Abstract
Congenital malformations are defects of the morphogenesis of organs or body during the pregnancy period and are identifiable at pre- or postnatal. They are identified as the major cause of child mortality worldwide. There is a need to understand the prevalence of congenital malformations in Tigray and Ethiopia in general as surveillance data are lacking. Hence, this study was designed to investigate the burden of major congenital malformations in the Tigray Region, Northern Ethiopia. Hospital-based cross-sectional study was conducted to identify neonates with major congenital anomalies in the labor ward admitted at six major public hospitals of Tigray region, Ethiopia between January 2018 and 2019. All newborns/neonates delivered in all study hospitals during the study period were considered as the study population. The prevalence of major congenital anomalies and the distribution of each type of major congenital anomalies within total birth were calculated. Data on maternal, and newborn demographic characteristics was collected. Statistical analysis was done using SPSS and p value < 0.05 was considered significant. A total of 12,225 births and terminations were recorded in the six hospitals during the study period. Of total 12,225 births and terminations examined, 383 births had major congenital malformations and the overall prevalence of congenital malformations was 3.13% of the total births examined. Congenital anomalies (CAs) of the central nervous system specifically neural tube defects (NTDs) were the commonest anomalies in this study, found in 68.7% (263NTDs/383 CAs) of the neonates with CAs. The overall prevalence of NTDs was 2.15% (263/12,225 births) of the total births examined. Maternal factors such as women 20 years of age or younger (p < 0.0001) and women older than 35 years of age (p < 0.0001), abortion history (p < 0.0001), gravidity above 4 (p = 0.005), were more likely associated with an increased risk of babies with congenital anomalies. Fetal factors including gestational ages below 28 weeks (p < 0.0001) and above 40 weeks (p < 0.0001) were strongly associated with an increased risk of babies with congenital anomalies. However, these associated factors were not resulted from multivariable logistic regression analysis. Thus, the result might be affected by possible confounding factors. This study has shown a high prevalence of major congenital anomalies in the study community. Of the total congenital anomalies observed, most of neonates are affected with neural tube defects, a birth defect with well–established evidence having folic acid deficiency or insufficiency is the predominant cause of spina bifida and anencephaly. This just screams urgency to implement effective/mandatory/ programs to get all women of reproductive age an adequate folic acid to prevent spina bifida and anencephaly.
Highlights
Congenital malformations are single or multiple defects of the morphogenesis of organs or bodies identified at birth or during the intrauterine life[1]
Three hundred eighty-three cases of major congenital malformation were observed during the study period
Of the total neural tube defects (NTDs) cases identified, spinal bifida was the commonest NTDs type occurring in 60% (158/263NTDs cases), followed by anencephaly in 28% (73/263NTDs cases), encephalocele in 12% (32/263NTDs cases) and hydrocephalus 8.3% (32/383), respectively
Summary
Congenital malformations are single or multiple defects of the morphogenesis of organs or bodies identified at birth or during the intrauterine life[1]. Congenital anomalies (CAs) could be minor or major malformation. Major structural malformations include anomalies in central nervous system anomalies (neural tube defects), the musculoskeletal system (orofacial clefts, and limb reduction defects), gastrointestinal tract, genitourinary system, and congenital heart disease (CHD). These malformations are life-threatening, having grievous effects on the well-being and survival of children born affected by these defects[1,2]. Chemical toxicants, infection agents, maternal disease, and extracellular factors such as X-rays or chemical pollution, and periconceptional hormonal disruption are among the environmental factors that lead to congenital anomalies. Socioeconomic factors affect reproductive health by differentiating the exposure to the other risk factors as well as the access to prevention measures[5,6]
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