National Center on Birth Defects and Developmental Disabilities Global Situation of Birth Defects and Initiatives for Prevention Mike Cannon, PhD Team Lead, Prevention Research Team National Center on Birth Defects and Developmental Disabilities, CDC August 9, 2016
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National Center on Birth Defects and Developmental Disabilities
Global Situation of Birth Defects and Initiatives for Prevention
Mike Cannon, PhD
Team Lead, Prevention Research Team
National Center on Birth Defects and Developmental Disabilities, CDC
Source: World Health Statistics 2011 - http://www.who.int/whosis/whostat/2011/en/index.html
Hidden burden of birth defects
Elective terminations
Spontaneous abortions
Stillbirths
Co-morbidities
Medical/surgical treatment
Hospitalizations
Long term disability
Quality of life
Social/emotional impact
Economic cost
Easier to measure Metrics readily available
Difficult to measure Evaluated less frequently
Prevalence, Mortality: Neonatal Infant Under-5
Many birth defects can be
swept away
Calls on Member States to prevent birth defects wherever possible, implement screening programs, and provide ongoing support and care to children with birth defects and their families.
CDC and WHO are providing support to Member States in SEAR
to improve birth defects data collection and implement prevention activities.
Risk Factors for Birth Defects • Nutrition
• Folate, vitamin B-12, iodine, or other micronutrient insufficiency; PKU
•Reduce the prevalence of folic acid-preventable neural tube defects by 35%
•Reduce the number of thalassaemia births by 50%
•Reduce congenital rubella
• Eliminate congenital syphilis
Source: Prevention and Control of Birth Defects in South-East Asia Region: Strategic Framework (2013-2017)
Source: MMWR, Vol. 16, No. 4
Introduction of rubella vaccine
Source: MMWR, Vol. 59, No. 14
The Global Challenge of Neural Tube Defects • Each year there are more than 300,000 babies born with a neural tube defect
(NTD). • NTDs include spina bifida, anencephaly, and other related defects • NTDs cause death, paralysis, or life-long disability – but, many are preventable!
Anencephaly Encephalocele Spina bifida
Global Burden of Neural Tube Defects
Source: Center for Spina Bifida Research, Emory University
Neural Tube Defects Prevalence Changes: Before and After Folic Acid Fortification
10.8
15.8 17.1
9.7
14.1
6.9
8.6 8.6
6.3
9.8
0
5
10
15
20
US Canada Chile Costa Rica South Africa
Before fortification After fortification
Rate per
10,000
births -36%
-46% -50%
-35%
-31%
Sources: US: CDC. CDC grand rounds: additional opportunities to prevent neural tube defects with folic acid fortification. MMWR. 2010;59(31):980-4. Canada: De Wals et al. 2007. Reduction in neural-tube defects after folic acid fortification in Canada. N Engl J Med357: 135–142. Chile: Cortes F et al. Wheat flour fortification with folic acid: changes in neural tube defects rates in Chile. Amer Jnl Med Genet A. 2012 Aug;158A(8):1885-90. Costa Rica; Tacsan Chen L. The Costa Rican experience: Reduction of neural tube defects following food fortification program. Nutr Revs. 2004: 62(6):S40-S43. South Africa: Sayed AR. Decline in the prevalence of neural tube defects following folic acid fortification and its cost-benefit in South Africa. Birth Defects Res A Clin Mol Teratol. 2008:82(4): 211-6.
Year of
Fortification
Return on
Investment
South Africa 2003 30 to 1
Chile 1998 12 to 1
US 1996 150 to 1
Cost Effectiveness of Fortification with Folic Acid
Sources:
• South Africa – Sayed AR, et al. Decline in the prevalence of neural tube defects following folic acid fortification and its
cost-benefit in South Africa . Birth Defects Research Part a-Clinical and Molecular Teratology2008 Apr;82(4):211-6.
• Chile – Llanos A, et al. Cost-effectiveness of a folic acid fortification program in Chile. Health Policy2007;83(2-
3):295-303
• US – Grosse S et al. Assessing the health and economic impacts of prevention: A case study of folic acid
fortification in the United States. Unpublished manuscript. 2014
Summary
Birth defects are an important cause of morbidity and mortality in SE Asia
Effective interventions can be implemented to prevent • Neural tube defects
• Congenital rubella
• Congenital syphilis
• Thalassaemia
Surveillance is a key piece of prevention
For more information, contact CDC 1-800-CDC-INFO (232-4636) TTY: 1-888-232-6348 www.cdc.gov The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.