Congenital Malformations in Gambian Newborns: A Hidden Burden of Morbidity and Mortality

In the bustling urban health facilities of The Gambia, a quiet but devastating challenge to newborn survival has been unfolding. Congenital malformations—structural or functional anomalies present at birth—remain a significant contributor to neonatal morbidity and mortality across West Africa. Yet, despite their impact, there has been a conspicuous gap in the literature regarding their clinical epidemiology in the African subregion. A new study, published in BMC Pregnancy and Childbirth, sought to fill this void by describing the clinical presentation, prevalence, risk factors, and adverse neonatal outcomes of newborns with easily recognisable congenital malformations in urban Gambia. The research, a descriptive cohort study embedded within the PregnAnZi-2 clinical trial, analysed data from 6,750 liveborn neonates delivered between October 2017 and May 2021 at two public health facilities. By leveraging the rigorous infrastructure of a clinical trial, the study provides robust, prospective data on a topic that has often been relegated to anecdotal reports or hospital-based retrospective reviews. The findings underscore a critical need for improved antenatal diagnosis and targeted interventions, particularly for women with a history of miscarriage, to optimise delivery strategies and improve perinatal outcomes in this setting.

Among the 6,750 neonates examined, 140 (2.1%) had at least one congenital malformation. While this prevalence may appear relatively low compared to global estimates, the study's active and passive surveillance for 28 days after delivery ensured that even minor anomalies were captured. The malformations were classified according to ICD11 definitions and further sub-classified into major or minor based on WHO guidance. Of the 150 total malformations identified, 44 (29.3%) were classified as major—those that significantly impact health, require surgical correction, or are life-threatening. The musculoskeletal system was the most frequently affected, accounting for 58% (87/150) of all malformations. The most common major malformation was talipes equinovarus, or clubfoot, identified in 43% (19/44) of major cases. This finding aligns with global patterns but highlights the particular burden of musculoskeletal defects in this population. The study also noted that the circulatory and skeletal systems were equally affected among congenital malformations recorded in neonatal deaths by day 28 after birth (23.8%, 5/21 each), suggesting that these systems may be associated with the most severe outcomes. The detailed classification and surveillance methodology provide a valuable baseline for future research and public health planning in The Gambia and similar settings.