Developmental dysplasia of the hip in Najran province, Saudi Arabia: Incidence and risk factors

Objectives: The objective of the study is to estimate the incidence of developmental dysplasia of the hip (DDH) in Najran Province, Saudi Arabia, and to identify associated risk factors. Methods: We conducted a retrospective observational study of 7,181 live births recorded in 2023 at the main maternity and children’s hospital in Najran, which accounted for approximately 71.4% of all live births in Najran Province that year. Infants meeting local DDH screening criteria underwent hip ultrasonography (Graf method) at 4–10 weeks. DDH was defined as Graf type IIc or higher. Multivariable logistic regression was used to evaluate risk factors. Results: Among 597 infants who underwent hip ultrasonography, 117 were diagnosed with DDH. This corresponds to an incidence of 16.29/1,000 hospital-recorded live births (95% confidence interval [CI] 13.61–19.49). Most DDH cases were mild (Graf IIc, 66.7%). Independent predictors of DDH were breech presentation (odds ratio [OR]: 4.99, 95% CI 2.77–8.99; p < 0.001), positive family history (OR = 3.37, 95% CI 2.07–5.48; p < 0.001), and improper swaddling (OR = 2.29, 95% CI 1.24–4.25; p = 0.007). Female sex was not an independent risk factor in this cohort. Conclusion: Najran demonstrates a notably higher DDH incidence than other Saudi regions, with breech presentation and family history as strong predictive factors, warranting mandatory screening. Improper swaddling emerges as a modifiable risk factor suitable for targeted public health intervention. These findings provide critical evidence to inform the development of region-specific healthcare policies and the appropriate allocation of resources to align with Vision 2030 for Saudi Arabia.