World Health Organization : Year 1993 ; World Health Organization, Hereditary Disease Program Icbdms Gl, No. 93.4: Guidelines for the Development of National Programmes for Monitoring Birth Defects

By E. E. Castilla

Book Id: WPLBN0000103313
Format Type: PDF eBook:
File Size: 3.05 MB
Reproduction Date: 2005

Title:	World Health Organization : Year 1993 ; World Health Organization, Hereditary Disease Program Icbdms Gl, No. 93.4: Guidelines for the Development of National Programmes for Monitoring Birth Defects
Author:	E. E. Castilla
Volume:
Language:	English
Subject:	Health., Public health, Wellness programs
Collections:	Medical Library Collection, World Health Collection
Historic Publication Date:
Publisher:	World Health Organization


Citation APA MLA Chicago E. Castill, B. E. (n.d.). World Health Organization : Year 1993 ; World Health Organization, Hereditary Disease Program Icbdms Gl, No. 93.4. Retrieved from http://www.gutenberg.us/

Description
Medical Reference Publication

Excerpt
1. INTRODUCTION Congenital anomalies, defined as macroscopical morphological anomalies present at birth, integrate the wider category of birth defects, together with mental retardation of prenatal origin, inborn errors of metabolism, and other disorders, mainly of genetic etiology. In an even wider scope, the congenital anomalies belong to the group of diseases defined as non-communicable and chronic. Even without actual data, it is reasonable to assume that developing populations are more readily exposed to teratogenic agents due to deficiencies in preventive systems, common to the ill-managed socio-political organizations, often found in those countries. Consequently, in addition to the poorly understood teratogenic risks of malnutrition and recurrent infections, rubella immunization is rare, people reproduce at extreme ages and therefore run the social and obstetric risks of adolescence, the risks of meiotic chromosome non-disjunction in advanced maternal age, and the risks of gene mutation in advanced paternal age. Marketing licences are casually handed out for drugs, pesticides, fertilizers and x-ray equipment and the environment is left unprotected from agricultural and industrial pollutants. This situation may be exemplified by the occurrence of Down syndrome, which is twice as frequent in Latin-America as in the USA (1); or by the use of the drug thalidomide in the early 1960s, when it was widely commercialized in most developing countries. Even when the aetiology of most congenital anomalies remains unknown, a certain proportion of them are due to well-recognized risk factors, and are therefore avoidable. The concept of avoidable congenital anomalies is of great importance since it implies the moral concept of responsibility. In other words, when a baby is born affected by an avoidable congenital anomaly, somebody is responsible for it: either the society in general or the health system. The definition of avoidable birth defects will largely depend upon the availability of technologies, which in turn is related to the degree of development of that society. Nevertheless, even in developing countries, at least 10% of all congenital anomaly-affected cases may be defined as avoidable since they may be easily prevented by primary basic measures, for example, a mentally retarded microcephalic baby, due to prenatal exposure to an unnecessary radioscopic examination, or a child with phocomelia due to thalidornide administration to a leprosy patient whose pregnancy was overlooked.

Table of Contents
CONTENTS GENERAL PRINCIPLES 1. INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4 2 . SITUATION ANALYSIS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5 2.1 DEMOGRAPHY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 2.2 BIRTHRATES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5 2.3 MORTALITY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6 2.4 RESOURCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 2.5 HETEROGENEITY . . . . . . . . .; . . . . . . . . . . . . . . . . . . . .; . . . . . 7 2.6 LOCAL NEEDS AND INTERESTS . . . . . . . . . . . . . . . . . . . . . . . . . 8 3 . OBJECTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9. 4 . METHODOLOGY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 4.1 BASIC FRAMEWORK . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 4.2 COHORT APPROACH . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 4.3 CASE-CONTROL APPROACH . . . . . . . . . . . . . . . . . . . . . . . . . . 11 5 . PROCEDURES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 5.1 DATA COLLECTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1 3 5.1.1 AFFECTED BIRTHS . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 5.1.2 ALL BIRTHS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 5.1.3 RISK FACTORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1 4 5.2 ROUTINE ANALYSIS OF DATA . . . . . . . . . . . . . . . . . . . . . . . . . 15 5.3 STATISTICAL TECHNIQUES . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 6 . OTHER PREVENTIVE ACTIVITIES . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 6.1 LEVELS OF PREVENTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 6.2 THE OPPORTUNITY FOR EACH LEVEL OF PREVENTION . . . . . . . . 17 6.3 PRIMARYPREVENTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 6.3.1 SURVEILLANCE AND A TASK FORCE . . . . . . . . . . . . . . 18 6.3.1.1 LOCAL PROBLEMS . . . . . . . . . . . . . . . . . . . 19 6.3.1.2 RUMOUR EVALUATION . . . . . . . . . . . . . . . . 20 6.3.1.3 OCCUPATIONAL RISKS . . . . . . . . . . . . . . . . 20 6.3.1.4 ENVIRONMENTAL RISKS . . . . . . . . . . . . . . . 21 6.3.2 MEDICAL SERVICES . . . . . . . . . . . . . . . . . . . . . . . . . . 21 6.3.2.1 GENETIC COUNSELLING . . . . . . . . . . . . . . . 21 6.3.2.2 TERATOGENIC INFORMATION SERVICE . . . . 21 6.3.3 CO-PARTICIPATION WITH OTHER PROGRAMMES . . . . . 22 6.3.4 DEMOGRAPHIC INTERVENTION . . . . . . . . . . . . . . . . . . 23 1 ...