title: Epidemiology of the neural tube defects in Kashmir Valley.
abstract: BACKGROUND
  Neural tube defects (NTD) 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.
  
  
  OBJECTIVE
  The aim of this study was to determine the incidence, types, demographics, risk factors, and other associated anomalies relevant to NTDs in Kashmir Valley.
  
  
  METHODS
  A 2-year hospital-based prospective study was carried out from November 2013 to October 2015. 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: Anteroposterior (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. District Kupwara was having the highest incidence (1.047) and district Srinagar the lowest incidence of NTD's (0.197). The 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 were70 females (56%) and 55 males (44%) respectively with a male:female ratio of 0.8:1.
  
  
  CONCLUSIONS
  The incidence rates of NTDs are very high for Kashmir Valley. Geographical distribution of NTDs at this place confirms a relationship between the socioeconomic status, educational status, maternal age and environmental factors for the development of an NTD. The results of this study point to the importance establishing a health policy to prevent NTDs 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, Lalded Womens Obstetrical/Gynaecological Hospital, Srinagar, Jammu and Kashmir, India.
authors.forename: Masooma
authors.initials: M
authors.lastname: Rizvi
keywords: Kashmir; meningoceles; myeloceles; myelomeningoceles; neural tube defects