ABSTRACT

Analysis of registered congenital malformation among births in Basrah for the period from 1990 to 2000 was carried out. In general there is an apparent increase in the incidence rate from 1995 upwards. In 2000 such incidence is almost six folds higher than in 1991. To improve statistical efficiency of the data collected and overcome small numbers of cases recorded, the pattern and incidence of congenital malformations are grouped into three periods, 1991 to 1994, 1995 to 1998 and 1999 to 2000. The incidence rate for the first period was 2.5 congenital malformations per 1000 births while the respective figure for the second period is 4.57 and for the third period was 13.49. Congenital heart diseases, and chromosomal aberrations are reported at a higher frequency during the latter years. Such unusual malformations as phocomelia and icthyosis (which were not reported in 1990 have been recorded later though in small numbers). The frequency of cleft lip and palate follows a similar trend. No apparent trends are observed in the remaining malformations. The above findings indicate clearly that there must be an exposure to a teratogenic factor prior to 1995 most probably radiation emitted from weapons used in the aggression against Iraq.

INTRODUCTION

Congenital anomalies constitute a major problem to human health. These represent a structural defect of prenatal onset which could be either in the form of a single primary defect in development or in the form of multiple malformations^[1]. Single primary defect could be a deformity, a malformation or a destruction. It has been estimated that 20% of birth defects are due to gene mutations, 5-10% to chromosomal abnormalities (structural and numerical) and about 5-10% due to exposure to a teratogenic agent of maternal factor^[2]. It has also been speculated that environmental factors account for not more than 10% leaving the etiology of a relatively high percentage unknown. Ionising radiation can be highly penetrating and is capable of causing mutation in man^[3] and those can cause defective development of human embryos if exposure occurs. In the preceding paper it was seen that weapons containing depleted uranium was used during the American and their allies aggression on Iraq. It was confirmed that there was unacceptable high level of radioactivity plants in Basrah, southern Iraq^[5]. The present study was carried out to test the hypothesis that in the light of the possible exposure of Basrah population to ionising radiation above the acceptable background activity following the 1991 aggression, an increase in the incidence and pattern of congenital anomalies would be expected.

METHODOLOGY

All registered cases of congenital anomalies among births which took place in the main maternity and children hospital in Basrah during the period from 1990 to 2000 were included in the study. Each birth was examined by (JH) for the presernce of any anomaly and photographic pictures were taken for documentation purposes. Because of the relatively small number of cases and to improve statistical efficiency of the data collected the data are grouped into three periods 1991 to 1994, 1995 to 1998 and 1999 to 2000. The total number of births, which took place in the hospital for each year, was also obtained for the sake of the calculation of the annual incidence rate of congenital anomalies per 1000 births for the three periods. The difference in the rates between the three periods was tested by SND test applied for the difference between two proportions.

RESULTS

Table-1 shows the number of births, the number of congenital anomalies registered and the incidence rate per 1000 of such anomalies for the years from 1990 to 2000. In 2000 the incidence rate was 17.6 per 1000 compared to 3.04 per 1000 in 1990. Fluctuations in the incidence rate from year to year can be noticed. When the data are grouped for the periods 1991 to 1994 and 1995 to 1998 and 1999-2000 to stabiles the data, the incidence rate for the fist period was 2.5 congenital anomalies per 1000 compared to 13.49 per 1000 for the second period. The difference is statistically highly significant (SND=5.37, P<0.01). Table-2 shows the pattern and relative frequency of congenital anomalies for the years 1990, 1991-1994, 1998 and 2000. It can be seen that congenital heart disease, multiple congenital deformities were reported at a higher frequency during the latter years. Chromosomal aberrations were slightly higher in 1995-2000 compared to earlier periods (7.3% compared to 5.4% in 1990 and 5.2% in 1991-1994). Thirty eight cases of phocomelia were reported in the years following aggression (1 in 1991-1994, 5 in 1995-1998 and 32 in 1999-2000) while no such cases were reported in 1990. Cleft lip and cleft palate followed a similar trend. No such increase has been reported with respect to other malformations and deformities.

DISCUSSION

The present study confirms that there is a significant rise in the incidence rate of congenital anomalies in Basrah during the period from 1990 to 2000. However, the figures reported are only underestimates, since it includes only discernible malformations. As more precise means of detecting subtle anomalies become available, these estimates will certainly increase^[2]. The fact that radioactivity of samples obtained from plants, soil and water in Basrah exceeded the natural background level, makes the hypothesis that the increased incidence of congenital anomalies due to such radiation more tenable. Such situation has been demonstrated in areas following nuclear accidents as in Chernobyl. For example in the Republic of Belarus which received different levels of radioactivity following the chernobyl catastrophe in 1986, the frequency of both congenital and fetal abnormalities has apparently increased^[6]. The same phenomenon was also observed in Northwest Croatia, one of the areas with the highest nuclear contamination from chernobyl^[7]. The types of congenital anomalies, which have increased in frequency in Basrah also, support our hypothesis. Multiple congenital malformation, reduction limb deformities and central nervous system anomalies are known to be increased in the areas which have been exposed to increased radioactivity.

The increased incidence of congenital anomalies in such situation is presumably due to exposure of pregnant women to radiation which exceeds 3000 mrads^[1]. Evidence of paternal exposure to ionising impact of radiation before conception or reproductive and development outcome is still inconclusive^[8]. The evidence so far presented the effect of ionising radiation in this study on the incidence of congenital anomalies is circumstantial. Cytogenetic studies recently developed could strengthen such evidence by allowing to estimate the absorbed radiation also using DNA probes to detect chromosomal aberration^[9].

Table-1: Incidence rates of congenital malformations

in Basrah 1990-2000

Year	No. of Births	No. of congenital malformation	Incidence rate per 1000 births
1990	12161	37	3.04
1991	9845	28	2.84
1992	11800	23	1.95
1993	12416	28	1.31
1994	12250	36	2.93
1995	10576	46	4.35
1996	10470	48	4.56
1997	13653	32	2.34
1998	10186	79	7.76
1999	13905	136	9.78
2000	12560	221	17.60

Table-2: Frequency distribution of various congenital malformations

for 1990, 1991-1994, 1995-1998, 1999,2000

Type of congenital malformation	1990 No. %	1991-1994 No. %	1995-1998 No. %	1999-2000 No. %
Meningomylocele	9 (24.3)	20 (17.4)	42 (20.5)	30 (8.40)
Anencephaly	3 (8.1)	14 (12.2)	16 (7.8)	46 (12.89)
Multiple congenital Malformations	7 (18.9)	30 (26.1)	49 (23.9)	112 (31.37)
Chromosomal Aberrations	2 (5.4)	6 (5.2)	15 (7.3)	8 (2.24)
Congenital heart Diseases	2 (5.4)	18 (15.7)	43 (21.0)	36 (10.08)
Bladder extrophy	2 (5.4)	1 (0.9)	2 (1.0)	1 (0.28)
Phocomelia	0 (0.0)	1 (0.9)	5 (2.4)	32 (8.96)
Icthyosis	0 (0.0)	5 (4.3)	5 (2.4)	6 (1.68)
Cleft lip & Palate	1 (2.7)	7 (6.1)	9 (4.4)	21 (5.88)
Omphalocele	2 (5.4)	5 (4.3)	5 (2.4)	0 (0.0)
Achondroplasia	3 (8.1)	3 (2.6)	9 (4.4)	4 (1.12)
Oesophageal atresia	1 (2.7)	3 (2.6)	3 (1.5)	11 (3.08)
Imperforate anus	1 (2.7)	1 (0.9)	0 (0.0)	5 (1.40)
Diaphramatic hernia	4 (10.8)	1 (0.9)	2 (1.0)	3 (0.84)
Hydrocephalus	0 (0.0)	0 (0.0)	0 (0.0)	39 (10.92)
Arthrogryposis	0 (0.0)	0 (0.0)	0 (0.0)	1 (0.28)
Cyclopia	0 (0.0)	0 (0.0)	0 (0.0)	2 (0.56)
Total	37	115	205	357
Incidence rate per 1000	3.04	2.5	4.57	13.49

REFERENCES

1.Jones KL. Dysmorphology. In: Nelson Textbook of Paediatrics. Editors: Behrman RE., Kliegman RM. And Arvin AA. W.B Saunders CO. 473-476.

2.Bishop JB, Witt KL & Sloane RA. Genetic toxicities of human teratogen. Mutation Research. 1997; 369: 9-43.

3.Sutton H. An Introduction to Human Genetics. Saunders College, Philadelphia. 1980; 198-202.

4.Yacoub A., et al. Depleted uranium and health of people in Basrah: an epidemiological evidence I. The incidence and pattern of malignant diseases in Basrah 1990-1998. The Medical Journal of Basrah University, 1999.

5.Saleh M. & Megwar A. The effect of using depleted uranium by the allied forces on man and the bisphere in selected regions of southern area of Iraq. A paper presented in the International Symposium on using Depleted uranium and its effect on Man and Environment in Iraq.

6.Lazjuk GI, Niko laev DL. & Novikova IV. Changes in registered congenital anomalies in the Republic of Belarus after the Chernoby1 accident. Stem Cells 1997; 15 Supp1.2: 253-260.

7.Kruslim B, Jukic S, Kos M et al. Congenital anomalies of the central nervous system at autopsy in Croatia in the period before and after Chernobyl accident. Acta Medica Croatica. 1998; 52: 103-107.

8.Friedler G. Paternal exposure: impact on reproductive and developmental outcome. An overview. Pharmacological and Biochemical Behaviour. 1996; 55: 691-700.

9.Natarajan AT, Beoi JJ, Darroudi F et al. Current cytogentic methods for detecting exposure and effects of mutagens and carcinogens. Environmental Health Perspective 1996; 104 Supp1.3:445-448.

تأثير اليورانيوم المنضب على صحة الإنسان في البصرة

2. نمط ومعدل حدوث التشوهات الخلقية بين الولادات في البصرة خلال الفترة 1990 – 2000

أ.د. عماد عودة السعدون، أ.م.د. جنان غالب حسن، أ.د. عالم عبد الحميد يعقوب، م. باحث (إحصائي) الهام عبد الصمد الطعمة

الخــلاصة

تم تحليل حالات التشوهات الخلقية للولادات في البصرة للفترة من 1990 – 2000 كان هناك زيادة ملحوظة في حصول حدوث تلك التشوهات في عام 1995 صاعداً. وكان عدد الحالات للعام2000 ستة أضعاف عام 1991. كان معدل حدوث التشوهات الخلقية للفترة من 1991 إلى 1994 هو 2،5 لكل 100،000 بينما كان معدل حدوثها للفترة من 1995 – 1998 هو 4،57 لكل 100,000 . وللفترة 1999 – 2000 هو 13,49 لكل 100,000 . وقد وجد أن تشوهات القلب الولادية وزيغ الصبغات (الكروموسومات) قد زادت في الفترة 1995 - 2000 بشكل ملحوظ. كما سجلت تشوهات لم يسبق تسجيلها كفقدان الأطراف والسماك. كما وجد بنفس الإتجاه فيما يتعلق بحالات شفة الأرنب، بينت تلك النتائج أنه لابد أن يكون هناك تعرض إلى عوامل ماسخة قبل عام 1995 وخصوصاً أثناء العدوان.