Rate, Pattern and Outcome of Congenital Malformed Babies at Omdurman Maternity Hospital in Sudan
Worldwide, the incidence of congenital anomalies is estimated at 3-7%, but actual numbers vary widely between countries . In the United States and Canada where congenital anomalies are diagnosed intra uterine and aborted, the incidence was 2-5% of all live births [6,7]. In Asia, the magnitude of congenital anomalies varies also with reported incidence of 2.5%of infants at birth in India . In Africa, results from different studies vary on the frequency of congenital anomalies. Therate of congenital anomalies was found to be 20/1000 among children aged 0-18 years by a study done in Egypt . Studiesfrom East Africa reported incidences of above 2 20/1000 live births, while the incidence of major anomalies was found to be 15/1000 births [1,2]. The cause of up to 60% of congenital anomalies in humans is still unknown. For 20-25% of anomalies there seems to be a “multifactorial” cause, whereby there is a complex interaction of genetic with environmental risk factors. Another 10-13% of anomalies have a purely environmental cause (e.g. infections, illness, or drug abuse in the mother). Only 12-25% of anomalies have a purely genetic cause. Of those caused by genetic factors, the majority are chromosomal anomalies. Various environmental factors have been identified to be risk factors for congenital anomalies. Among the risk factors are advanced maternal and paternal ages, parental consanguinity, teratogenic agents, such as infectious agents and drugs, and nutritional deficiencies . Rubella, cytomegalovirus, varicella and toxoplasma are infectious agents that can be transmitted to the fetus and cause adverse effects. Although different studies have been undertaken in different parts of the worlds but no such study has been undertaken in Khartoum state to best of our knowledge. The aim of this study is to study rate, pattern and outcome of congenital malformed babies delivered at Omdurman Maternity Hospital in Sudan.Materials and Methods
was collected from them.
The current study revealed that the incidence of congenital anomalies was 1.1%, Our results are in concordance with other studies [11-15], which showed that, the incidence varied from 1.2% to 1.81% in these studies. The patterns of congenital anomalies among the study are those apparently seen as musculoskeletal anomalies, nervous system defects and skin which typically like what seen in other studies from East Africa [1-3].
More over other numerous epidemiologic studies [11-15], have shown same finding that are along the same line as the current study. Additionally our result revealed that, in musculoskeletal group, polydactyl was most common malformation followed by spina bifida. In CNS group meningeocele was the most common malformation followed by hydrocephalus and anencephaly. The findings of the current study are correlate with previous studies [11,15]. To the contrary, Creasy and Alberman , performed a large study in London, a region with a fairly high neural tube defects (NTD) prevalence at birth, they estimated that the prevalence of NTDs (anencephaly or spina bifida) at 8 weeks’ gestation (an estimate of true incidence) was 5.3 per 1,000 population. The concurrent prevalence of NTDs at birth was 2.8 per 1,000. The discrepancy between their study and our study may be explained by multiple factors, such as variation in prevalence by race, as well as a population difference or a difference in methodology of socioeconomic level and small sample size in the current study.
It was observed in the present study the congenital anomalies were more common in babies born to old mother (age between 30-40 years) and again in mother aged 40 years and above. Similar observations were recorded in other studies also [11,17,18]. The congenital anomalies were seen more frequently in grandmultipara mothers who had parity of four and above which in our study was comparable to observations made by various authors. Chaturvedi et al  recorded increase in frequency of CNS anomalies in primi and fourth gravida mothers.
General risk factors usually have a direct influence on pregnancy and delivery as for example medical and reproductive factors. Specific risk factors are those that we can call “causes behind the causes” through their indirect effects causing congenital malformation. They are mainly socio-demographic factors such as for example age, consanguinity and habits. An overlapping of these groups of factors could also occur as in the case of consanguinity. Consanguinity, which was found in almost 43% of study cases, is a socio- demographic indirect cause as well as a direct general risk factor. It increases the probability of congenital anomalies which in turn may associate with fetal death  . Consanguinity was noted in 83 parents out of 190 deliveries who had malformed babies. Also exposure to drugs was noted in four mothers who delivered congenital malformed babies. The offender drugs were antiepileptic. The effect of these factors is well documented in literature [13,14] .
Concerning the outcome of babies delivered with congenital anomalies in this study all have significant mortality and morbidity, the majority are alive at the time of assessment although with their major defect which may be fatal as most of the death occurred due to anomalies seen with in the first year of life our obtained result goes with what is reported in literature[6,10] , although our study is cross sectional one and lack of follow up limits the rest of detailed morbidity but stillat the assessment the morbidity was proved. More over our study showed that stillbirth rate was 26.3%, 28 out of 50 weremacerated and the remaining 22 out of 50 was fresh stillbirth. Prevalence of preterm delivery among the study group was23.2%. Our finding is comparable with other studies [13,14] .
The present study highlighted high rate congenital anomalies and showed that polydactyl defect is identified as major musculoskeletal congenital abnormality and meningeocele as major CNS congenital abnormality in this community. The study definitely helps to know the pattern of congenital anomalies and to plan future strategies for prevention, early diagnosis and timely management.
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