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Burden and consequence of birth defects in Nepal-evidence from prospective cohort study
Prajwal Paudel1, Avinash K Sunny2, Rejina Gurung2
1Paropakar Maternity and Women's Hospital, Ministry of Health and Population, Kathmandu, Nepal.
Insights
Birth defects affect 5.8 per 1000 live births in Nepal. Younger maternal age and ethnicity are risk factors, increasing risks of asphyxia, infection, and mortality.
Area of Science:
- Public Health
- Pediatrics
- Genetics
Background:
- Globally, 7.9 million babies are born with birth defects annually, leading to significant mortality and disability.
- Accurate data on birth defect prevalence, risk factors, and consequences are crucial for effective prevention and management strategies.
- This study addresses the need for improved information on birth defects within Nepal.
Purpose of the Study:
- To assess the prevalence of birth defects in Nepal.
- To identify associated risk factors for birth defects.
- To determine the consequences of birth defects on infant health outcomes.
Main Methods:
- A prospective cohort study was conducted over 18 months in 12 Nepalese hospitals.
- Data were collected from 87,242 livebirths using semi-structured questionnaires and clinical case notes.
- Logistic regression analysis was employed to identify risk factors and consequences.
Main Results:
- The prevalence of birth defects was 5.8 per 1000 live births.
- Common defects included anencephaly, cleft lip/palate, clubfeet, eye abnormalities, and meningomyelocele.
- Risk factors identified were maternal age <20 years (aOR 1.64) and disadvantaged ethnicity (aOR 1.78). Babies with birth defects had increased odds of birth asphyxia (aOR 1.88), neonatal infection (aOR 1.82), and pre-discharge mortality (aOR 3.00).
Conclusions:
- Maternal age under 20 and disadvantaged ethnicity are significant risk factors for birth defects in Nepal.
- Birth defects substantially increase the risk of adverse outcomes, including birth asphyxia, neonatal infection, and mortality.
- Further research into the care provided to infants with birth defects is warranted.
Background:
Every 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.
Method:
This 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.
Results:
Among 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).
Conclusion:
Maternal 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.
Funding:
Swedish Research Council (VR).
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