Reducing Birth Defects Meeting the Challenge in the Developing World (2003) / Chapter Skim
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1 Introduction
1 Introduction
Pages 11-21
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From page 11... ...
These abnormalities may be apparent immediately after birth, or they may manifest later in life. Birth defects result from a variety of factors, but most cannot yet be ascribed to a specific cause (Nelson and Holmes, 19891.
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From page 12... ...
Families with an affected child have an increased incidence of almost all the birth defects that are restricted to a single organ system, such as cleft lip and/or cleft palate, developmental hip dysplasia, and most forms of cardiac anomalies (Simpson and Golbus, 19921. After the birth of an affected child, the risk that a subsequent child will be affected is typically 2-5 percent, which is many times higher than the incidence in the general population (less than 0.1 per cent for most single-organ malformations)
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From page 13... ...
. Ionlzlng raalatlon Complex genetic and unknown Down syndrome Trisomy 18 Trisomy 13 or- and p-Thalassemias Sickle cell disorder G6PDb deficiency Oculocutaneous albinism Cystic fibrosis Phenylketonuria Hemophilia A and B Congenital rubella syndrome Congenital cytomegalovirus Toxoplasmosis Insulin-dependent diabetes mellitus Phenylketonuria Hyperthermia Neural tube defects Iodine deficiency disorders Reduction deformities of limbs Several Several Neurological damage Fetal alcohol syndrome Congenital malformations involving single organ systems Neurological damage Neurological damage Congenital heart disease Neural tube defects Cleft lip and/or cleft palate Talipes or clubfoot Developmental dysplasia of the hip aThese birth defects were selected on the basis of severity, prevalence in developing countries, and representation in the medical literature of developing countries.
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From page 14... ...
INCREASE IN THE IMPORTANCE OF BIRTH DEFECTS WITH DECREASING INFANT MORTALITY Over the last four decades, the average infant mortality rate in developing countries has fallen from 137 to 66 per 1000 live births, largely as a result of improvements in safe childbirth and control of infectious diseases and malnutrition. Progress in lowering infant mortality rates has, however, varied greatly among developing countries.
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From page 15... ...
As infant mortality rates fall, birth defects are responsible for an increasing proportion of the infant mortality and morbidity (Modell and Kuliev, 1989; World Health Organization, 1997, 19991. In the majority of Latin American and Middle Eastern countries that have reduced infant mortality to less than 50 per 1,000, the infant mortality due to birth defects is as high as 25 percent (WorId Health Organization, 1997)
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From page 16... ...
16 REDUCING THE IMPACT OF BIRTH DEFECTS 200 180 160 140 120 100 80 60 20 1981 o 200 180 160 140 120 100 80 60 20 t~ t~ ~d t~ ~ ~ ~ tt O ~ ~ ~ ~ O ~ Q ~ ma ~ ,,, <,, ~ ~~ i, ~ ~ ~~ ~ m a, Y ~ cn 1991 O~ `d ~ ~ ~ tt O tt ~ ~ .~ ~ ~ ~ Q sit E >_ CO ·~t ~ o ~ ~ ~ ~~, cn ~ ~ ~ ~ .~ in O C' ~ a=, ~ ~ FIGURE 1-1 Infant mortality rates in North Africa, the Middle East, and Pakistan over two decades.
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From page 17... ...
SOCIAL, ECONOMIC, AND HEALTH CONTEXT Effective strategies to address birth defects in developing countries must consider the competing health needs of these populations, as well as a variety of social, economic, and health system-specific factors that limit resources for health care. These factors include the following (WorId Health Organization, 1999~: · Financial resources: The average per capita gross national products of developing countries are 10 to 40 times lower than those of developed countries.
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From page 18... ...
· Infant mortality: Rates of infant mortality in the cleveloping world vary from as low as 9 cleaths per 1,000 live births in Cuba to as high as 191 per 1,000 live births in Niger. · Burclen of disease: By the end of the twentieth century, about 42 percent of all cleaths in cleveloping countries were caused by avoidable conclitions such as infectious diseases, lack of reproductive health care, and nutritional deficiencies, compared with 6 percent in clevelopeci countries.
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From page 19... ...
Although most committee members give highest priority to the issues covered in the broader report, they acknowledge the lack of epidemiological information on the rates and disease burden of birth defects in many developing countries; the potential value of several affordable interventions; and, as countries reduce neonatal and infant mortality rates, the increasing proportion of the disease burden caused by birth defects. The data used for this study were assembled from bibliographic references on related topics and from databases such as MEDLINE, university libraries, and Internet sites of organizations associated with research and services for birth defects.
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From page 20... ...
Chapter 3 describes interventions that can reduce the impact of birth defects: first those that are effective and affordable in settings with limited resources, and then screening services for genetic birth defects that are appropriate for countries in which infant and neonatal mortality rates have been lowered using the most cost-effective interventions. Examples of interventions from developing countries are described in boxes throughout the text.
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From page 21... ...
1995. Congenital anomalies in rural black South African neonates a silent epidemic?
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