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 Table of Contents  
SHORT COMMUNICATION
Year : 2022  |  Volume : 10  |  Issue : 4  |  Page : 106-108

Adoption of a comprehensive approach to minimize the occurrence of birth defects in low- and middle-income nations


1 Deputy Director – Academics, Sri Balaji Vidyapeeth – Deemed to be University, Medical Education Unit Coordinator and Member of the Institute Research Council, Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Nellikuppam, Chengalpet District, Tamil Nadu, India
2 Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth – Deemed to be University, Ammapettai, Nellikuppam, Chengalpet District, Tamil Nadu, India

Date of Submission25-Jul-2022
Date of Decision17-Aug-2022
Date of Acceptance08-Sep-2022
Date of Web Publication27-Oct-2022

Correspondence Address:
Saurabh RamBihariLal Shrivastava
MD, FAIMER, PGDHHM, DHRM, FCS, ACME, M.Phil. (HPE). Professor, Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth (SBV) – Deemed to be University, Thiruporur - Guduvancherry Main Road, Ammapettai, Nellikuppam, Chengalpet District - 603 108, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mjhs.mjhs_61_22

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  Abstract 


Birth defects refer to those conditions that exist right from the time of birth and account for structural alterations in one or more parts of the newborn. It has been reported that 0.24 million and 0.17 million newborns have lost their lives within the first 28 days of life and between the ages of 1 month to 5 years respectively on an annual basis. Apart from deaths, birth defects have been linked to long-term disability, which accounts for significant impairment in the quality of life of individuals, their families, the community, and the health care delivery system. This calls for the need to take specific measures to ensure the prevention of birth defects either via eliminating the potential risk factors or through reinforcement of protective measures. To conclude, birth defects are a global public health concern linked to morbidity, disability, and mortality. Acknowledging the fact that most birth defects are either preventable or treatable, it is the need of the hour to take comprehensive and prompt measures to improve the existing scenario and thereby ensure improvement in the quality of life of individuals, families, and community.

Keywords: Birth defects, neural tube defects, screening, surveillance


How to cite this article:
Shrivastava SR, Shrivastava PS. Adoption of a comprehensive approach to minimize the occurrence of birth defects in low- and middle-income nations. MRIMS J Health Sci 2022;10:106-8

How to cite this URL:
Shrivastava SR, Shrivastava PS. Adoption of a comprehensive approach to minimize the occurrence of birth defects in low- and middle-income nations. MRIMS J Health Sci [serial online] 2022 [cited 2023 Feb 3];10:106-8. Available from: http://www.mrimsjournal.com/text.asp?2022/10/4/0/359956




  Introduction Top


Birth defects refer to those conditions that exist right from the time of birth and account for structural alterations in one or more parts of the newborn.[1] These defects can be identified in the antenatal period, at birth, and even in later stages of infancy or thereafter, based on when the parents notice some abnormality (such as hearing defects).[1] The global estimates suggest that 90% of newborns with serious types of birth defects are from low- and middle-income nations.[2] Further, birth defects have started to account for a major proportion of deaths in recent years, as deaths resulting because of other causes have demonstrated a decline. In-fact, it has been reported that 0.24 million and 0.17 million newborns have lost their lives within the first 28 days of life and between the ages of 1 month to 5 years respectively on an annual basis.[1],[2],[3]


  Etiology and Potential Risk Factors Top


The epidemiological trend has depicted that the most common severe birth defects include congenital heart defects, neural tube defects, and Down syndrome.[2] A number of etiological and risk factors have been identified that have enhanced the predisposition towards birth defects, including chromosomal abnormalities, cystic fibrosis, consanguineous marriage, and late pregnancy.[1],[3] In addition, exposure to infections (viz. Syphilis, Zika, Rubella, etc.), radiations, drugs (like alcohol or phenytoin) during the antenatal period also enhance the probability of birth defects. Further, low income, poor access to health care or screening services, maternal diseases like diabetes, and nutritional deficiency of iodine or folic acid during pregnancy have also been statistically associated with the development of birth defects.[2],[3] However, we cannot rule out the presence of interaction between genetic and environmental factors that explain the occurrence of other birth defects.[1],[2]


  Surveillance of Birth Defects Top


Surveillance is an essential and integral aspect of the health sector's response to the containment of birth defects, as many cases often go unreported.[4] The findings of a study done across health care establishments in Addis Ababa revealed that only 8% of these settings had a dedicated birth defect registry system, which is quite alarming.[5] Considering the fact that the presence of a strong surveillance system tends to minimize the costs involved in the management of these cases at a later date.[5] In-fact, for the prevention of neural tube defects, triple surveillance has been advocated for the cause (viz. inadequate amount of folic acid), the disease prevalence, and the consequences (like morbidity, disability, and deaths) resulting because of the same.[6],[7] The need of the hour is to strengthen and streamline surveillance activities and merge them with clinical care offered to ensure improved prevention and delivery of quality-assured care.[4],[5],[6],[7]


  Screening for Birth Defects Top


Screening for promoting early detection of birth defects is an essential strategy and can be carried out at three times, namely before conception (to identify these disorders after obtaining a thorough family history that can be passed from parents to children), in the peri-conception period, and neonatal screening.[1],[2] The screening done in the peri-conception period tends to identify those maternal attributes (such as advanced age, alcohol, tobacco, etc.) which put them at a higher risk of having a newborn with birth defects.[2],[8] This screening can be carried out by ultrasonography, chorionic villus sampling, amniocentesis, or screening of maternal blood for placental markers that in turn indicate chromosomal abnormalities. Newborn screening is an essential type of screening to promote early detection and thereby early referral and initiation of prompt treatment. This reduces mortality, morbidity, and even enhances the possibility of having better language and speech skills.[1],[2],[3],[4]


  Prevention of Birth Defects Top


Apart from deaths, birth defects have been linked to long-term disability, which accounts for significant impairment in the quality of life of individuals, their families, the community, and the health care delivery system.[3],[5],[9] This calls for the need to take specific measures to ensure the prevention of birth defects either via eliminating the potential risk factors or through reinforcement of protective measures.[2],[3],[4],[5] These strategies include the promotion of consumption of a healthy diet comprising of fruits and vegetables by adolescent girls and mothers in order to maintain a healthy weight. Further, we have to ensure that these adolescent girls and mothers also consume an adequate intake of vitamins and minerals, especially folic acid which plays a defining role in the prevention of neural tube defects.[1],[7]

In addition, pregnant women should limit exposure to hazardous substances (like pesticides or heavy metals), alcohol, tobacco, and avoid travel to the settings wherein there is an ongoing outbreak of infectious disease linked with the development of birth defects.[2],[8] Further, we have to be extremely cautious in terms of exposure to radiations or drugs during the antenatal period unless it is justified. Moreover, the administration of the rubella vaccine to children and women is an effective strategy to prevent the development of congenital rubella syndrome.[2] Also, there is a definite need to control sugar levels before and during pregnancy through counseling, proper diet, weight management, and administration of insulin. Finally, we have to take specific measures to create awareness about the birth defects among health care staff and motivate them to counsel all pregnant women about the do's and don'ts to prevent the development of birth defects.[1],[3],[4]


  Additional Measures Top


There is a definitive need to build capacity for the prevention and management of birth defects and this calls for the training of doctors and health workers.[6] In addition, we have to take specific measures to create awareness about the importance of newborn screening and the role it plays in the early detection of birth defects.[2] Further, we have to support the families who have children with birth defects to enable they can adequately take care of the child. There is an immense need to expand the reach of surgical facilities in rural and remote settings to ensure that all structural birth defects can be rectified.[4],[5] Finally, for better and sustainable results, we have to promote international collaboration and all the concerned stakeholders have to work in collaboration to respond to this global problem.[2],[3],[4],[5],[6]


  Conclusion Top


To conclude, birth defects are a global public health concern linked to morbidity, disability, and mortality. Acknowledging the fact that most birth defects are either preventable or treatable, it is the need of the hour to take comprehensive and prompt measures to improve the existing scenario and thereby ensure improvement in the quality of life of individuals, families, and community.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Ujagare D, Kar A. Birth defect mortality in India 1990-2017: Estimates from the global burden of disease data. J Community Genet 2021;12:81-90.  Back to cited text no. 1
    
2.
World Health Organization. Birth Defects – Key Facts; 2022. Available from: https://www.who.int/news-room/fact-sheets/detail/birth-defect. [Last accessed on 2020 Jul 25].  Back to cited text no. 2
    
3.
Benjamin RH, Scheuerle AE, Scott DA, Navarro Sanchez ML, Langlois PH, Canfield MA, et al. Birth defect co-occurrence patterns in the texas birth defects registry. Pediatr Res 2022;91:1278-85.  Back to cited text no. 3
    
4.
Zhou Y, Mao X, Zhou H, Qin Z, Wang L, Cai Z, et al. Epidemiology of birth defects based on a birth defect surveillance system in Southern Jiangsu, China, 2014-2018. J Matern Fetal Neonatal Med 2022;35:745-51.  Back to cited text no. 4
    
5.
Eshete M, Abate F, Abera B, Hailu A, Demissie Y, Mossey P, et al. Assessing the practice of birth defect registration at Addis Ababa health facilities. Ethiop J Health Sci 2021;31:683-7.  Back to cited text no. 5
    
6.
Lowry RB, Bedard T. Triple surveillance: The future for birth defect registries. Eur J Med Genet 2019;62:103553.  Back to cited text no. 6
    
7.
Botto LD, Mastroiacovo P. Triple surveillance: A proposal for an integrated strategy to support and accelerate birth defect prevention. Ann N Y Acad Sci 2018;1414:126-36.  Back to cited text no. 7
    
8.
Perry MF, Mulcahy H, DeFranco EA. Influence of periconception smoking behavior on birth defect risk. Am J Obstet Gynecol 2019;220:588.e1- 588.e7.  Back to cited text no. 8
    
9.
Lopez KN, Nembhard WN, Wang Y, Liu G, Kucik JE, Copeland G, et al. Birth defect survival for Hispanic subgroups. Birth Defects Res 2018;110:352-63.  Back to cited text no. 9
    




 

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Abstract
Introduction
Etiology and Pot...
Surveillance of ...
Screening for Bi...
Prevention of Bi...
Additional Measures
Conclusion
References

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