Member details

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History:

In Costa Rica, mandatory birth defects (BDs) surveillance began in 1985 with the creation of the CREC (Ministerio de Salud de Costa Rica, 1985), a hospital-based system, with a population scope. CREC has a central coordinating group, integrated by two pediatrician-epidemiologists and one secretary. This group coordinates a network of 32 hospitals (28 public and 4 private hospitals), which covers over 98% of all national live births. The National Children’s Hospital (NCH) -the country´s only national referral center for birth defects- became a member of CREC in 2008, together with secondary pediatric health centers with pediatric services.   ,The processes of detection, reporting, registration, follow-up, coding, and classification of cases and BDs are detailed in the Epidemiological Surveillance Protocol for Birth Defects in Costa Rica (Ministerio de Salud de Costa Rica et al., 2018). The case definition includes all live or dead newborns, weighing more than 500 g, and older than 20 weeks of gestational age, with any structural congenital anomalies –major or minor-. Coverage of dead births or stillbirths is less than 5%. Costa Rican law does not allow the elective termination of pregnancy due to fetal anomalies (ETOPFA) unless the health and the life of the mother are at risk. ,

Size and coverage::

CREC is an hospital based system with population coverage (plus than 98% of births). The report is mandatory and includes all births from public (98%) and private (5%) maternity wards. The annual average of births in the country is from 55 000 to 65000 in the last decade.

Legislation and funding:

CREC was created by decree in 1985. The CREC is located at INCIENSA (Costa Rican Institute for Research and Education in Nutrition and Health), which is attached to the Ministry of Health. This ministry provides all of the CREC's funds.

Sources of ascertainment:

This group coordinates a network of 32 hospitals (28 public and 4 private hospitals), which covers over 98% of all national live births. The National Children’s Hospital (NCH) -the country´s only national referral center for birth defects- became a member of CREC in 2008, together with secondary pediatric health centers with pediatric services.   ,Other sources of information are: discharge database from NCH, and abstractors in this hospital.

Exposure information:

We only collect information on maternal age for all birth defect reports. However, for enhanced surveillance of microcephaly and congenital Zika, we collect information on exposure to the Zika vector, medications and illnesses during pregnancy, infections in the mother, drug use (any, legal or illegal), violence, accidents, etc. during pregnancy.

Background information:

Costa Rica, a Central American middle-income country, is home to an estimated 5.1 million people with an approximate average of 70,000 births per year in the last 10 years (Instituto Nacional de Estadística y Censos, 2021a). The country has a single health system with universal national coverage,  which has been achieved through a unique national health insurance program  called the Costa Rican Social Security Fund (CCSS, for its acronym in Spanish) (Montenegro, 2013). Ninety-nine percent of births occur in hospitals, 94% in public hospitals, and all are attended by trained health personnel (Solis, 2019). Elective termination of pregnancy for fetal anomalies (ETOPFA) is not allowed to date. ,BDs are the second leading cause of infant mortality in the country; by 2020 infant mortality was 7.86 per 1,000 births and BDs represented 36.3% of infant deaths, surpassed only by perinatal conditions (Instituto Nacional de Estadística y Censos, 2021b),please specify

Addresses and staff:

website:  https://www.inciensa.sa.cr/inciensa/unidades_especializadas/unidad_enfermedades_congenitas.aspx,

Phone:

Fax:

E-mail:

International Clearinghouse for Birth Defects

International Clearinghouse for Birth Defects