Trend and burden of neural tube defects among cohort of pregnant women in Ethiopia: Where are we in the prevention and what is the way forward?

Abstract

Introduction Neural tube defect is one of the top five most serious birth defects in the world. In Ethiopia an accurate estimate of the trend and burden of neural tube defects is still unknown. There hasn’t been much research done on the prevalence and trend of neural tube defects in Eastern Ethiopia. To complement previous efforts of studies, the purpose of this study is to estimate the trend and burden of neural tube defects in Eastern Ethiopia as well as to investigate the epidemiological implications of the findings. Methods A facility-based retrospective cohort study was carried out from cohort pregnant women who delivered in selected hospitals. File records of all babies who were found to have neural tube defects could be reached between 2017 and 2019. A structured checklist was used to collect data. The incidence of each case was calculated by dividing the number of cases per year by the total number of live births in each hospital. To determine the linear trend of neural tube defects over time, linear trend of Extended Mantel-Haenszel chi-square was performed. Data were presented using frequencies and percentages. Data were analyzed using SPSS for windows version 25. Results A total of 48,750 deliveries were recorded during the three years of the study considered for analyses with 522 women having neural tube defect giving an incidence rate of 107.5 per 10,000 live births in the three years. The most common types of neural tube defects found in the area were anencephaly and spina bifida accounting for 48.1% and 22.6%, respectively. The distribution of neural tube defects varied across the study hospitals, with Adama Medical College Hospital having the highest proportion (46.6%). Over half of the mothers (56.7%) live in cities. Mothers in the age group 25–34 (46.9%) and multigravida mothers had higher proportions (64.4%).of neural tube defects. None of the mothers took folic acid before conception, and only 19% took iron folic acid supplementation during their pregnancy. Conclusion and recommendation The findings showed that an increasing trend and burden of neural tube defects and preconception folic acid supplementation is insignificant in the region which showed that where we are in the prevention of neural tube defects. The finding suggests that preconception folic acid supplementation in conjunction with health care services should be considered to reduce the risk of neural tube defects in the region. Aside from that, intensive prevention efforts for long-term folate intake through dietary diversification and appropriate public health interventions are required. Furthermore, data must be properly recorded in order to address disparities in neonatal death due to neural tube defects, and the determinants of neural tube defects should be investigated using large scale prospective studies with biomarkers.

Preconception of folic acid supplementation knowledge among Ethiopian women reproductive age group in areas with high burden of neural tube defects: a community based cross-sectional study

“…Ethiopia is one of the developing countries where the incidence of NTDs is highly prevalent ( 6 ) and where one-third of women were affected by folate deficiency ( 13 ) . It is important and crucial that WRA is having a knowledge of taking folic acid before pregnancy and during postpartum period for at least 4 weeks which helps protect against the occurrence of NTDs and other congenital abnormalities.…”

“…Therefore, the government must use folic acid-fortified foods in addition to educational programmes. This approach itself presents an important opportunity to reduce the risk of NTD in high-risk populations including in eastern Ethiopia ( 6 ) . Therefore, combining both approaches will help reduce risk and ensure that all pregnancies are protected to some level of protection.…”

“…However, the prevalence of NTD varies from region to region, ranging from 9 cases per 10 000 births in Europe to 21·9 cases in the Eastern Mediterranean region ( 5 ) . In Ethiopia, NTDs are a serious, preventable public health issue, and the burden of NTDs in the eastern part of Ethiopia was 105·7 per 10·000 which is the second highest rate in the country and the proportion of NTDs increased linearly year to year ( 6 ) , as women lack knowledge about preconception of folic acid. The countries such as United States, Canada, Costa Rica, South Africa, and Chile have effectively implemented food fortification with folic acid to reduce the risk of NTDs.…”

Effect of Picture-based health education and counselling on knowledge and adherence to preconception Iron-folic acid supplementation among women planning to be pregnant in Eastern Ethiopia: a randomized controlled trial

“…In Ethiopia, 84 % of women of reproductive age (WRA) had low levels of red blood cell folate (33,(36)(37)(38)(39) . Because of WRA with low serum folate levels, the incidence of NTDs in Ethiopia has increased alarmingly recording the highest rate and emerged as a major public health concern (40,41) , so there is an urgent need to develop an effective intervention programme to address the above-mentioned problem. Despite the fact that the Ethiopian healthcare system has a fertile ground for the provision of the IFAS to reduce the risk of NTDs, there is no preconception care services to women who discontinue modern contraception methods for planned pregnancy, and thus the golden opportunity for instituting key NTD preventative interventions is lost.…”

Red blood cell folate level and associated factors of folate insufficiency among pregnant women attending antenatal care during their first trimester of pregnancy in Addis Ababa, Ethiopia

“…21 The burden of NTD cases in Ethiopia is significantly higher than that in other sub-Saharan African countries. 22 The incidence of NTD cases in different regions of Ethiopia ranges from 131 to 25.7 per 10,000 births [23][24][25][26] Due to these reasons, the city's population is at a higher risk of folate deficiency that can lead to an increased occurrence of NTD. Unfortunately, no systematic study has been undertaken so far in Addis Ababa to understand whether folate deficiency is a public health problem in first-trimester pregnant women in causing NTD in the developing fetus.…”