The Incidence of Congenital Anomalies of The Kidney and Ureters as Seen at The Aga Khan Hospital Nairobi Kenya
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Congenital malformations are a tragedy to the patients, parents and also the clinicians in charge of the care of the patients. In many parts of the world congenital malformations evoke severe repercussions both emotional and physical. In some African tribes not infrequently gross structural visibly discernible malformations have been associated with unfaithfulness on the part of the mother. In other tribes it is looked at as God's way of punishment to the concerned parents for some unidentified sin. Many babies born with such defect have been killed soon after birth as a way of concealing such facts. Congenital malformations is becoming more and more a significant problem as perinatal mortality and morbidity due to infectious diseases and malnutrition are receeding to the background with improved health care. Okeahialam (29) correctly remarked years ago that increasing facilities to cater for congenitally malformed babies will soon be necessary. In fact Shija (35) found that congenital malformations were the third commonest reason for admission in the paediatric surgical wards at Muhimbili Hospital Dar-es-Salaam, Tanzania as early as 1975. It was only superseded by trauma (40%) and infectious diseases (23%). On the whole, it has reviously been estimated that as much as 2% of all new-borns have at least one or more major congenital malformations recognisable at birth (19). The figure doubles when these babies are followed up to childhood. The pattern and the incidence of congenital malformations in Kenya has been previously reported by Muga in 1985 (25), who followed up a series of 7,355 consecutive births at the Kenyatta National Hospital for a period of one year. The overall incidence of externally discernible malformations among the babies was 28.1 per 1,000 live births. Major malformations occured at a frequency of 15 per 1,000 total births. The leading system involved was the musculoskeletal system (33.9%) followed by the C.N.S. system (28.6%). According to the same author 50.9% of the babies born with major congenital malformations survived the neonatal period. The combined mortality rate (i.e., stillbirths and neonatal deaths) was 44.6% with the C.N.S. defects and chromosomal disorders being the leading causes of death.