Incidence, types, geographical distribution, and risk factors of congenital anomalies in Al-Ramadi Maternity and Children's Teaching Hospital, Western Iraq

To study the incidence, types, geographical distribution, and risk factors of congenital anomalies [CAs] in a teaching hospital. A total of 5864 neonates were examined for CAs between October 2010 and October 2011 in Al-Ramadi Maternity and Children's Teaching Hospital, Al-Ramadi, Western Iraq. Data include: neonate's name, gender, weight, and type of CAs, mother's age, residence, education, parity, consanguinity, smoking, illness, drugs, and ultrasound [U/S] results, father's age and smoking, and family recurrence of CAs. For every case, 2 controls were selected. Types and incidence of CAs was calculated. Odds ratio and confidence interval was utilized for risk factors evaluation. Overall CA incidences were 40.5/1000 for total births, 40.8/1000 live births, and 270.0/1000 for stillbirths. Twenty percent of CAs was found as multiple, 80% single, 63.8% major, and 36.2% minor. The cardiovascular system was found most affected, followed by genito-urinary system. Low birth weight, male gender, maternal smoking, consanguinity, parity, and CAs family recurrence were found to be significant risk factors, and oligohydramnios, polyhydramnios, and positive CAs by U/S, found as significant co-factors associated with CAs, while parental age, and maternal education were not considered risk factors. Although the incidence of CAs was lower than the Al-Fallujah rate, it is still higher than many developed and developing countries. Amniotic fluid volume changes in U/S may hide an ominous CA, and maternal smoking exposure during pregnancy and consanguinity may expose the family to a congenitally anomalous delivery

Secular trend of infant mortality rate during wars and sanctions in Western Iraq

To study the infant mortality rate [IMR] trend during wars and sanction periods in Western Iraq. Data collected from the birth and death certificates of Haditha Health Vital Statistics Center, Haditha city [80,000 population], Western Iraq, included name, age, gender, residence, and infant's place and date of births and deaths, in 5 different sanction and war stages of the country from 1987 to 2010, in a study period from July to December, 2010. The IMRs were analyzed and compared between these stages and with other studies. The IMR of last 2 years of the Iraq-Iran war [1980-1988] was 35.6/1000 and 33.8/1000, this decreased in the war free period [1989-1990] to 28.6/1000, then increased during the sanction period [1991-2003] to 46/1000 in 2002, decreased to 16/1000 in 2006 during no sanctions but increased violence, then increased to 24.5/1000 in 2010. Approximately two-thirds of deaths occurred during the neonatal period, and one third in the post neonatal periods. Males had higher IMR than females, and rural residence higher than urban. Economic sanctions increased IMR more than wars or violence in Haditha city. When compared with other parts of Iraq, and despite the different conflicts that faced the country during the 24 studied years, Haditha had a lower IMR, however, this was still higher than developed, and many developing countries

Low birth weight in western Iraq

In Iraq, several reports documented an increase in the prevalence of low birth weight [LBW] in the last 3 decades. This study was carried out to report on the rate of LBW in western Iraq during the period of widespread violence. All singleton live births in Al-Ramadi Maternity and Pediatrics hospital during the period of 1 st April to 1st October 2006, were included in the study. All the neonates were checked for birth weight and the expanded parelled was used to assess gestational age. Multiple logistic regressions was used to estimate odd ratio for LBW. A total of 400 singleton live birth were included in the study. Over all 31% of were LBW, and 67% of them were preterm. Maternal age, parties, education, lack of antenatal care and history of LBW and prematurity were risk factors. LBW and preterm birth neonates are still highly prevalent in Iraq and reflect the effect of sanctions, Gulf wars and widespread violence

Neural tube defects among neonates delivered in Al-Ramadi maternity and children's hospital, western Iraq

To study the incidence, types, and sites of neural tube defects [NTDs] and its associated maternal and environmental variables. All preterm and full term live and stillborn babies delivered at Al-Ramadi Maternity and Children's Hospital, Al-Anbar Governorate, Iraq, from the 1st of November 2007 to the 1st of November 2008 were examined for gender, gestational age, NTDs, and associated congenital malformations. Mother's data included age, parity, consanguinity, education, antenatal care, previous medical illnesses, other NTDs history, folic acid supplementation, and diagnostic ultrasound. Incidence was calculated per 1000 births. During the study, 33 infants were delivered with NTDs, giving an incidence of 3.3/1000 births. Most were of myelomeningocele and anencephaly types, and thoracolumbar and lumbosacral sites. Two-thirds of the cases found were from consanguineous marriage, 12 NTD's mothers took folic acid during their pregnancy, while none of them received the drug during the periconceptional period. Three mothers had another NTD affected babies before, and mothers 25-34 years old produced most of the NTD deliveries than any other age groups. The NTDs incidence is still high compared with developed, and some developing countries. High consanguinity marriage and 100% lack of periconceptional folic acid intake needs further study considerations to reduce such morbid and mortal anomalies

Association of consanguinity with congenital heart diseases in a teaching hospital in Western Iraq

To study the association of consanguinity as a risk factor for congenital heart diseases [CHDs]. Patients with suggestive signs of CHD admitted to the Al-Ramadi Maternity and Children Hospital, Al-Anbar Governorate, Iraq from January 2009 to January 2010 were subject to diagnostic investigations. Case data includes: name, age, gender, and cause of admission. Parents' data includes: age, residence, degree of consanguinity, and history of family recurrent CHDs. Three controls to one case [3:1] were selected to compare their consanguinity with the CHD cases. Odds ratio was used for the measurement of consanguinity and other variable risks on CHD occurrence. The CHD cases were 86. Selected controls were 258 non-CHD cases. The most recorded subtypes were ventricular septal defect [VSD], atrial septal defect [ASD], and tetralogy of fallot [ToF]. Consanguinity was found in 78% of cases and 43.3% in controls. First cousin consanguinity comprised 66.2% in cases and 35.6% in controls from all their marriages. Consanguinity was found a significant risk factor, more affecting the VSD and ASD than ToF subtypes, while parental age and infant gender were not found as risk factors. Consanguinity proved to be a risk factor for CHD. Further social education of the risks of consanguineous marriages in this tribal population is needed to reduce the prevalence of these morbid and mortal anomalies

Perinatal mortality rate in Al Ramadi maternity and children's hospital, western Iraq

To estimate the perinatal mortality rate [PMR] in Al-Ramadi city, Iraq, and study its associated causative factors following the 2003 Coalition Forces occupation of Iraq. All the hospital stillbirth, and early neonatal death deliveries at the Al-Ramadi Maternity and Children's Hospital, Al-Anbar Governorate, western Iraq, from 15th June to 15th December 2005 were included in the study. Data collected for the mother includes: age, residence, parity, plurality, mode of delivery, medical and obstetrical history, antenatal care [ANC], and previous perinatal death. For dead babies: gestational age, gender, birth weight, and Apgar scores were also collected. The total studied deliveries were 3,249 births. The perinatal mortalities were 125 [43 stillbirths, and 82 neonatal deaths], giving an overall PMR of [38.5/1000]. Males showed higher PMR [45.9/1000] than females [29.1/1000]. Low birth weight babies among live births were 939 [29.2%], and were of higher [95.8/1000] PMR than normal [15.1/1000] weight births. Significant association was found between the gestational age, Apgar score, maternal age, residence, previous medical history, previous perinatal death, and plurality with the PMR. While no association was found between the mode of delivery, parity, ANC, and PMR. This study showed lower rates than some Iraqi studies applied before 2003, but still was of higher PMR when compared with the rates of most neighboring Arab and other developed countries