A call for preventive care on World Birth Defects Day
An estimated 49,000 newborns died in Southeast Asia in 2013 due to birth defects which also caused an unknown number of spontaneous abortions and still births, according to the World Health Organisation (WHO).
Many infants with birth defects suffer long-term disabilities and this can impair them, their families and societies due to social and economic consequences.
Nearly 70% of birth defects can be prevented through multi-sectoral approaches with evidence-based interventions before and soon after conception.
The most common birth defects are heart and neural tube defects and Down’s syndrome.
A total of 94% of severe birth defects occur in middle- and low-resource settings. Socio-economic conditions that may make mothers more susceptible to malnutrition, iodine deficiency, folate insufficiency, obesity, or diabetes play a major role.
Infections such as rubella and environmental factors like exposure to pesticides, medication, alcohol and tobacco are important causative factors. Advanced maternal age causes Down’s syndrome in the baby. In addition, cultural practices such as marriages among first cousins, increases the risk of rare and serious birth defects.
Addressing the problem requires a strong political will, and — to match the wide range of causes — a multidisciplinary, multisectoral and multiple-programme approach with services involving health, nutrition, the food industry, social welfare sectors and civil society.
Services to prevent and care for children with birth defects should be integrated into existing health-care services, in particular the Reproductive-Maternal-Newborn-Child-Adolescent Health programmes, as well as in the existing programmes for nutrition, immunisation, STI, HIV, prevention of tobacco and alcohol addiction and non-communicable disease.
Public health education and preventive health-care services are critical components of birth defects prevention and control. All possible efforts need to be made, using appropriate health programmes, channels and platforms, to increase awareness among all stakeholders and the public on prevention, and early and adequate measures for managing birth defects in children to minimise the impact of birth defects.
Adolescent health programmes are an opportunity to introduce pre-marital counselling and pre-conception care packages that promote healthy lifestyles, balanced nutrition including micronutrients like folic acid and prevent health-risk behaviours such as tobacco and alcohol use, obesity, diabetes, and provide rubella immunisation. Many of these preventive interventions also prevent prematurity and low birth weight and can contribute further to the reduction of newborn mortality.
There are several opportunities to prevent and control birth defects and at a reasonable cost. Consumption of folic acid before and during early pregnancy significantly decreases the risk of neural tube defects. Fortification of food with folic acid and iron is a cost-effective strategy in several countries. Consumption of adequate amounts of iron can eliminate deficiency which results in anaemia and reduced mental and physical productivity. Mental impairment due to iodine deficiency can be prevented at a relatively low cost through iodisation of salt.
Congenital rubella syndrome (CRS) is associated with a number of birth defect such as cataracts and hearing and heart defects, which can be prevented by immunising women and girls with the rubella vaccine before they get pregnant. The CRS burden is particularly high in the region, which accounts for an estimated 48% of the global incidence. The WHO has prioritised rubella control and is working closely with countries to introduce rubella vaccines to their immunisation programme.
Birth defects of environmental origin can be addressed by prevention approaches and legislation controlling management of toxic chemicals.
Birth defects like thalassaemia and sickle cell diseases need a combination approach of carrier screening, counselling and prenatal diagnosis.
The existing primary health services need to be strengthened to make treatment and management of birth defects available. Significant improvements can be made even with limited resources. Affordable medications, surgical treatments and community-based rehabilitation can help improve the health and quality of life of children born with birth defects, and their families. Early detection of birth defects is important to start timely treatment to achieve reasonable functionality.
Recognising the need to prevent and control birth defects, countries in Southeast Asia have developed national plans. Efforts are being made to develop and strengthen registration and surveillance systems, build capacity and expertise for prevention and management of birth defects, and strengthen research.
Despite undermining the health and well-being of people in a big way, birth defects are under-recognised. The first ever World Birth Defects Day today is an effort to raise awareness of the occurrence of birth defects and advocate for development and implementation of primary prevention programmes and expansion of referral and care services for all persons with birth defects.
Addressing birth defects is important to achieve Millennium Development Goal 4 — of reducing child mortality, to which all countries are committed.
Significant achievements have been made to reduce deaths in under-fives, but the progress has not been the same with the newborn mortality rate. The under-five mortality rate in the region has declined from 118 deaths per 1,000 live births in 1990 to 47 deaths per 1,000 live births in 2013. But the newborn mortality rate declined from 47 per live birth to only 26 per 1,000 live births during the same period, with deaths caused by birth defects remaining static.
Child deaths and long-term disabilities caused by birth defects are preventable to a large extent. Inadequate attention to this public health issue is unacceptable.