title: Epidemiology of the neural tube defects in Kashmir Valley.
abstract: BACKGROUND
  Neural tube defects (NTDs) are the most common congenital malformations affecting the brain and spinal cord and have a multifactorial etiology. Genetic and environmental factors have been found to cause these defects, both individually and in combination.
  
  
  METHODS
  A 2-year hospital-based prospective study was carried out from November 2013 to October 2015 to determine the incidence, types, demographics, risk factors, and other associated anamolies relevant to NTDs in Kashmir Valley. A detailed history of the mother was taken along with detailed clinical examination of neonate including measurement of head circumference and checking the status of fontanella, whether lax/full/bulging/or tense, type of NTD. Investigations that were done included were X-ray skull: Anterior-posterior (AP) and lateral, X-ray spine: AP and lateral, ultrasonography abdomen, magnetic resonance imaging: Spine and brain.
  
  
  RESULTS
  The total number of babies with NTD's was 125 with an overall incidence of 0.503. Kupwara district was having the highest incidence (1.047) and Srinagar district the lowest incidence of NTD's (0.197). Majority of NTD's (116 cases, 92.8%) were found in the rural areas. Among the different types of NTD's, spina bifida had an incidence of 0.342 (85 cases, 68%) and anencephaly had an incidence of 0.113 (28 cases, 22.4%). There was a slight preponderance of females over males with NTD's. There were 70 females (56%) and 55 males (44%), respectively, with a male: female ratio of 0.8:1.
  
  
  CONCLUSIONS
  The incidence rates of NTDs is very high for Kashmir Valley. Geographical distribution of NTDs at this place confirms a relationship between the socioeconomic status, educational status, maternal too young or advanced age, and environmental factors for the development of a NTD. The results of this study point to the importance establishing a health policy to prevent NTD in Kashmir Valley.
authors.affiliation: Department of Neurosurgery, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India.
authors.forename: Masood Ahmed
authors.initials: MA
authors.lastname: Laharwal
authors.affiliation: Department of Neurosurgery, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India.
authors.forename: Arif Hussain
authors.initials: AH
authors.lastname: Sarmast
authors.affiliation: Department of Neurosurgery, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India.
authors.forename: Altaf Umer
authors.initials: AU
authors.lastname: Ramzan
authors.affiliation: Department of Neurosurgery, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India.
authors.forename: Abrar Ahad
authors.initials: AA
authors.lastname: Wani
authors.affiliation: Department of Neurosurgery, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India.
authors.forename: Nayil Khursheed
authors.initials: NK
authors.lastname: Malik
authors.affiliation: Department of Neurosurgery, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India.
authors.forename: Sajad Hussain
authors.initials: SH
authors.lastname: Arif
authors.affiliation: Department of Obstetrics and Gynaecology, Government Lalla Ded Hospital, Srinagar, Jammu and Kashmir, India.
authors.forename: Masooma
authors.initials: M
authors.lastname: Rizvi
keywords: Kashmir; meningoceles; myeloceles; myelomeningoceles; neural tube defects