Keerti Singh, C Greaves, L Mohammed, A Kumar. Prevalence and secular trend of severe congenital defects among newborn in Barbados - the need for clinical-epidemiological surveillance. Keerti Singh, C Greaves, L Mohammed, A Kumar. Faculty of Medical Sciences, UWI (Cave Hill) and The Queen Elizabeth Hospital, Barbados

Background defined as ‘‘a permanent change produced by an intrinsic abnormality of development in a body structure during prenatal life’’ prevalence in different population around the world has shown considerable variation in the recent years, many developing countries are experiencing an epidemiological transition, with a relative increase of morbidity and mortality due to congenital malformations

BACKGROUND epidemiological data on congenital malformations from long term population- based studies originating from the developing countries is scanty and that from the Caribbean region is lacking altogether. good epidemiological data on the prevalence rate and pattern of birth defects helps identify etiological factors and can be useful for their prevention and policy making.

Objectives what is the prevalence of major congenital malformations in this population? has there been a recent secular change in the prevalence of congenital malformations? what is the pattern of congenital malformations? what is the magnitude of contribution of congenital malformations to the over all perinatal morbidity and mortality?

Methods a retrospective study includes all the major congenital malformations in Barbados includes all live births and still births -1993 through 2012. both the spontaneous and induced abortions were excluded from the study due to the unavailability of good data.

Methods main source of data were the delivery registry maintained in the department of obstetrics and the newborn registry at the neonatal care unit the newborn hospital records at the Queen Elizabeth Hospital where over 90% of all deliveries take place.

Methods Data collection was performed by means of structured form which contained two parts. maternal characters - limited to the maternal age, parity and pleurality of gestation. neonatal characters - date of birth, live or stillbirth, gestational age, sex, pattern of Congenital Malformation. neonatal outcome in term of death or discharge from the hospital.

Methods Prevalence - was calculated in rates per ten thousand births according to the number of cases and non-cases of malformed children. malformation were classified according into - Q00-Q99 of the International Classification of Diseases 10. ethical approval was obtained from the Ethics Committee at the QEH as well as from the IRB UWI Cavehill & MOH, Barbados

Prevalence Rate 4/7/13

Pattern of malformation

Prevalence of Specific malformations 4/7/13

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Limitations retrospective nature of the study based on data derived from passive surveillance sources. may have compromised the case ascertainment and the prevalence be have been underreported. Lack of routine autopsy in cases of still births. Infrequent antenatal and postnatal screening

Discussion and Conclusion less than 1% of all live newborns have major CM which compares well with those reported in similarly designed recent studies. An increasing secular trend, but it could be a reflection of the better ascertainment of cases in the recent years Major congenital malformation is becoming an increasing burden on the health care resources. 4/7/13

Recommendation Therefore, any measures undertaken for further reduction in perinatal moratlity in this country will have to address the issue of CM. The first step in that direction would be active surveillance system for CM with setting up of a CM register in this country 4/7/13