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Congenital hypothyroidism screening in the West Bank: a test case for screening in developing regions
J Sack1, I Feldman, I Kaiserman
1Department of Pediatrics, Sheba Medical Center, Tel Hashomer, Israel.
Insights
Congenital hypothyroidism (CH) screening in the West Bank is feasible despite challenges. This program successfully screened infants up to one month old, detecting CH at rates higher than industrialized nations.
Area of Science:
- Pediatrics
- Endocrinology
- Public Health
Background:
- Neonatal screening for congenital hypothyroidism (CH) is crucial for early intervention.
- Implementing CH screening in the West Bank faced logistical and political challenges, including home births and early hospital discharges.
Purpose of the Study:
- To assess the feasibility and effectiveness of a CH screening program in the West Bank.
- To determine the incidence of CH in the Arab population of the West Bank and East Jerusalem.
Main Methods:
- A modified screening protocol prioritizing thyroid-stimulating hormone (TSH) testing was used to reduce recall rates.
- Infants were targeted for screening at maternal and child health centers before one month of age, with 64% sampled within the first week.
Main Results:
- From June 1990 to February 1994, 49,694 infants in the West Bank showed an incidence of CH of 1:2,070 (24 cases).
- From January 1987 to February 1994, 28,938 infants in East Jerusalem showed an incidence of CH of 1:1,447 (20 cases).
- Incidence rates in the West Bank and East Jerusalem were higher than in industrialized countries, potentially due to consanguinity and environmental factors.
Conclusions:
- Congenital hypothyroidism screening is achievable in the West Bank, even with logistical and political hurdles.
- Screening infants up to one month old allows for timely and effective treatment, establishing a baseline for future programs.
Abstract:
Screening for congenital hypothyroidism (CH) among the Arab population of the West Bank began in May 1987 as part of the neonatal screening program in Israel. In the West Bank many infants are born at home or are released from the hospital on the 1st day after birth and thus cannot be screened. However, we tried to reach the infants before the age of 1 month at the maternal and child health centers, where they receive immunization. In this screening program, 64% of the infants were sampled by the 1st week and 93% by 3 weeks of life. In contrast to the screening in Israel, where thyroxine determination is followed by thyroid-stimulating hormone measurement, in the West Bank thyroid-stimulating hormone was tested first in order to decrease the recall rates. From June 1990 to February 1994, 49,694 infants were screened in the West Bank, of whom 24 with CH were detected (an incidence of 1:2,070). From January 1987 to February 1994, 28,938 infants were screened in East Jerusalem, of whom 20 with CH were detected (incidence 1:1,447). There were differences between the incidence rates in the various districts. The incidence rates were higher than those reported from industrialized countries, but similar to those found in Saudi Arabia. This may be due to the high degree of consanguineous marriages among Arab populations and to environmental factors. In conclusion, in spite of the many difficulties, both practical and political, CH screening in the West Bank is feasible. Although screening all newborns shortly after birth is not possible, this study shows that a high percentage of them can be screened at a time when they can still be effectively treated. Our results could be used in due time as a baseline for a future independent screening program.
