Birth prevalence of neural tube defects in eastern Africa: a systematic review and meta-analysis

Abstract

Background Neural tube defects (NTDs) are associated with high rates of neonatal mortality and morbidity worldwide. The promotion of folic acid fortification and supplementation in pregnant women by the Food and Drug Administration significantly decreased the incidence of NTDs in the United States. This practice is not widely adopted in Eastern Africa countries. We hypothesized that these countries experience a higher burden of NTDs than countries that promote the use of folic acid. We aimed to estimate the birth prevalence of NTDs in the United Nations (UN) Eastern African region. Methods PubMed (Medline), Embase, and Cochrane Library databases were systematically searched from inception to December 17, 2021. We included randomized controlled trials or observational studies that reported the prevalence estimates of NTDs in Eastern Africa. Random effects model was used to pool the effect estimates. The GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach was used to assess the certainty of the evidence. Outcome measures were overall and specific (spina bifida, anencephaly, encephalocele) rates of NTDs per 10,000 births, including live and stillborn cases. Results The meta-analysis included 20 studies consisting of 752,936 individuals. The pooled prevalence of all NTDs per 10,000 births in Eastern Africa was 33.30 (95% CI: 21.58 to 51.34). Between-study heterogeneity was high (I2 = 97%, p < 0.0001), The rate was highest in Ethiopia (60 per 10,000). Birth prevalence of spina bifida (20 per 10,000) was higher than anencephaly (9 per 10,000) and encephalocele (2.33 per 10,000). No studies on NTDs were identified in 70% of the UN Eastern Africa region. Birth prevalence increased by 4% per year from 1983 to 2018. The level of evidence as qualified with GRADE was moderate. Conclusion The birth prevalence of NTDs in the United Nations region of Eastern Africa is 5 times as high as observed in Western countries with mandatory folic acid supplementation in place. Therefore, mandatory folic acid supplementation of stable foods may decrease the risk of NTDs in Eastern Africa.

Demographics, referral patterns and outcome of neural tube defect patients in Southwestern Uganda

“…Overall, 67.4% of patients were discharged (n = 157), 12.9% absconded (n = 30), 4.7% were transferred (n = 11), and 10% died (n = 23) (Table 2). Median length of stay was 12 days (IQR: [7][8][9][10][11][12][13][14][15][16][17][18][19]. In regards to post-delivery management, 12 patients required a blood transfusion (n = 5.1%) and 22 required oxygen supplementation (n = 9.4%).…”

“…It is estimated that globally 300,000 neonates are born with NTDs per year at a rate of 18.6 per 10,000 live births, with approximately 190,000 occurring in low-and-middle-income countries [2][3][4][5]. The prevalence of NTDs in Uganda has not be measured in a national study, but various hospital based surveillance studies have estimated it to range between 9.8 and 39.8 per 10,000 births [6][7][8][9][10][11]. Because spina bi da is a chronic condition, all affected infants require lifelong monitoring and management [4].…”

Birth prevalence and risk factors of neural tube defects in Ethiopia: a systematic review and meta-analysis

“…Ethiopia is one of the countries with a very high burden of stillbirth and neonatal mortality, with a rate of 24.6, and 33 occurrences per 1000 live births, respectively 12 13. In Ethiopia, the prevalence of NTDs ranges between 60 and 63 per 10 000 births, which is nearly two times higher than the estimated prevalence in East Africa 14 15. Furthermore, in Ethiopia, out of every 10 000 births, 104 result in death due to NTDs specifically craniorachischisis (it is a severe form of NTDs characterised by openings in both the brain and spinal cord) 16…”

Double Lumbar Localization of Myelomeningocele: Case Report

“…Spina bifida, also known as spinal dysraphia, is a congenital anomaly resulting from the neural tube’s failure to close during embryonic development. There is a general assumption that neural tube defects (NTDs) prevalence in Africa is comparatively higher than in developed countries, which is estimated to reach 3.33 events per 1,000 observations in Africa and 0.94 per 1,000 in Europe [1, 2]. Among the NTDs, spina bifida rate was the highest by an estimated 2.05 per 1,000 [1].…”

“…There is a general assumption that neural tube defects (NTDs) prevalence in Africa is comparatively higher than in developed countries, which is estimated to reach 3.33 events per 1,000 observations in Africa and 0.94 per 1,000 in Europe [1, 2]. Among the NTDs, spina bifida rate was the highest by an estimated 2.05 per 1,000 [1]. As Blencowe et al [3] more than 75% of children born with NTDs die before 5 years, while in Algeria 54.4% of the cases died in utero [4].…”