Health needs assessment for congenital anomalies in middle-income countries: Examining the case for neural tube defects
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ORIGINAL ARTICLE
Health needs assessment for congenital anomalies in middle-income countries: Examining the case for neural tube defects in Brazil Lavinia Schuler-Faccini & Maria Teresa V. Sanseverino & Lígia Marques de Rocha Azevedo & Sowmiya Moorthie & Corinna Alberg & Susmita Chowdhury & Gurdeep S. Sagoo & Hilary Burton & Luis C. Nacul
Received: 29 March 2013 / Accepted: 9 August 2013 / Published online: 30 August 2013 # Springer-Verlag Berlin Heidelberg 2013
Abstract Recent economic improvement in Brazil has been reflected in better maternal–child health indicators, with decreases in infant and perinatal mortality. However, under-five mortality due to congenital disorders remained unchanged, and congenital disorders have become the second leading cause of infant mortality. In the present study, we used the PHG Foundation Health Needs Assessment (HNA) Toolkit with the objective of first assessing the burden of disease caused by neural tube defects (NTDs) in Brazil and the impact of interventions already put in place to address the burden, and second to evaluate and prioritize further interventions and policies required for its prevention and treatment. The results from these two components of the HNA process are described in this paper. The published literature was reviewed to identify studies of NTDs (prevalence; morbidity; prenatal, perinatal, and postnatal mortality; treatment or prevention). Data on indicators of maternal and child health
Lavinia Schuler-Faccini and Maria Teresa V. Sanseverino have equally contributed to this manuscript. L. Schuler-Faccini : M. T. V. Sanseverino INAGEMP (Instituto Nacional de Genética Médica Populacional) at Teratogen Information Service, Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil L. Schuler-Faccini : L. M. de Rocha Azevedo INAGEMP at Genetics Department, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil S. Moorthie : C. Alberg : S. Chowdhury : G. S. Sagoo : H. Burton : L. C. Nacul Foundation for Genomics and Population Health (PHG Foundation), Cambridge, UK L. Schuler-Faccini (*) Genetics Department, Federal University of Rio Grande do Sul, Caixa Postal 15053, Agencia CAMPUS UFRGS, CEP 91501-970 Porto Alegre, Rio Grande do Sul, Brazil e-mail: [email protected]
were obtained directly from the Brazilian Ministry of Health, through the online Live Births Information System (SINASC) and from the Mortality Information System (SIM). Descriptive analyses included reports of the rates of NTD in liveborns, fetal, and infant deaths. Differences between folic acid flour prefortification (2001–2004) and post-fortification (2006–2010) periods were expressed as prevalence rate ratios. Around 20 % of fetal deaths were related to congenital disorders with approximately 5 % of those being NTDs. For infant mortality, congenital disorders were notified in approximately 15 % of cases, with NTDs present in 10 % of the malformed children. Although statistically significant, the prevalence rate ratio (PRR) for spina bifida in live
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