Congenital Malformations of the Central Nervous System in Rural Western Honduras: A 6-Year Report on Trends

Abstract

Background Central nervous system (CNS) malformations including neural tube defects (NTDs) are the second most common type of birth defects world-wide, and are major causes of childhood disability and mortality. We report the first analysis of prevalence in Western Honduras of CNS malformations including NTDs over six consecutive years. Methods Data from all patients with congenital CNS malformations and total live births between 2010 and 2015 were obtained through institution and regional registries from all three public referral hospitals in Western Honduras, representing 67 municipalities. Cases were identified using the ICD-10 CNS malformation codes. Birth prevalence was calculated as cases per 10,000 live births. Results Overall, 275 cases of CNS malformations were identified from 123,903 live births (54% Females, 58% NTDs). Overall 6- year birth prevalence of CNS malformations ranged from 13.9 and 31.1. Spina bifida variants and anencephaly represented 80% and 19% of reported NTDs, respectively. Total 6-year prevalence of NTDs in Western Honduras ranged from 7.0 to 17.4 over years studied. Six municipalities demonstrated average prevalence over 30 (maximum 49.0). Conclusion This is the first study reporting disease-burden of CNS malformations in Western Honduras. The nationwide birth-prevalence of NTDs in rural Honduras may have decreased since the implementation of prenatal health policies started in 2005. However, we identified regions with unexpectedly elevated prevalence, indicating high regional prevalence that could be targeted for improved preventative efforts, ultimately decreasing the burden of these conditions.

Actual epidemiological profile and management of central nervous system (CNS) malformations in a neurosurgery department in sub-Saharan Africa

“…The diagnoses were myelomeningocele (79.6%), encephalocele (12.5%) and Dandy Walker's malformation (9.1%) [1]. It was spina bifida in 80% and encephalocele in 19% [4]. We made the same observation in our series, probably related to the fact that neural tube defects and hydrocephalus are more symptomatic causing symptoms that worry and lead patients to consult most often, since they are hospital series for the most part.…”

“…The annual prevalence of CNS malformations in our study (6.4%) was superimposed on that of other authors (5%) [5]. This prevalence noted in our series was much lower than some noted in the literature: 13.5% [4]; 31.8% [6]. These variations could be linked, on the one hand, to the level of the technical platform for the diagnosis of these malformations and, on the other hand, by the selection criteria of these studies.…”

“…The sex ratio also varies between studies. It was 0.86 [8] and 0.85 [4] for some authors. Others noted a sex ratio of 1.1 [7] and 1.54 [6].…”

“…Neural tube defects were the most common in the literature [1,4,6,7,15]. The diagnoses were myelomeningocele (79.6%), encephalocele (12.5%) and Dandy Walker's malformation (9.1%) [1].…”

“…In developed countries, advances in antenatal diagnosis (amniocentesis, ultrasound, fetal MRI), genetic counseling and the rigorous application of preventive measures have contributed to a significant decrease in the incidence of these malformations [3]. In African societies, mysticalreligious considerations, and low socio-economic level contribute to an increase in the occurrence of CNS congenital malformations in the population [4].…”