George Nyadimo Agot

Cardiometabolic diseases (CMDs) are increasingly prevalent in Sub-Saharan Africa (SSA), underscoring the need to understand the existing public health burden. This would guide future policy strategies and interventions to mitigate the challenges posed. The aim of this systematic review was to provide a comprehensive overview of CMDs prevalence in SSA. A PRISMA 2020 compliant systematic literature search was conducted using MEDLINE and The Cochrane Library up to December 2024, including population-based studies with ≥100 participants, aged ≥15 years, and reporting CMDs prevalence in SSA. Random effects meta-analyses were conducted for prevalence, and meta-regression, for temporal trends, evaluated using the median data collection year. Overall, 266 unique studies of 846,511 participants were included; Ethiopia (n = 53), Nigeria (n = 36) and Ghana (n = 20) represented the most studies. Prevalences for the most widely studied condition included type 2 diabetes (T2D) (6.1%; 95% CI = 5.3-7.0), hypertension (27.1%; 95% CI = 25.5-28.8), stroke (1.4%; 95% CI = 1.0-2.0), hypercholesterolemia (11.3%; 95% CI = 7.4-17.0) and cardiovascular diseases (4.8%; 95% CI = 2.5-8.9). The temporal prevalence of hypertension and T2D between 2006 and 2014 showed no statistical significance (β = -0.0289 per year; p = 0.11) and (β = 0.0131 per year; p = 0.49), respectively. For stroke, a statistically significant temporal decline was observed beginning 2010 (β = b-0.1244 per year; p < 0.001). This systematic review reveals a substantial public health burden of CMDs in SSA. The high prevalence emphasises the need for targeted CMDs preventative care strategies in SSA. Notably, most studies were from Ethiopia and Nigeria, indicating the need for more research in other SSA countries for a comprehensive understanding of CMDs in the region.

Despite the notable gains that have been realized in reversing perinatal, neonatal, and childhood morbidity and mortality, insignificant actions on birth defects undermine the desired outcomes. A yearly upward trend of birth defects (44.04-205.28 per 100,000) livebirths between 2014 and 2018 attributed to known genetic, unknown multifactorial inheritance, and socio-demographic environmental factors, with an estimated unit economic cost of $ 1,139.73 for outpatient services was observed in Kiambu County, Kenya. Thus, interventions anchored on social health insurance would suffice.

INTRODUCTION: major external structural birth defects (MESBDs) are known to exert an enormous economic burden on individuals and health services; however, they have been vastly underprioritized as a public health problem in settings where cost analyses are limited. This study aimed to conduct a cost analysis of outpatient services for MESBDs in selected Kiambu County, Kenya hospitals. METHODS: a cross-sectional descriptive survey was conducted in four hospitals selected for providing outpatient corrective and rehabilitative services to the under-fives. An ingredient approach was used to gather data retrospectively on the cost drivers for castings, bracings, and tendonectomies from healthcare providers' perspectives for a one-year time horizon from January 1st, 2018, to December 31st, 2018. Prevalence-based morbidity data were extracted from outpatient occupational therapy clinic registers, whereas staff time was gathered through face-to-face inquiries. Associated cost drivers of 349 cases were quantified, valued using prevailing market prices, and categorized as recurrent costs. The unit economic costs were calculated as average costs, expressed in U.S. dollars, and inflated to the U.S. dollar Consumer Price Index from January 2018 to December 2018. RESULTS: the unit economic cost of all the cases was estimated at $1,139.73; $1,143.51 for neural tube defects (NTDs), $1,143.05 for congenital talipes equinovarus (CTEV), and $1,109.81 for congenital pes planus. CONCLUSION: the highest economic burden of MESBDs was associated with NTDs, and CTEV, respectively. We recommend further research to estimate the economic costs of MESBDs among school-going pupils to inform the equitable allocation of resources for health and childhood developmental programs.

INTRODUCTION: birth defects are defined as structural or functional congenital malformations occurring during intrauterine and detectable prenatally, at birth, or later. Birth defects-awareness creation among women of reproductive age would help in preventing the occurrence of birth defects of known aetiology worldwide. Thus, this study aimed to assess the birth defects knowledge of women of reproductive age. METHODS: we adopted a descriptive cross-sectional study design in eleven purposively selected public hospitals. The study population comprised women with children under five years, and attending child-welfare clinics at the study hospitals. Descriptive analyses consisting of means, standard deviations, medians, and ranges were used to summarize continuous variables, whereas, percentages and proportions were used to summarize categorical variables. RESULTS: the median age of the study participants was 26 years with a mean of 27 (Standard Deviation=5, Range=17-42). A majority (77%) achieved at least a secondary level of education, while the median gravidity was 2 with a mean of 2 (Standard Deviation=1, Range; 1-8). The study participants´ knowledge was above average (67%), implying in every 10 of reproductive age 3 had sub-optimal knowledge of birth defects. CONCLUSION: women of reproductive age were substantially deficient in birth defects knowledge in the county. Thus, we would like to recommend to public health policymakers and health care providers to formulate short health messages on birth defects tailored to women attending child welfare and antenatal clinics at all levels of health care including community health services in the county.

Background: Major external structural birth defects are known to exert an enormous economic burden on individuals and health services; however, they have been vastly unappreciated and underprioritized as a public health problem in settings where cost analyses are limited. Objective: The objective of this study was to conduct a cost analysis of outpatient services for major external structural birth defects in selected hospitals in Kiambu County, Kenya. Methods: A hospital-based cross-sectional study design was adopted in four hospitals where an ingredient approach was used to retrospectively gather data on cost drivers for interventions consisting of castings, bracings, and tendonectomies for the under-fives from health care providers’ perspectives for a one-year time horizon (January 1st, 2018, to December 31st, 2018). The hospitals were selected for providing outpatient corrective and rehabilitative services to the under-fives. Prevalence-based morbidity data were extracted from outpatient occupational therapy clinic registers, whereas staff-time for the hospitals’ executives comprising the medical superintendents, chief nursing officers, orthopedic surgeons, and health administrative officers were gathered through face-to-face enquires from the occupational therapists being the closest proxies for the officers. Following a predefined inclusion criterion, 349 cases were determined, and associated cost drivers identified, measured, and valued (quantified) using prevailing market prices. The costs were categorized as recurrent, and unit economic costs calculated as average costs, expressed in U.S Dollars, and inflated to the U.S Dollar Consumer Price Index from January 2018 to December 2018. Results: The unit economic cost of all the cases was estimated at $1,139.73; and $1,143.51 for neural tube defects, $1,143.05 for congenital talipes equinovarus, and $1,109.81 for congenital pes planus. Conclusions: The highest economic burden of major external structural birth defects in the county was associated with neural tube defects, followed by congenital pes planus despite having the fewest caseloads.

Background:Although major external structural birth defects continue to occur globally, the greatest burden is shouldered by resource-constrained countries with no surveillance systems. To our knowledge, many studies have been published on risk factors for major external structural birth defects, however, limited studies have been published in developing countries. The objective of this study was to identify risk factors for major external structural birth defects among children in Kiambu County, Kenya. Methods:A hospital-based case-control study was used to identify the risk factors for major external structural birth defects. A structured questionnaire was used to gather information retrospectively on maternal exposure to environmental teratogens, multifactorial inheritance, and sociodemographic-environmental factors during the study participants' last pregnancies. Descriptive analyses (means, standard deviations, medians, and ranges) were used to summarize continuous variables, whereas categorical variables were summarized as proportions and percentages in frequency tables. Afterward, logistic regression analyses were conducted to estimate the effects of the predictors on the odds of major external structural birth defects in the country. Results:Women who conceived when residing in Ruiru sub-county (adjusted odds ratio [aOR]: 5.28; 95% CI; 1.68-16.58; P<0.01), and Kiambu sub-county (aOR: 0.27; 95% CI; 0.076-0.95; P=0.04), and preceding siblings with history of birth defects (aOR: 7.65; 95% CI; 1.46-40.01; P=0.02) were identified as the significant predictors of major external structural birth defects in the county. Conclusions:These findings pointed to MESBDs of genetic, multifactorial inheritance, and sociodemographic-environmental etiology. Thus, we recommend regional defect-specific surveillance programs, public health preventive measures, and treatment strategies to understand the epidemiology and economic burden of these defects in Kenya. We specifically recommend the integration of clinical genetic services with routine reproductive health services because of potential maternal genetic predisposition in the region.

Background:Although major external structural birth defects continue to occur globally, the greatest burden is shouldered by resource-constrained countries largely with no surveillance systems. To the best of our knowledge, few studies have been published on the risk factors for these defects in developing countries. The objective of this study was to identify the risk factors for major external structural birth defects among children in Kiambu County, Kenya. Methods:A hospital-based case-control study was used to identify the risk factors for major external structural birth defects in Kiambu County. A structured questionnaire was used to gather information retrospectively on exposure to environmental teratogens, multifactorial inheritance, and sociodemographic-environmental factors during the study participants' last pregnancies. Descriptive analyses (means, standard deviations, medians, and ranges) were used to summarize continuous variables, whereas, categorical variables were summarized as proportions and percentages in frequency tables. Afterward, logistic regression analyses were conducted to estimate the effects of the predictors on major external structural birth defects in the county. Results:From the multivariable analyses, maternal age ≤34 years old, (aOR: 0.41; 95% CI: 0.18-0.91; P=0.03), and preceding siblings with history of birth defects (aOR: 5.21; 95% CI; 1.35-20.12; P =0.02) were identified as the significant predictors of major external structural birth defects. Conclusions:Maternal age ≥35 years old, and siblings with a history of birth defects were identified as the risk factors for major external structural birth defects in Kiambu County, Kenya. This pointed to a need to create awareness among couples against delaying childbearing beyond 35 years of age and the need for clinical genetic services for women of reproductive age with history of births affected by congenital anomalies.

INTRODUCTION: Major external structural birth defects are typical and have been attributed to childhood morbidity, mortality and lifelong resource-intensive disabilities. These defects continue to occur; however, they are yet to be recognized as public health problems in Kenya. The objective of this study was to estimate the prevalence of major external structural birth defects in Kiambu County in Kenya, 2014-2018. METHODS: a cross-sectional study design was adopted; a retrospective review of medical records was conducted between 2014 and 2018 abstracting 873 birth defects. Following a predetermined inclusion criterion, a five-year prevalence numerator of 362 cases was determined, whereas, a five-year prevalence denominator of 299,854 cases of registered live-births was obtained from the birth registrar. Annual prevalence estimates of 29 sub-groups and 6 groups of these defects were calculated as the number of cases (numerator) divided by the number of live-births (denominator). Associated 95% binomial exact 95% confidence intervals were also computed and expressed per 100,000 live-births. RESULTS: defects of the musculoskeletal system, the central nervous system, orofacial, genital organs, eye and anus were observed. Defects of the musculoskeletal system were the most prevalent, ranging from 22.98 (95% CI: 11.87-40.13) to 116.9 (95% CI: 92.98-145.08) per 100,000 live-births. Defects of the central nervous system followed ranging between 13.40 (95% CI: 5.39-27.61) and 32.79 (95% CI: 20.79-49.19) per 100,000 live-births. CONCLUSIONS: despite musculoskeletal system defects being the most common group, hypospadias; a defect of the male genital organ was the most prevalent among the sub-group of these defects.