Magnitude of Neural Tube Defects and Associated Risk Factors at Three Teaching Hospitals in Addis Ababa, Ethiopia

There is scarcity of data on prevalence of neural tube defects (NTDs) in lower-income countries. Local data are important to understand the real burden of the problem and explore risk factors to design and implement preventive approaches. This study aimed to determine prevalence and risk factors of NTDs. A hospital-based cross-sectional and unmatched case-control study was conducted at three teaching hospitals of Addis Ababa University. NTDs were defined as cases of anencephaly, spina bifida, and encephalocele based on ICD-10 criteria. The prevalence of NTDs was calculated per 10,000 births for both birth and total prevalence. During seven months, we observed 55 cases of NTDs out of 8677 births after 28 weeks of gestation—birth prevalence of 63.4 per 10,000 births (95% confidence interval (CI), 51–77). A total of 115 cases were medically terminated after 12 weeks of gestation. Fifty-six of these terminations (48.7%) were due to NTDs. Thus, total prevalence of NTDs after 12 weeks’ gestation is 126 per 10,000 births (95% CI, 100–150). Planned pregnancy (adjusted odds ratio (aOR), 0.47; 95% CI, 0.24–0.92), male sex (aOR, 0.56; 95% CI, 0.33–0.94), normal or underweight body mass index (aOR, 0.49; 95%, 0.29–0.95), and taking folic acid or multivitamins during first trimester (aOR, 0.47; 95%, 0.23–0.95) were protective of NTDs. However, annual cash family income less than $1,300 USD (aOR, 2.5; 95%, 1.2–5.5), $1,300–1,800 USD (aOR, 2.8; 95%, 1.3–5.8), and $1,801–2,700 USD (aOR, 2.6; 95%, 1.2–5.8) was found to be risk factors compared to income greater than $2,700 USD. The prevalence of NTDs was found to be high in this setting. Comprehensive preventive strategies focused on identified risk factors should be urgently established. More studies on prevention strategies, including folic acid supplementations, should be conducted in the setting.

Download Full-text

Incidence and risk factors for neural tube defects in a Bosnian population

Journal of Health Sciences ◽

10.17532/jhsci.2021.1167 ◽

2021 ◽

Author(s):

Elmedina Mrkulić ◽

Emina Vukas ◽

Hajrija Maksić ◽

Meliha Sakić ◽

Jasmina Mahmutović ◽

...

Keyword(s):

Risk Factors ◽

Folic Acid ◽

Bosnia And Herzegovina ◽

Neural Tube ◽

Neural Tube Defects ◽

Experimental Studies ◽

Neural Tube Closure ◽

Reproductive Age ◽

Cross Sectional ◽

Live Births

Introduction: Neural tube defects (NTDs) are multifactorial congenital anomalies of the central nervous system that results from failed neural tube closure between the 3rd and 4th weeks of embryonic development. Numerous clinical and experimental studies indicate that supplementation with folic acid before and during early pregnancy reduces the development of these anomalies. The present study examined the incidence and risk factors for NTDs and evaluated the effects of folic acid supplementation.Methods: This cross-sectional study included all children with NTDs who were hospitalized at the Pediatric Clinic, Clinical Centre University of Sarajevo during the period from January 01, 2008 to December 31, 2012. Data were collected retrospectively from the medical histories of hospitalized children. The study included children in pediatric clinics from four cantons (Sarajevo, Zenica–Doboj, Unsko–Sanski, and Central Bosnia) of the Federation of Bosnia and Herzegovina. The number of live births for the specified period in each of the four cantons was taken from a report by the Cantonal Ministry of Health.Results: Among the 69,096 live births recorded during the study period, 39 children had verified NTDs, with an overall incidence of 0.56:1,000 (or 5.6:10,000) in all four cantons. The most common NTDs were myelomeningocele with hydrocephalus (22/39, 56.4%), followed by isolated myelomeningocele (9/39, 23.1%), spina bifida occulta (7/39, 17.9%), and occipitocele (1/39, 2.6%). A total of 33.3% (13/39) of mothers took folic acid, but only one began supplementation prior to pregnancy, while 67.7% (26/39) of mothers did not take folic acid during pregnancy. NTDs were found more frequently in primiparas (53.8%), women with low education (basic school, 64.1%), and unemployed women (82.1%).Conclusion: It is important to make national recommendations for folic acid supplementation for women of reproductive age, but also change the public health policy that includes mandatory fortification of basic foods as this is the best measure for primary prevention of NTDs in the whole population regardless of employment and education status. Additional comprehensive studies are required to assess the incidence and risk factors throughout Bosnia and Herzegovina.

Download Full-text

Knowledge and intake of folic acid to prevent neural tube defects among pregnant women in urban China: a cross-sectional study

BMC Pregnancy and Childbirth ◽

10.1186/s12884-021-03893-4 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Mingming Cui ◽

Xiao-Lin Lu ◽

Yan-Yu Lyu ◽

Fang Wang ◽

Xiao-Lu Xie ◽

...

Keyword(s):

Folic Acid ◽

Pregnant Women ◽

Neural Tube ◽

Neural Tube Defects ◽

Rural Women ◽

Rural Areas ◽

Urban Areas ◽

Unplanned Pregnancy ◽

Urban China ◽

Cross Sectional

Abstract Background The prevalence of neural tube defects (NTDs) in China declined during 2000–2017 with periconceptional folic acid (FA) supplementation, which is effective in reducing the risk of birth defects. We aimed to assess the knowledge and actual use of FA among Chinese pregnant women and to explore factors associated with FA use before pregnancy. Methods All data were collected in face-to-face interviews during health visits among pregnant women. We collected information about knowledge and use of FA supplements and demographic, socioeconomic, and health status. One maternity and childcare hospital was chosen in each of four cities: Beijing, Huaibei, Kunming, and Haikou. In total, 435 pregnant women were randomly recruited for interviews conducted from June to December 2016. Results A total of 428 pregnant women were included in this survey. Of these, 82.0% (351/428) knew that FA can prevent NTDs, and 75.9% (325/428) knew the correct time to take FA. Overall, 65.9% (282/428) of women knew both that FA can prevent NTDs and the recommended time to take FA before pregnancy. Approximately 95.1% (407/428) of women reported having ever taken FA, only 46.3% (198/428) had begun to take FA supplementation before conception, and 64.5% (109/169) of women from rural areas failed to take FA before pregnancy. Women living in northern China (odds ratio [OR] = 1.81, 95% confidence interval [CI], 1.18–2.77), those with unplanned pregnancy (OR = 1.99, 95% CI 1.30–3.04), and highly educated women (OR = 2.37, 95% CI 1.45–3.88) were more likely to know about FA. Women who were homemakers (OR = 1.94, 95% CI 1.21–3.11) and had unplanned pregnancy (OR = 6.18, 95% CI 4.01–9.53) were less likely to begin taking FA before pregnancy. Conclusions Our survey showed that most pregnant women knew about FA. Although preconception intake of FA can help to reduce NTDs, improving the rate of FA intake before pregnancy is needed in urban areas of China, especially among homemakers and women from rural areas or with unplanned pregnancy. Campaigns are needed to increase awareness about FA and FA use before pregnancy among rural women, homemakers, and those with unplanned pregnancy and lower education levels.

Download Full-text

Folic acid awareness and intake among women in areas with high prevalence of neural tube defects in China: a cross-sectional study

Public Health Nutrition ◽

10.1017/s1368980011000097 ◽

2011 ◽

Vol 14 (7) ◽

pp. 1142-1147 ◽

Cited By ~ 12

Author(s):

Ziqian Zeng ◽

Ping Yuan ◽

Yanping Wang ◽

Xi Ma ◽

Jun Zhu

Keyword(s):

Folic Acid ◽

Neural Tube ◽

Neural Tube Defects ◽

Low Income ◽

Reproductive Age ◽

Intake Rate ◽

Childbearing Age ◽

Cross Sectional Survey ◽

Cross Sectional ◽

High Prevalence

AbstractObjectiveTo measure folic acid awareness and intake rates among women of childbearing age in certain areas of China with a high prevalence of neural tube defects (NTD).DesignA cross-sectional survey was carried out utilising a nineteen-item questionnaire enquiring into individual women's knowledge of, attitude towards and practice of folic acid supplementation.SettingA total of 293 low-income counties in six provinces of China.SubjectsWomen aged 19–44 years from six provinces with a high prevalence of NTD recruited from June to August 2008.ResultsAmong 33 025 participants, 57 % had heard of folic acid but only 15 % knew all of the core information. The intake rate was 12 %; only 8 % took the recommended dose and only 4 % of non-pregnant women took folic acid. Some women did not take folic acid because they did not know that they should take it (49 %) or they had misconceptions about it (24 %). According to logistic regression analysis, rural residence was a risk factor for folic acid awareness. Ethnicity, educational level, average annual income per person and pregnancy were the influencing factors of folic acid awareness and folic acid intake.ConclusionsAlthough more than half of the respondents had heard of folic acid, the intake rate was still very low in areas with a high prevalence of NTD. Thus, more efforts are needed to increase folic acid awareness and intake among women of reproductive age in these areas.

Download Full-text

Level of folic acid awareness for the prevention of neural tube defects and associated factors among pregnant women in Adama, South East Ethiopia

10.21203/rs.2.13117/v1 ◽

2019 ◽

Author(s):

MESELECH AMBAW DESSIE ◽

Ayanaw Worku Berihun

Keyword(s):

Folic Acid ◽

Pregnant Women ◽

Neural Tube ◽

Neural Tube Defects ◽

Congenital Anomalies ◽

Associated Factors ◽

Healthcare Providers ◽

P Value ◽

Antenatal Visit ◽

Cross Sectional

Abstract Abstract Background: Neural tube defects are congenital anomalies of the brain, spinal cord, and their surrounding structures. Folic acid intake before and during the early weeks of pregnancy could reduce neural tube and other birth defects. Folic acid usage in the protective period of pregnancy against the neural tube defects is related to high level of awareness. This study aimed at evaluating the level of folic acid awareness for the prevention of neural tube defects and associated factors among pregnant women in Adama, South East Ethiopia. Method: A descriptive cross-sectional study design was used. 398 consented pregnant women attending antenatal care in Adama were the participants of the study. The women were selected by using a systematic random sampling method. A structured pre-tested interviewer-administered questionnaire was used to collect the data. The questionnaire was concerned with participants’ demographic information, and their awareness about folic acid, roles of folic acid, and the recommended time of intake. Data were analyzed using SPSS version 20 statical software. Simple and multiple binary logistic regression analyses were conducted. 95% confidence interval and p-value were used to evaluate the association between dependent and independent variables. Results: Of the interviewed women, 20.9% reported having heard or read something about folic acid supplements. But only 1.01% and 6.03% were aware of the recommended time of intake and the role of folic acid in preventing neural tube defects and other congenital anomalies respectively. The healthcare providers were the primary source of information about folic acid, which account 78.3%. Folic acid awareness was associated with age, educational status, household monthly income, week of pregnancy at the first antenatal visit, any complication during current pregnancy, and use of folic acid during current pregnancy. Conclusions: Most of the pregnant women were not aware of folic acid, its importance and the recommended time of intake for preventing neural tube defects. Further effort is required from policymakers, healthcare providers, the media, and community to increase women's awareness about folic acid. Keywords: Folic acid, Awareness, Neural tube defects

Download Full-text

Folic acid usage and associated factors in the prevention of neural tube defects among pregnant women in Ethiopia: cross-sectional study

BMC Pregnancy and Childbirth ◽

10.1186/s12884-017-1506-2 ◽

2017 ◽

Vol 17 (1) ◽

Cited By ~ 9

Author(s):

Meselech Ambaw Dessie ◽

Ejigu Gebeye Zeleke ◽

Shimelash Bitew Workie ◽

Ayanaw Worku Berihun

Keyword(s):

Folic Acid ◽

Pregnant Women ◽

Neural Tube ◽

Neural Tube Defects ◽

Associated Factors ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional

Download Full-text

Occurrence of spina bifida in the Makerere University Galloway collection: an osteological anatomical study

Anatomy Journal of Africa ◽

10.4314/aja.v6i2.160477 ◽

1970 ◽

Vol 6 (2) ◽

pp. 952-956

Author(s):

Buwembo William ◽

Apolot Priscilla Obore ◽

Samuel Ziraba ◽

Mesarch Kange ◽

Ian Guyton Munabi ◽

...

Keyword(s):

Folic Acid ◽

Spina Bifida ◽

Neural Tube ◽

Neural Tube Defects ◽

Anatomical Study ◽

Nutrient Status ◽

Cross Sectional Study ◽

Historical Study ◽

Food Fortification ◽

Cross Sectional

Spina bifida is one of the commonest neural tube defects. Though food fortification with folic acid has been reported to reduce spina bifida, the incidence of spina bifida and the benefits of taking folic acid have not been documented in many developing countries including Uganda. This study set out to determine the incidence of spina bifida and related skeletal neural tube defects in the skeletons currently housed in the Galloway skeletal collection at Makererere University College of Health Sciences, Anatomy department with the aim of using the data to extrapolate on the usefulness of food fortification with folic acid. This was a descriptive cross sectional study on 226 skeletons in the Galloway osteological collection examined by an experienced anatomist for features of neural tube defects that ranged from non-fusion of the spinal arches to total absence of vertebral structures. Of the skeletons examined 43/226 (19%) had spina bifida. Of these 38/43 (88%) were male, suggesting a higher incidence of spina bifida in males than in the females. Overall 55.2% of the skeletons were within the age range of 20-55 years. This historical study highlights possible differences in the maternal micro nutrient status in the early months of pregnancy for various African populations as shown by the differences in the prevalence rates of minor spina bifida defects in the Galloway osteological collection. There is need for baseline studies on folic acid levels during pregnancy and the various local dietary sources of folic acid for Africans.Key words: Neural tube defects, osteology

Download Full-text

Level of Awareness and Knowledge of Folic Acid Intake among Women in the Reproductive Age in ARAR Region, Saudi Arabia

Journal of Pharmaceutical Research International ◽

10.9734/jpri/2021/v33i58a34118 ◽

2021 ◽

pp. 287-297

Author(s):

Abdulrahman Mazki Alanazi ◽

Abdullah Juayf Alanazi ◽

Yasir Wadi Alanazi ◽

Muhammad Sari Alanazi ◽

Ghada Rezk ◽

...

Keyword(s):

Saudi Arabia ◽

Folic Acid ◽

Neural Tube ◽

Neural Tube Defects ◽

Statistical Tests ◽

Folic Acid Supplementation ◽

Reproductive Age ◽

Online Questionnaire ◽

Cross Sectional ◽

Acid Supplementation

Background: Folic acid reduces the risk of neural tube defects. As approximately 50% of pregnancies are unintended, women of reproductive age should be aware of the importance of folic acid. This study aims to assess the level of awareness and knowledge among childbearing female on the importance of preconception folic acid supplementation in preventing neural tube defects (NTDs) in Arar city. Methodology: A population-based cross-sectional study was conducted in Arar city, Norther Saudi Arabia on included Saudi women in reproductive age. A pre-designed online questionnaire was used for data collection. Data was entered and analyzed using statistical package for Social Sciences Program, version 20 (SPSS Inc., Chicago, Illinois, USA). The results were displayed as counts, percentages. Appropriate statistical tests will be used for comparisons. P ≤ 0.05 is considered significant. Results: The sample consisted of 428 women in reproductive age, 60.1% aged between 30 to 40 years, 39% aged between 20 to 30 years and only 0.9% aged between 18 to 20 years old. 91.8% were married. 85% of participants reported that their doctor prescribed folic pills for them before. 95.1% think that women should take folic acid pills in pregnancy while 75.2% think that it is necessary to take folic pills pre-pregnancy. 85.3% had taken folic acid pills in previous pregnancy. 31.3% think that it should be stopped after pregnancy. 84.6% think that folate deficiency causes fetal abnormalities. Only 8.4% of studied women reported attending seminar or lecture on folic acid importance. Conclusion: The results of the current study affirmed good knowledge of folic acid supplementation usage during pregnancy among women in Arar, KSA. There was a significant association between knowledge of folic acid taking importance during pregnancy with marital status, number of children, and educational level of participants.

Download Full-text

Folic Acid for the Prevention of Fetal Neural Tube Defects

Africa Journal of Nursing and Midwifery ◽

10.25159/2520-5293/4363 ◽

2019 ◽

Vol 21 (1) ◽

Author(s):

Aremu Olayinka Olaitan ◽

Oladejo Oluwatobiloba Rukayat ◽

Olowokere Adekemi Eunice ◽

Olajubu Aanuoluwapo Omobolanle

Keyword(s):

Folic Acid ◽

Neural Tube ◽

Neural Tube Defects ◽

Demographic Factors ◽

P Value ◽

Women Of Childbearing Age ◽

Childbearing Age ◽

Cross Sectional ◽

Actual Use ◽

Socio Demographic Factors

The use of folic acid supplements before and during the first three months of pregnancy significantly reduces the risk of fetal neural tube defects (NTDs). This study assessed knowledge and factors that influence the use of folic acid, the actual use of folic acid and its relationship with socio-demographic factors among women of childbearing age in the Ife Central Local Government, Ile-Ife, Osun State, Nigeria. A cross-sectional descriptive design was adopted to select 400 women of childbearing age who participated in the study using a self-structured questionnaire. Results from this study showed that 39.8 per cent of the study participants had good knowledge about the benefits of folic acid, 64.6 per cent of the participants reported to have used folic acid at one time in their lives, while 55.5 per cent of them reported not to have taken folic acid before their pregnancy. This study also revealed a significant association between the respondents’ socio-demographic factors and the use of folic acid with a p-value of .000 (p-value < 0.05). The study concluded that knowledge about the use of folic acid for the prevention of NTDs among women of childbearing age is not adequate and that very few of them used folic acid at the appropriate time.

Download Full-text

Neural tube defects: how many cases could have been prevented in Portugal?

European Journal of Public Health ◽

10.1093/eurpub/ckaa166.964 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

P Braz ◽

A Machado ◽

I Kislaya ◽

C M Dias

Keyword(s):

Folic Acid ◽

Primary Prevention ◽

Neural Tube ◽

Neural Tube Defects ◽

Temporal Evolution ◽

Cross Sectional Study ◽

National Registry ◽

Cross Sectional ◽

Foetal Life ◽

Using Data

Abstract Neural tube defects (NTD) occurs when the neural tube does not close properly until the 28th day of foetal life. About 70% of NTD can be prevent if women start folic acid (FA) before pregnancy and until the end of 1st trimester. Portugal has this primary prevention since 1998, however the secondary prevention of NTD with TOPFA is still high (80%). The aim of this study is to describe when FA intake was started and estimate the number of cases that would have be prevented if FA intake started before pregnancy as recommended. A cross-sectional study using data from the National Registry of Congenital Anomalies between 2004-2017 was performed. The temporal evolution of the beginning of FA intake was analysed with Cochran-Armitage test for proportions. The proportion of preventable cases was estimated considering the 70% prevention fraction and the number of NTD cases registered in RENAC that occurred in pregnancies without the recommended FA supplementation. On average, 13.8% of all women started FA before pregnancy, 46.2% during 1st trimester and 6.1% did not take folic acid. A statistically significant trend (p < 0.001) was observed in the group that started before pregnancy with increase from 6.8% in 2004 to 17.9% in 2017. The prevalence of NTD was 4.2 cases / 10,000 births, ranging from 2 cases / 10,000 births (2007) to 7 cases / 10,000 births (2014). Between women who had a pregnancy with NTD, 16.8% started FA before pregnancy, 42.2% in the 1st trimester and 9.7% did not take the supplement. If all women had started FA before pregnancy, an estimated 202 NTD cases could have been prevented. In Portugal, the proportion of women who adhere to this measure is very low, similarly to other European countries, compromising the primary prevention of NTD. Perhaps due to the high percentage of TOPFA, the idea that this anomalies continue to affect our children has been lost. Primary prevention of NTDs should be encouraged with measures that promote FA supplementation. Key messages Primary prevention of NTD is possible. Proportion of women who adhere to primary prevention is low.

Download Full-text