The burden of congenital anomalies amenable to surgeries in low-income and middle-income countries: a modeled analysis

Published June 17, 2013, in The Lancet (opens in a new window)


An estimated 6% of global infant deaths are attributable to congenital anomalies, of which 92% occur in low-income and middle-income countries (LMICs). Some of the conditions can be treated by specialized surgical procedures that have been frequently provided through established vertical programs. This study aims to quantify the burden of congenital anomalies in LMICs that could be averted should the surgical programs be scaled up to 100% coverage.


We examined three conditions: cleft lip and palate (Cleft), congenital heart anomalies (CHAs), and neural tube defects (NTDs). We obtained the disability-adjusted life-years (DALYs) of these conditions from the Global Burden of Disease 2010 Study and split them into surgically avertable and non-avertable burdens. In doing this, we applied the lowest age-specific and sex-specific fatality rates among the 21 epidemiological regions to each LMIC region, assuming the differences of death rates between each region and the lowest rates as reflecting the gap in surgical coverage.


Of the estimated 21.4 million DALYs of the three conditions in LMICs, 12.7 million DALYs (59%) are avertable with full surgical coverage. NTDs have the largest potential, with 76% of burden avertable by surgery, followed by Cleft (62%) and CHAs (52%). Sub-Saharan Africa has the largest proportion of surgically avertable burden for Cleft (72%), North Africa and the Middle East for CHAs (75%), and South Asia for NTDs (80%). Sub-Saharan Africa and South Asia have considerably lower proportions of surgically avertable burden of CHAs (7% and 33%, respectively). This may be due to the high proportion of fatal cases coded as stillbirths and hence not captured in the burden of congenital anomalies. Therefore, the true avertable burden may be larger for CHAs.


There is substantial gain for surgical programs to make in reducing the burden of congenital anomalies in LMICs.


Bill & Melinda Gates Foundation.

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Higashi H, Barendregt JJ, Vos T. The burden of congenital anomalies amenable to surgeries in low-income and middle-income countries: a modeled analysis. The Lancet. 2013; 381:S62.