Abstract
BackgroundEvery year an estimated 7.9 million babies are born with birth defect. Of these babies, more than 3 million die and 3.2 million have disability. Improving nationwide information on prevalence of birth defect, risk factor and consequence is required for better resource allocation for prevention, management and rehabilitation. In this study, we assess the prevalence of birth defect, associated risk factors and consequences in Nepal.MethodThis is a prospective cohort study conducted in 12 hospitals of Nepal for 18 months. All the women who delivered in the hospitals during the study period was enrolled. Independent researchers collected data on the social and demographic information using semi-structured questionnaire at the time of discharge and clinical events and birth outcome information from the clinical case note. Data were analyzed on the prevalence and type of birth defect. Logistic regression was done to assess the risk factor and consequences for birth defect.ResultsAmong the total 87,242 livebirths, the prevalence of birth defects was found to be 5.8 per 1000 live births. The commonly occurring birth defects were anencephaly (3.95%), cleft lip (2.77%), cleft lip and palate (6.13%), clubfeet (3.95%), eye abnormalities (3.95%) and meningomyelocele (3.36%). The odds of birth defect was higher among mothers with age < 20 years (adjusted Odds ratio (aOR) 1.64; 95% CI, 1.18–2.28) and disadvantaged ethnicity (aOR 1.78; 95% CI, 1.46–2.18). The odds of birth asphyxia was twice fold higher among babies with birth defect (aOR 1.88; 95% CI, 1.41–2.51) in reference with babies without birth defect. The odds of neonatal infection was twice fold higher among babies with birth defect (aOR 1.82; 95% CI, 1.12–2.96) in reference with babies without birth defect. Babies with birth defect had three-fold risk of pre-discharge mortality (aOR 3.00; 95% CI, 1.93–4.69).ConclusionMaternal age younger than 20 years and advantaged ethnicity were risk factors of birth defects. Babies with birth defect have high risk for birth asphyxia, neonatal infection and pre-discharge mortality at birth. Further evaluation on the care provided to babies who have birth defect is warranted.FundingSwedish Research Council (VR).
Highlights
Birth defects are anomalies in morphogenesis during early foetal life resulting in structural, behavioural, functional and metabolic disorders that can be detected prenatally, at birth or later in infancy [1]
The odds of birth asphyxia was twice fold higher among babies with birth defect in reference with babies without birth defect
The odds of neonatal infection was twice fold higher among babies with birth defect in reference with babies without birth defect
Summary
Birth defects are anomalies in morphogenesis during early foetal life resulting in structural, behavioural, functional and metabolic disorders that can be detected prenatally, at birth or later in infancy [1]. In Nepal in 2010, among the estimated 600,000 born 40,000 births were are born with malformations with cleft lip and palate, neural tube defects, congenital heart disease as the commonest conditions [5, 6]. The prevalence of birth defect is widely variable ranging from 0.3 to 7% implicating various known and unknown factors interplaying differently in varied time and geographical location [7]. Often, these factors are recognised as genetic in origin (10–30%), environmental (5–10%), multi-factorial (20– 35%) and unknown (30–45%) [8]. We assess the prevalence of birth defect, associated risk factors and consequences in Nepal
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