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Journal of Indian Association of Pediatric Surgeons
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ORIGINAL ARTICLE
Year : 2010  |  Volume : 15  |  Issue : 2  |  Page : 53-55
 

Congenital malformations in Assam


1 Department of Pediatric Surgery, Assam Medical College, Dibrugarh, Assam - 786 002, India
2 Department of Pediatric Surgery, Gauhati Medical College, Guwahati, Assam - 781 006, India

Date of Web Publication24-Sep-2010

Correspondence Address:
Hemonta Kr. Dutta
Department of Pediatric Surgery, Assam Medical College, Dibrugarh, Assam - 786 002
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-9261.70639

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   Abstract 

Aim : To determine the annual incidence of congenital malformations in Assam and to analyze the data. Materials and Methods : Data regarding babies born with congenital malformations in the state of Assam during the year 2006 were obtained through questionnaires and analyzed. The results were compared with similar Indian data. Results : The overall incidence of congenital malformation was 0.08%. This was considerably lower than similar published data from other states. Five hundred and eleven babies were born with congenital malformations, with 421 (82.4%) having major malformations. Males were affected more than females, 334 (65.4%) vs. 177 (34.6%). The gastrointestinal and genitourinary systems accounted for 26% and 25.8%, respectively. Malformation involving the central nervous system was more common in certain ethnic groups. Conclusions : The incidence of malformations in certain systems was at variance with the data from other states.


Keywords: Congenital anomaly, congenital malformation, pediatric


How to cite this article:
Dutta HK, Bhattacharyya N C, Sarma J N, Kusre G. Congenital malformations in Assam. J Indian Assoc Pediatr Surg 2010;15:53-5

How to cite this URL:
Dutta HK, Bhattacharyya N C, Sarma J N, Kusre G. Congenital malformations in Assam. J Indian Assoc Pediatr Surg [serial online] 2010 [cited 2018 May 28];15:53-5. Available from: http://www.jiaps.com/text.asp?2010/15/2/53/70639



   Introduction Top


Congenital malformations are the leading cause of death in many developed countries. Many environmental factors are now recognized as potential causes of birth defects. A registry of birth defects will help in studying the malformation profile in a geographical locality and undertake etiologic studies.


   Materials and Methods Top


A questionnaire was sent to all pediatricians, pediatric surgeons, general surgeons, plastic surgeons and general practitioners in Assam working in both government and private setups. All babies born during the period 1 st January 2006 to 31 st December 2006 with congenital malformations were included in this study. Data from the three medical colleges were obtained. However, only 60% of the pediatricians working outside medical colleges participated in the study. Stillborn babies with malformations could not be included in our study.

Defects that caused serious structural, cosmetic and functional disability requiring surgical or medical management were classified as major anomalies. The remaining were categorized as minor anomalies. The findings of our study were compared with the prevalence of congenital malformation in other centers.


   Results Top


The total number of patients born with malformations during this period was 511. Among them, 421 (82.4%) had major anomalies and 90 (17.6%) had minor anomalies. There was a male preponderance, with 334 males (65.36%) to 177 females (34.64%). Three hundred and seventy-three patients (73.9%) were from the Assamese community, followed by 42 from the Tea tribes (8.22%). Four hundred and eighteen patients (81.8%) were Hindu, 66 were (12.9%) Muslims and 27 (5.28%) were from other religious sects. Malformations involving the gastrointestinal tract (26%) and genitourinary tract (25.8%) were the most common anomalies [Figure 1]. Facial defects were the next most common anomaly (17.4%). A significant number had malformations involving the central nervous system. Some rare anomalies like anterior encephalocele were also noted in a few. Mortality in live births due to congenital malformation was 0.008%.
Figure 1: Distribution of systems involved

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The total population of Assam is 28,665,000, with a birth rate of 24 per 1,000. In the present study, the overall incidence of congenital malformation in the live born babies is 0.08%. We have observed that the prevalence of birth defects in Assam is significantly lower as compared with few other places in India.


   Discussion Top


The overall incidence of congenital malformations in India ranges from 0.3% to 3.6%. [1],[2],[3] It is higher in centers where autopsy is carried out as a routine. [4] The prevalence of birth defects was found to be significantly lower in Assam than in compared groups, with the overall incidence of congenital malformation in the live born babies being only 0.08%. One reason for this difference is probably the inclusion of only those who sought medical care from physicians.

Stoltenberg et al. reported that the risk of birth defects is practically equal for all children with nonconsanguineous parents, independent of ethnic origin. [5] They also observed that the risk of birth defects was higher in populations with a higher frequency of consanguineous marriages. The incidence of consanguineous marriages in Assam is just 1.4% [6] compared to 55% in Pondicherry and 26.4% in Maharashtra. [7] The significant difference in the prevalence of birth defects in Assam vs. Maharashtra and Pondicherry may also be due the differences in the methodology and the year of study. In a study performed at Wardha, India, the incidence of congenital malformation was found to be 2.72%. [8] An increase in frequency was seen in advanced maternal age and in primi and fourth gravida mothers. Outside India, the incidence varied from 0.9% in Northampton Shire [9] to 3.4% in Michigan [10] and 5.5% in Afghanistan. [11]

The most common system involved in our study was the gastrointestinal system [Figure 2], followed closely by the genitourinary tract [Figure 3]. The musculoskeletal system [12] and the central nervous system [13] were the most commonly involved systems (Davanagere, Karnataka) [13],[14] in other studies.
Figure 2: Distribution of GIT malformations

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Figure 3: Distribution of GUT malformations

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One interesting observation in this study has been the report of three cases of anterior encephalocele, which is rare in other parts of the country, and still rarer in the West. All the three were from the ethnic Tea garden community, in whom other central nervous system (CNS) malformations are also frequently seen. In our study, only 29 (5.6%) patients had CNS malformation. The reason for this lower incidence may be the prevalence of nonconsanguineous marriages in Assam. Anterior encephalocele, although rare in India, is very common in the neighboring Burma and Thailand. [15] Because of the geographical proximity of Assam with these two countries, it is conjectured that the etiological factor may be similar.

The present study is a preliminary one to obtain first-hand information about the magnitude of the problem of congenital malformations in our state. The Birmingham Malformation Register data showed that data for a single year was not considered complete until ascertainment had continued for 6 years after birth, by which time the malformation rate had risen from 19.1 per thousand to 26.7 per thousand. [16] The study also emphasized the fact that environmental teratogenic effects must be involved in the etiology of many malformations and that, among the viruses, several strains of Coxsackie A and B and Echoviruses may be involved in a chronic or recurring manner. The incidence of congenital malformation is also six-times higher among still births. In the present study, we could not record the still births as data were collected only from patients seeking medical care.

We propose to follow-up with another study that will include the following: (a) record of the still births and associated malformation if any and (b) maternal history - maternal age, consanguinity, illness during pregnancy, past abortion, presence of poly or oligohydramnios and history of any medication during pregnancy.

 
   References Top

1.Merchant SM. Indian Council of Medical Research Center, Mumbai, Annual Report. 1989. p 27.  Back to cited text no. 1      
2.Datta V, Chaturvedi P. Congenital malformations in rural Maharashtra. Indian Pediatr 2000;37:998-1001.   Back to cited text no. 2      
3.Verma M, Chhatwal J, Singh D. Congenital malformations-a retrospective study of 10,000 cases. Indian Pediatr 1991;28:245-52.  Back to cited text no. 3      
4.Verma IC, Mathews AR. Congenital malformations in India. In: Satyavati GV, editor. Peoples of India: Some genetic aspects. New Delhi: Indian Council of Medical Research; 1983. p. 70.  Back to cited text no. 4      
5.Stoltenberg C, Magnus P, Lie RT, Daltveit AK, Irgens LM. Birth Defects and parental consanguinity in Norway. Am J Epidemiol 1997;145:439-48.   Back to cited text no. 5  [PUBMED]  [FULLTEXT]  
6.Bittles AH. Impact of consanguinity on Indian population. Indian J Hum Genet 2002;8:45-51.  Back to cited text no. 6    Medknow Journal  
7.Bittles AH. Empirical Estimates of the global prevalence of consanguineous marriages in contemporary societies, paper no 0074. Centre for Human genetics Edith Cowen University, Perth, Western Australia. Morrisons Institute of Population and Resource studies. California: Stanford University Stanford; 1998.  Back to cited text no. 7      
8.Chaturvedi P, Banerjee KS. An epidemiological study of congenital malformations in newborn. Indian J Pediatr 1993;60:645-53.  Back to cited text no. 8  [PUBMED]    
9.Pleydell MJ. Anencephaly and other congenital abnormalities. An epidemiological study in Northampton shire. Br Med J 1960;1:309-14.  Back to cited text no. 9  [PUBMED]  [FULLTEXT]  
10.Evan TN, Brown GC. Congenital malformations and viral infections. Am J Obstet Gynecol 1963;87:749-61.  Back to cited text no. 10      
11.Singh M, Jawadi MH, Arya LS, Fatima. Congenital malformations at birth among liveborn infants in Afghanistan: A prospective study. Indian J Pediatr 1982;49:331-335  Back to cited text no. 11      
12.Kulshreshta R, Nath LM, Upadhyay P. Congenital malformations in live born infants in a rural community. Indian Pediatr 1983;20:45-9.  Back to cited text no. 12      
13.Stevenson AC, Johnston HA, Stewart MI, Golding DR. Congenital malformations: A report of study of series of consecutive births in 24 centers. Bull World Health Organ 1966;34:9-127.  Back to cited text no. 13  [PUBMED]  [FULLTEXT]  
14.Tibrewal NS, Pai PM. Congenital malformations in newborn period. Indian Pediatr 1974;11:403-7.  Back to cited text no. 14      
15.Thu A, Kyu H. Epidemiology of frontoethmoidal encephalomeningocoele in Burma. J Epidemiol Community Health 1984;38:89-98.  Back to cited text no. 15      
16.Knox EG, Armstrong EH, Lancashire RJ. The quality of notification of congenital malformations. J Epidemiol Community Health 1984;38:296-305.  Back to cited text no. 16      


    Figures

  [Figure 1], [Figure 2], [Figure 3]


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    Abstract
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