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Determinants of Congenital Anomalies in Afghanistan

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Determinants of Congenital Anomalies in Afghanistan Determinants of congenital anomalies in Afghanistan Dr. Said Mujahid Hashimi Afghanistan 53rd International Course in Health Development (ICHD) September 19th, 2016- September, 7th 2017 KIT (Royal Tropical Institute) Development Policy and Practice/ Vrije Universiteit Amsterdam I Determinant of congenital anomalies in Afghanistan A thesis submitted in partial fulfilment of the requirement for the degree of Master of Public Health by Dr. Said Mujahid Hashimi Afghanistan Declaration: Where other people's work has been used (either from a printed source, the internet or any other source) this has been carefully acknowledged and referenced in accordance with the departmental requirement. The thesis ‘Determinants of congenital anomalies in Afghanistan’ is my own work. Signature …… ……………………………………………… 53rd International Course in Health Development (ICHD) September 19, 2016-September 7, 2017 KIT (Royal Tropical Institute)/ Vrije Universiteit Amsterdam Amsterdam, The Netherlands September 2017 Organized by: (KIT) Royal Tropical Institute, Development Policy, and Practice Amsterdam, The Netherlands In cooperation with: Vrije Universiteit Amsterdam/Free University of Amsterdam (VU) Amsterdam, The Netherlands II Table of Contents List of Figures ........................................................................................................................................... VII List of Tables ............................................................................................................................................ VII List of Box ................................................................................................................................................ VII Acknowledgement ................................................................................................................................... VIII Abstract ........................................................................................................................................................ X Glossary…………………………………………………………………………………………………….X Abbreviations ............................................................................................................................................ XII Introduction .............................................................................................................................................. XIV Chapter 1 ..................................................................................................................................................... 1 1. Country background .......................................................................................................................... 1 1.1. Geography ...................................................................................................................................... 1 1.2. Population ...................................................................................................................................... 1 1.3. Political situation ........................................................................................................................... 1 1.4. Economy: ....................................................................................................................................... 2 2. Health system ...................................................................................................................................... 2 2.1. National health strategies and policies: .......................................................................................... 2 2.1.1 Response to congenital anomalies in Afghanistan: .................................................................... 3 2.2. Structure of health care service delivery: ...................................................................................... 3 Chapter 2 ..................................................................................................................................................... 4 Congenital Anomalies ................................................................................................................................. 4 2.1. Definition ........................................................................................................................................... 4 2.2. Causes and determinanta .................................................................................................................... 4 2.2.1. Preconception causes and determinants ..................................................................................... 4 2.2.2. Post conception causes and determinants ................................................................................... 5 2.3. The burden of congenital anomalies ............................................................................................... 5 2.4. Prevention and treatment ................................................................................................................ 5 2.4.1. Primary prevention:..................................................................................................................... 5 2.4.2. Secondary prevention: ................................................................................................................. 6 III 2.4.2. Tertiary prevention:..................................................................................................................... 6 Chapter 3 ..................................................................................................................................................... 7 Problem statement, Justification and methodology ................................................................................. 7 3.1. Problem statement .............................................................................................................................. 7 3.2. Justification ...................................................................................................................................... 11 3.3. Overall objective .............................................................................................................................. 11 3.3.1. Specific Objectives ................................................................................................................... 11 3.4. Methodology ................................................................................................................................... 12 3.4.1. Study design: ............................................................................................................................. 12 3.4.2. Search strategy: ......................................................................................................................... 12 3.5. Keywords ......................................................................................................................................... 12 3.6. Strength and limitations ................................................................................................................... 12 3.7. Conceptual framework ..................................................................................................................... 12 Chapter 4 ................................................................................................................................................... 14 Findings and discussion ............................................................................................................................ 14 4.1. Parental Factors ............................................................................................................................. 14 4.1.1. Consanguinity ........................................................................................................................... 14 4.1.2.Maternal age: ............................................................................................................................. 15 4.1.3. Paternal age: .............................................................................................................................. 15 4.1.4. Exposure to certain medicins during pregnancy ....................................................................... 15 4.1.5. Congenital infections ................................................................................................................ 16 4.1.6. Febrile illness during pregnancy ............................................................................................... 17 4.1.7. Maternal obesity and insulin dependent diabetes: .................................................................... 17 4.1.8. Nutritional status of mother: ..................................................................................................... 18 4.2. Behaviour factors ........................................................................................................................... 19 4.2.1. Smoking: ................................................................................................................................... 19 4.2.2. Alcohol consumption: ............................................................................................................... 19 4.3. Environmental Factors .................................................................................................................. 19 4.3.1.Socio-economical condition(SEC): ...............................................................................................
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