Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK; College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.
Emory Global Health Institute, Emory University, Atlanta, GA, USA.
Lancet Glob Health. 2023 Jul;11(7):e1041-e1052. doi: 10.1016/S2214-109X(23)00191-2. Epub 2023 Jun 1.
Neural tube defects are common birth defects resulting in severe morbidity and mortality; they can largely be prevented with periconceptional maternal intake of folic acid. Understanding the occurrence of neural tube defects and their contribution to mortality in settings where their burden is highest could inform prevention and health-care policy. We aimed to estimate the mortality attributed to neural tube defects in seven countries in sub-Saharan Africa and southeast Asia.
This analysis used data from the Child Health and Mortality Prevention Surveillance (CHAMPS) network and health and demographic surveillance systems from South Africa, Mozambique, Bangladesh, Kenya, Mali, Ethiopia, and Sierra Leone. All stillbirths and infants and children younger than 5 years who died, who were enrolled in CHAMPS, whose families consented to post-mortem minimally invasive tissue sampling (MITS) between Jan 1, 2017, and Dec 31, 2021, and who were assigned a cause of death by a determination of cause of death panel as of May 24, 2022, were included in this analysis, regardless the cause of death. MITS and advanced diagnostic methods were used to describe the frequency and characteristics of neural tube defects among eligible deaths, identify risk factors, and estimate the mortality fraction and mortality rate (per 10 000 births) by CHAMPS site.
Causes of death were determined for 3232 stillbirths, infants, and children younger than 5 years, of whom 69 (2%) died with a neural tube defect. Most deaths with a neural tube defect were stillbirths (51 [74%]); 46 (67%) were neural tube defects incompatible with life (ie, anencephaly, craniorachischisis, or iniencephaly) and 22 (32%) were spina bifida. Deaths with a neural tube defect were more common in Ethiopia (adjusted odds ratio 8·09 [95% CI 2·84-23·02]), among female individuals (4·40 [2·44-7·93]), and among those whose mothers had no antenatal care (2·48 [1·12-5·51]). Ethiopia had the highest adjusted mortality fraction of deaths with neural tube defects (7·5% [6·7-8·4]) and the highest adjusted mortality rate attributed to neural tube defects (104·0 per 10 000 births [92·9-116·4]), 4-23 times greater than in any other site.
CHAMPS identified neural tube defects, a largely preventable condition, as a common cause of death among stillbirths and neonatal deaths, especially in Ethiopia. Implementing interventions such as mandatory folic acid fortification could reduce mortality due to neural tube defects.
Bill & Melinda Gates Foundation.
神经管缺陷是一种常见的出生缺陷，可导致严重的发病率和死亡率；通过围孕期母亲摄入叶酸，很大程度上可以预防神经管缺陷。了解神经管缺陷的发生情况及其对高负担国家死亡率的影响，可为预防和医疗保健政策提供信息。本研究旨在估计撒哈拉以南非洲和东南亚 7 个国家的神经管缺陷所致的死亡率。
本分析使用了来自儿童健康和死亡率监测（CHAMPS）网络的数据以及南非、莫桑比克、孟加拉国、肯尼亚、马里、埃塞俄比亚和塞拉利昂的人口健康和动态监测系统的数据。所有在 2017 年 1 月 1 日至 2021 年 12 月 31 日期间登记于 CHAMPS、其家庭同意进行微创组织取样（MITS）、且死因判定小组确定死亡原因为 2022 年 5 月 24 日的仍在胎中、婴儿或 5 岁以下死亡的儿童，无论死因如何，均纳入本分析。MITS 和先进的诊断方法用于描述合格死亡者中神经管缺陷的频率和特征，确定危险因素，并根据 CHAMPS 地点估算死亡率分数和死亡率（每 10000 例活产）。
对 3232 例仍在胎中、婴儿和 5 岁以下儿童的死因进行了确定，其中 69 例（2%）死于神经管缺陷。大多数死于神经管缺陷的是死胎（51 例[74%]）；46 例（67%）为无生命活力的神经管缺陷（即无脑畸形、颅脊柱裂或脊柱裂后凸），22 例（32%）为脊柱裂。神经管缺陷死亡在埃塞俄比亚更为常见（校正比值比 8.09[95%CI 2.84-23.02]），女性（4.40[2.44-7.93]）和未接受产前保健的母亲（2.48[1.12-5.51]）中更为常见。埃塞俄比亚的神经管缺陷死亡率分数最高（7.5%[6.7-8.4%]），神经管缺陷死亡率最高（每 10000 例活产 104.0 例[92.9-116.4]），是任何其他地点的 4-23 倍。
CHAMPS 发现神经管缺陷是一种主要可预防的疾病，也是死胎和新生儿死亡的常见原因，在埃塞俄比亚尤其如此。实施强制性叶酸强化等干预措施可降低神经管缺陷导致的死亡率。
比尔及梅琳达·盖茨基金会。
Zotero 插件
