Congenital malformations in sub-Saharan Africa—warnings of a silent epidemic?

• Published in: The Lancet infectious diseases 2021-05, Vol.21 (5), p.594-596
• Main Authors: Sié, Ali, Hanefeld, Johanna, Chaponda, Mike, Chico, R Matthew, LeDoare, Kirsty, Mayaud, Philippe, Drexler, Jan Felix, Jaenisch, Thomas
• Format: Article
• Language: English
• Subjects: Abnormalities; Africa South of the Sahara - epidemiology; Capacity development; Children; Comment; Congenital defects; COVID-19; COVID-19 - epidemiology; Dengue fever; Diagnosis; Epidemics; Epidemiology; Humans; Infections; Infectious diseases; Latin America - epidemiology; Maternal & child health; Microcephaly; Pandemics; Public health; SARS-CoV-2; Severe acute respiratory syndrome coronavirus 2; Signs and symptoms; Vector-borne diseases; Viruses; Zika Virus; Zika Virus Infection - epidemiology
• ISSN: 1473-3099; 1474-4457
• DOI: 10.1016/S1473-3099(21)00061-X

There was no epidemiological surveillance for Zika virus established at the time, since the African-origin virus was previously endemic in Africa and Asia only; clinicians either failed to notify authorities of suspected cases, or reported Zika, dengue, and chikungunya infections in parallel, with limited diagnostic facilities available to differentiate between them.1 A lack of common understanding about diagnosis and symptoms produced different case definitions and a wide range of case estimates;2 early estimates of the risk of microcephaly varied across Brazil.3 These challenges delayed meaningful epidemiological interpretations and probably contributed to an increase in unsafe abortions4 and pregnancy delays5 throughout Latin America for fear of the Zika-associated complications. Data from two African countries (Côte d'Ivoire and Cameroon) show a large variability in head circumference without the presence of Zika virus-induced microcephaly.10 In addition, the origin of the Latin American Zika outbreak remains poorly understood and longer-term consequences of various vector-borne diseases, including chikungunya and dengue, on maternal health and child development are only partly understood.11,12 To address gaps in knowledge, we need to improve our understanding of the epidemiology and aetiology of congenital malformations and develop better tools for diagnosis, management, and prevention of infection-related causes in sub-Saharan Africa.11 We therefore call for greater and more comprehensive action in research, capacity building, and development of a public health approach to congenital abnormalities in sub-Saharan Africa. Of equal importance is strengthening health system responses to children who are born with congenital abnormalities in sub-Saharan Africa to ensure that new knowledge on the public-health burden goes hand in hand with the development of services and interventions to improve health and wellbeing of parents and affected children.