Birth Defects: Magnitude, Associated Factors, Knowledge, Beliefs, and Attitudes

Jemberie, Molla Taye (2017) Birth Defects: Magnitude, Associated Factors, Knowledge, Beliefs, and Attitudes. PhD thesis, Addis Ababa University.

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Abstract

Introduction: Birth defect, also known as congenital anomaly, is defined as structural or functional defect that may be detected during pregnancy or visible at birth or later in life. In early pregnancy, each body organ has a critical period of organogenesis. Interference during this early pregnancy with intrinsic and extrinsic factor/s could lead to different forms of birth defects. Birth defects are the major causes of morbidity, mortality, and disability of newborn, infant, and child. They are also causes of embryonic and early fetal deaths. A significant number of babies with birth defects are born in Ethiopia. However, the magnitude and the causes of such birth defects are not sufficiently studied and the data is scarce in Ethiopia. Objectives: To assess the magnitude and associated factors of birth defects/congenital anomalies in children in Amhara Region and Addis Ababa. The study also aimed to explore the knowledge, beliefs, and attitudes of children’s parents/caretakers towards birth defect and their causes. Methods: The study used both quantitative and qualitative components. The quantitative study included prospective and retrospective cross sectional studies by interviewing children’s mothers/caretakers and reviewing retrospective medical records. The study subjects were recruited in purposively-selected hospitals from the Amhara Region and Addis Ababa based on caseloads. A structured questionnaire with open and close-ended questions were used to collect data for the prospective cross sectional study. Data retrieving form with verbatim description was used to collect the data from children’s medical records of the period 2010-2014. Data collectors were trained midwives, nurses, and other health professionals working at the selected study hospitals. From a total population of 76,201 children of 0-17 years old, 1,518 children with birth defects were identified as study subjects and their mothers/caretakers were interviewed in the prospective cross sectional study. From 319,776 children medical records reviewed, 6,076 children of 0-17 years old were identified with birth defects. For the case control study, 414 children (207 with birth defects and 207 without birth defects) of 0-11 months old were studied. Statistical procedures, such as proportions, bi-variate, and multi-variate were used to analyze the data and determine frequency of birth defects, associated risk factors and Odds Ratio.The qualitative study was aimed to assess the perceived beliefs, knowledge, and attitudes of parents/caretakers on birth defects and their risk factors. Focus group discussions and in-depth interviews were the design for the study. Semi structured discussion guiding topics prepared in English were translated into Amharic. Children’s parents/caretakers were selected as study subjects. The text contents were sorted, coded, decided, and categorized according to theme variables. Inductive content analysis method was used to analyze the transcripts. Explanations and write up was done on the categories and relationships between the participants’ responses. Results: The overall proportion of birth defects was 1.99%, which is closer to 2% (95% CI: 1.89-2.09). The majority (57.6%) of the children were male. About 84.9% of the children were 0-4 years old. Birth defects were more frequent in children born from multigravidae (72.5%) and lower in primigravidae (27.5%). The mean age of children’s mothers was +28 years with a range of 15- 49 years. Mothers below 20 years old were 5% and above 35 years old were 12%. The remaining 83% of mothers were in the age group of 20 – 35years. The proportion of neural tube defects, orofacial clefts, masculo-skeletal system defects, syndrome disorders, and cardiovascular system anomalies were 40.3% with 95% CI: 37.7-43, 23.3% with 95% CI: 21.3-25.4, 23.1% with 95% CI: 20.9-25.2, 8% with 95% CI: 6.7-9.4, and 2.6% with 95% CI: 1.8-3.4, respectively. About 52.4% of the birth defects occurred in urban and 47.6% in rural places. Among the defects, cardiovascular system defects (82.5) are the most frequent defects in urban, whereas orofacial clefts (69.2%) are the most frequent defects in rural places. About 90.8% of the defects were single as compared to 9.2% of multiple defects. The linear trends of birth defects over the five year period of 2010-2014 was OR of 1 (base year), 1.46, 1.5, 1.55, and 2.53, respectively, [Extended Mantel-Haenszel chi square for linear trend = 356.7 (P<0.0001)]. Thus, the magnitude of birth defects showed a statistically significant increased trend over the five years. In the case-control study, about 8.9% of mothers had maternal illness during early pregnancy; 15.7% had a history of passive smoking of cigarettes; 10.4% used un-prescribed drugs; 2.9% had a history of blood relationship between children’s parents; 3.4% had a history of exposure to chemicals; and 2.2% had a history of exposure to radiation.Maternal alcohol consumption in early or throughout the pregnancy (AOR=3.143; 95% CI: 1.536-6.429, P-value=0.002) and maternal illness during early pregnancy (AOR=5.366; 95% CI: 3.080-9.346, P-value=0.000) were significantly associated with birth defects. Iron folate/folic acid use before and during early pregnancy (AOR=0.273; 95% CI: 0.161-0.463, P-value=0.000) and multivitamin usage during pregnancy (AOR=0.87; 95% CI: 0.027-0.284, Pvalue=0.000) had a protective effect from birth defect. In the qualitative study, the majority of the participants’ perceived beliefs, views, and attitudes on birth defects and their risk factors were mixed up and contradictory to each other. About half of the participants believed that birth defects could occur due to an offense against God’s grace or as a punishment for a multitude of sins committed by parents. Some of the participants believed that contraceptive pills, un-prescribed drugs, and fertilizers could be the risk factors of birth defects. Overall, the knowledge of participants on the causes of birth defects was low. Some participants said stigma, feeling of inferiority and discrimination were the impacts/consequences of birth defects. They also expressed that raising a child with major birth defect is a very difficult and awkward. Conclusion: Neural tube defects, orofacial clefts, and musculo-skeletal system defects were the most frequent defects as they accounted for about 86.7% of the birth defects. The magnitude of birth defects increased during 2010-2014. Alcohol drinking and maternal illness were the risk factors of birth defects. Iron folate/folic acid and multivitamins have protective effect against birth defects. Knowledge, beliefs, and attitudes of children’s mothers/caretakers on birth defects and their causes was varied and contradictory to each other. The knowledge of participants on birth defects and their causes were insufficient. In general, the magnitude of the problem indicates the necessity of urgent public health actions to control or reduce the occurrence of birth defects in Ethiopia.

Item Type:	Thesis (PhD)
Uncontrolled Keywords:	Birth Defect, Children, Magnitude, Case-control, Associated Factors, Etiologies, Teratogen, Knowledge, Belief, Attitude, Ethiopia
Subjects:	R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
Divisions:	Africana
Depositing User:	Emmanuel Ndorimana
Date Deposited:	20 Nov 2018 08:53
Last Modified:	20 Nov 2018 08:53
URI:	http://thesisbank.jhia.ac.ke/id/eprint/7594

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