title: Birth prevalence of neural tube defects and orofacial clefts in India: a systematic review and meta-analysis.
abstract: BACKGROUND
  In the last two decades, India has witnessed a substantial decrease in infant mortality attributed to infectious disease and malnutrition. However, the mortality attributed to birth defects remains constant. Studies on the prevalence of birth defects such as neural tube defects and orofacial clefts in India have reported inconsistent results. Therefore, we conducted a systematic review of observational studies to document the birth prevalence of neural tube defects and orofacial clefts.
  
  
  METHODS
  A comprehensive literature search for observational studies was conducted in MEDLINE and EMBASE databases using key MeSH terms (neural tube defects OR cleft lip OR cleft palate AND Prevalence AND India). Two reviewers independently reviewed the retrieved studies, and studies satisfying the eligibility were included. The quality of included studies was assessed using selected criteria from STROBE statement.
  
  
  RESULTS
  The overall pooled birth prevalence (random effect) of neural tube defects in India is 4.5 per 1000 total births (95% CI 4.2 to 4.9). The overall pooled birth prevalence (random effect) of orofacial clefts is 1.3 per 1000 total births (95% CI 1.1 to 1.5). Subgroup analyses were performed by region, time period, consanguinity, and gender of newborn.
  
  
  CONCLUSIONS
  The overall prevalence of neural tube defects from India is high compared to other regions of the world, while that of orofacial clefts is similar to other countries. The majority of studies included in the review were hospital based. The quality of these studies ranged from low to moderate. Further well-designed, high quality community-based observational studies are needed to accurately estimate the burden of neural tube defects and orofacial clefts in India.
authors.affiliation: South Asia Centre for Disability Inclusive Development and Research, Indian Institute of Public Health-Hyderabad, Public Health Foundation of India, Hyderabad, India.
authors.forename: Komal Preet
authors.initials: KP
authors.lastname: Allagh
authors.affiliation: University of Hyderabad, Hyderabad, India.
authors.forename: B R
authors.initials: BR
authors.lastname: Shamanna
authors.affiliation: South Asia Centre for Disability Inclusive Development and Research, Indian Institute of Public Health-Hyderabad, Public Health Foundation of India, Hyderabad, India.
authors.forename: Gudlavalleti V S
authors.initials: GV
authors.lastname: Murthy
authors.affiliation: National Institute for Health Research Bristol Nutrition Biomedical Research Unit at University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Bristol, United Kingdom; The UK National Institute for Health Research Bristol Nutrition Biomedical Research Unit in Nutrition, Diet and Lifestyle at University Hospitals Bristol NHS Foundation Trust and the University of Bristol and the School of Oral and Dental Sciences, University of Bristol, Bristol, United Kingdom.
authors.forename: Andy R
authors.initials: AR
authors.lastname: Ness
authors.affiliation: London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors.forename: Pat
authors.initials: P
authors.lastname: Doyle
authors.affiliation: Indian Institute of Public Health-Delhi, Public Health Foundation of India, Delhi, India.
authors.forename: Sutapa B
authors.initials: SB
authors.lastname: Neogi
authors.affiliation: South Asia Centre for Disability Inclusive Development and Research, Indian Institute of Public Health-Hyderabad, Public Health Foundation of India, Hyderabad, India.
authors.forename: Hira B
authors.initials: HB
authors.lastname: Pant
mesh_terms: D002971:Cleft Lip / Q000453:epidemiology*; D002972:Cleft Palate / Q000453:epidemiology*; D006801:Humans; D007194:India / Q000453:epidemiology; D009436:Neural Tube Defects / Q000453:epidemiology*; D036801:Parturition; D015995:Prevalence