Counting Birth Defects in Low and Middle Income Country Settings: The Sri Lanka’s Experience

Background: Availability of quality birth defects data, utilizing such data effectively at different levels and dissemination to all stakeholders, facilitate effective birth defects prevention and control.

Objective: We aimed to review opportunities available for integrating birth defects surveillance (BDS) into the existing healthcare delivery system and implement a BDS

Methods: We conducted an in-depth analysis of healthcare system of Sri Lanka based on all sources available (documents/reports/internet searches/databases) to identify entry points and opportunities to integrate BDS.

Results: Sri Lanka reports a low maternal mortality ratio (32.5 per 100,000 live births) and infant mortality rate (9.7 per 1,000 live births). Birth defects contribute to 18.1% of infant deaths reported from hospitals. Prevalence of birth defects at birth 1.8%. Antenatal care coverage (99%) and institutional deliveries (99.9%), a majority (92%) in specialized units. Neonatal examinations (coverage 100%) are carried out in all institutional births based on a standardised format. Perinatal deaths are subjected to institutional audits with a coverage of 98%. Each house is designated to a public health midwife covering domiciliary post-partum care (82% coverage).

A national birth defects prevention and control action plan was formulated and a national BDS mechanism was developed. BDS was implemented on pilot basis in Southern Province (10 hospitals) with the objective of scaling up to country-wide surveillance in coming years. Data are collected on to a web-based database maintained by Family Health Bureau. Preliminary data over one year has reported 419 cases up to 2 years. Leading causes were cardiac defects, chromosomal disorders, cleft lip/palate and gastro-intestinal defects with female predominance. Many mothers were in 20-35 year age group and a significant proportion (28 %) are >35years.

Conclusions: With the available service delivery system, Sri Lanka and countries with similar contexts can easily integrate BDS as an effective measure to capture birth defects.