Page 19 - UNAM Virtual Graduation e-Book (April2021)

FACULTY OF HEALTH SCIENCES
SCHOOL OF MEDICINE

DOCTOR OF PHILOSOPHY IN MEDICINE-SURGERY

CANDIDATE: AMAAMBO Filemon

CURRICULUM VITAE

Filemon Amaambo was born in the Oshikoto region and matriculated from
Oshigambo High School. His qualifications include Bachelor of Medicine and
Bachelor of Surgery (MBChB), 1977, University of Natal; Fellow of the Royal College
of Physicians and Surgeons (FRCS), 1984, Glasgow; Postgraduate Diploma in
International Research Ethics (PGDIRE), 2007, University of Cape Town; Fellow of College of Surgeons (FCS), College
of Surgeons of East, Central and Southern Africa (COSECSA), 2017. His professional career includes working as a
Medical Intern, Medical Officer, Registrar, Consultant Surgeon, Medical Superintendent and Chief Specialist in the
Ministry of Health and Social Services as well as Adjunct Professor of Surgery at the University of Namibia. He is
currently serving as an Associate Dean of the School of Medicine at the University of Namibia.

CANDIDATE’S DISSERTATION

ASSESSMENT OF NEURAL TUBE DEFECTS IN TWO NORTHERN NAMIBIA HOSPITALS: INCIDENCE, SEASONAL VARIATION,
RISK FACTORS AND PREVENTION STRATEGIES FOR FOLATE SENSITIVE DEFECTS

The doctoral study was undertaken and completed under the supervision of Prof Shirley Hodgson (University of
London, UK) as Main Supervisor with Prof Christian Hunter and Prof Honore Kabwebwe Mitonga as Co-Supervisors
(UNAM).

Neural tube defects (NTDs) represent severe congenital abnormalities of the nervous system and are among
significant abnormalities associated with high mortality and morbidity rates. Incidence of NTDs varies globally,
being highest in low-income countries. Most high-income countries have managed to document and reduce the
incidence of NTDs through folate based primary prevention strategies. However, inadequate documentation of
NTDs is frequent in low and upper-middle income countries, including Namibia. This study focused on assessing the
incidence, seasonal variation, risk factors, and comparing maternal postpartum red blood cell folate in cases and
controls in Onandjokwe and Oshakati hospitals over 12 months. The aims of the study were to identify evidence
that NTDs constitute both a clinical and a societal problem, and to propose locally adapted prevention strategies
for folate – sensitive NTDs. The study objectives were to assess the incidence of NTDs, determine an association
between the conception of NTD babies and seasonal variation (rainfall), identify related risk factors, and to compare
postpartum maternal red blood cell folate in cases and controls. A cross-sectional design to assess the incidence
of NTDs and descriptive-statistical analysis were utilised. A case-control design was used to compare postpartum
maternal red blood cell folate and other risk factors between cases and controls. The study population was
mothers who gave birth in the two hospitals over 12 months. Non-random consecutive sampling was used to select
participants - mothers with and without NTD babies - to minimise bias when studying rare conditions. Participants
were informed, counselled and requested to voluntarily sign consent forms. Questionnaires were administered face
to face to participants and blood samples were drawn to determine postpartum red blood cell folate. Data was
analysed using Epi-info software. The results of the study were: a) a high neural tube defects incidence of 11 per
10000 births requiring intervention; b) a seasonal variation in the birth and conception of babies with NTDs, which
could be associated with seasonal rainfall pattern; c) the risk factors possibly related to NTDs were unemployment,
low level of education, diet lacking fruits and vegetables, and low maternal red blood cell folate. Hydranencephaly
cases were very high. The study made recommendations, proposed future research areas and outlined preventive
strategies for NTDs in the Northern regions. It underscored health education about NTDs, sustainable consumption
of fruits and vegetables to compliment folate supplementations + Vit B12 and food fortification for all childbearing
women.

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