Neural tube defects and factors associated with severity in children attending Kijabe Hospital, Kiambu County, Kenya

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 cross- sectional 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.