A hospital-based birth defects surveillance system in Kampala, Uganda
A hospital-based birth defects surveillance system in Kampala, Uganda
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DOI：
10.1186/s12884-019-2542-x
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发表时间：
2019-10-22
影响因子：
3.1
通讯作者：
Musoke, Philippa
中科院分区：
文献类型：
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作者：
Mumpe-Mwanja, Daniel;Barlow-Mosha, Linda;Musoke, Philippa
2010年，世界卫生大会通过了一项决议，呼吁各国尽可能预防出生缺陷。虽然出生缺陷监测计划是指导预防干预措施实施和评估的重要信息来源，但许多承担出生缺陷最大负担的国家没有监测计划。本文分享了乌干达一个以医院为基础的出生缺陷监测项目的结果，该项目可以被类似的资源有限的国家所采用。方法对2015年8月至2017年12月期间在坎帕拉四家选定医院分娩的所有信息性分娩（包括活产、死产和自然流产）进行出生缺陷检查，无论胎龄如何。人口统计数据由助产士通过产妇访谈和审查医院患者记录获得，并输入电子数据收集工具。通过医生的床旁检查和出生缺陷专家对照片和叙述性描述的审查，确认了已识别的出生缺陷。分子中包括有确诊出生缺陷的信息性出生（活产、静态流产和自然流产），分母中包括有信息性出生（活产、静态流产和自然流产）总数，以估计每10 000例出生的出生缺陷患病率。结果出生缺陷总患病率为66.2/10000（95%CI 60.5-72.5）。最常见的出生缺陷（每10，000例出生）为：尿道下裂，23.4/10，000（95% CI 18.9-28.9）;马蹄内翻足，14.0/10，000（95% CI 11.5-17.1）和神经管缺陷，10.3/10，000（95% CI 8.2-13.0）。最不普遍的是：小头畸形，1.6/10，000（95% CI 0.9-2.8）;小耳畸形和无耳畸形，1.6/10，000（95% CI 0.9-2.8），无耳畸形，2.0/10，000（95% CI 1.2-3.4）。结论以医院为基础的监测项目与积极的病例确定可以产生可靠的出生缺陷患病率的流行病学数据，并可以告知预防政策和服务提供需求，在低收入和中等收入国家。
Background In 2010, the World Health Assembly passed a resolution calling upon countries to prevent birth defects where possible. Though birth defects surveillance programs are an important source of information to guide implementation and evaluation of preventive interventions, many countries that shoulder the largest burden of birth defects do not have surveillance programs. This paper shares the results of a hospital-based birth defects surveillance program in Uganda which, can be adopted by similar resource-limited countries. Methods All informative births, including live births, stillbirths and spontaneous abortions; regardless of gestational age, delivered at four selected hospitals in Kampala from August 2015 to December 2017 were examined for birth defects. Demographic data were obtained by midwives through maternal interviews and review of hospital patient notes and entered in an electronic data collection tool. Identified birth defects were confirmed through bedside examination by a physician and review of photographs and a narrative description by a birth defects expert. Informative births (live, still and spontaneous abortions) with a confirmed birth defect were included in the numerator, while the total informative births (live, still and spontaneous abortions) were included in the denominator to estimate the prevalence of birth defects per 10,000 births. Results The overall prevalence of birth defects was 66.2/10,000 births (95% CI 60.5-72.5). The most prevalent birth defects (per 10,000 births) were: Hypospadias, 23.4/10,000 (95% CI 18.9-28.9); Talipes equinovarus, 14.0/10,000 (95% CI 11.5-17.1) and Neural tube defects, 10.3/10,000 (95% CI 8.2-13.0). The least prevalent were: Microcephaly, 1.6/10,000 (95% CI 0.9-2.8); Microtia and Anotia, 1.6/10,000 (95% CI 0.9-2.8) and Imperforate anus, 2.0/10,000 (95% CI 1.2-3.4). Conclusion A hospital-based surveillance project with active case ascertainment can generate reliable epidemiologic data about birth defects prevalence and can inform prevention policies and service provision needs in low and middle-income countries.