Neural tube defects as a cause of death among stillbirths, infants, and children younger than 5 years in sub-Saharan Africa and southeast Asia: an analysis of the CHAMPS network.
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Madrid Lola, Vyas Kartavya J, Kancherla Vijaya, Leulseged Haleluya, Suchdev Parminder S, Bassat Quique, Sow Samba O, El Arifeen Shams, Madhi Shabir A, Onyango Dickens, Ogbuanu Ikechukwu, Scott J Anthony G, Blau Dianna, Mandomando Inacio, Keita Adama M, Gurley Emily S, Mahtab Sana, Akelo Victor, Sannoh Sulaiman, Tilahun Yenenesh, Varo Rosauro, Onwuchekwa Uma, Rahman Afruna, Adam Yasmin, Omore Richard, Lako Sandra, Xerinda Elisio, Islam Kazi Munisul, Wise Amy, Tippet-Barr Beth A, Kaluma Erick, Ajanovic Sara, Kotloff Karen L, Hossain Mohammad Zahid, Mutevedzi Portia, Tapia Milagritos D, Rogena Emily, Moses Francis, Whitney Cynthia G, Assefa Nega, CHAMPS Consortium
Аннотация
METHODS: 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.
FINDINGS: 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.
INTERPRETATION: 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.
FUNDING: Bill & Melinda Gates Foundation.