Just how prevalent are congenital anomalies in Kenya? Two radiologists –Dr Callen Kwamboka Onyambu of the Kenyatta National Referral Hospital, and Dr Norah Mukiri Tharamba, of Mathari Teaching and Referral Hospital – sought to find out with a 2015 study at the Kenyatta National Referral Hospital.
For their study, they recruited 500 pregnant women, with a mean age of 28.2 years, who were getting routine obstetric ultrasounds.
Only two mothers were above 35, while one was below 20 years, and for most of the participating mothers, it was their first or second pregnancy.
Two mothers reported a previous pregnancy with a congenital anomaly and both said they were taking folate supplements prior to the current pregnancy.
Only three mothers had the first ultrasound done at between 10 to 14 weeks of pregnancy (at 10 weeks, anomalies such as anencephaly – a neural tube defect that occurs between the 23rd and 26th day after conception, leading to the absence of a major portion of the brain, skull and scalp – can be detected.
Most mothers (nearly eight in 10) had the first ultrasound done at between 28 and 41 weeks of pregnancy.
Fifteen foetal anomalies were diagnosed, indicating a prevalence of three per cent.
The most common foetal anomalies involved the head (nearly two per cent or eight babies), while the other anomalies detected (anomalies of the spine, pulmonary, bladder and kidney, and skeletal defects) affected less than one per cent of the foetuses.
Of the 15 foetuses that had congenital defects, six had multiple anomalies, one of the six pregnancies was terminated due to multiple anomalies (scoliosis, pulmonary hypoplasia, absent kidneys and bladder), some of which were fatal, and nine of the babies died within days of birth.
One foetus had stomach bubble anomalies, and the baby received corrective surgery, but died due to other complications.
On follow-up after birth, four mothers reported persistent infant chest problems that required frequent hospital visits indicating that the infants might have cardiac anomalies, which are easily missed on ultrasound.
In the baby whose ultrasound showed it had one leg bone that was shorter than the other, the mother reported no noticeable difference in the lower limbs of the baby post-delivery.
In findings published last year in the journal BMC Pregnancy and Childbirth, the researchers noted that early detection of congenital anomalies using ultrasound could help prepare and counsel parents and help in planning for early intervention where possible.
However, they noted that pregnant mothers begin to attend antenatal clinics way into the pregnancy, locking many out of the preventative intervention of folic acid supplements (which help prevent neural tube defects).
Data from the Kenya Demographic Health Survey 2014, shows that nearly six in 10 pregnant women make the recommended four antenatal visits, but most women (43 per cent) had their first antenatal check-up at between four and five months of pregnancy. A further 31 per cent only went for their first antenatal visit at between six and seven months of pregnancy. Only 20 per cent of women had their first antenatal check-up before their fourth month of pregnancy.
Moreover, 69 per cent of pregnant women who attended the antenatal clinics took iron and folic acid supplements, meaning that three in 10 women missed out on the folate supplement intervention to help prevent birth defects.
For this reason, they recommended that management of anomalies be included into the primary healthcare system (e.g. in health centres) and that programmes to reduce congenital anomalies such as Down Syndrome be established.