Magnitude and determinants of neural tube defect in Africa: a systematic review and meta-analysis

Abstract

Background Neural tube defects (NTDs) are a group of disorders that arise from the failure of the neural tube close between 21 and 28 days after conception. About 90% of neural tube defects and 95% of death due to these defects occurs in low-income countries. Since these NTDs cause considerable morbidity and mortality, this study aimed to determine the prevalence and associated factors of NTDs in Africa. Methods The protocol of this study was registered in the International Prospective Register of Systematic Reviews (PROSPERO number: CRD42020149356). All major databases such as PubMed/MEDLINE, EMBASE, CINAHL, Web of Science, African Journals Online (AJOL), and Google Scholar search engine were systematically searched. A random-effect model was used to estimate the pooled prevalence of NTDs in Africa, and Cochran’s Q-statistics and I2 tests were used to assess heterogeneity between included studies. Publication bias was assessed using Begg ’s tests, and the association between determinant factors and NTDs was estimated using a random-effect model. Results Of the total 2679 articles, 37 articles fulfilled the inclusion criteria and were included in this systematic review and meta-analysis. The pooled prevalence of NTDs in Africa was 50.71 per 10,000 births (95% CI: 48.03, 53.44). Folic acid supplementation (AOR: 0.40; 95% CI: 0.19–0.85), maternal exposure to pesticide (AOR: 3.29; 95% CI: 1.04–10.39), mothers with a previous history of stillbirth (AOR: 3.35, 95% CI: 1.99–5.65) and maternal exposure to x-ray radiation (AOR 2.34; 95% CI: 1.27–4.31) were found to be determinants of NTDs. Conclusions The pooled prevalence of NTDs in Africa was found to be high. Maternal exposure to pesticides and x-ray radiation were significantly associated with NTDs. Folic acid supplementation before and within the first month of pregnancy was found to be a protective factor for NTDs.

Prevalence of neural tube defects among pregnant women in Addis Ababa: A community-based study using prenatal ultrasound examination

“…NTDs represent a substantial health burden in Ethiopia [8], [13], [14]. A systematic meta-analysis from different countries in Africa revealed a pooled birth prevalence of 21 per 10,000 births in Africa and suggested that Ethiopia was one of the countries with highest prevalence of NTD in Africa [15]. In contrast, a systematic review of data from 75 countries with different health system and economic developmental levels found a median prevalence of NTD at birth of 1.1 per 10,000 births [6].…”

Evaluation of neural tube defects from 2014 to 2019 in Turkey

“…In a meta-analysis study that included 19 studies from 1968 to 2013, the overall pooled prevalence of NTDs in India was 45.00 per 10,000 total births (95% CI 42.00, 49.00) [ 28 ]. In a recent study, which included a meta-analysis of 37 publications from the African region in 1990 and 2020, the prevalence of NTDs was reported as 50.71 (95% CI 48.03, 53.44) per 10,000 births [ 10 ].…”

“…), genetic predisposition, and environmental factors play a role in the etiology [ 2 , 7 – 9 ]. Geography, race, maternal obesity, antiepileptic drug use, pesticide exposure, smoking, indoor air pollution from predominantly biomass heating, x-ray radiation exposure, family history, and previous history of stillbirth have been reported to contribute to the development of NTDs [ 10 – 13 ]. Previous studies have shown that a significant proportion of NTDs can be prevented with pre-pregnancy folic acid supplementation (PFAS) [ 14 – 16 ].…”

A quest for genetic causes underlying signaling pathways associated with neural tube defects

“…Several studies demonstrated the negative medical side effects caused by an enhanced and indiscriminate use of pesticides ( 69 , 70 ). Several lines of evidence reported that pesticides contribute to significant developmental and reproductive disorders with carcinogenic and teratogenic capabilities ( 69 , 71 , 72 ). Several previous experimental and case reports indicated a connection between congenital disorders and pesticide exposure ( 69 – 71 , 73 , 74 ).…”