CHAPTER FOUR

DATA PRESNTATION, ANALYSIS AND DISCUSION

4.1. Introduction

This chapter presents the data analysis interpretation and discussion part of the research. The
study attempted to assess the Prevalence of congenital anomalies and types detected by
ultrasound in Olenchitti Hospital, Oromia regional state from November 2022 up to January
2023 for 3 months. The collected data were presented and analyzed using SPSS version 22.0
statistical software. The study used Descriptive Analysis, correlation analysis, specifically
Pearson correlation to measure the degree of association between different variables under
consideration.

Socio-Demographic and General Characteristics

This study was carried out at public health hospitals in Olenchiti town to assess the prevalence
congenital anomalies and types detected by ultrasound. A total of 196 mothers and their
maternal’ cards were reviewed with a response rate of 100%. As is shown in the figures 4.1to 4.3
below more than two-third, 161 (82.1%) of mothers were between the age interval of 20-35. All
most all of them, 169 (86.2%) of mothers were married and live together with their husbands,
and more than half of the response 104 (53.1%) of them were permanently resident of Rural.
Figure 4.1: shows the Maternal Age diagnosed with congenital anomalies

Maternal Age
95
85
75
65
55
45
35
25
15
5
Below 20 years 20-25 years 26-35 years Above 36 years
Frequency 17 69 92 18
Percent 8.7 35.2 46.9 9.2
Source: Researcher Data (2023)
Figure 4.2: shows the Marital Status of mothers diagnosed with congenital anomalies

Marital Status
170
150
130
110
90
70
50
30
10
Single Married and live Married but Divorced
together Separated
Frequency 15 169 10 2
Percent 7.7 86.2 5.1 1

Source: Researcher Data (2023)

Figure 4.3: shows the Place of Residence of mothers diagnosed with congenital anomalies

Permanent Place of Residence

Frequency Percent
Urban 92 46.9
Rural 104 53.1

Source: Researcher Data (2023)

General Characteristics
Table 4.1 shown that 188 (95.9%) of the types of the birth outcome of newborns were singletons
and 8 (4.1%) multiple births (twins) respectively. The study concluded that the birth outcome of
newborns with singletons dominated the sample for this study. On the other hand, in the study
area, the majority 185 (94.4%) of mothers had no previous history of abortion and 11 (5.6%) had
previous history of abortion, 152 (77.2%) had no previous history of drug intake during
pregnancy, 23 (11.7%) did not take folic acid at the time of pregnancy.
In spite of Gestational age the study was classified the pattern as 1 st trimester (< 36 weeks), 21
(10.7%), 2nd trimester (37-40 weeks), 146 (74.5%) and 3rd trimester (>40 weeks) in 29 (14.8%).
The preterm was more frequent among classes of gestational age indicating that most CA cases
were born before completing their developmental terms. About 4 (2.04%) of the newborns with
CAs were in 1st-order birth for their family and 2(1.02%) had birth order of the 3rd in their
family.
Table 4.1: General Characteristics of mothers diagnosed with congenital anomalies
Maternal Presence of Congenital Anomalies
Characteristics Type of Pregnancy Yes No
Frequency Percent Frequency Percent Frequency Percent
Single 188 95.9 6 3.06 182 92.85
Twin 8 4.1 1 0.51 7 3.57
Total 196 100 7 3.57 189 96.42
Pervious History of Yes No
Abortion
Yes 11 5.6 4 2.04 7 3.57
No 185 94.4 3 1.53 182 92.85
Total 196 100.0 7 3.57 189 96.42
Previous history of Yes No
Drug Intake
Yes 44 22.4 4 2.04 7 3.57
No 152 77.6 3 1.53 182 92.85
Total 196 100 7 3.57 189 96.42
Folic Acid Intake Yes No
Yes 173 88.3 7 3.57 166 84.72
No 23 11.7 0 0 23 11.7
Total 196 100.0 189 96.42
Gestational Age Yes No
1st-Trimester 21 10.7 2 1.02 19 9.69
2nd-Trimester 146 74.5 4 2.04 142 72.45
3rd-Trimester 29 14.8 1 0.51 28 14.28
Total 196 100 7 3.57 189 96.42
Birth Order Yes No
1st-order 89 45.4 4 2.04 85 43.36
2nd-order 43 21.9 1 0.51 42 21.42
3rd-order 46 23.5 2 1.02 44 22.44
 >3rd-order 18 9.2 0 0 18 9.2
Total 196 100 7 3.57 189 96.42
Source: Researcher Data (2023)

Prevalence of Congenital Anomalies

A total of 7 different CAs were recorded from 196 cases of newborns. The types of CA identified
were Neural tube defect (i.e. Anencephaly, Hydrocephalus, Spinal bifida) and gastrointestinal
defects (i.e. Omphelocele, Duodenal atresia). The prevalence of Neural tube defect and
gastrointestinal defects were 2.6%, and 1%, respectively s shown in the table below.
Table 4.2: Types of Congenital Anomalies detected
Birth Defect Frequency Percent Valid Percent Cumulative Percent
Valid Not Covered 189 96.4 96.4 96.4
Neural tube defects 5 2.6 2.6 99.0
Gastrointestinal
2 1.0 1.0 100.0
defects
Total 196 100.0 100.0
Source: Researcher Data (2023)
As it is indicated in table 4.3 Out of the total 196 patients for whom ultrasound evaluation was
done during the study period 5 cases were identified as having neural tube defect (corresponding
to 2.5 % incidence or 25 cases per 1000). Out of the 5 cases identified 3 were cases of
anencephaly, one had Hydrocephalus, another one had spinal bifida.
Table 4.3: Frequency of types CA with neural tube defects

Neural Tube Defect Frequency Percent Valid Percent Cumulative Percent

Valid Not Covered 191 97.4 97.4 97.4
Anencephaly 3 1.5 1.5 99.0
Hydrocephalus 1 .5 .5 99.5
Spinal bifida 1 .5 .5 100.0
Total 196 100.0 100.0
Source: Researcher Data (2023)
Regarding Gastrointestinal Defects Out of the total 196 patients for whom ultrasound evaluation
was done during the study period 2 cases were identified as having Gastrointestinal Defects
(corresponding to 1 % incidence or 10 cases per 1000). Out of the 2 cases identified 1 were cases
of Omphelocele and the other one had duodenal atresia as shown in the table below.
Table 4.4: Frequency of types CA with Gastrointestinal Defects
 Gastrointestinal Defects Frequency Percent Valid Percent Cumulative Percent
Valid Not Covered 194 99.0 99.0 99.0
Omphelocele 1 .5 .5 99.5
Duodenal atresia 1 .5 .5 100.0
Total 196 100.0 100.0
Source: Researcher Data (2023)
Factors Associated With Congenital Anomalies
Maternal Factors
The maternal factors investigated in the present study were maternal age, previous history of
abortion, previous history of drug intake, folic acid intake and their relationship with type of
pregnancy (the presence of those types of factors in types of pregnancy as shown in the figure
below. In can be concluded that as shown in the figure 4.4, most of CA cases happened in
singleton pregnancy type and caused by previous history of abortion and previous history of drug
intake.
Figure 4.4 maternal characteristic and presence of CA

Source: Researcher Data (2023)

Over all factors associated with Congenital Anomalies
Variables that showed significant association in the correlation model were previous history of
abortion and drug intake during pregnancy .These variables were taken to the correlation analysis
models to control for confounding variables, and still previous history of abortion and drug
intake during pregnancy remained significantly associated with Congenital Anomalies with value
of (p<0.5).
Table 4.4: Correlation analysis between overall factors and CA
Previous
Maternal Pervious History Folic Acid history of Drug History
Age of Abortion Intake Intake of CA
MA Pearson
1 .092 -.062 .014 -.001
Correlation
Sig. (2-tailed) .199 .390 .841 .986
PHA Pearson
.092 1 .020 .453** .431**
Correlation
Sig. (2-tailed) .199 .780 .000 .000
FAI Pearson
-.062 .020 1 -.070 .070
Correlation
Sig. (2-tailed) .390 .780 .331 .328
PHDI Pearson
.014 .453** -.070 1 .160*
Correlation
Sig. (2-tailed) .841 .000 .331 .025
CA Pearson
-.001 .431** .070 .160* 1
Correlation
Sig. (2-tailed) .986 .000 .328 .025
**. Correlation is significant at the 0.01 level (2-tailed).
*. Correlation is significant at the 0.05 level (2-tailed).
c. Listwise N=196
Source: Researcher Data (2023)
The correlation table revealed that there was a positive significant relationship between Pervious
History of Abortion, Previous history of Drug Intake and Congenital Anomalies with (0.431 **, p
< 0.001) and (0.160**,p < 0.05), respectively. This implies that the two independent variables
have the potential to cause congenital anomalies in this study. In other words children whose
mothers had previous history of abortion and Children whose mothers had previous drug intake
were also more likely to have Congenital Anomalies
 CHAPTER FIVE
DISCUSSION
Birth defects, also called CAs, occur at a rate of 1 in every 33 newborn babies. Some of these
CAs are minor and others are major defects. In most cases, the major defects are the leading
causes of high perinatal mortality and morbidity in developing countries as well as in developed
countries (Rosano et al., 2000). According to World Health Statistics, about 260,000 neonatal
deaths worldwide are caused by CAs accounting 7% of all neonatal deaths in the globe (Rizk et
al., 2014). However, it is varying from 5% in south-east Asia to more than 25% in Europe. It was
also indicated that between country variations, from 4% (Bangladesh, Equatorial Guinea,
Ethiopia, Liberia, Mali, and Sierra Leone) and an estimated 8% in China (Rizk et al., 2014).

This study established that, the overall prevalence rate of BDs was 3.57 per 1000 births, where
NTDs were the most prevalent constituting 71.43 % of all the defects. A report from the previous
study done in referral hospital of northwestern Ethiopia showed that the NTDs were the most
prevalent types of CAs with a frequency of 32.5% (Adane and Seyoum, 2018). However, the
proportion in this finding was higher than that of northwestern Ethiopia. The difference might be
because of socioeconomic differences between the two study populations within a different
geographical locations or it might be because of the level of exposure to the causative agents.

In this study out of the total 196 patients for whom ultrasound evaluation was done during the
study period 5 cases were identified as having neural tube defect (corresponding to 2.5 %
incidence or 25 cases per 1000). Out of the 5 cases identified 3 were cases of anencephaly, one
had Hydrocephalus, another one had spinal bifida and also 2 cases were identified as having
Gastrointestinal Defects (corresponding to 1 % incidence or 10 cases per 1000). Out of the 2
cases identified 1 was cases of Omphelocele and the other one had duodenal atresia. The
prevalence rate of NTDs was slightly similar (25 per 1000 births) when compared with the
prevalence rate (20.1 per 1000 births) of NTDs in China (Zhang et al., 2012).

In this study, anencephaly was the most common types of CAs with a frequency of 1.5% and
followed by Hydrocephalus, Spinal bifida, Omphelocele, and Duodenal atresia having 1% for
each respectively. In line with this findings, Abbey et al. (2017) reported that the prevalence of
the major CAs at the University of Port Harcourt Teaching Hospital in the Niger Delta during the
period 2011– 2014 was 20.7 per 1,000 live births, with those of the central nervous system
predominating at 27% of the total BDs. In both studies, the NTDs were more prevalent than the
other CAs.

In the current study, history of Abortion was found to be significantly associated with the
presence of CA. Results of other investigations also have shown that the prevalence of CA was
higher in stillbirth, spontaneous abortion and prematurity (Kuciene R, Dulskiene V. (2008),
Hoffman J.I, Kaplan S. (2002)). These findings were also consistent with findings from a
systematic review and meta-analysis done in China where the risk of CA increased by 18% in
spontaneous abortion and by 58% in induced abortion with an odd ratio of 1.28 in mothers with
previous history of abortion(Feng Y., 2015).

The history of drug intake during pregnancy has been found to have a significant positive
relationship with prevalence of CA. This study go in line with scientific published article done in
America explained the risk of CAs has been increased after the mother treated with several drugs
(Hsin H.C., 2016).

Conclusion

The present study had identified a comparatively high prevalence of CAs (35.8%) among
mothers diagnosed with congenital anomalies. The pregnancy type distribution of CAs in this
study showed that singleton predominated than twin having CA. The current study identified that
anencephaly; Hydrocephalus, Spinal bifida, Omphelocele, and Duodenal atresia were more
common birth difects. It also identified anencephaly the commonest CAs followed by followed
by Hydrocephalus, Spinal bifida, Omphelocele, and Duodenal atresia.

There was significant association between maternal drug intake and history of abortion with
CAs.

Recommendation

The burden of congenital anomalies in Olenchiti Governmental hospitals was found to be high.
The hospitals should mobilize more resources for optimal and timely management of these
patients. These resources should include human resources, such as counselors, pediatric
surgeons, cardiologists, pediatric anesthetists, nurses and others.
An adequate supply of medical equipment and medications are also important. The hospitals
should also plan the introduction of genetic testing services for accurate diagnosis in the future.

Olenchiti town or woreda and eash showa zone Health Offices in collaboration with Minster of
Health should create awareness about the risk of taking medication during pregnancy.

Further large scale research should be carried out to determine the prevalence of CAs and type of
CAs detected by ultrasound.