Download Abstract: Neural tube defects are severe, preventable congenital

Abstract:
Neural tube defects are severe, preventable congenital anomalies of the central nervous system. They
affect 5/10,000 births in Kenya annually. Socio-demographic characteristics and antenatal practices may
alter a woman’s risk of bearing a child with a neural tube defect. This study described women with affected
children, factors associated with neural tube defect severity and early presentation for treatment. A crosssectional study was conducted among mothers of children with neural tube defects attending Kijabe
Hospital and 14 satelitte clinics between May to August 2013. A case was defined as a child aged < 5 years
with a confirmed diagnosis of anencephaly, encephalocele or spina bifida. Factors associated with severity
and early presentation for treatment was determined using odds ratio as measure of association and
significance level of < 0.05. Median maternal age was 27 years (range15-49), 137 (52%) mothers had
primary education, 116 (44%) were housewives and 158 (60%) had > 2 children. Most mothers (97%)
attended antenatal clinic but median gestation at first visit was 5 months. Eighteen (7%) mothers took folic
acid supplements in the first trimester; one (0.4%) during the peri-conceptional period. Spina bifida was the
commonest anomaly comprising 254 (96%) cases; 66(25%) in the lumbosacral region. Comorbidities seen
included hydrocephalus in 177 (67%) children and lower limb paralysis in 164 (62%). Mothers aged >
30years (OR 3.2; p value <0.001), those with lower education (OR1.8; p-value 0.04) and children of birth
order 2- 5 (OR 2.0; p-value 0.02) were more likely to severe neural tube defect. Residing in Kiambu, Nairobi
or Nakuru counties (AOR 2.5; p value 0.003) was the only independent factor associated with early
presentation to Kijabe Hospital for treatment. Most mothers of affected children were aged <30 years and
had primary level education. Almost all did not take folic acid supplements during periconceptional period.
A considerable proportion of mothers were exposed to pesticides and medications during the affected
pregnancy. Maternal antenatal practices should be taken into consideration when implementing preventive
interventions for neural tube defects. Further studies are required to establish if folate deficiency, pesticide
exposure or medication use during pregnancy increase the risk of neural tube defects.