What is this study about?

The study has been conducted to assess the prevalence of congenital birth defects in children among the Iraqi population in nine governorates.

Who is conducting the study and who is the owner of the study findings?

The ownership of the study lies with the Federal Ministry of Health of Iraq. The approval processes, agreement on methodology and sample size and the geographical distribution of the study sample lies solely under the authority of the Ministry of Health. WHO has provided technical support in study design, methodology, data collection, data analysis and report writing.

What mechanism was established between the Ministry of Health and WHO to conduct the study?

A steering committee has been established by the Ministry of Health in which WHO serves as the secretariat. All decisions are discussed and approved by the steering committee. The steering committee is chaired by the Deputy Minister of Health. In addition to Ministry of Health and WHO, the membership includes members from Ministry of Planning, the PM secretariat and the Ministry of Health and Ministry of Planning of the Kurdistan Regional Government.

Where did the funding for the study come from?

The study is co-financed by the Ministry of Health of Iraq and WHO.

When did the study begin and when will the results will released?

Discussion and preparation for the study started in mid-2011. It took almost 10 months to develop the methodology, subject it to pilot-testing and make amendments after the pilot testing. The study started in May/June 2012 and the data collection process was completed at the beginning of October 2012. Currently, data are being analysed and based on the decision of Ministry of Health of Iraq, the results of the study will be published either at the end of this year or beginning of next year.

What is the overall sample of the study (both geographical and numbers) and what was the criteria to select this sample? 

The study is conducted in 8+1 governorates of Iraq out of the total 18 governorates. The reason for saying 8+1 is that Baghdad has been divided in two governorates because of the size of the population.

The governorates in which the study has been conducted are Baghdad (Karkh and Rafafa), Diyala, Anbar (including the district of Fallujah), Suleimaniyah, Babel, Basrah, Mosul and Thi-Qar. Two districts are selected from each governorate (one as high risk and the other as control).

The criteria for declaring a district as high risk is based on existing statistics showing high number of congenital birth defect cases. A total of 10 800 households from 18 districts of the 8+1 governorates have been selected as a sample size making it uniformly 600 households per district. All mothers in these households who are married, between the ages of 15 and 49 years, and who have a child with any congenital birth anomaly are included as respondents. Two-stage sampling has been undertaken for each child; one before the onset of the 2003 war and the other after the onset of 2003 war. 

What aspects of congenital birth defect are being looked at and why?

The study is looking at the prevalence of congenital birth defects in the selected 8+1 governorates among children. The reason for looking at congenital birth defects is the need of the Ministry of Health to gather more evidence about congenital birth defects in the country as a result of an increase in reported numbers in Ministry of Health health information reports. Other studies conducted in Iraq have pointed towards an increase in prevalence. These independent studies were confined to smaller geographical areas (a few districts) and reviewed only  hospital records. For this reason it was decided by the Ministry of Health to conduct a household survey on a wider sample size.

Is the study looking at a possible link between prevalence of child birth defects and the use of depleted uranium?

No, absolutely not. The study is only looking at the prevalence of congenital birth defects in selected governorates.

If prevalence of these defects is high, will that be evidence that depleted uranium has been used in some or all of the governorates?

Since the issue of associating congenital birth defects with exposure to depleted uranium has not been included the scope of this particular study, establishing a link between the congenital birth defects prevalence and exposure to depleted uranium would require further research.

Will the study contribute to the debate in the recent studies conducted independently and/or the news reports appearing in international media?

The mandate of the study is to map and scientifically assess the prevalence of congenital birth defects using the most viable methodology for a larger sample size and geographical area. At this point, no effort to either substantiate or negate the findings of other studies can be employed because the study is not aiming to establishing cause–effect associations between the prevalence and environmental risk factors of congenital birth defects.

When will be the results of the study be launched and who will launch the study results?

The data collection process has been recently completed and the results are being analysed by the Ministry of Health and WHO. The data analysis process will conclude at the end of 2012 following which time the report writing process will start. The study results will be launched by the Ministry of Health

What type of congenital birth anomalies are being looked at?

All types of congenital birth anomalies are looked into according to International Classification of Diseases (ICD 10). Around 29 codes are included in the data collection process which covers the spectrum of all congenital anamolies.

Who can be contacted in the Ministry of Health and WHO for further questions?

Ministry of Health

Dr Mohamed Jaber, Advisor to the Director General Public Health Ministry of Iraq, Deputy Chair of the steering committee, phone: 009647901446432.

Dr Ziad Tariq, Spokesperson and Head of Media, Ministry of Health of Iraq, phone: 009647901497261.

WHO

Dr Syed Jaffar Hussain, WHO Representative in Iraq, phone: Iraq - 009647901944039; Jordan - 00962797204183.

Dr Mohamed Ali, Regional Advisor, Data and statistics/World Health Organization, Regional Office for the Eastern Mediterranean, Cairo, Egypt, phone: 0020222765363.

Mr Tarik Jasarevic, Media Relations, World Health Organization, headquarters, Geneva, phone: +41 22 791 5099; mobile: +41 793 676 214.

Will there be any follow-up action after the results are launched?

If the results show a high prevalence, WHO will advocate for additional studies to find out the reasons and invite other agencies/institutions to conduct further research.