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CONGENITAL DISEASES IN BULGARIA

CONGENITAL DISEASES IN BULGARIA. E. Terlemesian, S. Stoyanov University of Chemical Technology and Metallurgy Centre of Ecology Sofia, Bulgaria. CONGENITAL DISEASES IN BULGARIA. Introduction Congenital diseases in Bulgaria Infant mortality rates Discussion Conclusion. OBJECTIVES.

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CONGENITAL DISEASES IN BULGARIA

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  1. CONGENITAL DISEASES IN BULGARIA E. Terlemesian, S. Stoyanov University of Chemical Technology and Metallurgy Centre of EcologySofia, Bulgaria

  2. CONGENITAL DISEASES IN BULGARIA • Introduction • Congenital diseases in Bulgaria • Infant mortality rates • Discussion • Conclusion

  3. OBJECTIVES To present statistical data on - the incidence rates, - types and - trends in the congenital diseases and - infant mortality rates in Bulgaria during the last years and to discuss the causal factors.

  4. Sofia Register of Congenital Anomalies (SORCA) • emerged in 1996 • in response to a growing need for current scientific information about the effects of drugs and other environmental agents on developing human embryo and fetus. • 40 isolated congenital anomalies (CA) and congenital diseases, detectable at birth or to the end of the first year of live have been detected out of 34124 pregnancies, registered in the period 1996 – 1999 • almost one third of the registered families have contacted personally

  5. EUROCAT • has 41 members in 20 countries • more than one million births per year are surveyed • in EU member states and non-EU countries • the central database helds a total of more than 250 000 cases of congenital anomalies since 1980 including live births, stillbirths and termination of pregnancy following prenatal diagnosis

  6. Sofia register database, 1996 – 1999 Source: Euroworkshop on reproductive and developmental toxicity of pesticides, Sofia, 2000

  7. Sofia register data base for congenital anomalies, 1996 - 1999 Source: Euroworkshop on reproductive and developmental toxicity of pesticides, Sofia, 2000

  8. Registered congenital anomalies by type, 1996 - 1999 Source: Sofia Register Database, 1996 – 1999; EUROCAT, 1996 - 2001

  9. Registered congenital anomalies in Sofia and EUROCAT by type, 1996 1999

  10. Registered congenital anomalies in Sofia and EUROCAT by type, 1996 - 1999

  11. Source: http://encyclopedia.thefreedictionary.com

  12. Total number of live births in Bulgaria

  13. Percentage of total live births in Bulgaria according to the mother’s age

  14. Total In the town In the country side 20 18 16 14 12 10 8 1980 1985 1990 1995 2000 2005 Year Mortality rates – all ages, per 1000

  15. 26 Total In the town 24 Mortality rate per 1000 In the country side 22 20 18 16 14 12 10 1980 1985 1990 1995 2000 2005 Year Infant mortality rate per 1000 live births

  16. Delivery at home During the last years an increased trend of delivery at home is registered in Bulgaria. This is a reason for the high mother mortality In the rural areas mother mortality is 25,5 per 100 000 births In Kazakhstan – 40 per 100 000 births Source: UN Population Fund Report, 2004

  17. Infant mortality rates per 100 000 live births (2003)

  18. Trends in the mortality rates in the period 1990 – 2003 according to different reasons

  19. Infant mortality rates Source: National Statistical Institute Yearbook: Health, 2002, 2003

  20. Infant mortality rate due to congenital anomalies

  21. Infant mortality rates due to congenital anomalies

  22. Infant mortality rates due to certain conditions, originating in the prenatal period

  23. Territorial distribution of infant’s mortality in 2003 caused by congenital anomalies and due to reasons originating in the prenatal period

  24. SORCA data: • About 60 per cent of the registered fetus/children cases have been identified as isolated, probably multifactorial congenital anomalies • 40 per cent – with multiple congenital anomalies distributed as follows: * chromosomal aberrations – 8 per cent * single gene disorders – 10 per cent, * purely environmental – 2 per cent and * multiple congenital anomalies of unknown etiology – 20 per cent The experience of the TIS in Jerusalem - reported 38000 calls for twelve years. Of them • 75 per cent – due to exposure to drugs, • 9 per cent – to exposure to diagnostic irradiation, • 6 per cent – suspected to have intrauterine infection, • 5 per cent – due to vaccination and • only 2 per cent following exposure to environmental pollutants

  25. OTIS fact sheets of the effects of environmental agents Summarize six categories of exposure: • medications • infections • illicit substances • herbal products • maternal medical conditions • others

  26. Risk assessment of prenatal exposures requires knowledge about • chemical structure • dosage • developmental stage at exposure • duration of exposure

  27. Types of exposures Source: www.otispregnancy.org

  28. Distribution of the reproductive status Source: www.otispregnancy.org

  29. Epidemiological work in cities with high level of environmental pollution • with dioxins (Chapaevsk) – higher frequency of newborn with congenital hydrocephaly • with PCBs (Serpukov) – 4.5 newborn with CA per 100 newborn • 2.2 newborn with CA per 100 newborn in the majority of other Russian cities Source: Revich at al, 2000

  30. Pesticides used in Bulgaria (in tons) in the period 2002 - 2004 Source: Annual Report, National office for Plant Defence, 2004, p. 45

  31. The area of wine yards treated with herbicides (thousands ha) Source: Annual Report, National office for Plant Defence, 2004, p. 44

  32. Expenses spent for permanent disposal of the pesticides unfit for use Source: Annual Report, National office for Plant Defence, 2004, p. 45

  33. Strategy for reduction the hazardous impact of pesticides in Bulgaria • Systematic control of the appearance, dissemination, density and degree of invasion of the plant diseases, insects and weeds and their natural regulators. • Localization of pests in the unplantet areas (locusts) • Determination the exact time of the pesticides application • Use of more effective chemicals • Control of their content in soil, water, plants and food

  34. Executive Body – National Office for Plant Defense Responsibilities: • Biological testing of the Plant Defense Products (PDP) according Directive 91/414/EEC and Annex I for PDP and their active substances • Official registration of PDP and their active substances • 54 of the included in Annex I 91 active substances are components of PDP, permitted in Bulgaria • Control of the import of PDP • Control of PDP in the market network

  35. Shortages • Problems with the pesticides unfit for use * Deposited in ruined, unprotected stores * Illegal use of forbidden pesticides * Trans-boundary pollution with pesticides • Control is increasing but not regular and not enough • It does not cover all regions of the country

  36. Measures • Inventory in correspondence with Directive 67/548/EEC and Annex 5 for the recent available chemicals • 35 tons DDT from 6 stores are exterminated in the Netherlands • Permanent disposal of the pesticides forbidden for use

  37. Conclusion • Sofia Register of Congenital Anomalies (SORCA) emerged in 1996 in response to a growing need for current scientific information about the effects of drugs and other environmental agents on developing human embryo and fetus. • 40 isolated congenital anomalies (CA) and congenital diseases have been detected out of 34124 pregnancies, registered in the period 1996 – 1999 in Sofia. • In general, the incidence rates of CA in Sofia do not differ significantly from the average figures of EUROCAT (1996 – 2001). Prevalence of non-chromosomal congenital anomalies has been registered.

  38. Conclusion • Total chromosomal anomalies, registered in Sofia per 10000 pregnancies, are almost twice less than the registered by EUROCAT diseases. At the same time the age-specific fertility of Bulgarian women in 1998 – 2002 shows that the average age of mothers has increased. • In 2003 certain conditions, originating in the prenatal period (386/1000 live births) and congenital anomalies (259,8/1000 live births) could be ranked at the first two places between the causes of the infant deaths. In the period 1990 – 2003 trends of reduction are noticed for the both leading reasons for the infant mortality.

  39. Conclusion • About 2 per cent of the registered fetus/children cases have been identified to be with purely environmental etiology. • In the well developed agricultural areas and highly industrialized regions in Bulgaria with production of big amount of energy the proportion of congenital anomalies and conditions, originating in the prenatal period as reasons for infant mortality exceed the averages for the country. • Strategy for reduction the amount of the pesticides used for plant defence in Bulgaria is elaborated, which includes systematic control of the appearance, dissemination, density and the degree of invasion of the plant diseases, insects and weeds and their natural regulators and control on the PDP.

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