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Screening for congenital hypothyroidism--a new era in Bangladesh
Mizanul Hasan1, Nurun Nahar, Anindita Ahmed
1Institute of Nuclear Medicine, Dhaka, Bangladesh.
Insights
Bangladesh
Area of Science:
- Neonatal health
- Endocrinology
- Public health initiatives
Background:
- Neonatal screening is an emerging public health concept in Bangladesh.
- The country faces significant challenges with high infant and child mortality rates due to malnutrition, diarrhea, and communicable diseases.
- Implementing newborn screening programs presents considerable logistical and societal hurdles.
Purpose of the Study:
- To introduce and evaluate a pilot newborn screening program for congenital hypothyroidism (CH) in Bangladesh.
- To assess the feasibility and initial incidence of CH in a resource-limited setting.
- To understand community and healthcare professional reception to neonatal screening.
Main Methods:
- Thyroid-stimulating hormone (TSH) levels are measured from filter paper blood samples using immunoradiometric assay (IRMA).
- Blood samples are collected via cord blood or heel prick.
- A cutoff value of 20 mIU/l triggers recall for serum T4 evaluation.
Main Results:
- Approximately 2600 newborns were screened in the pilot program.
- Two cases of congenital hypothyroidism were detected, yielding an incidence rate of 1:1300.
- The program is in its early stages, focusing on popularization and infrastructure development.
Conclusions:
- The pilot program demonstrates the potential for neonatal screening in Bangladesh, despite existing health challenges.
- Community acceptance is mixed, highlighting the need for increased program publicity and awareness.
- Government and international support are crucial for the program's sustainability and expansion.
Abstract:
Neonatal screening is a new concept in Bangladesh. Currently a pilot program is ongoing where newborns are screened for congenital hypothyroidism (CH). In a country like Bangladesh, where people are still fighting childhood problems like malnutrition, diarrhea and other communicable diseases with a high infant and child mortality rate, instituting a newborn screening program is a challenge. TSH is measured on filter paper using IRMA methods. Both cord and heel prick blood are used. A cut off value of 20 mIU/l is used above which all babies are recalled for serum T4 evaluation. Approximately 2600 newborns have been screened in the pilot program. Of these, 2 newborns were detected with CH (incidence rate 1:1300). Since it is a new program in Bangladesh, effort is mainly given on popularizing the program and building necessary infra-structure. The newborn screening program has been accepted with mixed reaction in the community. Hopefully, the government is developing a positive attitude towards the program. The paediatricians and obstetricians are also interested. The program needs more publicity. Patronization by the government and other international bodies will be essential for continuation of the program.