Congenital Anomalies in Low‐ and Middle‐Income Countries: The Unborn Child of Global Surgery

Sitkin, Nicole; Ozgediz, Doruk; Donkor, Peter; Farmer, Diana L.

doi:10.1007/s00268-014-2714-9

Cited by 129 publications

(126 citation statements)

References 68 publications

(61 reference statements)

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“…Congenital malformation otherwise known as birth defects or congenital abnormalities are structural, functional, genetic, or behavioral anomalies, including metabolic disorders that occur during fetal development and can be diagnosed prenatally, at birth or later in life . They are important causes of adverse pregnancy outcomes, neonatal morbidity, and mortality in developed and developing countries …”

Section: Introductionmentioning

confidence: 99%

Drug‐related teratogenic and pathologic causes of birth defects in a tertiary hospital in Southwestern Nigeria

Offor

Awodele

Oshikoya

2019

Pharmacology Res & Perspec

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Birth defects are important causes of neonatal morbidity and mortality. A good understanding of the etiology is a vital step toward developing improved treatment and preventive strategies. We conducted an audit of medical records of newborns with birth abnormalities in a tertiary hospital over a 10‐year period, using a Pro forma designed to collect information on obstetric history, antenatal history, sociodemographics of parents, and the type of birth abnormality. Of the 180 medical records reviewed, female babies were 92 (51.1%) and male babies were 86 (47.8%). The mean age of the fathers was 38.2 + 6.2, and mothers 31.8 + 4.9. Majority 115 (63.9%) of the mothers had records of acute illnesses, and 23 (12.8%) chronic illnesses during pregnancy. Unspecified febrile illness 44 (38.3%), malaria 40 (34.8%), typhoid 8 (6.9%), hypertension 13 (56.5%), pregestational diabetes 4 (17.4%), and HIV 3 (13.0%) were the commonest maternal pathologies. Most of the documented birth abnormalities were Down's syndrome 34 (15.2%); congenital hydrocephalus 32 (14.3%); acyanotic congenital heart defect 30 (13.4%); deformity of the digits 26 (11.6%); and ventricular septal defect 20 (8.9%). The prevalence of maternal pathologies calls for concern, as these may be implicated in birth defects, therefore should be further investigated in future studies.

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Section: Introductionmentioning

confidence: 99%

Drug‐related teratogenic and pathologic causes of birth defects in a tertiary hospital in Southwestern Nigeria

Offor

Awodele

Oshikoya

2019

Pharmacology Res & Perspec

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“…Sites with generalized HIV-epidemics could contribute significant quantities of data to ART safety surveillance systems. However, these sites are predominately located in resource-limited settings, where few countries have surveillance programs in place, and those with a program are addressing challenges such as lack of trained health personnel to properly identify and classify the anomaly, lack of systematic and harmonized data collection processes, lack of allocation of appropriate health resources to surveillance programming, the need to establish a longitudinal exam and reporting component, and the lack of sufficient, and in some settings, any geneticists or a multidisciplinary team to validate findings and assist with definitive interventions and/or support care [7, 8]. …”

Section: Introductionmentioning

confidence: 99%

Detecting congenital malformations - Lessons learned from the Mpepu study, Botswana

et al. 2017

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IntroductionA large and increasing number of HIV-infected women are conceiving on antiretroviral treatment (ART). While most antiretrovirals are considered safe in pregnancy, monitoring for rare pregnancy and infant adverse outcomes is warranted.MethodsWe conducted a retrospective secondary analysis nested within a clinical trial of infant cotrimoxazole vs. placebo prophylaxis in Botswana (the Mpepu Study). Infants were examined at birth, and at least every 3 months through 18 months of age. Abnormal physical findings and diagnostic testing revealing malformations were documented. Post hoc, a geneticist classified all reported malformations based on available documentation. Structural malformations with surgical, medical or cosmetic importance were classified as major malformations. We present a descriptive analysis of identified malformations.ResultsBetween 2011 and 2014, 2,933 HIV-infected women who enrolled in the Mpepu study delivered 2,971 live-born infants. Study staff conducted 2,944 (99%) newborn exams. One thousand eighty-eight (38%) women were taking ART at conception; 1,147 (40%) started ART during pregnancy; 442 (15%) received zidovudine monotherapy; and 223 (7%) received no antiretroviral during pregnancy. Of 33 reported anomalies, 25 (76%) met congenital malformations criteria, 10 (30%) were classified as major malformations, 4 (40%) of which were identified after the birth exam.DiscussionOur results highlight the importance of staff training on identification of congenital malformations, programmatic monitoring beyond the birth examination and the value of geneticist involvement in the malformations classification process in resource-limited settings. These elements will be important to fully define antiretroviral drug safety in pregnancy.SignificanceSurveillance systems for monitoring the safety of antiretroviral use during pregnancy among HIV-infected women in resource-limited setting are lacking. The World Health Organization’s published programmatic recommendations for such surveillance systems represents the gold standard. We employed data from a clinical trial in Botswana, a country with a generalized HIV epidemic and high antiretroviral uptake by HIV-infected women, to highlight practical opportunities to strengthen congenital malformation surveillance systems in these settings where over 1 million HIV infected pregnant women reside.Trial registrationClinical Trials.gov NCT01229761

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“…8,24 The candidate indicators were extracted from the World Health Organization's Global Health Observatory Data Repository and the World Bank's DataBank.…”

Section: Country-level Indicatorsmentioning

confidence: 99%

Estimate of Unmet Need for Cleft Lip and/or Palate Surgery in India

Stewart

Carlson

Hatcher

et al. 2016

JAMA Facial Plast Surg

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raniofacial cleft anomalies are common, affecting 1 in 600 live births annually. 1 However, cleft lip and/or palate (CL/P) disproportionately affects newborns in low-and middle-income countries (LMICs) owing to substandard nutrition and a lack of prenatal care. 2,3 Infants born with CL/P in LMICs face significant barriers to treatment, which often lead to prolonged disfigurement, social stigma, speech impairment, and feeding difficulty that may result in malnutrition and even death. [4][5][6] Although CL/P is a complex condition that benefits from comprehensive care, the provision of safe, timely, and effective surgery helps to achieve a successful outcome. 5,6 Like other LMICs, India lacks reliable documentation of birth anomalies 7 ; thus, accurate estimates of the burden of CL/P in India are few. 4 A multicenter hospital-based study of 94 610 births 8 reported that the incidence of CL/P was 9.3 per 10 000 births and the incidence of cleft palate was 1.7 per 10 000 births. Khajanchi et al 4 performed a populationbased assessment of the unmet need for CL/P treatment in a single district. They reported a CL/P incidence of 7.3 per 10 000 live births. With a crude birth rate of 200 per 10 000 population and 1.25 billion people, as many as 3 infants with CL/P are born in India every hour. The proportion of these cases that receive safe, timely, and effective surgical care IMPORTANCE The unmet need for cleft lip and/or palate (CL/P) care in India is significant. However, estimates required for CL/P care program planning are lacking.OBJECTIVE To estimate the unmet need for CL/P surgery in India at the state level. DESIGN, SETTING, AND PARTICIPANTSTo determine the proportion of individuals with CL/P who presented for care in India, data were used from patients who received care at Operation Smile programs in 12 low-and middle-income countries from June 1, 2013, to May 31, 2014. The resulting model describes the prevalent unmet need for cleft surgery in India by state and includes patients older than the surgery target ages of 1 and 2 years for cleft lip and cleft palate repair, respectively. Next, the total number of unrepaired CL/P cases in each state was estimated using state-level economic and health system indicators. MAIN OUTCOMES AND MEASURESPrevalent unmet need for CL/P repair. RESULTSIn the 28 states with available data, an estimated 72 637 cases of unrepaired CL/P (uncertainty interval, 58 644-97 870 cases) were detected. The percentage of individuals with unrepaired CL/P who were older than the respective target ages ranged from 37.0% (95% CI, 30.6%-43.8%) in Goa to 65.8% (95% CI, 60.3%-70.9%) in Bihar (median, 57.9%; interquartile range, 52.6%-63.4%). The rate of unrepaired CL/Ps ranged from less than 3.5 per 100 000 population in Kerala and Goa to 10.9 per 100 000 population in Bihar (median rate, 5.9 [interquartile range, 4.6-7.3] per 100 000 population).CONCLUSIONS AND RELEVANCE An estimated 72 000 cases of unrepaired CL/P are found in India. Poor states with less health care infrastructure have exception...

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Congenital Anomalies in Low‐ and Middle‐Income Countries: The Unborn Child of Global Surgery

Cited by 129 publications

References 68 publications

Drug‐related teratogenic and pathologic causes of birth defects in a tertiary hospital in Southwestern Nigeria

Drug‐related teratogenic and pathologic causes of birth defects in a tertiary hospital in Southwestern Nigeria

Detecting congenital malformations - Lessons learned from the Mpepu study, Botswana

Estimate of Unmet Need for Cleft Lip and/or Palate Surgery in India

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