Epidemiology of congenital anomalies of the central nervous system in children in Enugu, Nigeria: A retrospective study

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Study Justification:
– Congenital anomalies, including those of the central nervous system (CNS), are a significant cause of morbidity, mortality, and fetal loss.
– Understanding the prevalence and associated factors of CNS congenital anomalies in children is crucial for effective prevention and management strategies.
Study Highlights:
– The study found a prevalence of 0.98% for CNS anomalies in children in Enugu, Nigeria.
– The most common CNS anomaly observed was spina bifida cystica, followed by congenital hydrocephalus.
– A significant number of mothers did not take periconceptional folic acid supplementation, which is associated with an increased risk of CNS anomalies.
– Efforts should be made to raise awareness and provide access to preventive health education, including the use of folic acid supplementation and standard prenatal care for at-risk mothers.
Study Recommendations:
– Create awareness about the importance of periconceptional folic acid supplementation among women of childbearing age.
– Implement preventive health education models to reduce the risk of CNS congenital anomalies.
– Provide access to standard prenatal care for at-risk mothers.
Key Role Players:
– Health educators and community health workers to disseminate information about the importance of folic acid supplementation and prenatal care.
– Obstetricians and gynecologists to provide guidance and support for at-risk mothers.
– Policy makers and government officials to allocate resources and develop programs for preventive health education.
Cost Items for Planning Recommendations:
– Development and distribution of educational materials on folic acid supplementation and prenatal care.
– Training and capacity building for health educators and community health workers.
– Implementation of prenatal care programs and services.
– Monitoring and evaluation of the effectiveness of preventive health education initiatives.

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong. The study design is a cross-sectional retrospective study, which limits the ability to establish causality. However, the study provides specific prevalence rates and identifies associated factors. To improve the strength of the evidence, future studies could consider using a control group for comparison and conducting a prospective study design.

Background: Congenital anomalies, including those of the central nervous system (CNS), are among the leading causes of morbidity, mortality, and fetal loss. Objective: To determine the prevalence and associated factors of CNS congenital anomalies in children. Methods: A cross-sectional retrospective study of children managed with CNS anomalies was undertaken. Relevant clinical data of identified cases based on standard case definitions were retrieved from their case record files. Data were analyzed using SPSS 20.0 while the level of statistical significance was set at P < 0.05. Results: Seventy-two cases of CNS anomalies were identified over the period under review; out of 7329 total pediatric admissions giving a prevalence of 0.98%. Spina bifida cystica, 49 (68.0%) was the most common of the five anomalies seen followed by congenital hydrocephalus 11 (15.3%). Fifty-seven (79.2%) of the mothers did not take periconceptional folic acid supplementation (P < 0.05) whereas 25 (34.7%), 6 (8.3%), and 1 (1.4%) reported history of febrile illness in the first trimester of pregnancy, alcohol use, and diabetes mellitus in pregnancy, respectively. Majority of the cases of spina bifida cystica (30 [61.2%]) seen had corrective surgeries while the overall case fatality rate was 1 (1.4%). Conclusions: Spina bifida cystica was the most common anomaly of the CNS seen in this study and majority of the mothers of affected children did not take periconceptional folic acid supplementation (P < 0.05). Efforts should be made to create awareness and apply adequate preventive health education models including the use of periconceptional folic acid supplementation as well as the provision of access to standard prenatal care to at risk mothers.

This was a cross sectional retrospective study in which a review of the records of all newborns admitted in the newborn special care unit (NBSCU) and neurosurgical ward of the UNTH, Enugu, over a 42-month (3 years 6 months) period (January 1, 2011 and June 30, 2014) was undertaken. The case files of these babies were retrieved from the hospital records department and examined individually by the investigators. Ethical approval for this study was sought from the Health Ethics Research Committee of the UNTH, Ituku-Ozalla, Enugu, Nigeria. Data collection was done using a semi-structured questionnaire designed for the study. The diagnoses of the CNS anomalies were based on clinical evaluations and ultrasound findings and meeting the standard (International Classification of Diseases-10) case definitions.[2] Patient's history including antenatal history, history of exposure to teratogens, and family history of consanguinity (first cousins) and birth defects (up to second and in some few cases third generation pedigree) were obtained from these folders. Further information obtained included maternal age, paternal age, type of delivery, gestational age, and type of CNS congenital and other associated anomalies. The prevalence rate was estimated as a percent of the total number of babies admitted in the units within the period of the study (number of babies with CNS congenital abnormalities/total number of babies admitted in the hospital for the duration of study). Data were analyzed using SPSS 20.0 (Armonk, NY: IBM Corp). Rates and proportions were calculated with 95% confidence intervals. The proportions were compared using Chi-square with the level of significance set at P < 0.05. Inability to use a control group for actual comparison of the findings.

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Based on the provided information, here are some potential recommendations for innovations to improve access to maternal health:

1. Increase awareness: Efforts should be made to create awareness among women about the importance of periconceptional folic acid supplementation and its role in preventing congenital anomalies of the central nervous system (CNS). This can be done through targeted health education campaigns, community outreach programs, and collaboration with healthcare providers.

2. Improve prenatal care: Access to standard prenatal care should be provided to at-risk mothers. This includes regular check-ups, screenings, and counseling on healthy behaviors during pregnancy. Healthcare facilities should be equipped with the necessary resources and trained staff to provide comprehensive prenatal care.

3. Telemedicine and remote consultations: Implementing telemedicine and remote consultation services can help improve access to maternal health services, especially in remote or underserved areas. This allows pregnant women to receive medical advice, consultations, and monitoring without the need for physical travel.

4. Mobile health (mHealth) interventions: Utilize mobile health technologies, such as smartphone applications and text messaging services, to deliver important health information, reminders, and support to pregnant women. This can help improve adherence to prenatal care guidelines and provide access to educational resources.

5. Strengthen healthcare infrastructure: Invest in improving healthcare infrastructure, particularly in areas with limited access to maternal health services. This includes establishing well-equipped maternity clinics, increasing the number of skilled healthcare providers, and ensuring the availability of essential medical supplies and equipment.

6. Collaborative partnerships: Foster collaborations between healthcare providers, government agencies, non-profit organizations, and community leaders to address the barriers to maternal health access. This can involve joint initiatives, resource sharing, and coordinated efforts to reach vulnerable populations.

It is important to note that these recommendations are based on the information provided and may need to be tailored to the specific context and needs of the community.
AI Innovations Description
Based on the information provided, the recommendation to improve access to maternal health and reduce the prevalence of CNS congenital anomalies in children in Enugu, Nigeria is as follows:

1. Create awareness: Efforts should be made to raise awareness among women of childbearing age about the importance of periconceptional folic acid supplementation. This can be done through community health education programs, antenatal clinics, and outreach campaigns.

2. Provide access to prenatal care: Ensure that all pregnant women have access to standard prenatal care, including regular check-ups, ultrasound screenings, and counseling on healthy pregnancy practices. This can be achieved by strengthening the healthcare system and improving the availability and affordability of prenatal services.

3. Implement preventive health education models: Develop and implement effective preventive health education models that target at-risk mothers. These models should emphasize the importance of proper nutrition, avoiding teratogens (substances that can cause birth defects), and maintaining a healthy lifestyle during pregnancy.

4. Improve healthcare infrastructure: Invest in improving healthcare infrastructure, particularly in rural areas, to ensure that pregnant women have easy access to healthcare facilities and skilled healthcare professionals. This may involve building or upgrading maternity clinics, training healthcare workers, and providing necessary medical equipment and supplies.

5. Conduct further research: Conduct further research to better understand the factors contributing to CNS congenital anomalies in Enugu, Nigeria. This research can help identify additional preventive measures and interventions that can be implemented to reduce the prevalence of these anomalies.

It is important to note that these recommendations should be implemented in collaboration with relevant stakeholders, including healthcare providers, policymakers, community leaders, and non-governmental organizations, to ensure their effectiveness and sustainability.
AI Innovations Methodology
Based on the provided information, here are some potential recommendations to improve access to maternal health:

1. Increase awareness and education: Efforts should be made to create awareness among women about the importance of periconceptional folic acid supplementation and its role in preventing CNS congenital anomalies. This can be done through health education campaigns, community outreach programs, and antenatal care services.

2. Improve access to prenatal care: Ensuring that all pregnant women have access to standard prenatal care is crucial. This includes regular check-ups, screenings, and early detection of any potential issues. This can be achieved by strengthening healthcare systems, improving infrastructure, and increasing the availability of trained healthcare professionals.

3. Enhance availability of diagnostic tools: Access to diagnostic tools such as ultrasound can aid in the early detection and diagnosis of CNS congenital anomalies. Efforts should be made to improve the availability and accessibility of these tools, particularly in low-resource settings.

4. Strengthen healthcare facilities: Investing in healthcare facilities, particularly in areas with high prevalence rates of CNS congenital anomalies, can help improve access to maternal health services. This includes improving the infrastructure, equipment, and staffing levels to ensure quality care for pregnant women.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could involve the following steps:

1. Define the target population: Identify the specific population or region where the recommendations will be implemented.

2. Collect baseline data: Gather data on the current prevalence of CNS congenital anomalies, access to prenatal care, and awareness levels among pregnant women in the target population.

3. Implement the recommendations: Introduce the recommended interventions, such as awareness campaigns, improved prenatal care services, and enhanced diagnostic tools, in the target population.

4. Monitor and evaluate: Continuously monitor the implementation of the recommendations and collect data on key indicators, such as the number of women receiving prenatal care, the uptake of folic acid supplementation, and the prevalence of CNS congenital anomalies.

5. Analyze the data: Use statistical analysis software, such as SPSS, to analyze the collected data and determine the impact of the recommendations on improving access to maternal health. Compare the data before and after the implementation of the recommendations to assess any changes or improvements.

6. Draw conclusions and make recommendations: Based on the analysis of the data, draw conclusions about the effectiveness of the implemented recommendations in improving access to maternal health. Identify any gaps or areas for further improvement and make recommendations for future interventions.

It is important to note that this is a general methodology and may need to be adapted based on the specific context and resources available for the study.

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