Folate Deficiency Is Spatially Dependent and Associated with Local Farming Systems among Women in Ethiopia

Abstract

Background Folate is essential for the synthesis and integrity of DNA, normal cell formation and body growth. Folate deficiency among women of reproductive age (WRA) increases the risk of poor birth outcomes including neural tube defect (NTD) affected pregnancies. Folate status is largely dependent on dietary intakes. Objectives To explore the spatial distribution of biomarkers of folate status and their association with farming systems among non-pregnant WRA in Ethiopia. Methods Serum and red blood cell (RBC) folate concentration data were derived from the Ethiopia National Micronutrient Survey of 2015. The spatial dependencies of folate concentration of WRA was investigated and its relationship with the dominant local farming system was explored. Results The median serum folate and RBC folate concentrations were 12.3 nmol L–1 and 567.3 nmol L–1, respectively. The national prevalence of folate deficiency using homocysteine concentration as metabolic indicator based on serum and RBC folate concentration was 11.6% and 5.7%, respectively. The majority of women (77.9%) had low RBC folate concentrations consistent with increased risk of NTD affected pregnancies. Folate nutrition was spatially dependent at distances of up to 300 km. A marked variability in folate concentration was observed between farming systems where greater RBC folate concentration (median 1,036 nmol L–1) was found among women from Lake Tana fish-based system while the lowest RBC folate concentration (median 386.7 nmol L–1) was observed in highlands or sorghum-chat mixed system. Conclusion The majority (78%) of WRA in Ethiopia had low folate status potentially increasing the risk of NTD affected pregnancies. These findings may help national and subnational nutrition intervention strategies to target the most affected areas in the country.

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

“…This variation may be explained by the fact that 78% of women within the reproductive age group had low RBC folate concentrations and the concentrations become much lower among pregnant women 107 108. Additionally, ecologically, the burden is disproportionately concentrated in the highland sorghum khat mixed farming system 109. In this context, the eastern parts of the county, including the Somali and Harari regions, are grouped under the aforementioned farming system, which may have contributed to a high burden of NTDs.…”

Neural Tube Defect in a Resource Limited Setting: Clinical Profile and Short Term Outcome

“…Ethiopia faces a high level of folate deficiency among women; 3 a recent study revealed that 78% of women of reproductive age in Ethiopia had low folate status. 4 WHO recommends that all women, from the moment they begin trying to conceive until 3 months of gestation, should receive folic acid supplementation. Moreover, a woman who has a fetus diagnosed with NTD or has given birth to a child with NTD should receive information on the risk of recurrence, be advised on the protective effect of periconceptional folate supplementation and be offered high-dose supplementation.…”

Micronutrients and socio-demographic factors were major predictors of anaemia among the Ethiopian population

“…Serum folate was assessed using a microbiologic assay. The methodology for preparation and analysis of serum samples for folate is described in detail elsewhere (Sisay et al (49) ).…”