabilitation; and building systems and resources that support assistive technology and rehabilitation. We propose ways for countries to prioritize and integrate early identification, referral and care for children with congenital anomalies to strengthen health systems for all. We identify opportunities to expand policy and planning and to design service delivery and workforce strategies through World Health Organization guidelines and frameworks for rehabilitation. We argue that the global health community must act to ensure that rehabilitation services to support functioning from birth are well established, accepted and integrated within health systems, and that disability is prioritized within child health. These steps would strengthen health systems, ensure functioning from birth and make rehabilitation accessible to all.
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Affiliation(s)
- Tracey Smythe
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, England
| | - Lindsey Freeze
- MiracleFeet, Chapel Hill, United States of America (USA)
| | - Anna Cuthel
- MiracleFeet, Chapel Hill, United States of America (USA)
| | | | | | - Nukhba Zia
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Abdulgafoor M Bachani
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
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2
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Reis LC, Barbian MH, Cardoso-Dos-Santos AC, Silva EVDL, Boquett JA, Schuler-Faccini L. Prevalence of congenital anomalies at birth among live births in the state of Maranhão from 2001 to 2016: temporal and spatial analysis. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2021; 24:e210020. [PMID: 33886893 DOI: 10.1590/1980-549720210020.supl.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 12/07/2020] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES To analyze the prevalence at birth and the spatial and temporal distribution of congenital anomalies (CAs) among live births in the state of Maranhão in 2001 to 2016. To describe demographic, gestational and neonatal variables of interest. METHODS Ecological, population-based study, using secondary data from the Live Birth Information System (SINASC). Annual prevalence of total and per-group CAs was calculated. Spatial analyzes were based on the Local Indicators of Spatial Association (LISA) and the Moran I Index, and interactive maps were generated. Demographic, gestational and neonatal variables of interest available from SINASC were described in the group of newborns with CAs. RESULTS 1,831,830 live births, 6,110 with CAs (33.4/10,000) were included. Higher frequencies occurred in more recent years. Spatial clusters have been observed in specific years. The prevalence of newborns with CAs was different between categories of variables considered as risk factors for this outcome. CONCLUSION The prevalence at birth of total CAs was lower than expected for major human defects (3%). The temporal peak of records in 2015/2016 is probably related to the increase in CAs caused by gestational infection by the Zika virus. The spatial clusters were probably due to variations at random due to the small number of births as they are not repeated in other years. Studies like this are the basis for the establishment of CA surveillance programs.
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Affiliation(s)
- Luzivan Costa Reis
- Postgraduate Program in Genetics and Molecular Biology, Department of Genetics, Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brazil
| | - Márcia Helena Barbian
- Institute of Mathematics and Statistics, Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brazil
| | - Augusto César Cardoso-Dos-Santos
- Postgraduate Program in Genetics and Molecular Biology, Department of Genetics, Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brazil.,Health Surveillance Secretariat, Ministry of Health - Brasília (DF), Brazil
| | - Elis Vanessa de Lima Silva
- Postgraduate Program in Genetics and Molecular Biology, Department of Genetics, Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brazil
| | - Juliano André Boquett
- Postgraduate Program in Genetics and Molecular Biology, Department of Genetics, Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brazil.,Postgraduate Program in Child and Adolescent Health, Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brazil
| | - Lavínia Schuler-Faccini
- Postgraduate Program in Genetics and Molecular Biology, Department of Genetics, Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brazil.,Postgraduate Program in Child and Adolescent Health, Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brazil.,Medical Genetics Service, Hospital de Clínicas de Porto Alegre, National Institute of Medical Genetics - Porto Alegre (RS), Brazil
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3
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Rocha AG, de Souza PRA, Wachholz GE, Fraga LR, Sanseverino MTV, Terra AP, da Silva AA, Vianna FSL, Abeche AM, Larrandaburu M, Del Campo M, Schuler-Faccini L. Fetal Alcohol Spectrum Disorders: Health Needs Assessment in Brazil. Alcohol Clin Exp Res 2020; 44:660-668. [PMID: 31984499 DOI: 10.1111/acer.14294] [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: 06/21/2019] [Accepted: 01/11/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Fetal alcohol syndrome (FAS) is a disorder caused by alterations in embryo-fetal development due to prenatal alcohol exposure. It is estimated that between 0.5 and 2 per 1,000 individuals are born with FAS every year. In Brazil, there are few studies addressing the extent of the problem of FAS/fetal alcohol spectrum disorders (FASD); these studies are confined to limited geographic areas. Therefore, we decided to perform a health needs assessment for FAS/FASD in Brazil. METHODS To estimate the prevalence of FAS and FASD in Brazil, we used information from the literature, which estimates between 0.5 and 2/1,000 births per year for FAS and 10 to 50/1,000 for FASD. RESULTS We estimated that approximately 1,500 to 6,000 children are born with FAS every year. Considering the whole population, the prevalence would be 95,377 to 380,000 affected people. However, when we consider FASD as a whole, we estimate that between 1,900,000 and 9,500,000 Brazilians might suffer the more severe consequences of alcohol exposure during pregnancy and be living with FASD. CONCLUSION The results of the current study indicate that FAS and FASD are prevalent disorders in Brazil, and more policies targeting alcohol intake during pregnancy must be developed.
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Affiliation(s)
- Anastácia Guimarães Rocha
- From the Brazilian Teratogen Information Service, Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Paulo Ricardo Assis de Souza
- From the Brazilian Teratogen Information Service, Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Gabriela Elis Wachholz
- From the Brazilian Teratogen Information Service, Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Postgraduate Program in Genetics and Molecular Biology, Institute of Biosciencces, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Lucas Rosa Fraga
- From the Brazilian Teratogen Information Service, Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Department of Morphological Sciences, Institute of Health Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Genomic Medicine Laboratory, Experimental Research Center, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Maria Teresa V Sanseverino
- From the Brazilian Teratogen Information Service, Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Postgraduate Program in Genetics and Molecular Biology, Institute of Biosciencces, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Anna Pires Terra
- From the Brazilian Teratogen Information Service, Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Postgraduate Program in Genetics and Molecular Biology, Institute of Biosciencces, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - André Anjos da Silva
- From the Brazilian Teratogen Information Service, Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,School of Medicine, Univates University, Lajeado, Brazil
| | - Fernanda Sales Luiz Vianna
- From the Brazilian Teratogen Information Service, Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Postgraduate Program in Genetics and Molecular Biology, Institute of Biosciencces, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Alberto Mantovani Abeche
- From the Brazilian Teratogen Information Service, Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | | | - Miguel Del Campo
- Department of Pediatrics, University of California San Diego, San Diego, California
| | - Lavínia Schuler-Faccini
- From the Brazilian Teratogen Information Service, Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Postgraduate Program in Genetics and Molecular Biology, Institute of Biosciencces, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Postgraduate Program in Child and Adolescent Health, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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Modell B, Darlison MW, Lawn JE. Historical overview of development in methods to estimate burden of disease due to congenital disorders. J Community Genet 2018; 9:341-345. [PMID: 30209753 PMCID: PMC6167262 DOI: 10.1007/s12687-018-0382-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 08/23/2018] [Indexed: 12/21/2022] Open
Abstract
Congenital disorders (often also called birth defects) are an important cause of mortality and disability. They encompass a wide range of disorders with differing severity that can affect any aspect of structure or function. Understanding their epidemiology is important in developing appropriate services both for their prevention and treatment. The need for epidemiological data on congenital disorders has been recognised for many decades. Here, we provide a historical overview of work that has led to the development of the Modell Global Database of Congenital Disorders (MGDb)—a tool that can be used to generate evidence-based country, regional and global estimates of the birth prevalence and outcomes of congenital disorders.
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Affiliation(s)
- Bernadette Modell
- WHO Collaborating Centre for Community Genetics, Centre for Health Informatics and Multiprofessional Education (CHIME), University College London, London, UK
| | - Matthew W Darlison
- WHO Collaborating Centre for Community Genetics, Centre for Health Informatics and Multiprofessional Education (CHIME), University College London, London, UK.
| | - Joy E Lawn
- London School of Hygiene & Tropical Medicine, London, UK
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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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6
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Bidondo MP, Groisman B, Barbero P, Liascovich R. Public health approach to birth defects: the Argentine experience. J Community Genet 2015; 6:147-56. [PMID: 25564015 DOI: 10.1007/s12687-014-0209-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 12/15/2014] [Indexed: 11/30/2022] Open
Abstract
Birth defects are a global problem, but their impact is particularly severe in low and middle income countries, where the conditions for prevention, treatment, and rehabilitation are more critical. The epidemiological transition in the infant mortality causes, and the concern of the community and the mass media about the teratogenic risk of environmental pollutants, has made health authorities aware of the importance of birth defects in Argentina. The objective of this paper is to outline those actions specifically taken in Argentina aimed at the prevention of birth defects at a national level. Firstly, we focus on birth defects in Argentina on a general basis, and then we present different laws and actions taken in terms of surveillance and public health programs, primary, secondary, and tertiary prevention. Finally, we present the Teratology Information Service "Fetal Health Line", and the genetic services organization and health professionals training by the National Center of Medical Genetics and the National Program of Genetics Network. In conclusion, in the country, several programs focus on different approaches to the problem, and the challenge is to coordinate the teamwork between them. Finally, we list tips to address birth defects from the public health perspective.
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Affiliation(s)
- María Paz Bidondo
- National Registry of Congenital Anomalies of Argentina (RENAC), National Center of Medical Genetics, National Ministry of Health, Av. Las Heras 2670, 3er piso, 1425, Buenos Aires, Argentina
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7
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Sitkin NA, Ozgediz D, Donkor P, Farmer DL. Congenital anomalies in low- and middle-income countries: the unborn child of global surgery. World J Surg 2015; 39:36-40. [PMID: 25135175 PMCID: PMC4300430 DOI: 10.1007/s00268-014-2714-9] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Surgically correctable congenital anomalies cause a substantial burden of global morbidity and mortality. These anomalies disproportionately affect children in low- and middle-income countries (LMICs) due to sociocultural, economic, and structural factors that limit the accessibility and quality of pediatric surgery. While data from LMICs are sparse, available evidence suggests that the true human and financial cost of congenital anomalies is grossly underestimated and that pediatric surgery is a cost-effective intervention with the potential to avert significant premature mortality and lifelong disability.
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Affiliation(s)
- Nicole A. Sitkin
- />Department of Surgery, University of California, Davis, Sacramento, CA USA
| | - Doruk Ozgediz
- />Department of Surgery, Yale University School of Medicine, New Haven, CT USA
| | - Peter Donkor
- />Department of Surgery, School of Medical Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- />Department of Maxillofacial Sciences, Dental School, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Diana L. Farmer
- />Department of Surgery, University of California, Davis, Sacramento, CA USA
- />Department of Surgery, University of California, Davis School of Medicine, University of California, Davis Health System, 2221 Stockton Blvd, Suite 3112, Sacramento, CA 95817 USA
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Abstract
INTRODUCTION Genomic science is developing rapidly, and engagement of public health professionals will be necessary to appraise new technologies and use them effectively. SOURCES OF DATA We use established domains of public health and draw on the literature and expert knowledge to illustrate how genomic technologies give rise to new applications. AREAS OF AGREEMENT Genomic technologies are useful in rare inherited disease, including population screening programmes, in health care and for surveillance, diagnosis and treatment of infectious disease. AREAS OF CONTROVERSY It is less clear when and how genetic susceptibility testing will be used for common chronic disease prevention or protection from environmental hazards. GROWING POINTS Developments in public health practice will be necessary to ensure rapid and effective implementation of genomic science. AREAS TIMELY FOR DEVELOPING RESEARCH Public health researchers should address how to accelerate the implementation of genomics for health benefit in developed and developing countries.
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Affiliation(s)
- H Burton
- PHG Foundation, 2 Worts Causeway, Cambridge CB1 8RN, UK
| | - C Jackson
- Centre for Infectious Disease Epidemiology, Mortimer Market Centre, University College London, London WC1E 6JB, UK
| | - I Abubakar
- Centre for Infectious Disease Epidemiology, Mortimer Market Centre, University College London, London WC1E 6JB, UK Centre for Infectious Disease Surveillance and Control, Public Health England, 61 Colindale Avenue, Colindale, London NW9 5EQ, UK
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Schuler-Faccini L, Sanseverino MTV, de Rocha Azevedo LM, Moorthie S, Alberg C, Chowdhury S, Sagoo GS, Burton H, Nacul LC. Health needs assessment for congenital anomalies in middle-income countries: Examining the case for neural tube defects in Brazil. J Community Genet 2014; 5:147-55. [PMID: 23990401 PMCID: PMC3955461 DOI: 10.1007/s12687-013-0165-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2013] [Accepted: 08/09/2013] [Indexed: 10/26/2022] Open
Abstract
Recent economic improvement in Brazil has been reflected in better maternal-child health indicators, with decreases in infant and perinatal mortality. However, under-five mortality due to congenital disorders remained unchanged, and congenital disorders have become the second leading cause of infant mortality. In the present study, we used the PHG Foundation Health Needs Assessment (HNA) Toolkit with the objective of first assessing the burden of disease caused by neural tube defects (NTDs) in Brazil and the impact of interventions already put in place to address the burden, and second to evaluate and prioritize further interventions and policies required for its prevention and treatment. The results from these two components of the HNA process are described in this paper. The published literature was reviewed to identify studies of NTDs (prevalence; morbidity; prenatal, perinatal, and postnatal mortality; treatment or prevention). Data on indicators of maternal and child health were obtained directly from the Brazilian Ministry of Health, through the online Live Births Information System (SINASC) and from the Mortality Information System (SIM). Descriptive analyses included reports of the rates of NTD in liveborns, fetal, and infant deaths. Differences between folic acid flour pre-fortification (2001-2004) and post-fortification (2006-2010) periods were expressed as prevalence rate ratios. Around 20 % of fetal deaths were related to congenital disorders with approximately 5 % of those being NTDs. For infant mortality, congenital disorders were notified in approximately 15 % of cases, with NTDs present in 10 % of the malformed children. Although statistically significant, the prevalence rate ratio (PRR) for spina bifida in live births was only 0.937 (95 % confidence interval (CI) 0.884-0.994), a decrease of 6.3 % when comparing the pre and post-fortification periods. The impact of fortification seemed to be more visible in fetal deaths due to anencephaly (PRR = 0.727, 95 % CI 0.681-0.777) and for spina bifida (PRR = 0.700, 95 % CI 0.507-0.967) with associated decreases of 27.3 and 30 %. The lower impact of folic acid fortification in Brazil, compared to other Latin-American countries, can be due to differences in dietary habits, concentration of folic acid in flour, as well as characteristic population ethnic composition. The HNA led to the identification of the needs to be addressed in Brazil, including the improvement of reporting congenital disorders within the nationwide birth certification system, and revision of the policy of flour folic acid fortification.
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Affiliation(s)
- Lavinia Schuler-Faccini
- INAGEMP (Instituto Nacional de Genética Médica Populacional) at Teratogen Information Service, Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil,
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