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Fareed A, Farhat S, Kerhani AA, Choudhary A, Raza SSM. Fetal in-utero management of myelomeningocele: a mini-review on history, challenges, management gap, and recommendations. Ann Med Surg (Lond) 2024; 86:3196-3198. [PMID: 38846903 PMCID: PMC11152817 DOI: 10.1097/ms9.0000000000002061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Accepted: 04/02/2024] [Indexed: 06/09/2024] Open
Affiliation(s)
- Areeba Fareed
- Karachi Medical and Dental College, Karachi, Pakistan
| | - Solay Farhat
- Faculty of Medical Sciences, Lebanese University
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Tirsit A, Yigaramu M, Zewdneh D, Kucha W, Hagos S, Shikur B, Laeke T, Moen BE, Lie RT, Lund-Johansen M, Mahesparan R. Risk Factors for Neural-Tube Defects Detected in Utero: A Prospective Community-Based Study from Addis Ababa. World Neurosurg 2024; 185:e683-e690. [PMID: 38417626 DOI: 10.1016/j.wneu.2024.02.108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 02/19/2024] [Accepted: 02/20/2024] [Indexed: 03/01/2024]
Abstract
BACKGROUND A recent community-based study from Addis Ababa identifying Neural Tube Defect (NTD) cases by ultrasound examination of pregnant women showed a higher prevalence of 17 per 1000 fetuses. The risk factors behind the high prevalence remain unclear. METHODS Altogether 891 of the 958 women participated in the ultrasound examination. Thirteen with unaffected twin pregnancies were excluded. Among 878 singleton pregnancies, 15 NTD cases were identified. Serum Folate, vitamin B12, and homocysteine levels were measured in case-mothers and a sub-set of 28 noncase mothers. Because of the modest sample size, exact logistic regression analysis was used to estimate associations between risk factors and NTDs. RESULTS Serum vitamin status was generally poor for participants in the study. Still, relatively higher values of folate or vitamin B12 in serum, appeared to be protective for NTD (odds ratio [OR] = 0.61 per ng/ml, 95% Confidence interval [CI]: 0.42-0.85 and OR = 0.67 per 100 pg/ml, 95% CI: 0.41-1.02, respectively). High serum homocysteine was associated with higher risk of NTD (OR = 1.3 per μmol/l, 95% CI: 1.02-1.8). Women aged 30 years or more had an OR of 3.5 (95% CI: 1.1-12) for having a NTD child, and families with NTD children had lower household income. Women in the NTD group also had more spontaneous abortions or stillbirths in previous pregnancies. Self-reported intake of folate did not appear to protect against NTDs. CONCLUSIONS Within this high-prevalence community, poor vitamin status was identified as a risk factor for NTDs detected at ultrasound examination. Improving food security and fortification of foods or food ingredients could be alternative measures.
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Affiliation(s)
- Abenezer Tirsit
- Division of Neurosurgery, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia; Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Mahlet Yigaramu
- Department of Gynecology and Obstetrics, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia
| | - Daniel Zewdneh
- Department of Radiology, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia
| | - Winner Kucha
- Department of Biochemistry, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia
| | - Seifu Hagos
- School of Public health, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia
| | - Bilal Shikur
- School of Public health, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tsegazeab Laeke
- Division of Neurosurgery, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia; Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Bente E Moen
- Department of Global Public Health and Primary Care, Centre for International Health, University of Bergen, Bergen, Norway
| | - Rolv T Lie
- Department of Global Public Health and Primary Care, Centre for International Health, University of Bergen, Bergen, Norway; Centre for Fertility and Health, Norwegian Institute of Public Health, Bergen, Norway
| | - Morten Lund-Johansen
- Department of Clinical Medicine, University of Bergen, Bergen, Norway; Department of Neurosurgery, Haukeland University Hospital, University of Bergen, Bergen, Norway
| | - Rupavathana Mahesparan
- Department of Clinical Medicine, University of Bergen, Bergen, Norway; Department of Neurosurgery, Haukeland University Hospital, University of Bergen, Bergen, Norway.
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Tesfay N, Hailu G, Habtetsion M, Woldeyohannes F. Birth prevalence and risk factors of neural tube defects in Ethiopia: a systematic review and meta-analysis. BMJ Open 2023; 13:e077685. [PMID: 37940152 PMCID: PMC10632862 DOI: 10.1136/bmjopen-2023-077685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 10/19/2023] [Indexed: 11/10/2023] Open
Abstract
OBJECTIVE This study aims to estimate the prevalence of neural tube defects (NTDs) and to identify potential risk factors in the Ethiopian context. STUDY DESIGN Systematic review and meta-analysis. STUDY PARTICIPANTS A total of 611 064 participants were included in the review obtained from 42 studies. METHODS PubMed (Medline), Embase and Cochrane Library databases in combination with other potential sources of literature were systematically searched, whereby studies conducted between January 2010 and December 2022 were targeted in the review process. All observational studies were included and heterogeneity between studies was verified using Cochrane Q test statistics and I2 test statistics. Small study effects were checked using Egger's statistical test at a 5% significance level. RESULT The pooled prevalence of all NTDs per 10 000 births in Ethiopia was 71.48 (95% CI 57.80 to 86.58). The between-study heterogeneity was high (I2= 97.49%, p<0.0001). Birth prevalence of spina bifida (33.99 per 10 000) was higher than anencephaly (23.70 per 10 000), and encephalocele (4.22 per 10 000). Unbooked antenatal care (AOR 2.26, 95% CI (1.30 to 3.94)), preconception intake of folic acid (AOR 0.41, 95% CI (0.26 to 0.66)), having chronic medical illness (AOR 2.06, 95% CI (1.42 to 2.99)), drinking alcohol (AOR 2.70, 95% CI (1.89 to 3.85)), smoking cigarette (AOR 2.49, 95% CI (1.51 to 4.11)), chewing khat (AOR 3.30, 95% CI (1.88 to 5.80)), exposure to pesticides (AOR 3.87, 95% CI (2.63 to 5.71)), maternal age ≥35 (AOR 1.90, 95% CI (1.13 to 3.25)), maternal low educational status (AOR 1.60, 95% CI (1.13 to 2.24)), residing in urban areas (AOR 0.75, 95% CI (0.58 to 0.97))and family history of NTDs (AOR 2.51, 95% CI (1.36 to 4.62)) were associated with NTD cases. CONCLUSION The prevalence of NTDs in Ethiopia is seven times as high as in other Western countries where prevention measures are put in place. Heredity, maternal and environmental factors are associated with a high prevalence of NTDs. Mandatory fortification of staple food with folic acid should be taken as a priority intervention to curb the burden of NTDs. To smoothen and overlook the pace of implementation of mass fortification, screening, and monitoring surveillance systems should be in place along with awareness-raising measures. PROSPERO REGISTRATION NUMBER CRD42023413490.
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Affiliation(s)
- Neamin Tesfay
- Centre of Public Health Emergency Management, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Girmay Hailu
- Centre of Public Health Emergency Management, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Medhanye Habtetsion
- Centre of Public Health Emergency Management, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Fistum Woldeyohannes
- Health Financing Program, Clinton Health Access Initiative, Addis Ababa, Ethiopia
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Kancherla V. Neural tube defects: a review of global prevalence, causes, and primary prevention. Childs Nerv Syst 2023; 39:1703-1710. [PMID: 36882610 DOI: 10.1007/s00381-023-05910-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 02/27/2023] [Indexed: 03/09/2023]
Abstract
Neural tube defects (NTDs) are common birth defects and contribute to life-long disabilities, high medical care costs, and perinatal and child mortality. This review is a primer on prevalence, causes, and evidence-based prevention strategies for NTDs. The estimated average global prevalence of NTDs is two cases per 1000 births, amounting to approximately 214,000-322,000 affected pregnancies worldwide annually. Prevalence and associated adverse outcomes are disproportionately high in developing countries. NTDs have multiple risk factors including genetic and non-genetic (i.e., maternal nutritional status, pre-pregnancy diabetes, early pregnancy exposure to valproic acid (anti-epileptic medication), and a previous pregnancy affected by a NTD) factors. Maternal folate insufficiency before and during early pregnancy is the most common risk factor and is preventable. Folic acid (vitamin B9) is required for formation of the neural tube early in pregnancy, around 28 days after conception, when most women are unaware of their pregnancies. Current guidelines recommend that all women planning or capable of pregnancy take a daily supplement containing 400-800 μg of folic acid. Mandatory folic acid fortification of staple foods (e.g., wheat flour, maize flour, rice) is safe, economical, and the effective intervention for primary prevention of NTDs. Currently, about 60 countries are implementing mandatory folic acid fortification of staple foods, preventing just a quarter of all preventable NTD cases worldwide. There is an urgent need for active champions, including neurosurgeons and other healthcare providers, to generate political will and promote effective mandatory food fortification with folic acid, and reach equitable primary prevention of NTDs in all countries.
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Affiliation(s)
- Vijaya Kancherla
- Center for Spina Bifida Prevention, Department of Epidemiology, Emory University Rollins School of Public Health, 1518 Clifton Rd NE, Atlanta, GA, 30322, USA.
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Wakoya R, Afework M. Burden of Neural Tube Defects and Their Associated Factors in Africa: A Systematic Review and Meta-Analysis. Int J Pediatr 2023; 2023:9635827. [PMID: 37388625 PMCID: PMC10307122 DOI: 10.1155/2023/9635827] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 05/21/2023] [Accepted: 06/03/2023] [Indexed: 07/01/2023] Open
Abstract
Background Neural tube defects are a type of congenital anomaly caused by an abnormality in the development of the brain and spinal cord during embryogenesis. They cause high rates of mortality, morbidity, and lifelong disability. There are several studies carried out worldwide reporting different findings on the burden and associated factors. The aim of this study is to carry out a systematic review and meta-analysis of the burden of neural tube defects and their associated factors in Africa. Methods A total of 58 eligible articles were identified systematically using databases such as PubMed, Embase, African Journal Online Library, ProQuest, Cochrane, Google Scopus, Google Scholar, and Grey literature. Extracted data were analyzed using STATA 16.0 statistical software. The heterogeneity of studies was determined using the Cochrane Q test statistic and I2 test statistics with forest plots. A random effects model was used to examine the pooled burden of neural tube defects, subgroups of the region, subtypes of NTDs, sensitivity analysis, and publication bias. The association between NTDs and associated factors was studied using a fixed-effect model. Results Fifty-eight studies with a total of 7,150,654 participants in 16 African countries revealed that the pooled burden of neural tube defects was 32.95 per 10,000 births (95% CI: 29.77-36.13). The Eastern African region had the highest burden in the subgroup analysis, with 111.13 per 10,000 births (95% CI: 91.85-130.42). South African countries had the lowest burden, at 11.43 per 10,000 births (95% CI: 7.51-15.34). In subtype analysis, spina bifida had the highest pooled burden at 17.01 per 10,000 births (95 percent CI: 15.00-19.00), while encephalocele had the lowest at 1.66 per 10,000 births (95% CI: 1.12-2.20). Maternal folic acid supplementation (AOR: 0.38; 95% CI: 0.16-0.94), alcohol consumption (AOR: 2.54; 95% CI: 1.08-5.96), maternal age (AOR: 3.54; 95% CI: 1.67-7.47), pesticide exposure (AOR: 2.69; 95% CI: 1.62-4.46), X-ray radiation (AOR: 2.67; 95% CI: 1.05-6.78), and history of stillbirth (AOR: 3.18; 95% CI: 1.11-9.12) were significantly associated with NTDs. Conclusion The pooled burden of NTDs in Africa was found to be high. Maternal age, alcohol consumption, pesticide and X-ray radiation exposure, history of stillbirth, and folic acid supplementation were significantly associated with NTDs.
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Affiliation(s)
- Reta Wakoya
- Department of Biomedical Science, Menelik II Medical and Health Science College, Addis Ababa, Ethiopia
- Department of Anatomy, School of Medicine, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia
| | - Mekbeb Afework
- Department of Anatomy, School of Medicine, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia
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Yang X, Zeng J, Gu Y, Fang Y, Wei C, Tan S, Zhang X. Birth defects data from hospital-based birth defect surveillance in Guilin, China, 2018-2020. Front Public Health 2022; 10:961613. [PMID: 36091541 PMCID: PMC9449144 DOI: 10.3389/fpubh.2022.961613] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Accepted: 08/08/2022] [Indexed: 01/24/2023] Open
Abstract
Objectives Birth defects (BDs) are a major contributor to perinatal and infant mortality, morbidity and lifelong disability worldwide. A hospital-based study on birth defects was designed in Guilin city in the Guangxi province of Southwestern China aiming to determine the prevalence of BDs in the studied region, and the classify the BDs based on clinical presentation and causation. Methods The study involved BDs among all pregnancy outcomes (live births, stillbirths, death within 7 days, and pregnancy terminations) born in the 42 registered hospitals of Guilin between 2018 and 2020. The epidemiological characteristics of BDs and the etiologic profile of BDs were evaluated in this study. Results Of the total 147,817 births recorded during the study period, 2,003 infants with BDs were detected, giving a total prevalence rate of 13.55 per 1,000 births. The top five BD types were congenital heart defects, polydactyly, syndactyly, malformations of the external ear, and talipes equinovarus, whereas, neural tube defects, congential esophageal atresia, gastroschisis, extrophy of urinary bladder, were the least common BD types in these 3 years. Only 8.84% of cases were assigned a known etiology, while most cases (91.16%) could not be conclusively assigned a specific cause. Conclusion This study provides an epidemiological description of BDs in Guilin, which may be helpful for understanding the overall situation in Southwest China of BDs and aid in more comprehensive studies of BDs in future healthcare systems, including funding investment, policy-making, monitor, prevention. Strong prevention strategies should be the priority to reduce BDs and improve the birth quality.
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Affiliation(s)
- Xingdi Yang
- Public Health, Guilin Medical University, Guilin, China,The Guangxi Key Laboratory of Environmental Exposomics and Entire Lifecycle Heath, Guilin, China,Guangxi Health Commission Key Laboratory of Entire Lifecycle Health and Care, Guilin, China
| | - Jianjuan Zeng
- Department of Child Health Care, Guilin Maternal and Child Health Hospital, Guilin, China
| | - Yiping Gu
- Public Health, Guilin Medical University, Guilin, China,The Guangxi Key Laboratory of Environmental Exposomics and Entire Lifecycle Heath, Guilin, China,Guangxi Health Commission Key Laboratory of Entire Lifecycle Health and Care, Guilin, China
| | - Yiming Fang
- Public Health, Guilin Medical University, Guilin, China,The Guangxi Key Laboratory of Environmental Exposomics and Entire Lifecycle Heath, Guilin, China,Guangxi Health Commission Key Laboratory of Entire Lifecycle Health and Care, Guilin, China
| | - Caiyun Wei
- Public Health, Guilin Medical University, Guilin, China
| | - Shengkui Tan
- Public Health, Guilin Medical University, Guilin, China,The Guangxi Key Laboratory of Environmental Exposomics and Entire Lifecycle Heath, Guilin, China,Guangxi Health Commission Key Laboratory of Entire Lifecycle Health and Care, Guilin, China,*Correspondence: Shengkui Tan
| | - Xiaoying Zhang
- Public Health, Guilin Medical University, Guilin, China,The Guangxi Key Laboratory of Environmental Exposomics and Entire Lifecycle Heath, Guilin, China,Guangxi Health Commission Key Laboratory of Entire Lifecycle Health and Care, Guilin, China,Xiaoying Zhang
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