Integrated surveillance strategy to support the prevention of neural tube defects through food fortification with folic acid: the experience of Costa Rica

Benavides‐Lara, Adriana; Fernández-Sánchez, Oscar; Barboza-Argüello, María de la Paz; Alfaro-Calvo, Thelma; Martı́nez, Homero

doi:10.1007/s00381-023-05837-z

Cited by 6 publications

(1 citation statement)

References 32 publications

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“…These results are the consequence of a large food fortification program with folic acid implemented in the country since 1997 (corn and wheat flour), and the increase in food staples, such as milk in 2001 and rice in 2002 (Barboza‐Argüello et al, 2015). This program resulted in a decrease of more than 70% in NTD prevalence comparing pre and post‐fortification periods (Benavides‐Lara et al, 2023).…”

Section: Discussionmentioning

confidence: 99%

Population‐based prevalence and trend of birth defects in Costa Rica from 2000 to 2019

Benavides‐Lara,

Barboza‐Argüello

2023

Birth Defects Research

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BackgroundWe aimed to analyze the prevalence and trend of birth defects (BDs) in Costa Rica, where BDs are the second leading cause of infant and under‐five mortality.MethodsA descriptive analysis of selected BDs prevalence and trends from 2000 to 2019 was performed, based on data from the Costa Rican Birth Defects Register Center, the national BDs surveillance system with coverage of 98% of live births in the country. We used Joinpoint regression to identify any calendar year where a significant change in trend occurred; the annual percent change (APC) and the average annual percent change (AAPC) were determined. Marginal means and prevalence ratios by subperiod (2000–2009 as referent and 2010–2019) were estimated using Poisson regression, and compared using Wald's chi‐square tests (alpha ≤0.05).ResultsFrom 2000 to 2019, BDs occurred in 2.3% of live births (95% CI: 2.3–2.4); 73% of which were major BDs. Males presented a significantly higher prevalence (sex ratio 1.13 males/females). The trend showed an AAPC of +3.7 (p < .05) with two joinpoints, 2005 and 2013. A significant APC (+11.3) was observed during 2005–2013, within the context of improvements in the surveillance system, such as the increase in the reporting age, and the incorporation of other data sources in addition to maternity hospitals. Most of the BDs groups presented a significant upward trend. The highest AAPC was observed for the respiratory system (+11.7), congenital heart defects (+9.5), and nervous system (+8.5).ConclusionsThe BDs present a clear upward trend in the last two decades due, among other things, to a significant improvement in the surveillance system.

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Section: Discussionmentioning

confidence: 99%

Population‐based prevalence and trend of birth defects in Costa Rica from 2000 to 2019

Benavides‐Lara,

Barboza‐Argüello

2023

Birth Defects Research

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Orofacial clefts in Costa Rica, 1996–2021: Analysis of surveillance data

de la Paz Barboza‐Argüello,

Benavides‐Lara

2024

Birth Defects Research

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BackgroundOrofacial clefts (OFCs) are among the most common birth defects (BD). In 2008, a series of improvements began in the Costa Rican Birth Defect Register Center (CREC). We aim to explore trends between 1996 and 2021.MethodsA trend analysis of OFCs from 1996 to 2021 and a descriptive analysis of OFCs from 2010 to 2021 were performed based on data from the CREC, the national BD surveillance system. Prevalence at birth was calculated according to the type: cleft palate (CP), cleft lip with or without CP (CL ± P), and presentation (isolated, multiple non‐syndromic, or syndromes). We used joinpoint regression to identify if a significant change in trend occurred; the average annual percent change (AAPC) was determined. Marginal means and prevalence ratios by subperiod (1996–2009 as referent and 2010–2021) were estimated using Poisson regression and compared using Wald's chi‐square tests (α ≤.05).ResultsWe found a significant AAPC for OFCs prevalence of +1.4: +0.6 for isolated, +2.9 for multiple non‐syndromic, and +7.7 for syndromes (p < .05). When comparing the OFC's prevalence of the subperiod 2010–2021 (11.86 per 10,000) with 1996–2009 (9.36 per 10,000) the prevalence ratio was 1.3 (p < .01): 1.1 (p < .05) for isolated, 1.6 (p < .01) for multiple non‐syndromic, and 3.3 (p < .01) for syndromes. The prevalence of OFCs from 2010 to 2021 was 9.1 for CL ± P and 2.8 for CP. Seventy‐one percent of the OFCs were isolated, 22% multiple non‐syndromic, and 7% syndromes.ConclusionThe trend in OFCs' prevalence is toward increasing, mainly due to improvements in the surveillance system.

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