High burden of neural tube defects in Tigray, Northern Ethiopia: Hospital-based study

Abstract

IntroductionNeural tube defects are the major causes of fetal loss and considerable disabilities in infants. Currently, there is no significant research on the incidence of Neural tube defects in the Tigray region of Ethiopia.ObjectiveTo determine the incidence and clinical pattern of the Neural Tube Defects.MethodsA hospital-based cross-sectional study was conducted from October 2016 to June 2017. All pregnancy outcomes were examined for any externally visible birth defects and neurological integrity by trained midwives under the supervision of senior obstetrics and gynecology and a neurosurgeon. Data were collected using a survey tool to collect maternal and newborn demographic data and a checklist developed to capture newborns with Neural Tube Defects. Data were analyzed using SPSS version 20. The prevalence of NTDs was calculated per 10,000 births.ResultOut of the 14,903 births during the study period, a total of 195 infants were born afflicted with Neural Tube Defects. The burden of infants with anencephaly and spina bifida was 66.4 and 64.4 per 10, 000 births, respectively. The overall incidence rate of NTDs in this study was 131 per 10, 000 births of which 23% were liveborn and 77% were stillborn. The highest burden of Neural Tube Defects was observed in Adigrat Hospital from Eastern Zone of Tigray (174 per 10,000 births) and Lemlem Karl Hospital from Southern Zone of Tigray (304 per 10,000 births) compared to Kahsay Abera Hospital from Western Zone (72.8 per 10,000 births) and Sihul Hospital from North Western Zone of Tigray (69.8 per 10,000 births).Conclusion and recommendationAssuming that the non folic acid preventable rate should be 5 per 10,000 births, our prevalence rate is 131 per 10,000 births, and then we have a rate or an epidemic that is 26 times what it should be. This just emphasizes the urgency to implement effective programs to get all women of reproductive age to have adequate folic acid to prevent all of folic acid-preventable spina bifida and anencephaly, which would prevent 96% (125/130) of spina bifida and anencephaly in the Tigray Provence.

Anatomical patterns of cleft lip and palate deformities among neonates in Mekelle, Tigray, Ethiopia; implication of environmental impact

“…In contrast, an Iranian study had 13% of CLP neonates associated with other congenital anomalies of the head, face and heart [33]. The higher incidence of limb malformations may be due to their association with neural tube defects, whose prevalence has been found to be as high as 26 times the normal non-folic acid preventable rate in Tigray region, Northern Ethiopia [34].…”

High potential for reducing folic acid‐preventable spina bifida and anencephaly, and related stillbirth and child mortality, in Ethiopia

“…We utilized the latest available data for Ethiopia from multiple sources on the number of live births, stillbirths, and child mortality rates (including neonatal, infant, and under‐five mortality) to estimate our findings for the year 2016. Based on published literature, we assumed anencephaly and spina bifida prevalence in Ethiopia to be 6.5 per 1,000 total births each, and their combined prevalence to be 13 per 1,000 total births (Berihu et al, ). The term total births in the denominator includes both live and stillbirths.…”

“…Based on recent literature from Ethiopia, we assumed that 100% of all anencephaly cases and 53% of all spina bifida cases were stillborn (Berihu et al, ). We then applied neural tube defects‐related mortality proportions from a population‐representative surveillance in Ireland for births between 1976 and 1987 (Sutton, Daly, & Kirke, ).…”

“…The global average prevalence is estimated to be 1.9 per 1,000 live births (95% uncertainty interval [UI]: 1.5–2.3 per 1,000 live births) (Blencowe et al, ). However, a large public hospital‐based surveillance study from northern Ethiopia reported an epidemic level of prevalence, at 13 per 1,000 births of at least 20 weeks' gestation, including cases that were identified as live births and stillbirths from spontaneous abortions (Berihu et al, ). This reported prevalence in Ethiopia, compared to that noted currently in the United States (0.5 per 1,000 live births) (Williams et al, ), is 26‐fold higher.…”

“…Recent nutritional surveys in reproductive‐aged women of Ethiopia provide evidence of significant folate deficiency in Harari (81%), Tigray region (54%), Dire‐Dawa (53%), and the entire country of Ethiopia (46%) (Haidar, Melaku, & Robocik, ). The 2016 Ethiopian National Micronutrient Survey reported that micronutrient deficiencies were common among women of reproductive age living in rural areas; 32% of women of reproductive age in the country were deficient in their red blood cell folate concentrations (Ethiopian Public Health Institute, ), supporting the high prevalence of spina bifida and anencephaly noted in northern Ethiopia (Berihu et al, ).…”