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Central nervous system congenital malformations in a developing country: issues and challenges against their prevention

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Abstract

Background

Little efforts are geared towards prevention of CNS anomalies in the developing countries.

Methods

A 1-year prospective cross-sectional analysis of the cases of CNS congenital anomalies seen in a Nigerian neurosurgical unit. This included both the children’s and parents’ sociodemographics, the profiles of the CNS anomalies, and the maternal obstetric health behaviors toward primary and/or secondary prevention of the anomalies. Statistical analysis was done with the Pearson’s chi-square (or Fishers’ exact) test. Level of significance set at P < 0.05.

Results

There were 54 cases of cranial and spinal gross CNS anomalies, including 32 neural tube defects; two thirds of the parents were low-income earners, and half had only basic education. Thirty percent of the pregnancies were unbooked; the mean gestational age (GA) at booking and commencement of obstetric micronutrient supplementation was 4.6 months. No case had periconceptional folic acid supplementation. Obstetric ultrasonography was performed late in pregnancy (mean GA 6 months), made positive diagnosis of CNS anomaly in only 14%, and was performed mainly in unsupervised private clinic settings in 98%.

Conclusions

Little or no attention is currently paid to the prevention of CNS congenital anomalies in much of the low- and middle-income countries of the world. There is a great need to regulate the practice of obstetric ultrasonography in Nigeria. There is even a much greater, more fiercely urgent need to ensure periconceptional folic acid supplementation for all women of childbearing age through appropriate food fortification in these societies.

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References

  1. Oakeshott P, Hunt GM (2003) Long--term outcome in open spina bifida. Br J Gen Pract 53:632–636

    PubMed  Google Scholar 

  2. Tuli S, Tuli J, Drake J, Spears J (2004) Predictors of death in pediatric patients requiring cerebrospinal fluid shunts. J Neurosurg Pediatr 100:442–446

    Google Scholar 

  3. Ouyang L, Grosse SD, Armour BS, Waitzman NJ (2007) Health care expenditures of children and adults with Spina Bifida in a privately insured U. S. population. Birth Defects Res (Part A) 79:552–558

    Article  CAS  Google Scholar 

  4. Harris MB, Banta JB (1990) Cost of skin care in the myelomeningocele population. J Pediatr Orthop 10:355–361

    CAS  PubMed  Google Scholar 

  5. Oakley GP, Brent RL (2008) Birth defects prevention: “The Fierce Urgency of Now”. Birth Defects Res (Part A) 82:745–747

    Article  CAS  Google Scholar 

  6. Padmanabhan R (2006) Etiology, pathogenesis and prevention of neural tube. Cong Anom (Kyoto) 46:55–67

    Article  CAS  Google Scholar 

  7. Aslan H, Yildirim G, Ongut C, Ceylan Y (2007) Termination of pregnancy for fetal anomaly. Int J Gynaecol Obstet 99:221–224

    Article  CAS  PubMed  Google Scholar 

  8. Vaknin Z, Ben-Ami I, Reish O, Herman A, Maymon R (2006) Fetal abnormalities leading to termination of singleton pregnancy: the 7--year experience of a single medical center. Prenat Diagn 26:938–943

    Article  PubMed  Google Scholar 

  9. Njamnshi AK, de Paul Djientcheu V, Lekoubou A, Guemse M, Obama MT, Mbu R, Takongmo S, Kago I (2008) Neural tube defects are rare among black Americans but not in sub--Saharan black Africans: the case of Yaounde--Cameroon. J Neurol Sci 270:13–17

    Article  CAS  PubMed  Google Scholar 

  10. de Paul Djientcheu V, Njamnshi AK, Wonkam A, Njiki J, Guemse M, Mbu R, Obama MT, Takongmo S, Kago I, Tetanye E, Tietche F (2008) Management of neural tube defects in a sub-Saharan African country: The situation in Yaounde, Cameroon. J Neurol Sci 275:29–32

    Article  PubMed  Google Scholar 

  11. Sayed AR, Bourne D, Pattinson R, Nixon J, Henderson B (2008) Decline in the prevalence of neural tube defects following folic acid fortification and its cost-benefit in South Africa. Birth Defects Res A Clin Mol Teratol 82:211–216

    Article  CAS  PubMed  Google Scholar 

  12. Oakley GP, Bell KN (2009) Update on prevention of folic acid-preventable Spina Bifida and anencephaly. Birth Defects Res (Part A) 85:102–107

    Article  Google Scholar 

  13. Ekanem TB, Okon DE, Akpantah AO, Mesembe OE, Eluwa MA, Ekong MB (2008) Prevalence of congenital malformations in Cross River and Akwa Ibom states of Nigeria from 1980–2003. Cong Anom (Kyoto) 48:167–170

    Article  Google Scholar 

  14. Hadzagic-Catibusic F, Maksic H, Uzicanin S, Hadzagic-Catibusic S, Zubcevic S, Merhemic Z, Cengic A, Kulenovic E (2008) Congenital malformations of the central nervous system: clinical approach. Bosn J Basic Med Sci 8:356–360

    PubMed  Google Scholar 

  15. Rasmussen SA, Erickson JD, Reef SE, Ross DS (2009) Teratology: from science to birth defects prevention. Birth Defects Res (Part A) 85:82–92

    Article  CAS  Google Scholar 

  16. Botto LD, Moore CA, Khoury MJ, Erickson JD (1999) Neural-tube defects. N Engl J Med 341:1509–1519

    Article  CAS  PubMed  Google Scholar 

  17. Berry RJ, Li Z, Erickson JD, Li S, Moore CA, Wang H, Mulinare J, Zhao P, Wong LC, Gindler J, Hong S, Correa A (1999) Prevention of neural-tube defects with folic acid in China. China-US collaborative project for neural tube defect prevention. N Engl J Med 341:1485–1490

    Article  CAS  PubMed  Google Scholar 

  18. De Wals P, Tairou F, Van Allen MI, Uh SH, Lowry RB, Sibbald B, Evans JA, Van den Hof MC, Zimmer P, Crowley M, Fernandez B, Lee NS, Niyonsenga T (2007) Reduction in neural-tube defects after folic acid fortification in Canada. N Engl J Med 357:135–142

    Article  PubMed  Google Scholar 

  19. Llanos A, Hertrampf E, Cortes F, Pardo A, Grosse SD, Uauy R (2007) Cost-effectiveness of a folic acid fortification program in Chile. Health Policy 83:295–303

    Article  PubMed  Google Scholar 

  20. Mehta TS, Deborah L (2005) Imaging of fetal cerebral ventriculomegaly: a guide to management outcome. Semin Fetal Neonatal Med 10:421–428

    PubMed  Google Scholar 

  21. Verrotti C, Caforio E, Gramellini D, Nardelli GB (2007) Ultrasound screening in second and third trimester of pregnancy: an update. Acta Biomed 78:229–232

    PubMed  Google Scholar 

  22. Antonsson P, Sundberg A, Kublickas M, Pilo C, Ghazi S, Westgren M, Nikos P (2008) Correlation between ultrasound and autopsy findings after 2nd trimester termination of pregnancy. J Perinat Med 36:59–69

    Article  PubMed  Google Scholar 

  23. Grandjean H, Larroque D, Salvator L, Eurofetus Study Group (1999) The performance of routine ultrasonographic screening of pregnancies in the Eurofetus Study. Am J Obstet Gynecol 181:446–454

    Article  CAS  PubMed  Google Scholar 

  24. WHO (2009) WHO Statistical Information system: world health statistics 2009. Accessed at http://www.who.int/whosis/whostat/2009/en/index.html

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Correspondence to Amos Olufemi Adeleye.

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Adeleye, A.O., Dairo, M.D. & Olowookere, K.G. Central nervous system congenital malformations in a developing country: issues and challenges against their prevention. Childs Nerv Syst 26, 919–924 (2010). https://doi.org/10.1007/s00381-009-1079-0

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  • DOI: https://doi.org/10.1007/s00381-009-1079-0

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