title: An increase in spina bifida cases in Tunisia, 2008-2011.
abstract: BACKGROUND
  The term spina bifida refers to a group of neural tube defects that result in malformations of the spinal cord and the surrounding vertebrae. Though the etiologies of spina bifida remain largely unknown, several risk factors have been identified, including feto-maternal characteristics.
  
  
  OBJECTIVE
  To discover possible underlying reasons for the increase of spina bifida and identify intervention targets, an investigation was undertaken comparing spina bifida-affected pregnancy notifications in 2008-2011 with notifications in the period 1991-1994.
  
  
  METHODS
  Characteristics and outcomes of births with spina bifida and pregnancy characteristics of mothers were recorded in the medical chart. Comparisons of pregnancies affected by a spina bifida in 2008-2011 were made with pregnancies affected by a spina bifida in the period 1991-1994. Statistical analysis was undertaken using Poisson regression and Chi-squared tests.
  
  
  RESULTS
  From 1991 through 1994, the prevalence of identified spina bifida cases was equal to 0.3/10,000 births compared to 1.6/10,000 births in 2008-2011. This increase was statistically significant (P<0.001). The prevalence of females was equal to 0.45 per 10,000 births over the period 1991-1994 compared to 1.88 per 10,000 births during the period 2008-2011. As for males, the prevalence was equal to 0.16 per 10,000 births in 1991-1994 compared to 1.88 in 2008-2011. The difference was statistically significant (P<0.001) between both genders. A mother's age of over 30 years had significant impact on the emergence of spina bifida (P=0.02, OR=3.93, CI=1.23-12.47). As well as, maternal blood type was a significant risk factor for the appearance of spina bifida (P=0.008). Results also had shown that fetal weight and term, gestity and parity were significant risk factors for the occurrence of spina bifida (P<0.05).In this study, results have been interpreted with caution due to analyses not being adjusted.
  
  
  CONCLUSIONS
  This analysis highlighted areas where prevention efforts should be strengthened and surveillance data improved.
authors.affiliation: Faculté des Sciences de Bizerte, Université de Carthage, 7021 Zarzouna, Bizerte, Tunisia; UR 06/SP14 Troubles du développement embryo-fœtal et placentaire, Service d'embryo-fœtopathologie, Centre de Maternité et de Néonatologie La Rabta et de la Faculté de Médecine de Tunis, Université El Manar II, 1007 Tunis, Tunisia. Electronic address: nasrikaouther512@gmail.com.
authors.forename: Kaouther
authors.initials: K
authors.lastname: Nasri
authors.affiliation: UR05/08-08, Département de biochimie, Hôpital la Rabta et de la Faculté de Médecine de Tunis, Université El Manar II, 1007 Tunis, Tunisia.
authors.forename: Mohamed Kacem
authors.initials: MK
authors.lastname: Ben Fradj
authors.affiliation: Faculté des Sciences de Bizerte, Université de Carthage, 7021 Zarzouna, Bizerte, Tunisia; UR 06/SP14 Troubles du développement embryo-fœtal et placentaire, Service d'embryo-fœtopathologie, Centre de Maternité et de Néonatologie La Rabta et de la Faculté de Médecine de Tunis, Université El Manar II, 1007 Tunis, Tunisia.
authors.forename: Mariem
authors.initials: M
authors.lastname: Aloui
authors.affiliation: UR 06/SP14 Troubles du développement embryo-fœtal et placentaire, Service d'embryo-fœtopathologie, Centre de Maternité et de Néonatologie La Rabta et de la Faculté de Médecine de Tunis, Université El Manar II, 1007 Tunis, Tunisia.
authors.forename: Nadia
authors.initials: N
authors.lastname: Ben Jemaa
authors.affiliation: UR 06/SP14 Troubles du développement embryo-fœtal et placentaire, Service d'embryo-fœtopathologie, Centre de Maternité et de Néonatologie La Rabta et de la Faculté de Médecine de Tunis, Université El Manar II, 1007 Tunis, Tunisia.
authors.forename: Aida
authors.initials: A
authors.lastname: Masmoudi
authors.affiliation: 01/UR/08-07 Laboratoire d'histologie, embryologie et biologie cellulaire de la Faculté de Médecine de Tunis, Université El Manar II, 1007 Tunis, Tunisia.
authors.forename: Michèle Véronique
authors.initials: MV
authors.lastname: Elmay
authors.affiliation: Laboratoire de génétique, immunologie et pathologie humaine, faculté des sciences de Tunis, Université El Manar, 2092 Tunis, Tunisia.
authors.forename: Raja
authors.initials: R
authors.lastname: Marrakchi
authors.affiliation: UR 06/SP14 Troubles du développement embryo-fœtal et placentaire, Service d'embryo-fœtopathologie, Centre de Maternité et de Néonatologie La Rabta et de la Faculté de Médecine de Tunis, Université El Manar II, 1007 Tunis, Tunisia.
authors.forename: Soumeya
authors.initials: S
authors.lastname: Siala Gaigi
mesh_terms: D005260:Female; D006801:Humans; D008297:Male; D011247:Pregnancy; D015995:Prevalence; D012307:Risk Factors; D016135:Spinal Dysraphism / Q000453:epidemiology*; D014416:Tunisia / Q000453:epidemiology
keywords: Descriptive epidemiology; Meningocele; Myelomeningocele; Neural tube defects; Rachischisis; Spina bifida