1 15 1 https://www.nal.usda.gov/exhibits/speccoll/files/original/24722c12f18a266338b77b1415f99208.pdf d011e5d300b3e4836b02672d137cdb32 PDF Text Text Item ID Number 00579 Author Cutting, Robert T. Corporate Author U. S. Department of Defense Report/Article TftlQ Congenital Malformations, Hydatidiform Moles, and Stillbirths in the Republic of Vietnam, 1960-1969 Journal/Book Title Year 197 MOUth/Dey December Color ° D Number of Images 34 DeSOriptOU NOtQS Alvin L. Young filed this item under the category "Human Exposure to Phenoxy Herbicides and TCDD" Tuesday, February 20, 2001 Page 579 of 680 ��CONGENITAL MALFORMATIONS //v HYDATIDIFORM MOLES AND STILLBIRTHS IN THE REPUBLIC OF VIETNAM 1960 -1969 Robert T. Cutting 1 Tran Huu Phuoc 2 Joseph M. Ballol Michael W. Benenson1 Charles H. Evans 3 D e c e m b e r 1970 1 US Army Medical Research Team (Walter Reed Army Institute of Research), Vietnam (Present address: Walter Reed Army Institute of Research, Wash., DC 20012) 2 Ministry of Health, Government of the Republic of Vietnam 3 0ffice of the Command Surgeon, Military Assistance Command, Vietnam For sale by the Superintendent of Documents, U.S. Government Printing Office Washington, D.C. 20402 - Price 45 cents I) �SYNOPSIS-ABSTRACT A ten-year survey of the incidence of stillbirths, hydatidiform moles and congenital malformations was conducted in the Republic of Vietnam using records maintained at 22 hospitals. The study collected 480,087 livebirths, 16,166 stillbirths, 2,866 moles and 2,355 malformations of all types. The military use of herbicides is depicted and the data are sorted into two time periods, pre- or light-spraying years (1960-65) and heavyift&i,spraying years (1960-69). Comparing the earlier with the later period the stillbirth rate was 36.1 and 32.0, the mole rate was 6.6 and 5.6 and the malformation rate was 5.5 and 4.5 per 1000 livebirths. biased by data from population centers. The survey is �ACKNOWLEDGMENTS Dr. Trang Minh Tung - Minister of Health, Government of the Republic of Vietnam Dr. Dinh Xuan Minh -- Special Assistant to the Minister of Health Dr. Dang Quoc Phu -- Director, National Institutes of Public Health Dr. Trung Minh Cac — Vice General Director of Health, Ministry of Health Vo Liet Nu-- Chief, Records Section, Tu-Du Maternity Hospital BG Richard R. Taylor — Command Surgeon, Military Assistance Command, Vietnam Dr. Theodore R. Woodward — Professor of Medicine, University of Maryland, School of Medicine Col. Robert J. T. Joy - Deputy for Medical and Life Sciences, Office of Director of Defense Research and Engineering Maj. Herbert E. Segal - Division of Preventive Medicine, Walter Reed Army Institute of Research �CONTENTS Page Synopsis-Abstract » i Acknowledgments ii Introduction 1 Methods 3 Results 4 Discussion ° 5 Conclusions 7 Tables 9 Figure 1 Location of Hospitals Visited 25 Figure 2 Number of Livebirths Collected by Year, Republic of Vietnam 1960 - 1969 26 Figure 3 Countrywide Incidence of Stillbirths, Malformations and Moles per 1000 Livebirths per Year Figure 4 Acres Sprayed by Year, Republic of Vietnam, 1960-1969 References. „ 27 28 29 �INTRODUCTION In 1969 Bionetics Research Laboratories reported an increase incidence of developmental abnormalities in rats and mice born of mothers which had received 2, 4, 5-trichlorophenoxyacetic acid (2,4,5-T) during early pregnancy (1). Because herbicides* containing this compound had been used for military purposes in the Republic of Vietnam (RVN), concern was expressed about possible similar effects in humans. To determine whether such effects could be shown in humans, the Ministry of Health, RVN, (MOH) and the US Military Assistance Command, Vietnam (MACV) undertook a cooperative study of obstetrical records over the 10 year interval 1960 - 1969 in 22 hospitals. This report describes the incidence of recorded congenital malformations, stillbirths, and hydatidiform moles in RVN before (1960 - 1965) and after (1966 - 1969) large scale military use of herbicides. * A gent Orange, used in Vietnam defoliant operations, is composed of a 1:1 mixture of the n-butyl esters of 2,4-dichlorophenoxyacetic acid and 2,4,5-trichlorophenoxyacetic acid. ��METHODS Evaluations of Obstetrical Records and Survey Procedures. The initial efforts were directed to assess the availability and accuracy of obstetrical records in Vietnamese medical facilities, and to develop techniques for review and interpretation. A pilot study performed in seven provincial and district hospitals and one Saigon hospital (Tu-Du) revealed that Vietnamese obstetrical records were available and accurate, and developed reviewing techniques. The survey was then extended to other medical care facilities throughout the country. Hospital Ledger. In all but four hospitals, a Daily Summary Ledger, prepared by the chief midwives served as the primary source document. This contained 15-20 categories of information on each obstetrical or gynecologic patient. The following information was recorded: hospital admission number; patient's name, age, parity, and date of admission; presentation, time, and method of delivery; baby's sex, weight, and general condition at birth; placenta weight; estimate of blood loss; and name of person attending. A "remarks" column recorded such data as vacuum extraction, reversion, placenta delivery assistance, Caesarean section and indication, blood transfusion, uterine revision, maternal or infant complications with treatment and results, and, most germane to this study, congenital malformations. Some hospitals also included in the Ledger the patient's address and occupation, father's name and occupation, baby's name, date of discharge or departure prior to discharge, and whether patient paid for her care. The accuracy of the information in the Daily Summary Ledger in each hospital was tested by comparing it to the information in random samples of individual medical records. Several hundred such comparisons failed to reveal any discrepancies. No Daily Summary Ledger was kept at Hue, My Tho, or Tay Ninh; at these hospitals each individual obstetrical and gynecological record available was individually examined. Records System at Tu-Du A system of automatic data processing is used at Tu-Du Maternity Hospital in Saigon which was devised by a staff member trained in statistics in the United States and who has been chief of that medical records office for 12 years. The system uses manual coding of the information derived from the hospital records, transposition to punch cards and compilation. Eighteen malformation types are specified; these include all those commonly observed, the remainder are categorized as unspecified. �Criteria for Stillbirth, Malformation and Mole. Abortions were distinguished from stillbirths by recorded fetal weight. Stillbirth was defined as fetuses weighing 750gm. or more and without evidence of life after complete separation from the mother. Only a few weighed less than lOOOgm. In the rare case where fetal weight was not recorded, stillbirth was defined as a birth with a gestation period of twenty-four weeks or longer. Malformations were counted in both livebirths and stillbirths. Malformations associated with abortions were not counted. More than one malformation was occasionally recorded for a single infant and these malformations were counted individually. In no case were more than three malformations recorded for a single birth. Hydatidiform moles were counted only if delivered. Hospitals Surveyed The location of each hospital visited is shown in Figure 1. All are Ministry of Health public hospitals and are free to those who do not desire or cannot afford to pay. RESULTS A total of 499,119 birth events were counted. There were 480,087 livebirths, 16,166 stillbirths, and 2,866 hydatidiform moles. Table 1 shows the location and type of hospital by geographic area, the years for which data were available and the number of livebirths counted. A small number of birth events for the years 1959 and 1970 were collected and are included in Table 1 for completeness. If these data are excluded, there are 488,852 total birth events, which include 470,200 livebirths, 15,812 stillbirths and 2,840 hydatidiform moles during the 1960-69 decade under consideration. Figure 2 shows the number of livebirths collected by year. Hospitals outside the Capital contributed the largest portion of the progressive increase in number of livebirths. Only a few hospitals had records for the entire decade. There is a relative lack of data for the first half of the decade. Before 1969, hospital records were kept for varying periods of time. Since 1969, MOH has required records maintenance for a minimum of five years. The incidence of abnormal birth events by geographic area is shown in Table 2, and includes 1959 and 1970 data. All rates are expressed as per 1000 livebirths. Wide variations in some hospitals' annual incidence of all birth events were observed, and in some hospitals the rates were unrealistically low. Except in the smallest hospitals, variation in rates was usually greater between hospitals than the year-to-year variation within hospitals. Excluding the small district hospitals, stillbirth rates varied from 8.7 at Long Dien (4,214 livebirths over 7 years) to 62.7.at Qui Nhon (6,303 livebirths over 4 years). Hydatidiform mole rates varied from 1.4 at Tan An (24,596 livebirths �'over"» years) 10 ib'i'iTai'""Can ivno (16,066HVfeeinttgtfVerCU years). Maltormation rates varied from 1.1 at Tan An to 7.4 at Hue (5,271 livebirths over 2.3 years). Table 3 presents annual birth abnormality rates for the years 1959 - 1970. If 1959 and 1970 data are excluded, the rates for the decade are: stillbirth - 33.6, moles -6.0, and malformations - 4.9. Figure 3 depicts the decline in the countrywide stillbirth rate, and the stable mole and malformation rates. The rates of stillbirths, moles and malformations for the four geographic areas are compared in Table 4. Congenital Malformations. Table 5 presents the 2,355 congenital malformations by type collected from all hospitals. Only obvious congenital malformations were recorded. Forty percent of all malformations were not specified by type in the Ledger nor in the individual medical records of the patients. Anencephaly, cleft lip/palate, clubfoot and hydrocephaly accounted for over 80% of all specified malformations. Congenital heart disease was not recorded nor were there autopsy reports on those infants who were dead at birth or died shortly thereafter. The hospital records do not distinguish between harelip and cleft palate, the general term "bee de lievre" being used for both malformations. Unusual deformities, such as those associated with thalidomide, were not reported. Individual Hospital Data Tables 9 through 29 present the birth defect data for each individual hospital surveyed. Herbicide Usage in Vietnam. Figure 4 shows the number of acres sprayed by year in Vietnam during the decade (3). Prior to 1966 there was comparatively little use of herbicides. Since 1966, more than 800,000 acres were sprayed annually. The birth defect data were grouped into pro- and light-spraying years (1960 - 1965) and heavy-spraying years (1966 - 1969). In Table 6 the data for these two periods are compared. The data for the years 1959 and 1970 are not included in this Table. DISCUSSION This study does not directly test a relationship between herbicides and birth abnormalities. Such an assessment would require prospective studies with examination of one population before and after exposure, or examination of two comparable populations with only one exposed to herbicides. Information about the precise dose of herbicide to which pregnant women were exposed and the week of pregnancy would be required. Careful examination and follow-up appraisal of all livebirths would be necessary to detect �tne presence ot inapparent maitorniauons. Ail stillborn ana luiant ueatns wouia require post-mortem examination. The dose of herbicide could then be related to embryological development of malformations. It is obviously impossible to carry out such a study. This study has several biases. The first is that nearly all the information was derived from population centers and larger hospitals. In the six district hospitals visited (Tables 1 and 2) there were only 9857 livebirths with 86 stillbirths (a rate of 8.7), 3 moles (a rate of 0.3) and 14 malformations (a rate of 1.4). The two Saigon maternity hospitals contributed 59% of the data. The second bias is the absence of data from private medical sources. There are several private hospitals in Saigon with large obstetrical departments and excellent standards of practice. Many other cities have private hospitals. All cities had several private "cliniques" usually directed by a single physician. Wealthier Vietnamese often attend these private hospitals, and the birth defect rates in this population might differ from those obtained in this survey. This is suggested by data from the Da Lat province hospital which has two classes of patients. One class, presumably wealthier, pays for obstetrical care. Both classes are served by the same obstetrical personnel and the same labor and delivery rooms. The only difference is assignment to different areas of the hospital for the post-partum period. The hospital maintains the records separately and the information was so collected and analyzed in this study (Tables 1, 2, 20, and 21). The paying class had lower stillbirth, mole and malformation rates. The third bias is that the data are restricted almost exclusively to ethnic Vietnamese. There are a half million Chinese living in the Saigon/Cholon area and they use the six private Chinese hospitals in the area, none of which were surveyed. Montagnards as a rule do not enter district or province hospitals, but deliver at home. Untoward events limited the availability of data at some hospitals. These include a mortar round exploding in the record room at My Tho in 1968, a flood in the record room at Qui Nhon in 1965, the loss of 1961 and 1962 Hung Vuong records which were borrowed for a medical school project, administrative disposition of record files, before 1965 at Can Tho and Ban Me Thout and before 1967 at Pleiku and Tay Ninh, and finally the 1968 Tet Offensive when several hospitals became battlegrounds and some records were destroyed. During the earlier part of the decade, some hospitals reported very few birth defects and hospital personnel frankly admitted incomplete reporting during those years. Most of the directors of the hospitals visited had been appointed within the past few years, and improvement in records keeping coincident with their assignment resulted in more complete reporting during the latter part of the decade. This has caused comparatively higher reported rates for recent years and in some hospitals the data suggest an upward trend when one actually may not exist; i.e., at Baria,Nha Trang, and Ban Me Thuot. Changes in local obstetrical referral practices influence rates in specific hospitals. For example, those district hospitals near province hospitals began to refer problem cases to the province hospital when doctors with obstetrical training were assigned. Referral practice has been influenced by gradual improvement in roads, public trans- �portation, and security. The referral system accounts for the higher abnormality rates in province hospitals. This influence is also noted in the Capital area. For example, Tan An and Bien Hoa refer many problem and mole patients to the Tu-Du hospital in Saigon. Rates are influenced by other factors. A study of moles begun in the Nha Trang hospital in 1968 resulted in a striking increase in the mole rate, probably due to more complete reporting and to the referral of a larger number of patients with suspected moles from surrounding districts. The feasibility of relating the birth data collected to the quantity of herbicide sprayed by province by year was studied. Initially it seemed possible that abnormal birth event rates might be correlated to the amount of herbicide sprayed. The records for each aerial spray mission, including map coordinates of the area covered and the type and quantity of herbicide used, were made available by MACV. However, it was not possible to determine what proportion of any province's total yearly birth events are included in this survey. Neither the MOH Maternal and Child Health Program nor the birth registry system collect complete data. RVN officials estimate that currently only 70% of all births are reported to MOH and only 50% are reported as registered to the National Institute of Statistics. Our inability to obtain a consistent sample of birth events by province precluded meaningful correlation between spray and birth event data. Comparisons of birth event data between countries are difficult because of variations in reporting procedures and differences in definitions of the various events. The incidence of stillbirths, moles, and malformations from studies in large Asian populations (4-13) is shown in Tables 7 and 8. The data from this study fall within the ranges reported by other workers. CONCLUSIONS Medical records at Vietnamese medical facilities were found to be sufficiently complete and accurate to compile birth events data for the decade of the sixties. Except in the Saigon area, there was frequent under-reporting of abnormal birth events particularly in the first part of the decade, resulting in unrealistically low rates in some hospitals for that earlier period. This survey collected information on 480,087 livebirths, 16,166 stillbirths, 2,866 moles and 2,355 congenital malformations of all types from medical records maintained at 22 hospitals representing the Coastal, Interior, Capital and Delta geographic regions. There was a decline in the countrywide stillbirth rate and stable mole and malformation rates during the decade, weighted by the Saigon experience which contributed 59% of the data. Meaningful correlation of any province's annual abnormal birth events to quantitative herbicide data was precluded by our inconsistent sampling of birth data. �Sorting the data into two time periods, before (1966-65) and after (1966-69) the large scale military use of herbicides, failed to show any influence of herbicides. Rather, a downward trend was observed in all categories of abnormal birth events. In comparing the earlier with the later period the countrywide stillbirth rate was 36.1 and 32.0, the mole rate was 6.6 and 5.6, and the malformation rate was 5.5 and 4.5. These rates are within the ranges reported for other Asian populations. A natural variation was observed in the incidence of abnormal birth events as recorded during the decade. This variation was frequently of a greater magnitude between hospitals than the year-to-year variation within hospitals. The effect of any single variable (i.e., herbicides) cannot be demonstrated unless it changes this natural variation and is not masked by other variables. Such a change was not found in this survey. Vietnam Herbicides Malformations Moles Stillbirths , �TABLE 1. LOCATION AND TYPE OF HOSPITALS SURVEYED, YEARS OF DATA AVAILABILITY, AND NUMBER OF LIVEBIRTHS COUNTED TYPE* YEARS** D P P P D P P D 1962-70 1960-70 1964-70 1966-69 1966-70 1967-69 1968-70 1967-70 4,375 13,543 15,789 6,190 1,190 13,061 5,271 3,553 P P P P P 1967-69 1968-70 1966-70 1960-70 1960-70 6,947 2,488 5,808 4,658 10,860 C C C(P) 1960-69 1959-69 1961-69 182,450 99,600 40,099 D P P P P HOSPITAL 1969-70 1965-69 1969 1964-70 1961-69 740 16,056 3,922 18,891 24,596 Coastal Plain Long Dien Baria Nha Trang Qui Nhon Tuy Phuoc Da Nang Hue Hue Districts (3) LIVEBIRTHS Interior Tay Ninh Pleiku Ban Me Thuot j Da Lat (Paying) Da Lat (Nonpaying) Capital Tu-Du Maternity Hospital Hung Vuong Maternity Hospital Bien Hoa Delta Cai Rang Can Tho My Tho Kien Hoa Tan An TOTAL *D » District, P = Province, C = Capital ** Data for 1970 restricted to the first 3-4 months 480,087 �TABLE 2. HOSPITAL INCIDENCE OP BIRTH ABNORMALITIES BY GEOGRAPHIC AREA Stillbirths Rate* Moles Malformations Coastal Plain Long Dien Baria Nha Trang Qui Nhon Tuy Phuoc Da Nang Hue Hue Districts (3) 8.7 26.2 47.0 62, 14, 42, 48, 4.7 0.8 4.3 6.8 0.3 1.8 2.7 2.9 4.0 0.8 2.8 7.4 1.1 Interior Tay Ninh Pleiku Ban Me Thuot Da Lat (Paying) Da Lat (Nonpaying) 37.9 27.7 43.6 20.0 51.0 6.3 2.4 2.1 1.1 5.6 1.4 0.8 0.9 1.7 6.3 Capital Tu-Du Hung Vuong Bien Hoa 34.8 32.3 21.8 9.2 4.1 1.1 7.1 5.0 2.4 18.9 54.4 43.8 30.3 22.9 1.8 15.8 10.4 1.7 1.4 1.8 6.4 4.6 1.2 1.1 33.7 6.0 4.9 0 1.9 6.3 3.2 Delta Cai Rang Can Tho My Tho Kien Hoa Tan An COUNTRYWIDE *per 1000 livebirths 10 �TABLE 3. Year INCIDENCE OF STILLBIRTHS, HYDATIDIFORM MOLES AND CONGENITAL MALFORMATIONS, BY YEAR Livebirths Stillbirths WT. Rate* No. Moles Rlfte* Malformations No7 Rate* 3,258 25,106 24,355 21,326 33,060 39,009 46,821 53,013 69,844 73,188 84,478 6,629 TOTAL 125 1,022 919 744 1,153 1,381 1,632 1,839 2,159 2,288 2,675 229 38.3 40.7 37.7 34.9 34.9 35.4 34.8 34.7 30.9 31.3 31.2 34.5 9 186 164 134 207 249 318 323 359 381 519 ' 17 2.8 7.4 6.7 6.3 6.3 6.4 6.8 6.1 5.9 5.2 6.1 2.6 11 184 121 148 187 210 202 320 276 334 341 17 3.4 7.3 5.0 6.9 5.6 5.4 4.3 6.0 3.9 4.6 4.0 2.6 480,087 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 16,166 33.7 2,866 6.0 2,355 4.9 *per 1000 livebirths TABLE 4. Area COMPARISON OF STILLBIRTHS, MOLES AND MALFORMATIONS BY GEOGRAPHIC AREA Livebirths Stillbirths Ro~IRate* Moles No; Malformations NoT Rate* Capital Coastal Interior Delta 322,149 62,972 30,761 64,205 10,368 2,371 1,232 2,195 32.5 38.6 40.0 34.3 2,134 240 128 364 6.6 3.8 4.2 5.7 1,900 192 93 170 5.8 3.0 3.0 2.6 TOTAL 480,087 16,126 33.7 2,866 6.0 2,355 4.9 *per 1000 livebirths 11 �TABLE 5. TYPE, NUMBER, DISTRIBUTION, AND RATE OF CONGENITAL MALFORMATIONS OBSERVED IN 480,087 LIVEBIRTHS Type Not specified Anencephaly Cleft lip/palate Hydrocephaly Clubfoot Ventre batracien** Monster Umbilical Achondroplasia Polydactyly Abnormal genitalia Spina bifida Evisceration Hermaphrodite Imperforate anus Tumor Ascites Siamese twins Malformation of legs Large abdomen Malformation of hands Microcephaly Syndactyly Others (specified) TOTAL Number Percent of Total 935 525 452 136 39.7 22.3 19.2 5.8 3.5 3.2 1.8 0.5 0.6 0.3 0.3 0 0 0 0 0.2 0.2 0 .1 0 .1 0 .1 0 .1 0 .1 0 .1 0.6 81 76 42 11 13 8 8 8 7 6 6 5 4 3 3 3 3 3 2 15 100.0 2,355 *per 1000 livebirths **Enlarged abdomen with or without ascites 12 Rate* 1.95 1.09 0.94 0.28 0.17 0.16 0.09 0.02 0.03 0.02 0.02 0.02 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.03 4.91 �TABLE 6. COMPARISON OF BIRTH EVENTS DATA IN LIGHT-SPRAYING TO HEAVY-SPRAYING YEARS, COUNTRYWIDE AND BY GEOGRAPHIC AREAS Light^Spraying (1960-65)f Heavy-Spraying (1966-69) N o T R a t e N o . R a t e * Countrywide Livebirths Stillbirths Moles Malformations 189,677 6,851 1,258 1,052 36.1 6.6 5.5 280,523 8,961 1,582 1,271 32.0 5.6 4.5 Coastal Plain Livebirths Stillbirths Moles Malformations 12,580 366 20 27 29.1 1.6 2.1 47,347 1,892 211 148 40.0 4.4 3.1 Interior Livebirths Stillbirths Moles Malformations 7,052 360 39 34 51.0 5.5 4.8 21,619 794 85 54 36.7 3.9 2.5 Capital Livebirths Stillbirths Moles Malformations 151,726 5,641 1,141 965 37.2 7.5 6.4 167,165 4,602 984 924 27.5 5.9 5.5 18,319 484 58 26 26.4 3.2 1.4 44,392 1,673 302 145 37.4 6.8 3.3 Delta Livebirths Stillbirths Moles Malformations *per 1000 livebirths 13 �TABLE 7. COMPARISON OF STILLBIRTH, MALFORMATION, AND ANENCEPHALY RATES AMONG ASIAN POPULATIONS Period No. Births Stillbirth Rate* Hsu Stevenson 1951-53 1961-64 32,176 9,872 13.8 11.5 0.56 1.3 Sanghvi Kolah Stevenson (Bombay) Stevenson (Calcutta) 1946-55 1960-63 1961-64 76,763 29,553 39,498 25.9 43.7 14.0 8.6 0.8 0.9 1.5 1961-64 19,191 46.2 3.0 0.3 Indonesia Suharjono 1962-67 15,018 - 5.7 1.0 Japan Neel 1948-54 64,569 - 10.2 0.6 Malaysia Stevenson 1961-64 15,937 25.2 10.4 1.0 Philippines Jongco Abad-Vasquez Stevenson 1962-63 1961-63 1961-64 46,025 28,663 29,669 15.0 20.6 5.6 12.8 8.4 G.8 0.6 0.5 Singapore Stevenson 1961-64 39,683 12.3 8.6 0.5 Taiwan Wei 1955-62 14,834 - 8.7 1.2 Thailand Siriraj Hosp. 1966 14,332 - 47.8** 0.4 Vietnam Cutting 1960-65 1966-69 180,884 249,779 36.1 32.0 5.5 4.5 1.1 1.0 Country Hong Kong India Author *per 1000 livebirths **A11 malformations, major and minor Malformation Rate* Anencephaly Rate* �TABLE 8. COMPARISON OF HYDATIDIFORM MOLE RATES AMONG ASIAN POPULATIONS Author Rate** Hong Kong King* 1.8 Japan Hasegawa* 4.3 Philippines Acosta-Sison* 5.9 Taiwan Wei* 8.0 Vietnam Cutting 1960-65 1966-69 6.6 5.6 Country *as reported by Marquez-Montes, et al. **per 1000 livebirths TABLE 9. LONG DIEN DISTRICT HOSPITAL Stillbirths Rate Year Livebirths No. 1962 1963 1964 1965 1966 1967 1968 1969 1970 701 101 298 747 656 601 610 508 153 1 1 3 10 8 6 3 3 3 1.4 9.9 10.0 13.4 12.2 10.0 4.9 5.9 19.6 38 8.7 TOTAL (1/3) 4,375 *A11 rates are expressed per 1000 livebirths 15 Moles 0 0 0 0 0 0 0 0 0 Malformations Rate* NoT 2 0 0 2 1 1 2 0 0 2.8 2.7 1.5 1.7 3.3 1.8 �TABLE 10. BARIA PROVINCIAL HOSPITAL Stillbirths Rate Year Livebirths No. 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 588 1,368 1,353 1,303 1,169 1,334 1,444 1,659 1,391 1,562 372 27 38 32 27 39 41 36 32 32 41 11 13,543 356 (1/3) TOTAL TABLE 11. Year Livebirths 1964 1965 1966 1967 1968 1969 1970 1,507 2,111 2,113 2,767 3,168 3,615 TOTAL (1/4) Moles No. Malformations No. Rate 3 2 9 3 6 1 0.8 0.8 2.2 1.3 5.4 2.2 3.8 2.7 3 4 3 1 6 3 3 2 5 4 2 5.1 2.9 2.2 0.8 5.1 2.2 2.0 1.2 3.6 2.5 5.4 26 1.9 36 2.7 0 0 0 46 28 24 21 34 31 25 19 23 26 30 1 1 26.2 NHA TRANG PROVINCIAL HOSPITAL Stillbirths Rate No. 508 61 86 132 149 146 146 22 40 41 62 50 46 37 43 15,789 742 47.0 No. Moles Rate Malformations No. Rate 5 10 4 12 22 41 6 16 1.9 4.3 6.9 11.3 11.8 1 2 14 5 8 10 6 100 6.3 46 3.2 4.7 0.7 0.9 6.7 1.8 2.5 2.8 11.8 2.9 �TABLE 12. Livebirths QUI NHON PROVINCIAL HOSPITAL Stillbirths No. Rate 0 7 6 7 1,178 1,491 1,772 1,749 60 79 133 116 51 52 75 62 6,190 TOTAL 388 62.7 TABLE 13 . Livebirths 1966 1967 1968 1969 1970 Moles No . R~ate 4.7 3.4 4.0 20 3.2 Year 1967 1968 1969 TOTAL 3.4 TUY PHUOC DISTRICT HOSPITAL Stillbirths No . Rate Moles No. R~ate 7 15 21 11 15 1 0 0 0 0 3.7 14.3 1 Malformations Rate No7 0.8 272 260 331 260 67 2 4 7 3 1 1,190 17 TABLE 14. TOTAL (1/3) 21 0 0 1 0 0 DA NANG PROVINCIAL HOSPITAL 0.8 Malformations Rate RoT Stillbirths No. Rate Moles No. R~ate 4,620 4,347 4,094 174 198 185 38 46 45 16 19 21 3.5 4.4 5.1 13 14 10 13,061 557 42.7 56 4.3 37 Livebirths 17 3.0 2.8 3.2 2.4 �TABLE 15. Year Livebirths HUE PROVINCIAL HOSPITAL Stillbirths No. Rate Moles No. Rate Malformations No. Rate 1968 1969 1970 (1/3) 1,156 2,837 1,278 51 132 73 44 46 57 14 12.1 20 2 7.0 1.6 9 21 9 7.8 7.4 7.0 TOTAL 5,271 256 48.5 36 6.8 39 7.4 TABLE 16. Year Livebirths HUE DISTRICT HOSPITALS Stillbirths Rate NoT Cua-Huo 1969 1970 (1/3) 560 178 Thanh-Noi 1969 1970 (1/3) 174 212 Tay-Loc 1967 1968 1969 1970 (1/3) 783 694 675 277 6 2 4 3 7.6 2.8 5.9 10.8 3,553 17 4.7 Moles No. R~ate TOTAL 2 0 3.5 1.7 Malformations NoT Rate 1 0 1.7 0 0 18 1.2 1.4 1.5 0.3 1.1 �TABLE 17. TAY NINH PROVINCIAL HOSPITAL Livebirths NoT Stillbirths Rate Moles No. Rate 1967(3/4) 1968 1969 1,818 2,563 2,566 55 109 99 30 43 39 8 17 19 4.4 6.6 7.4 TOTAL 6,947 263 37.9 44 6.3 Year TABLE 18. Year Livebirths Malformations No. Rate 2.2 1.2 1.2 10 1.4 PLEIKU PROVINCIAL HOSPITAL Stillbirths N < T R a t e 1968 1969 1970 (1/4) 840 1,304 344 20 36 13 24 28 38 TOTAL 2,488 69 27.7 19 Moles No"Rate 4 2 0 4.7 1.5 2.4 Malformations No. Rate 2 0 0 2.3 0.8 �TABLE 19, BAN ME THUOT PROVINCIAL HOSPITAL Stillbirths Rate Livebirths No. 1966 1967 1968 1969 1970 (1/3) 1,201 1,417 1,227 1,292 671 56 57 43 60 37 TOTAL 5,808 253 Year TABLE 20. Year 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 (1/2) TOTAL 0 0 0 9 3 47 40 35 46 55 43.6 Stillbirths Rate No. 236 221 232 259 760 5 3 3 3 18 4,658 Malformations Rate No. 6.9 4.5 3.9 12 2.1 0.9 DA LAT PROVINCIAL HOSPITAL - PAYING Livebirths 276 624 679 947 424 Moles No. Rate 21 14 13 12 24 (data missing from 10 36 15 24 12 18 12 13 12 28 93 20.0 20 Moles W. R~ate No. 2.6 1 0 0 0 2 hospital) 0 1 1.6 1 1.5 1 1.1 0 0 1 0 3 1 1.1 Malformations Rate 4.2 2.6 _ 1.6 3.2 2.4 1.7 �TABLE 21. Year 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 (1/2) TOTAL DA LAT PROVINCIAL HOSPITAL - NONPAYING Livebirths Stillbirths Rate No. 1,376 651 10,860 TABLE 22. 12 5 4 5 5 6 7 5 3 8 1 17.1 6.3 4.7 5.1 5.3 5.6 6.4 4.4 2.4 5.8 1.5 2 5 8 9 5 2 8 3 11 11 4 2.8 6.3 9.4 9.1 5.3 1.9 7.3 2.6 8.7 8.0 6.1 51.0 554 943 1,067 1,092 1.136 1,261 61 5.6 68 6.3 TU-DU MATERNITY HOSPITAL, SAIGON Stillbirths Rate Year Livebirths No. 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 12,350 11,294 11,482 12,795 17,099 18,747 19,429 23,776 26,675 28,803 535 519 517 500 637 705 691 626 699 829 182,450 6,258 TOTAL Malformations Rate No. 72 72 48 66 38 73 51 42 46 35 25 51 57 41 65 36 78 56 48 58 48 16 704 793 852 985 Moles Rate No. 43 46 45 39 37 38 36 26 26 29 34.8 21 Moles NcTKate Malformations No. Rate 145 140 122 139 182 195 189 187 188 196 12 12 11 12 11 10 9.7 7.9 7.0 6.8 138 87 123 125 142 115 166 125 138 144 11 7.7 11 9.8 8.3 6.1 8.5 5.3 5.2 4.9 1,683 9.2 1,303 7.1 �TABLE 23. HUNG VUONG MATERNITY HOSPITAL, SAIGON Stillbirths Rate Livebirths No. 1959* 1960 1961** 1962** 1963 1964 1965 1966 1967 1968 1969 3,258 11,228 4,608 238 11,088 8,693 10,665 11,349 13,667 12,257 12,549 125 404 133 6 412 366 360 366 397 308 342 TOTAL 99,600 Year 3,219 Moles Rate No. Malformations Rate No. 41 37 29 25 37 43 34 32 29 25 27 9 29 16 0 46 44 52 50 64 38 59 2.8 2.8 3.5 4.2 5.1 4.9 4.4 4.7 3.1 4.7 11 40 14 2 43 40 57 79 78 72 63 3.4 3.6 3.0 8.4 3.9 4.6 5.3 7.0 5.7 6.0 5.0 32.3 07 4.1 499 5.0 * Opened September 1959. ** Records borrowed and lost for this period. TABLE 24. BIEN HOA PROVINCIAL HOSPITAL Stillbirths Rate Moles NoT" Rate Year Livebirths No. 1961 1962 1963 1964 1965 1966 1967 1968 1969 4,166 5,058 142 108 112 96 89 84 88 91 81 34 25 26 22 21 21 19 19 16 1 6 11 5 8 1 1 7 4 40,099 891 21.8 44 TOTAL 4,344 4,331 4,371 4,227 4,056 4,735 4,811 Malformations No. Rate 0.2 1.4 2.5 1.1 1.9 0.2 0.2 1.5 0.8 11 7 5 8 8 12 12 21 14 2.6 1.6 1.2 1.8 1.9 3.0 2.5 4.4 2.8 1.1 98 2.4 �TABLE 25. CAI RANG DISTRICT HOSPITAL Livebirths Year 1969 1970 Stillbirths Rate No. Moles Rate No. Malformations Rate No. TOTAL 551 189 11 3 20 16 1 0 1.8 - 1 0 1.8 - 740 (1/3) 14 18.9 1 1.3 1 1.3 TABLE 26. CAN THO PROVINCIAL HOSPITAL 1965 1966 1967 1968 1969 TOTAL Stillbirths Rate Livebirths Year' (1/2) No. 1,769 3,650 3,697 3,498 3,442 93 163 224 210 183 53 47 60 60 53 16,056 873 54.4 Moles Rate No. 34 55 37 54 74 254 19 15 10 15 22 15.8 Malformations Rate No. 5 25 20 32 20 2.8 6.8 5.4 9.1 5.8 102 6.4 TABLE 27. MY THO PROVINCIAL HOSPITAL Stillbirths Rate Livebirths No. 3,922 172 43.8 23 Moles No. Rate 41 10.4 Malformations Rate No. 18 4.6 �TABLE 28. KIEN HOA PROVINCIAL HOSPITAL Year 1964 1965 1966 1967 1968 1969 1970 TOTAL Livebirths (1/3) Stillbirths Rate No. Moles No. Rate Malformations No. Rate 1,793 3,079 3,269 3,564 2,680 3,201 1,305 66 75 110 108 90 89 35 37 24 34 30 34 28 27 1 3 10 6 3 6 4 0.6 0.9 3.1 1.7 1.1 1.9 3.1 3 6 5 4 3 3 2 1.7 1.9 1.5 1.1 1.1 0.9 1.5 18,891 573 30.3 33 1.7 23 1.2 TABLE 29. TAN AN PROVINCIAL HOSPITAL Stillbirths Rate Year Livebirths No. 1961 1962 1963 1964 1965 1966 1967 1968 1969 1,905 2,124 2,198 2,376 3,075 3,028 3,229 3,228 3,433 27 36 33 59 95 65 91 76 81 24,596 563 TOTAL Moles No. Rate Malformations Rate No. 14 17 15 28 31 21 29 23 23 1.0 0.9 2.3 1.7 2.3 1.3 1.8 0.6 0.9 3 4 3 2 6 4 2 2 1.4 1.8 1.3 0.6 2.0 1.2 0.6 0.6 22.9 24 2 2 5 4 7 4 6 2 .3 35 1.4 26 1.1 �HUE DA NANG TUY PHUOC QUI NHON NHA TRANG DALAT BIEN HOA SAIGON LONG DIEN TAN AN MYTHO KIENHOA LOCATION OF HOSPITALS VISITED 25 Figure 1 �NUMBER OF LIVE BIRTHS COLLECTED, BY YEAR REPUBLIC OF VIETNAM, I960 - 1969 80 CAPITAL AREA 70 OUTSIDE CAPITAL AREA 60 o o 3 50 m 40 UJ 30 20 10 I960 61 62 i n. ii 63 64 65 66 67 68 69 YEAR 26 Figure 2 �COUNTRYWIDE INCIDENCE OF STILLBIRTHS,MALFORMATIONS, AND MOLES PER 1000 LIVE BIRTHS PER YEAR 1960-1969 • - STILLBIRTH x - MALFORMATION o - MOLE CC §40 \ O o O UJ 35 z UJ Q O ^ 30 10 I960 61 62 63 64 65 66 YEAR 27 67 68 69 70 Figure 3 �ACRES SPRAYED BY YEAR, REPUBLIC OF VIE I NAM 1960-1969 O O O 0~ O O O UJ o: a. <r o 0 I960 61 62 63 64 65 66 67 68 69 YEAR 28 Figure 4 �REFERENCES 1. Bionetics Research Laboratories: Evaluation of the Teratogenic Activity of Selected Pesticides and Industrial Chemicals in Mice and Rats. Vol. Ill, 1969 2. U. S. Department of the Army, Training Circular. TC-3-16. Employment of Riot Control Agents, Flame, Smoke, Antiplant Agents, and Personnel Detectors in Counterguerrilla Operations, April 1969 3. U. S. Congress. House. Committee on Science and Astronautics. Report to the Subcommittee on Science, Research and Development. Prepared by the Science Policy Research Division, Legislative References Service, Library of Congress (Committee Print) Serial F. Aug 8, 1969. 91st Cong. 1st Sess. US Govt. Printing Office, 1969. p. 15 4. Penrose AC: Genetics of Anencephaly. J Ment Del Res 1:4-15, 1957 5. Stevenson AC, Johnson HA, Stewart MIP, Golding DR: Congenital Malformations: A Report of a Study of Series of Consecutive Births in 24 Centers. Bull WHO 34:Suppl 9, 1966 6. Kolah PJ, Master PA, Sanghvi LD: Congenital Malformation and Perinatal Mortality in Bombay. Ame J Obstet Gynec 97:400-406, 1967 7. Suharjono, Sunoto, Sudijonto, Sugiono M, Sutedjo: The incidence of Congenital Malformation in the Dr Tjiptomangunkusumo General Hospital, Jakarta, 1962-1967. Paediatrica Indonesians 9:9-12, 1969 8. Neel JV; A Study of Major Congenital Defects in Japanese Infants. Amer J Hum Genetics 10:398-445, 1958 9. Jonco AP, Carlos FC, Fernadez EV: Congenital Anomalies in Filipinos. J Philippine Med Assn 41:57-60, 1965 10. Abad-VasquezL, Pascual-Poblete E, Jonco A: Congenital Malformation in the Newborn. J Philippine Afed Assn 41:294-303, 1965 11. Wei PY, Chen YP: Congenital Malformations, Especially Anencephalus, in Taiwan. Amer J Obstet Gynec 91:870-876, 1965 12. Annual Report, Siriraj Hospital, Bangkok, Thailand, 1966 13. Marquez-Montes H, de la Vega GA, Robles M, Bolio-Cicero A: Epidemiology and Pathology of Hydatidiform Mole in the General Hospital of Mexico. Amer J Obstet Gynec 85:856-864, 1963 29 GPO 903.233 � Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Alvin L. Young Collection on Agent Orange Description An account of the resource <p style="margin-top: -1em; line-height: 1.2em;">The Alvin L. Young Collection on Agent Orange comprises 120 linear feet and spans the late 1800s to 2005; however, the bulk of the coverage is from the 1960s to the 1980s and there are many undated items. The collection was donated to Special Collections of the National Agricultural Library in 1985 by Dr. Alvin L. Young (1942- ). Dr. Young developed the collection as he conducted extensive research on the military defoliant Agent Orange. The collection is in good condition and includes letters, memoranda, books, reports, press releases, journal and newspaper clippings, field logs and notebooks, newsletters, maps, booklets and pamphlets, photographs, memorabilia, and audiotapes of an interview with Dr. Young.</p> <p>For more about this collection, <a href="/exhibits/speccoll/exhibits/show/alvin-l--young-collection-on-a">view the Agent Orange Exhibit.</a></p> Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Box The box containing the original item. 031 Folder The folder containing the original item. 0579 Series The series number of the original item. Series III Subseries I Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Creator An entity primarily responsible for making the resource Cutting, Robert T. Tran Huu Phuoc Joseph M. Ballo Michael W. Benenson Charles H. Evans Description An account of the resource <strong>Corporate Author: </strong>U. S. Department of Defense Date A point or period of time associated with an event in the lifecycle of the resource 1970-12-01 Title A name given to the resource Congenital Malformations, Hydatidiform Moles, and Stillbirths in the Republic of Vietnam, 1960-1969 Subject The topic of the resource health effects human exposure congenital birth defects ao_seriesIII