RESUMEN
BACKGROUND: Globally, birth defects are the fourth most common cause of neonatal mortality. They cause substantial morbidity, and often long-term disability. Despite this, the impact of birth defects on public health has received little attention in low- and middle-income countries. AIMS: To report the types, incidence and geographic distribution of birth defects in the East New Britain Province of Papua New Guinea. METHODS: Data were collected over 3 years on newborns with birth defects seen at Rabaul Hospital, born anywhere in the province. Each affected newborn was examined, the anomaly diagnosed and classified. The exact home location was recorded to understand geospatial distribution. To calculate incidence, data were collected on all newborns with a congenital anomaly in a cohort of 2000 consecutive live births at Rabaul Hospital in 2019. RESULTS: Over 3 years, 2018-2020, 137 newborns with birth defects were identified, born in any part of the province. Congenital heart defects, hydrocephalus, microcephaly, craniofacial anomalies, imperforate anus, trachea-oesophageal fistula and diaphragmatic hernia were the most common anomalies. Eight cases of Down syndrome and other chromosomal anomalies were identified. The incidence in 2019 was 14 per 1000 live births. Geographic mapping showed the highest number of cases in the region on the Gazelle Peninsula, the area around the active volcanos. CONCLUSIONS: This study provides insights into the incidence and types of birth defects in a rural island province and showed it was possible to map geospatial distribution to further explore epidemiology.
Asunto(s)
Anomalías Congénitas , Humanos , Papúa Nueva Guinea/epidemiología , Anomalías Congénitas/epidemiología , Recién Nacido , Incidencia , Femenino , Masculino , Población Rural/estadística & datos numéricosRESUMEN
Although the WHO recommends all countries use International Classification of Diseases (ICD)-10 coding for reporting health data, accurate health facility data are rarely available in developing or low and middle income countries. Compliance with ICD-10 is extremely resource intensive, and the lack of real data seriously undermines evidence-based approaches to improving quality of care and to clinical and public health programme management. We developed a simple tool for the collection of accurate admission and outcome data and implemented it in 16 provincial hospitals in Papua New Guinea over 6â years. The programme was low cost and easy to use by ward clerks and nurses. Over 6â years, it gathered data on the causes of 96,998 admissions of children and 7128 deaths. National reports on child morbidity and mortality were produced each year summarising the incidence and mortality rates for 21 common conditions of children and newborns, and the lessons learned for policy and practice. These data informed the National Policy and Plan for Child Health, triggered the implementation of a process of clinical quality improvement and other interventions to reduce mortality in the neediest areas, focusing on diseases with the highest burdens. It is possible to collect large-scale data on paediatric morbidity and mortality, to be used locally by health workers who gather it, and nationally for improving policy and practice, even in very resource-limited settings where ICD-10 coding systems such as those that exist in some high-income countries are not feasible or affordable.