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Investigating the use of ultrasonography for the antenatal diagnosis of structural congenital anomalies in low-income and middle-income countries: a systematic review
  1. Stephanie Michele Goley1,
  2. Sidonie Sakula-Barry2,
  3. Nana Adofo-Ansong3,
  4. Laurence Isaaya Ntawunga4,
  5. Maame Tekyiwa Botchway5,
  6. Ann Horton Kelly1,
  7. Naomi Wright6
  1. 1Department of Global Health & Social Medicine, King’s College London, London, UK
  2. 2Health Information Department, World Cancer Research Fund, London, UK
  3. 3Department of Paediatrics, Mafikeng Provincial Hospital, Mafikeng, South Africa
  4. 4Rwanda Spina Bifida and Hydrocephalus Relief, University of Rwanda, Kigali, Rwanda
  5. 5Department of Paediatric Surgery, University of the Witwatersrand, Johannesburg-Braamfontein, Gauteng, South Africa
  6. 6King’s Centre for Global Health and Health Partnerships, King’s College London, London, UK
  1. Correspondence to Stephanie Michele Goley; stephanie.goley{at}


Background Congenital anomalies are the fifth leading cause of under-5 mortality globally. The greatest burden is faced by those in low/middle-income countries (LMICs), where over 95% of deaths occur. Many of these deaths may be preventable through antenatal diagnosis and early intervention. This systematic literature review investigates the use of antenatal ultrasound to diagnose congenital anomalies and improve the health outcomes of infants in LMICs.

Methods A systematic literature review was conducted using three search strings: (1) structural congenital anomalies; (2) LMICs; and (3) antenatal diagnosis. The search was conducted on the following databases: Medline, Embase, PubMed and the Cochrane Library. Title, abstract and full-text screening was undertaken in duplicate by two reviewers independently. Consensus among the wider authorship was sought for discrepancies. The primary analysis focused on the availability and effectiveness of antenatal ultrasound for diagnosing structural congenital anomalies. Secondary outcomes included neonatal morbidity and mortality, termination rates, referral rates for further antenatal care and training level of the ultrasonographer. Relevant policy data were sought.

Results The search produced 4062 articles; 97 were included in the review. The median percentage of women receiving an antenatal ultrasound examination was 50.0% in African studies and 90.7% in Asian studies (range 6.8%–98.8%). Median detection rates were: 16.7% Africa, 34.3% South America, 34.7% Asia and 47.3% Europe (range 0%–100%). The training level of the ultrasound provider may affect detection rates. Four articles compared morbidity and mortality outcomes, with inconclusive results. Significant variations in termination rates were found (0%–98.3%). No articles addressed referral rates.

Conclusion Antenatal detection of congenital anomalies remains highly variable across LMICs and is particularly low in sub-Saharan Africa. Further research is required to investigate the role of antenatal diagnosis for improving survival from congenital anomalies in LMICs.

PROSPERO registration number CRD42019105620.

  • screening
  • neonatology
  • congenital abnorm

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  • Contributors NW conceived the idea for this study. NW, AK and SMG devised the study design. SMG, SS-B, NA-A, LIN, MTB and NW performed the literature review. SMG drafted the manuscript with significant contributions from NW and AK. All authors reviewed and approval the final submitted manuscript.

  • Funding NW receives funding from the Wellcome Trust to undertake a Clinical PhD in Global Health at King’s Centre for Global Health and Health Partnerships, King’s College London (Funder Reference: 203905/Z/16/Z).

  • Map disclaimer The depiction of boundaries on this map does not imply the expression of any opinion whatsoever on the part of BMJ (or any member of its group) concerning the legal status of any country, territory, jurisdiction or area or of its authorities. This map is provided without any warranty of any kind, either express or implied.

  • Competing interests There are no competing interests.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.