Research The Epidemiology and Economic Burden of Structural Birth Defects in Kenya: A Case of Kiambu County

The Epidemiology and Economic Burden of Structural Birth Defects in Kenya: A Case of Kiambu County

Abstract

Background:

Birth defects remain a worldwide public health problem causing prenatal, infant and, childhood morbidity, mortality, postnatal physical lifelong disabilities and reduced quality of life, life expectancy and economic productivity. Substantial economic resources are usually dedicated to treatment of SBDs among children in Kenya.

Study objectives:

This study seeks to determine epidemiology and economic burden of SBDs in Kiambu county from 1st January 2014 to 31st December 2018 through the
following objectives: – To estimate the prevalence of SBDs, to identify the risk factors for major SBDs and to empirically determine the “shadow prices” of corrective health service for SBDs.

Methodology:

This study targets all children born in Kiambu county during the study period from 1st January 2014 to 31st December 2018 and cases defined as live-births of at least 28 weeks gestation, with at least a clinically obvious external SBDs of any body organ and/or system, and/or ascertained by a medical specialist(s) born to a resident mother of Kiambu county during the study period, born at home and/or any of the participating hospitals and/or received/receiving care at the hospitals participating in the study. Following sample sizes statistically determined, and probability proportional to size self-weighted samples, descriptive cross-sectional and case-control study designs will be conducted.

Objective 1:

To estimate the prevalence of SBDs, a descriptive cross-sectional study will be carried out at the 14 hospitals, where numerator data consisting of live-births with SBDs will be abstracted retrospectively by research assistants lead by the principal investigator from MOH 333, NBU and pediatric records, whereas, the denominator will consist of the number of live births reported or projected by KNBS by years from 1st January 2014 to 31st December 2018. Retrospective data will include maternal education, age, sub-county, occupation,
parity, gestation age, nature of gestation, alcohol consumption, trimester prenatal care began and antenatal care visits, sex of child. Categorical variables will be analyzed as descriptive statistics and summarized in proportions/percentages and results presented in graphs, tables and narratives summaries. Prevalence of specific SBDs will be calculated by dividing the numerator (number of cases of specific structural birth defects in the county each year) by the denominator (number of live births in the county reported/projected by the KNBS) yearly during the study period.

Objective 2:

To identify the risk factors for major external SBDs, a hospital-based case-control study will be conducted at 2 specialized hospitals, where, primary data will be collected through structured interviewer-administered questionnaires. The occurrence of these defects will be hypothesised to depend on maternal education, age, residence, occupation, parity, gestation, alcohol consumption, indoor pollution, iron-folic acid supplementation, trimester prenatal care began and antenatal care visits, and a logistic regression model will be used to calculate odds ratios at 95% CI controlling for potential confounders.

Objective 3:

To determine the “shadow prices” of corrective health service for SBDs, a descriptive cross-sectional study will be carried out at 2 specialized hospitals with primary data collected using healthcare provider/managers semi-structure interview guides, and secondary data through retrospective review of medical/hospital records. Continuous variables, i.e. total economic costs, unit economic costs and DALYs will be analyzed by descriptive statistics and summarized in mean at 95% CI, median, inter-quartile range (IQR), histograms and boxplots, linear regression analysis will estimate marginal effects of the predictors on shadow prices of health among children with SBDs, Lastly, the “shadow prices” of corrective health services, demand for health and health care will be econometrically estimated using two-stage least squares (2SLS) and ordinary least squares (OLS) models. The results will
be presented in tables, graphs and narratives summaries.

Study utility:

Overall, the study results will be used to inform policy decisions on resource allocation for the defects, improve understanding of public and economic burden of SBDs, provide a reference point for establishment of national surveillance system, registry and formulation of public health policy framework for prevention and control of SBDs among women of reproductive age. The knowledge of the risk factors may be tailored to formulate specific
interventions and inform risk-based surveillance of specific SBDs among women of reproductive age. Lastly, we envisage to contribute to the realm of epidemiol-economics or epi-economics which involves the application of epidemiology and economic theories in biomedical, public health and epidemiology studies.