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      Magnitude of Birth Defects in Central and Northwest Ethiopia from 2010-2014: A Descriptive Retrospective Study

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          Abstract

          Background

          Birth defects are defined as structural and functional defects that develop during the organogenesis period and present at birth or detected later in life. They are one of the leading causes of infant and child mortality, morbidity, and long term disability. The magnitude of birth defects varies from country to country and from race/ethnicity to race/ethnicity, and about 40–60% of their causes are unknown. The known causes of birth defects are genetic and environmental factors which may be prevented. For various reasons, there is lack of data and research on birth defects in Ethiopia.

          Objective

          The major objective of this study is to estimate the magnitude of birth defects in Ethiopia.

          Subject and Methods

          A hospital based, retrospective, cross sectional, descriptive study was conducted. The subjects were babies/children aged 0–17years who visited selected hospitals between 2010 and 2014. Fourteen hospitals (8 in Addis Ababa, 6 in Amhara Region) were selected purposively based on case load. A data retrieving form was developed to extract relevant information from record books.

          Results

          In the hospitals mentioned, 319,776 various medical records of children aged 0–17years were found. Of these, 6,076 (1.9% with 95% CI: 1.85%–1.95%) children were diagnosed as having birth defects. The majority (58.5%) of the children were male and 41.5% female. A slightly more than half (51.1%) of the children were urban dwellers, while 48.9% were from rural areas. Among the participants of the study the proportion of birth defects ranged as follows: orofacial (34.2%), neural tube (30.8%), upper and lower limb (12.8%), cardiovascular system (10.3%), digestive system and abdominal wall (4.8%), unspecified congenital malformations (2.5%), Down syndrome (2%), genitourinary system (2%), head, face, and neck defects (0.4%), and others (0.3%). The trend of birth defects increased linearly over time [Extended Mantel-Haenszel chi square for linear trend = 356.7 (P<0.0001)]. About 275 (4.5%) of the cases had multiple (associated) birth defects and 5,801 (95.5%) isolated (single) birth defects. Out of the total birth defects, 6,018 (99%) were major and 58 (1%) minor.

          Conclusion

          The magnitude of birth defects increased from 2010–2014. Orofacial and neural tube defects contributed about two thirds of the birth defects. There is an urgent need for registry and surveillance system strategies for intervention and control of birth defects in Ethiopia.

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          Most cited references21

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          A matched case–control study of preterm birth in one hospital in Beijing, China

          Background Preterm birth is an unresolved global health issue. The etiologies of preterm birth are complex and multifactorial. To examine risk factors related to preterm birth, a matched case–control study was conducted in a hospital in Beijing, China where little data on preterm birth have been published in the scientific literature. Methods A 1:1 matched case–control study was conducted in 172 pairs of women with preterm birth (case group) and term delivery (control group). Eligible subjects were interviewed in person by well-trained investigators using a questionnaire. Information on obstetric diagnosis and newborns were abstracted from inpatients’ medical records. Univariate and multivariate conditional logistic regression models were used to measure the associations between related factors and preterm birth. Results Univariate analysis showed that 6 of 12 factors were associated with preterm birth. Multivariate results showed that gestational hypertension (OR = 7.76), low gestational weight gain (OR = 3.02), frequent prenatal care (OR = 0.16), balanced diet (OR = 0.36), and high gestational weight gain (OR = 0.41) were associated with preterm birth. Conclusion This study provides information on preterm birth in Beijing, China, and it also lends support to existing evidence about the role of maternal nutritional status, prenatal care and gestational hypertension as risk factors for preterm birth.
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            Infant mortality and congenital anomalies from 1950 to 1994: an international perspective.

            To provide an international perspective on the impact of congenital anomalies on infant mortality from 1950 to 1994. Population-based study based on data obtained from vital statistics reported to the World Health Organisation. 36 countries from Europe, the Middle East, the Americas, Asia, and the South Pacific. On average, infant mortality declined 68.8 per cent from 1950 to 1994. In the countries studied, infant mortality attributable to congenital anomalies decreased by 33.4 per cent, although it recently increased in some countries in Central and Latin America and in Eastern Europe. Anomalies of the heart and of the central nervous system accounted for 48.9 per cent of infant deaths attributable to congenital anomalies. During 1990-1994, infant mortality attributable to congenital anomalies was inversely correlated to the per capita gross domestic product in the countries studied. At the same time, the proportion of infant deaths attributable to congenital malformations was directly correlated with the per capita gross domestic product. Congenital malformations account for an increasing proportion of infant deaths in both developed and developing countries. Infant mortality attributable to congenital anomalies is higher in poorer countries although as a proportion of infant deaths it is greater in wealthier countries. Conditions such as spina bifida, whose occurrence can be reduced through preventive strategies, still cause many infant deaths. The apparent increase of infant mortality because of congenital anomalies in some countries should be investigated to confirm the finding, find the causes, and provide prevention opportunities.
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              Pattern and factors associated with congenital anomalies among young infants admitted at Bugando medical centre, Mwanza, Tanzania

              Background Congenital anomalies or birth defects are among the leading causes of infant mortality and morbidity around the world. The impact of congenital anomalies is particularly severe in middle- and low-income countries where health care resources are limited. The prevalence of congenital anomalies varies in different parts of the world, which could reflect different aetiological factors in different geographical regions. Methods Between October 2012 and January 2013, a cross-sectional study was conducted involving young infants below 2 months of age, admitted at a university teaching hospital in Tanzania. Face-to-face interviews with parents/caretakers of young infants were carried out to collect socio-demographic and clinical information. Physical examinations were performed on all young infants. Echocardiography, X-ray, cranial as well as abdominal ultrasonographies were performed when indicated. Results Analysis of the data showed that among 445 young infants enrolled in the study, the prevalence of congenital anomalies was 29%, with the Central Nervous System (CNS) as the most commonly affected organ system. Maternal factors that were significantly associated with congenital anomalies included the lack of peri-conceptional use of folic acid (OR = 3.1; 95% CI = 1.4-6.7; p = 0.005), a maternal age of above 35 years (OR = 2.2; 95% CI = 1.1-4.3; p = 0.024) and an inadequate attendance to antenatal clinic (OR = 2.1; 95% CI = 1.4-3.3; p < 0.001). Infant factors that were significantly associated with congenital anomalies were female sex, a birth weight of 2.5 kg or more, singleton pregnancy and a birth order above 4. Conclusions Due to the high prevalence of congenital anomalies observed in this particular context, the hospital should mobilize additional resources for an optimal and timely management of the patients with congenital anomalies. In this study, the proportion of women taking folic acid supplements during early pregnancy was very low. Efforts should be made to ensure that more women use folic acid during the peri-conceptional period, as the use of folic acid supplement has been linked by several authors to a reduced occurrence of some congenital anomalies.
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                Author and article information

                Contributors
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                5 October 2016
                2016
                : 11
                : 10
                : e0161998
                Affiliations
                [1 ]Department of Anatomy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
                [2 ]School of Dentistry, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
                [3 ]Internal medicine, School of Medicine, College of Medicine and Health Sciences, the University of Gondar, Gondar, Ethiopia
                [4 ]School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
                Tabriz University of Medical Sciences, ISLAMIC REPUBLIC OF IRAN
                Author notes

                Competing Interests: The authors, Dr. Mekbeb Afework, Professor Alemayehu Worku and Dr. Wondwossen Fantaye receive salary from Addis Ababa University. Dr. Ermias Diro and Mr. Molla Taye receive salary from the University of Gondar. The authors have declared that no competing interests exist.

                • Conceptualization: MT.

                • Data curation: MT.

                • Formal analysis: MT MA AW ED.

                • Funding acquisition: MT.

                • Investigation: MT MA AW WF ED.

                • Methodology: MT MA AW WF ED.

                • Project administration: MT.

                • Supervision: MT MA AW WF ED.

                • Validation: MT MA AW WF ED.

                • Visualization: MT.

                • Writing – original draft: MT.

                • Writing – review & editing: MT MA AW WF ED.

                Article
                PONE-D-16-15509
                10.1371/journal.pone.0161998
                5051902
                27706169
                d08f20d1-0d85-4b93-94f2-eec6fc964347
                © 2016 Taye et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 17 April 2016
                : 16 August 2016
                Page count
                Figures: 0, Tables: 7, Pages: 12
                Funding
                This study obtained fund from Addis Ababa University and the University of Gondar for data collection only. The authors declare that they have no fund for the publication of this manuscript. The funders have no role in the study design, data analysis and decision to publish for preparation of the manuscript.
                Categories
                Research Article
                Medicine and Health Sciences
                Congenital Disorders
                Birth Defects
                Biology and Life Sciences
                Developmental Biology
                Morphogenesis
                Birth Defects
                People and Places
                Population Groupings
                Ethnicities
                Amhara People
                Medicine and Health Sciences
                Congenital Disorders
                Congenital Anomalies
                Medicine and Health Sciences
                Congenital Disorders
                Birth Defects
                Cleft Lip and Palate
                Biology and Life Sciences
                Developmental Biology
                Morphogenesis
                Birth Defects
                Cleft Lip and Palate
                Medicine and Health Sciences
                Otorhinolaryngology
                Cleft Lip and Palate
                People and Places
                Geographical Locations
                Africa
                Ethiopia
                Medicine and Health Sciences
                Congenital Disorders
                Birth Defects
                Cleft Lip and Palate
                Cleft Lip
                Biology and Life Sciences
                Developmental Biology
                Morphogenesis
                Birth Defects
                Cleft Lip and Palate
                Cleft Lip
                Medicine and Health Sciences
                Otorhinolaryngology
                Cleft Lip and Palate
                Cleft Lip
                People and Places
                Population Groupings
                Age Groups
                Children
                Infants
                People and Places
                Population Groupings
                Families
                Children
                Infants
                Medicine and Health Sciences
                Congenital Disorders
                Birth Defects
                Neural Tube Defects
                Biology and Life Sciences
                Developmental Biology
                Morphogenesis
                Birth Defects
                Neural Tube Defects
                Custom metadata
                All relevant data are within the paper.

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