{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T11:51:25Z","timestamp":1776081085263,"version":"3.50.1"},"reference-count":41,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T00:00:00Z","timestamp":1774483200000},"content-version":"unspecified","delay-in-days":25,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100009402","name":"Mekelle University","doi-asserted-by":"publisher","award":["MU-IRB 1800\/2020,protocol renewal MU-IRB 2101\/2023"],"award-info":[{"award-number":["MU-IRB 1800\/2020,protocol renewal MU-IRB 2101\/2023"]}],"id":[{"id":"10.13039\/501100009402","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,2,11]]},"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To assess the prevalence and patterns of externally visible structural birth defects in the Tigray Region during the war and siege period.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Retrospective hospital-based cross-sectional analysis of delivery records from 11 public hospitals in the Tigray Region of Ethiopia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>11 selected public hospitals that remained relatively functional during the war in the Tigray Region of northern Ethiopia and provided maternity and neonatal care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>All recorded delivery outcomes between October 2020 and December 2023 were reviewed. A total of 54\u2009626 birth records, including both live births and stillbirths, were analysed. Each record was systematically screened to identify the presence and type of birth defects.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Primary and secondary outcome measures<\/jats:title>\n                    <jats:p>The prevalence and patterns of externally visible structural birth defects were evaluated using retrospective hospital delivery record reviews. The primary outcome was the prevalence of externally visible structural birth defects per 10\u2009000 births. Secondary outcomes was the distribution of the specific types of the congenital anomalies, the proportion of stillbirth among affected births and characteristics related to maternal antenatal care (ANC) and folate supplementation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 54\u2009626 deliveries reviewed, 2055 cases (3.8%) involved externally visible structural birth defects, corresponding to a prevalence of 376.2 per 10\u2009000 births (95%\u2009CI 360.1 to 392.8). The most frequent anomalies were neural tube defects, particularly anencephaly (136.6 per 10\u2009000 births) and spina bifida (110.6 per 10\u2009000 births), together accounting for more than three-quarters of all defects. Other relatively common defects included hydrocephalus (33 per 10\u2009000 births), clubfoot (23.4 per 10\u2009000 births) and cleft lip\/palate (20.5 per 10\u2009000 births). A large proportion of affected births were stillbirths (73%). 82% of these mothers had not received periconceptional folate or multivitamin supplementation, and 87% did not attend ANC in the first trimester.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This study highlights a substantial burden of structural birth defects in the conflict-affected Tigray Region, Ethiopia. The findings underscore the urgent need to improve access to ANC and periconceptional folate supplementation. Future research should explore the role of environmental, nutritional and genetic factors in the observed rise in congenital anomalies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-107607","type":"journal-article","created":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T10:56:33Z","timestamp":1776077793000},"page":"e107607","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Burden of birth defects in a war and siege-affected region: a retrospective hospital-based cross-sectional study from Tigray region, Northern Ethiopia"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3089-3287","authenticated-orcid":false,"given":"Birhane Alem","family":"Berihu","sequence":"first","affiliation":[{"name":"Department of Anatomy, Mekelle University College of Health Sciences, Mek\u2019ele, Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1929-3192","authenticated-orcid":false,"given":"Hayelom Kebede","family":"Mekonen","sequence":"additional","affiliation":[{"name":"Department of Anatomy, Mekelle University College of Health Sciences, Mek\u2019ele, Ethiopia"},{"name":"Department of Pain and Neural Sciences, University of Maryland, Baltimore, Maryland, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tony","family":"Magana","sequence":"additional","affiliation":[{"name":"Neurosurgery, Mekelle University College of Health Sciences, Mek\u2019ele, Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7666-1110","authenticated-orcid":false,"given":"Tafere Gebreegziabher","family":"Belay","sequence":"additional","affiliation":[{"name":"Department of Health Sciences, Central Washington University, Ellensburg, Washington DC, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5111-7984","authenticated-orcid":false,"given":"Yibrah Berhe","family":"Zelelew","sequence":"additional","affiliation":[{"name":"Department of Gynecology and Obstetrics, Mekelle University, Mek\u2019ele, Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yared Godefay","family":"Debeb","sequence":"additional","affiliation":[{"name":"Physiology, Mekelle University College of Health Sciences, Mek\u2019ele, Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2104-0699","authenticated-orcid":false,"given":"Peixin","family":"Yang","sequence":"additional","affiliation":[{"name":"Maryland School of Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Maryland, Baltimore, Maryland, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-8525-9138","authenticated-orcid":false,"given":"Haftu","family":"Berhe","sequence":"additional","affiliation":[{"name":"Department of Maternity and Reproductive Health, Mekelle University College of Health Sciences, Mek\u2019ele, Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0707-4363","authenticated-orcid":false,"given":"Afework","family":"Mulugeta","sequence":"additional","affiliation":[{"name":"Nutrition, Mekelle University College of Health Sciences, Mekelle, Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2026,3,26]]},"reference":[{"key":"2026032607201272000_16.3.e107607.1","unstructured":"World Health Organization . 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