CONGENITAL-ANOMALIES IN RURAL BLACK SOUTH-AFRICAN NEONATES - A SILENTEPIDEMIC

Study objective. To ascertain the incidence and spectrum of congenital anomalies in neonates born in a rural hospital. Design. This was a pr ospective, hospital-based study, undertaken on liveborn neonates over the period 12 June 1989 - 31 December 1992. Setting. Mankweng Hospital , Sovenga, Northern Transvaal. Main results. Of a total of 10 380 neon ates born during this period, 7 617 (73,4%) were examined within the f irst 24 hours of life. On the basis of published observations, only 26 ,2% of severe congenital anomalies diagnosable by age 5 years are diag nosable at birth. In this South African study the finding at birth of severe, externally visible congenital anomalies in 14,97 per 1 000 liv ebirths could mean that by age 5 years the minimum cumulative incidenc e of severe congenital anomalies may involve 57,14 per 1 000 children. Extrapolating from other Third-World studies, the cumulative incidenc e of severe congenital anomalies in such communities may affect up to 84,85 per 1 000 children by the age of 5 years. High incidences of neu ral tube defects (3,55 per 1 000 livebirths) and Down syndrome (2,10 p er 1 000 livebirths), both conditions which can be prevented by prenat al screening, were recorded. Conclusions. These figures indicate the n ecessity for inclusion of appropriate prenatal, genetic, family planni ng and paediatric facilities into the primary health care delivery sys tem of rural areas, to manage such problems and to initiate programmes to reduce the incidence of selected congenital anomalies such as Down syndrome and neural tube defects.