The birth prevalence of congenital anomalies in developing countries is similar to that observed in developed countries. However, the health impact of birth defects is higher because of a lack of adequate services for the care of affected infants and a higher rate of exposures to infections and malnutrition. A number of successful measures for the prevention of congenital anomalies are being taken in a number of developing nations. Primary prevention programs are based on public education about preconceptional and prenatal risks. Prevention based on reproduction options includes teratogen information services and prenatal screening for fetal anomalies. In addition, programs for the detection of congenital malformations at birth, followed by early treatment, are contributing to secondary prevention. Prevention of congenital anomalies in the developing world requires: (a) good epidemiological data on the prevalence and types of birth defects and genetic disorders; (b) educating health professionals in the goals and methods of preventing birth defects at low cost but with high impact, and (c) expansion of family planning and improvement of antenatal care combined with educational campaigns to avoid the risks for birth defects. The basis for public health preventive measures should be the primary health care level. In a sizable proportion of developing countries, the stage is already set for these measures to be implemented. Required are education, political will, and proper organization and allocation of resources.

1.
Penchaszadeh VB: Implementing genetic services in developing countries. The case of Latin America; in Kuliev A, Greendale K, Penchaszadeh V, Paul NW (eds): Genetic Services Provision: An International Perspective. Birth Defects Original Article Ser 1992;28:17–26.
2.
WHO: Prevention and care of genetic diseases and birth defects in developing countries (WHO/HGN/GL/WAOPBD/99.1). Geneva, WHO, 1999.
3.
WHO: Primary health care approaches for prevention and control of congenital and genetic disorders (WHO/HGN/WG/00.1). Geneva, WHO, 2000.
4.
Penchaszadeh VB: Delivery of genetic services in developing countries; in Khoury MJ, Burke W, Thompson E (eds): Genetics and Public Health in the 21st Century. New York, Oxford University Press, 2000, pp 301–327.
5.
Leck I, Record RG, McKeown T, et al: The incidence of malformations in Birmingham, England, 1950–1959. Teratology 1968;1:263.
6.
International Clearinghouse for Birth Defects Monitoring Systems: Congenital Malformations Worldwide. A Report from the International Clearinghouse for Birth Defects Monitoring Systems. Amsterdam, Elsevier, 1991.
7.
International Clearinghouse for Birth Defects Monitoring Systems, WHO, EUROCAT: World Atlas of Birth Defects, ed 1. Geneva, WHO, 1998.
8.
UNICEF: The State of the World’s Children. Early Childhood. New York, UNICEF, 2000.
9.
WHO Advisory Group on Hereditary Diseases: Community Approaches to the Control of Hereditary Diseases. Geneva, WHO, 1985.
10.
Xiao KZ, Zhang ZY, Su YM, et al: Central nervous system congenital malformations, especially neural tube defects in 29 provinces, metropolitan cities and autonomous regions of China: Chinese Birth Defects Monitoring Program. Int J Epidemiol 1990;19:978–982.
11.
Mutchinick O, Lisker R, Rabinsky V: The Mexican Program of Registration and Epidemiologic Surveillance of External Congenital Malformations (SPA). Salud Publica Mex 1988;30:88–100.
12.
Saborio M. Experience in providing genetic services in Costa Rica; in Kuliev A, Greendale K, Penchaszadeh VB, Paul NW (eds): Genetic Services Provision: An International Perspective. Birth Defects Original Article Ser 1992;28:96–102.
13.
Nazer JH, Lopez-Camelo J, Castilla EE: ECLAMC: Results of thirty years of epidemiological surveillance of neural tube defects. Rev Méd Chile 2001;129:531–539.
14.
Xiao KZ, Lang ZC, Chen JH, Liu SL, et al: Consecutive three-year birth defects monitoring in Sichuan province. Heredity Dis 1988;5:65–68.
15.
Castilla EE, Orioli IM: Prevalence rates of microtia in South America. Int J Epidemiol 1986;15:364–368.
16.
Modell B, Boulyjenkov V: Distribution and control of some genetic disorders. World Health Stat Q 1988;41:209–218.
17.
Castilla EE, Lopez-Camelo JS: The surveillance of birth defects in South America. 1. The search for time clusters: Epidemics. Ad Mutagen Res 1990;2:191–210.
18.
Venter PA, Christianson AL, Hutamo CM, Makhura MP, Gericke GS: Congenital anomalies in rural black South African neonates – a silent epidemic? S Afr Med J 1995;85:15–20.
19.
Carothers AD, Hecht CA, Hook EB: International variation in reported livebirth prevalence rates of Down syndrome, adjusted for maternal age. J Med Genet 1999;36:386–393.
20.
WHO Scientific Group: Control of hereditary diseases. Report of a WHO Scientific Group. Geneva, WHO Technical Report Series 1996, No. 865.
21.
Castilla EE: Reproduction age as risk factor for birth defects. Braz J Genet 1996;19(suppl):92.
22.
United Nations Fund for Population Activities: The State of World Population 1998. New York, United Nations Fund for Population Activities, 1998.
23.
Schuler-Faccini L, Leite JCL, Vieira-Sanseverino MT, Mizunski-Peres R: Evaluation of potential teratogens in Brazilian population. Cienc Saude Colectiva 2002, in press.
24.
Cutts FT, Robertson SE, Diaz-OrtegaJL, Samuel R: Control of rubella and congenital rubella syndrome (CRS) in developing countries. 1. Burden of disease from CRS. Bull World Health Organ 1997;75:55–68.
25.
Cutts FT, Wynnyck E: Modelling the incidence of congenital rubella syndrome in developing countries. Int J Epidemiol 1997;28:1176–1184.
26.
Murray C, Lopez A (eds): The Global Burden of Disease. Cambridge, Harvard School of Public Health, 1996.
27.
McDermott J, Steketee R, Larsen S, Wirima J: Syphilis-associated perinatal and infant mortality in rural Malawi. Bull World Health Organ 1993;71:773–780.
28.
World Bank: Confronting AIDS. Public Priorities in a Global Epidemic. New York, Oxford University Press, 1997.
29.
Castilla EE, Ashton-Prolla P, Barreda-Mejia E, Brunoni D, et al: Thalidomide, a current teratogen in South America. Teratology 1996:54:273–277.
30.
D’Amato RJ, Luoghnan MS, Flynn E, Folkman J: Thalidomide is an inhibitor of angiogenesis. Proc Natl Acad Sci USA 1994;91:4082–4085.
31.
Schuler L, Sanseverino MT, Clavijo HA, Ashton-Prolla P, et al: Preliminary report on the first Brazilian teratogen information service (SIAT). Braz J Genet 1993;16:1085–1095.
32.
Costa SH, Vessey MP: Misoprostol and illegal abortion in Rio de Janeiro, Brazil. Lancet 1993;341:1258–1261.
33.
Coelho HLL, Teixeira AC, Santos AP, et al: Misoprostol and illegal abortion in Fortaleza, Brazil. Lancet 1993;341:1261–1263.
34.
Pastuszak AL, Schuler L, Speck-Martins CE, Coelho KEFA, Cordello SM, Vargas F, Brunoni D, Schwarz IVD, Larrandaburu M, Safattle H, Meloni VFA, Koren G: Use of misoprostol during pregnancy and Moebius’ syndrome in infants. N Engl J Med 1998;338:1881–1885.
35.
Schuler L, Pastuszak A, Sanseverino TV, Orioli IM, et al: Pregnancy outcome after exposure to misoprostol in Brazil: A prospective, controlled study. Reprod Toxicol 1999;13:147–151.
36.
Shepard TH: Catalog of Teratogenic Agents, ed 8. Baltimore, Johns Hopkins University Press, 1995.
37.
Holmes LB, Harvey EA, Coull BA, Huntington KB, Khosibin S, Hayes AM, Ryan LM: The teratogenicity of anticonvulsant drugs. N Engl J Med 2001;344:1132–1138.
38.
Viljoen D: Fetal alcohol syndrome. S Afr Med J 1999;89:958–960.
39.
Croxford J, Viljoen D: Alcohol consumption by pregnant women in the Western Cape. S Afr Med J 1999;89:962–965.
40.
May PA, Brooke L, Gossage JP, Croxford J, Adnams C, Jones KL, Robinson L, Viljoen D: Epidemiology of fetal alcohol syndrome in a South African community in the Western Cape Province. Am J Public Health 2000;90:1905–1912.
41.
Warren KR, Calhoun FJ, May PA, Viljoen DL, Li TK, Tanaka H, Marinicheva GS, Robinson LK, Mundle G: Fetal alcohol syndrome: An international perspective. Alcohol Clin Exp Res. 2001 May;25(suppl ISBRA):202S–206S.
42.
Pharoah PO: Iodine-supplementation trials. Am J Clin Nutr 1993;57(suppl):276S–279S.
43.
Maberly G: Iodine deficiency. Bull World Health Organ 1998;76(suppl 2):118–120.
44.
Czeizel AE, Dudás I: Prevention of the first occurrence of neural tube defects by periconceptional vitamin supplementation. N Engl J Med 1992;327:1832–1835.
45.
Penchaszadeh VB, Christianson AL, Giugliani R, Boulyjenkov, Katz M: Services for the prevention and management of genetic disorders and birth defects in developing countries. Community Genet 1999;2:196–201.
46.
Penchaszadeh VB: Community genetics in Latin America: Challenges and perspectives. Community Genet 2000;3:124–127.
47.
Penchaszadeh VB, Beiguelman B: Medical genetics services in Latin America: Report of a meeting of experts. Pan Am J Public Health 1998;3:409–420.
48.
Robertson SE, Cutts FT, Samuel R, et al: Control of rubella and congenital rubella syndrome (CRS) in developing countries. 2. Vaccination against rubella. Bull World Health Organ 1997;75:55–68.
49.
Pan American Health Organization: Report on Vaccines and Immunization. 128th Session of the Executive Committee, 25–29 June 2001. Washington, PAHO, 2001, pp 10–11.
50.
Smithells RW, Sheppard S, Schorah CJ, et al: Apparent prevention of neural tube defects by vitamin supplementation. Arch Dis Child 1981;56:911.
51.
MRC Vitamin Study Research Group: Prevention of neural tube defects: Results of the Medical Research Council Vitamin Study. Lancet 19991;338:131–137.
52.
Anonymous: Recommendations for the use of folic acid to reduce the number of cases of spina bifida and other neural tube defects. MMWR Recomm Rep 1992;41(RR-14):1–7.
53.
Cornel MC, Erickson JD: Comparison of national policies on periconceptional use of folic acid to prevent spina bifida and anencephaly. Teratology 1997;55:134–137.
54.
Berry RJ, Zhu l, Erickson JD, Song l, et al: Prevention of neural tube defects with folic acid in China. N Engl J Med 1999;341:1485–1490.
55.
Cuba Neuropathy Investigation Team: Epidemic optic neuropathy in Cuba: Clinical characterization and risk factors. N Engl J Med 1995;333:1176–1182.
56.
Rodriguez L, Sanchez R, Hernandez J, Carrillo L, et al: Results of 12 years of combined maternal serum α-fetoprotein screening and ultrasound fetal monitoring for prenatal detection of fetal malformations in Havana City, Cuba. Prenat Diagn 1997;4:301–304.
57.
Stanbury JB: Prevention of iodine deficiency; in Howson CP, Kennedy ET, Horowitz A (eds): Prevention of Micronutrient Deficiencies: Tools for Policymakers and Public Health Workers. Washington, National Academy Press, 1998.
58.
Delange F, de Beoist B, Pretell E, Dunn JT: Iodine deficiency in the world: Where do we stand at the turn of the century? Thyroid 2001;11:437–447.
59.
Heredero L: Comprehensive national genetic program in a developing country – Cuba; in Kuliev A, Greendale K, Penchaszadeh VB, Paul NW (eds): Genetic Services Provision: An International Perspective. Birth Defects Original Article Ser 1992;2852–2857.
60.
Heredero L: Medical genetic services in Cuba; in Penchaszadeh VB, Beiguelman B (eds): Medical Genetic Services in Latin America 1998. Geneva, WHO, 1998 (WHO/HGN/CONS/MGS/98.4).
61.
Lo WHY: Medical genetics in China. J Med Genet 1988;25:253–257.
62.
Ren A, Li Z: Current status of genetic counseling in the prevention of birth defects in China. Proceed Int Conf Birth Defects Disabilities Dev World, August 6–10, 2001, Johannesburg, South Africa, p 32.
63.
Jenkins T: Medical genetics in South Africa. J Med Genet 1990;27:760–779.
64.
Viljoen D, Beighton P, Hitseroth: Medical genetics in primary health care. S Afr Med J 1995;85:1–3.
65.
Christianson AL, Venter PA, Modiba JH, Nelson MM: Development of a primary health care clinical genetic service in rural South Africa. The Northern Province experience, 1990–1996. Community Genet 2000;3:77–84.
66.
Department of Health, South Africa: Human Genetic Policy Guidelines for the Management and Prevention of Genetic Disorders, Birth Defects and Disabilities. Pretoria, Department of Health, 2001.
67.
Unpublished WHO document 1985;HMG/AG/85.10. Geneva, WHO.
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