Towards a stronger, healthier nation

By Carl Muller

Think of the future - children to be born, the parents to be, that whole parade of life that marches, that rises and falls that comes and goes in that inevitable cycle what does any country seek to have in the days to come? Surely a strong people, a land peopled with those fit to carry name and fame, fit to bear the burdens of each age and, moreover, fit to bring forth the strong, healthy children of tomorrow. This is the vibrancy of a nation, for all falls apart where health, mental and physical fitness fails.

In the General Hospital, Kandy, Dr. Bryan Walker, a Voluntary Service Overseas volunteer, pilots a team of concerned and dedicated doctors and medical researchers at the Birth Defects Research Unit.

The Unit's concern is with the education of health care workers, especially midwives, and those of reproductive age island-wide. Behind it is the one compelling call to all Sri Lankans, to parents and parents-to-be, to those of reproductive age, to doctors and medical students: Babies must be healthy, happy and strong! Ensure this, and the next generation rises, free of birth problems and defects.

The Birth Defects Research Unit had, at the outset, a great deal of research to accomplish. Mention must be made here of the invaluable assistance provided by the GIS Planning and Monitoring Unit of the Rural Regional Development project, Kandy, where much mapped-out information was provided regarding population, human pursuits and occupations, urban and rural activities, etc. All this pointed the way to the gathering of medical information. A vital part of the ongoing data collection is the registering of births, and the BDRU has, up to early February, registered the 20,000th birth in its Access Data Base, achieving an initial target after nearly two years of work.

Looking at the picture as a whole, we are faced with the grim and unpleasant business of birth defects. How many mothers shudder to see those "Children of a Lesser God'' - children who are autistic. Mongoloid, babies deformed by Rubella and other infections, children born with spina bifida, with heart abnormalities, with cleft palates and lips, with brain defects. Who is the mother who does not want to take home a beautiful, healthy baby, born in its good, natural time, perfect in every way; proud mother to be sure, a mother who will receive the well-wishes of all around her.

And who is the mother who will wish to undergo the trauma of premature birthing, of an infant in intensive care, or a baby that is deformed or congenitally under-equipped to face life?

And yet as Dr. Walker points out, birth anomalies prevail and this is why the BDRU has launched an all-important national awareness campaign with a striking leaflet in Sinhala, Tamil and English. The leaflet, which tells all those of reproductive age about having "Healthy Babies'' gives in clear form the necessary information about the avoidance of risk factors for the developing foetus. This leaflet is available to every newly-married couple, and soon it will be reinforced with posters and calendars, a TV drama, articles in schools newspapers, radio broadcasts - every way possible to get the message across.

The WHO believes that with necessary education, a 10 percent reduction of birth anomalies can be achieved world-wide. On a national scale, we learn of Hungary which is committed to a 60 percent reduction through improvements in education and health care.

At the BDRU, data so far collected suggests that birth defects can be reduced by 30,000 in the next decade at no real cost and with the means now available.

The idea, simply put, is to ensure primary health care which is the most cost-effective and least traumatic of the ways of reducing birth anomalies.

The truth then, is that all parents want their babies to be healthy and strong. But even in the UK we learn that there are 10-20 percent, spontaneous abortions in clinically recognized pregnancies, that the still birth rate is 1 percent and major birth defect rate is 2-3 percent

There is no real figure for the birth defect rate in Sri Lanka, but we have a still birth rate of 2 percent. The BDRU leaflet now in circulation island-wide, not only tells us what to do and not do, but also directs mothers-to-be to the places country-wide (The nearest prenatal and antenatal clinics, for example) where advice and help is available.

Naturally as Dr. Udayangani Ramadasa of the BDRU says, premature babies are most susceptible to medical problems than healthy babies. Infants born before 37 completed weeks are defined premature, and of the 15,000 birth data collected from Kandy General Hospital and the Peradeniya Teaching Hospital, ten percent - that is 1500 babies were born prematurely. The figures are also most educative:

Sinhalese 11,700 mothers 1170 premature births— 10%
Tamils 1050 mothers 168 premature births - 16%
Moors 2250 mothers 202 premature births - 9%

Most of the Tamils were from the plantations and the high rate of premature births may be associated with inadequate or unbalanced nutrition.

It is also seen that mothers under 20 or over 35 are most likely to give birth to premature babies. The best child-bearing age is between 20 and 35 where there are less congenital malformations and fewer low-weight babies. It is known that 32 percent of premature babies require medical aid at birth, accounting for a significant effect on health care costs. Also, of all babies who die within 24 hours, a third of this number were born premature.

Smoking is also a risk. In the check of 15,000 births, 40 percent of the mothers said that their husbands smoked and it was seen how paternal smoking increases the risk of premature birth by 2 percent.

Further, those in their third pregnancy and onwards have a higher risk of bearing premature babies. Of the 15,000 mothers, 6,900 were in their first pregnancy, 3,900 in their third. This is where family planning plays a necessary role because multiple pregnancy also increases the rate of prematurity by 26 percent.

The BDRU has seen that of all deliveries. 3 percent of the babies are born with external abnormalities which contribute to lifelong morbidity. Birth weight is another significant factor. Again, tests have given the following particulars:

Sinhalese babies 11850 checked average weight 2878 grams
Tamil babies 870 checked average weight 2753 grams
Muslim babies 2250 checked average weight 2977 grams
Other babies 15 checked average weight 2954 grams

It is seen that the Tamil babies largely born of plantation mothers, have the lowest value in birth weight. Obviously nutrition or education may be less, but as Dr. Chintake Nimesh Malavige of the BDRU says, there may also be a genetic component here as this group is socially isolated from the rest of the country. Also, birth weights are lower when relatives marry.

All in all Sri Lankan birth weights are about 400 grams lower than the western counterparts and Dr. Malavige says there is a need to establish norms for Sri Lankan birth weights.

The BDRU's leaflet offers everyone of reproductive age, in clear form, the many ways parents can be sure of having healthy babies:

1. Vaccination against German measles (Rubella). This must be done while the mother is young and at least three months before pregnancy. Rubella contacted by the mother can cause severe damage to the developing baby, especially to the brain, heart, and also affect sight and hearing.

2. Do not marry blood relatives. Those who do have a higher risk of having babies born with physical problems and even born dead.

3. The ideal age to have babies. Mothers under 18 and over 35 have far more babies with problems. The ideal age is between 20 and 30. Space out your family with a couple of years between each child, and have your last child before you are 35.

4. The taking of Folic Acid. This is most important. It is one of the Vitamin B group and reduces risks of defects to the brain, spinal cord and heart of the baby. It must be taken daily particularly during the first three months of pregnancy and starting at least one month before conception.

5. All-important checkup BEFORE getting pregnant. Mothers must check for high blood pressure. diabetes, kidney diseases and anaemia before becoming pregnant. If such is not controlled the baby can be severely harmed.

6. The taking of medicines during pregnancy. Avoid, as far as possible, medicines during pregnancy, but if prescribed take them exactly as the doctor says. Too much can be dangerous, even deadly. In malarial areas, antimalarials should be taken throughout pregnancy. Above all avoid alcohol.

7. The risks through smoking. Mothers who smoke damage themselves and their babies. This applies to fathers too. A father who smokes in the company of a pregnant mother can cause the baby to be born premature, of low birth weight, and be affected by childhood cancers and other illnesses.

8. Maintain a good balance of healthy food, exercise and sleep. Do not allow yourself to get overweight or underweight.

The BDRU has found that the general public is unaware of many of the risks to the developing foetus. In its data base it was found, for instance, that only nine out of 6822 mothers took a folate supplementation in time to avoid birth defects.

Pregnancy health care must be improved. especially since 169,000 couples marry annually. The birth rate today is about 360,000 babies each year for an 18 million plus population. In the next decade, Dr. Walker says, there will be 350,000 babies born. Of them, about 15,000 will have defects of the brain and spinal cord, most of these avoidable, and a similar number will have heart defects, also avoidable.

It all goes to show that the BDRU has much to do to ensure a better, stronger, fitter tomorrow for the nation. This is no exercise where you ''catch 'em young".

This is that tremendous exercise where you catch them even before they are born - use the parents to ensure that the lives they fashion will be of the best quality. The ultimate long-term planning? You could say that, and you will be right all the way!

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