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The burden of selected congenital anomalies amenable to surgery in low and middle-income regions: cleft lip and palate, congenital heart anomalies and neural tube defects
  1. Hideki Higashi1,2,
  2. Jan J Barendregt2,
  3. Nicholas J Kassebaum1,3,
  4. Thomas G Weiser4,
  5. Stephen W Bickler5,
  6. Theo Vos1,2
  1. 1Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
  2. 2School of Population Health, University of Queensland, Brisbane, Queensland, Australia
  3. 3Division of Anesthesiology & Pain Medicine, Seattle Children's Hospital, Seattle, Washington, USA
  4. 4Department of Surgery, School of Medicine, Stanford University, Stanford, California, USA
  5. 5Department of Surgery, School of Medicine, University of California, San Diego, California, USA
  1. Correspondence to Dr Hideki Higashi, Institute for Health Metrics and Evaluation, University of Washington, 2301 Fifth Ave, Suite 600, Seattle, WA 98121, USA; h.higashi{at}


Objective To quantify the burden of selected congenital anomalies in low and middle-income countries (LMICs) that could be reduced should surgical programmes cover the entire population with access to quality care.

Design Burden of disease and epidemiological modelling.

Setting LMICs from all global regions.

Population All prevalent cases of selected congenital anomalies at birth in 2010.

Main outcome measures Disability-adjusted life years (DALYs).

Interventions and methods Surgical programmes for three congenital conditions were analysed: clefts (lip and palate); congenital heart anomalies; and neural tube defects. Data from the Global Burden of Disease 2010 Study were used to estimate the combination of fatal burden that could be addressed by surgical care and the additional long-term non-fatal burden associated with increased survival.

Results Of the estimated 21.6 million DALYs caused by these three conditions in LMICs, 12.4 million DALYs (57%) are potentially addressable by surgical care among the population born with such conditions. Neural tube defects have the largest potential with 76% of burden amenable by surgery, followed by clefts (59%) and congenital heart anomalies (49%). Sub-Saharan Africa and South Asia have the greatest proportion of surgically addressable burden for clefts (68%), North Africa and Middle East for congenital heart anomalies (73%), and South Asia for neural tube defects (81%).

Conclusions There is an important and neglected role surgical programmes can play in reducing the burden of congenital anomalies in LMICs.

  • Congenital Abnorm
  • Epidemiology
  • Paediatric Surgery

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