Muhimbili University College of Health Sciences

Percent of all neurological anomalies

Meningomyelocele	23	56.1%
Congenital Hydrocephalus	10	24.4%
Microcephaly	3	7.3%
Anencephaly	2	4.9%
Occipital encephalocele	1	2.4%
Frontal encephalocele	2	4.9%
Total	41	100%

Figure 2

Neonate with a large occipital meningoencephalocele

Figure 1

One of two twins with an open myelomeningocele

Table 2. Frequency of neural tube defects among neonates admitted to the Neonatal Ward of the Muhimbili National Hospital n=31

Type of Defect	Percentage
Meningomyelocele	74.2%
Microcephaly	9.6%
Anencephaly	6.5%
Occipital encephalocele	3.2%
Frontal encephalocele	6.5%

Table 3. Incidence of neural tube defects at the MNH

Type of defect	Incidence
Meningomyelocele	1.35 per 1000
Microcephaly	0.11 per 1000
Encephalocele	0.18 per 1000
Anencephaly	0.12 per 1000
All NTD	1.82 per 1000

Figure 3.

Neonate with exencephaly. He died shortly after birth

D

Discussion

The overall incidence of NTD of 1.82 per 1000 live births seen at the MNH in Dar es Salaam is comparable to that reported by other workers. Furthermore the commonest form of NTD is the meningomyelocele, which in this series has an incidence of 1.35 per 1000 live births per annum. No attempt has been made to evaluate the management of NTD and its outcome. This will form the subject of a future study. However, there were 9 deaths recorded among the neonates with NTD and congenital hydrocephalus. This is likely to be an underestimate as more could have died at home after discharge. It is well known now that preconceptional folic acid supplements prevent the development of neural tube defects. The need for epidemiological data regarding the incidence of NTD would help in planning interventional activities such as folic acid supplements for prospective mothers at risk.

This is a retrospective study which has the inherent shortcomings resulting from difficulties in obtaining complete and systematic data. Nevertheless the findings are based on a carefully recorded register of all admissions and represent the magnitude of the problem at MNH. Further prospective studies covering larger population areas would be helpful.