scholarly journals Prevalence of Goiter Among School-Aged Children in Ethiopia: Update of Systematic Review and Meta-analysis

2021 ◽  
Vol 10 ◽  
pp. 216495612098866
Author(s):  
Yohannes Tekalegn ◽  
Kebebe Bekele ◽  
Biniyam Sahiledengle ◽  
Demelash Woldeyohannes
Keyword(s):  
Systematic Review ◽  
Iodine Deficiency ◽  
Meta Analysis ◽  
Random Effect ◽  
Health Concern ◽  
School Age Children ◽  
Forest Plot ◽  
School Age ◽  
Analysis Model ◽  
Pooled Prevalence

Background Iodine deficiency is a major public health concern throughout the world. Goiter is the most visible sign of iodine deficiency. In Ethiopia, a study finding regarding the prevalence of goiter among school-age children is inconsistent and highly variable. Objectives To estimate the pooled prevalence of goiter among school-age children in Ethiopia. Methods Three international databases (MEDLINE/Pub-Med, Google Scholar and Science Direct) were systematically searched. Besides, the reference sections of identified articles were searched to increase the chance of detecting missed articles in gray literature. STATA Version 14 statistical software was used to conduct a meta-analysis. The pooled prevalence with a 95% confidence interval was displayed using the forest plot. A random-effect meta-analysis model was used to compute the pooled prevalence, and The Cochrane Q test statistics and I2 test were used to assess the heterogeneity of the studies. Results A total of 14 studies fulfilled the inclusion criteria and included in this systematic review and Meta-analysis, with a total sample size of 26,282. The finding of this systematic review revealed that the pooled prevalence of goiter among school-age children was 42.9% (95% CI: 38.8–46.9). The highest prevalence of goiter (46.7%) was observed in Oromia region and the lowest (26.3%) was observed in Benishangul-Gumuz region. Conclusions This review finding revealed that more than two in five of the school children in Ethiopia suffer from iodine deficiency disorder as manifested by the goiter rate.

scholarly journals Undernutrition and its determinants among Ethiopian adolescent girls: a protocol for systematic review and meta-analysis

BMJ Open ◽  
2019 ◽  
Vol 9 (5) ◽  
pp. e026718 ◽  
Author(s):  
Wubet Worku Takele ◽  
Achenef Asmamaw Muche ◽  
Zeleke Abebaw Mekonnen ◽  
Yehualashet Fikadu Ambaw ◽  
Fasil Wagnew
Keyword(s):  
Systematic Review ◽  
Adolescent Girls ◽  
Meta Analysis ◽  
Health Concern ◽  
Forest Plot ◽  
P Value ◽  
Pooled Prevalence ◽  
Registration Number ◽  
Trim And Fill ◽  
Meta Analyses

IntroductionIn Ethiopia, undernutrition is the common public health concern, swaying the lives of lots of adolescent girls. Its sequelae are not only limited to them, but rather their upcoming offspring are vulnerable too. Even though some studies have been carried out in different parts of the country, the national pooled prevalence and determinants of undernutrition are not known. Therefore, this study is aimed at determining the pooled prevalence and determinants of undernutrition among adolescent girls in Ethiopia.MethodsPublished articles will be retrieved from databases such as Medline and PubMed. Electronic search engines such as Google Scholar and Google will be used. To identify eligible studies, the Joanna Briggs Institute quality appraisal checklists prepared for different study designs will be used. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist will be used to maintain the scientific robustness of the study. The presence of heterogeneity among studies will be examined by forest plot as well as I2heterogeneity test. Potential causes of heterogeneity will be explored by carrying out sensitivity and subgroup analyses. The DerSimonian and Laird random-effects model will be used provided that heterogeneity is observed. Publication bias will be examined by observing funnel plots, and objectively by Egger’s regression test. If the funnel plot is asymmetric and/or Egger’s test was found to be statistically significant (p<0.05), the trim and fill (Duval and Tweedie’s) analysis will be performed. The presence of a statistical association between independent and dependent variables will be declared if the p value is <0.05 with the 95% CI.Ethics and disseminationSince this is a systematic review and meta-analysis, ethical clearance will not be a concern. The results of the study will be published in a peer-reviewed reputable journal and presented at different scientific research conferences.Trial registration numberCRD42018106180.

scholarly journals Epidemiology of intestinal parasitic infections in Ethiopian children: A systematic review and meta-analysis

2020 ◽  
Author(s):  
Legese Chelkeba ◽  
Zeleke Mekonnen ◽  
Yonas Alemu ◽  
Daniel Emana
Keyword(s):  
Systematic Review ◽  
Geographical Distribution ◽  
Intestinal Parasites ◽  
Meta Analysis ◽  
School Age Children ◽  
Parasitic Infections ◽  
School Age ◽  
Pooled Prevalence ◽  
Parasite Infections ◽  
Risk Areas

Abstract Background : Numerous studies have been carried out on assessing the prevalence of intestinal parasites infections (IPIs) among preschool and school-age children in Ethiopia, but there is lack of study systematically gathered and analyzedinformation for policymakers. Therefore, the aim of this systematic review and meta-analysis was to provide a summary on prevalence, geographical distribution and trends of IPIs among preschool and school-age childrenin Ethiopia. Methods :The search were carried out in Medline via PubMed, Scopus, Science Direct, Web of Science, and Google Scholar from 1996to July2019 for studies describing prevalence of IPIs among preschooland school-age children. We conducted meta-regression to understand the trends and the source of heterogeneity and pooled the prevalence using ‘metaprop’ command using STATA software version 14. Results : Eighty-three(83) studies examining 56,786 fecal specimens were included. The prevalence of IPIs was 48 %( 95%CI: 42% to 53%) and showedsignificantly decreasing trends 17% (95% CI: 2.5% to 32%) for each consecutive 6 years) and was similar in males and females. The pooled prevalence in years 1997–2002, 2003–2008, 2009–2014 and >2014 was 71% (95% CI: 57% to 86%), 42% (95% CI: 27% to 56%), 48% (95% CI: 40% to 56%) and 42% (95% CI: 34% to 49%), respectively. Poly-parasitism was observed in 16% (95% CI: 13% to 19 %,) of the cases. Conclusion: Intestinal parasite infections are highly prevalent among preschool and school-age children and well distributed across the regional states of Ethiopia. Southern and Amhara regional states carry the highest burden.We observed significant decreasing trends in prevalence of IPIs among preschool and school-age Ethiopian children over the last two decades.Therefore, this study is important to locate the geographical distribution and identified high risk areas that should be prioritized further interventions, which complement global efforts towards elimination of IPIs infections by 2020

scholarly journals Prevalence of anencephaly in Africa: a systematic review and meta-analysis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Mohammed Oumer ◽  
Anteneh Ayelign Kibret ◽  
Amanuel Girma ◽  
Ashenafi Tazebew ◽  
Mezgebu Silamsaw
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Random Effect ◽  
Fetal Loss ◽  
Control Measures ◽  
Cochrane Library ◽  
Forest Plot ◽  
Analysis Model ◽  
Birth Prevalence ◽  
Folic Acid Fortification

AbstractAnencephaly is a severe anomaly of the brain that results from the failure of the cephalic part of the neural tube to close during the fourth week. It occurs at least in one per thousand births and is the major cause of fetal loss and disabilities in newborns. The objective of this review is to determine the birth prevalence of anencephaly in Africa. We identified relevant studies via a search of databases like PubMed Central, PubMed/Medline, Science Direct, Joanna Briggs Institute, African Journals Online, Embase, Google Scholar, Web of Science, and Cochrane Library. After examining the heterogeneity of studies via the Cochran Q test and I2 test (and Forest plot for visual inspection), the prevalence of anencephaly was estimated using the random-effect meta-analysis model. Consequently, we carried out subgroup, sensitivity, meta-regression, trim and fill, time-trend, and meta-cumulative analyses. In this systematic review and meta-analysis, the twenty-four studies reported a total of 4,963,266 births. The pooled birth prevalence of anencephaly in Africa was 0.14% (95% CI: 0.12, 0.15%). Higher burden of anencephaly was detected in Ethiopia (0.37%, CI: 0.15, 0.58%), Algeria (0.24%, CI: 0.24, 0.25%), and Eritrea (0.19%, CI: 0.19, 0.19%). The higher pooled prevalence of anencephaly was observed in the studies that included both live births and stillbirths (0.16%) and in studies done after the year 2010 (0.25%) whereas, the lower burden was detected among countries that had a mandatory folic acid fortification (0.05%). High birth prevalence of anencephaly was detected in Africa. Strong prevention and control measures should be the priority because of an increment in the magnitude of anencephaly. Helping in prevention programs, which should be the ultimate contribution of this study to the field.

Prevalence of Soil-transmitted Helminth Infections Among School-age Children in Ethiopia: a Systematic Review and Meta-analysis

2021 ◽  
Author(s):  
Muluken Azage ◽  
Achenef Motbainor ◽  
Genet Gedamu ◽  
Wendemagegne Enbiale
Keyword(s):  
Systematic Review ◽  
Control Strategies ◽  
Data Extraction ◽  
Meta Analysis ◽  
Control Measures ◽  
School Age Children ◽  
Cochrane Library ◽  
School Age ◽  
Preventive Chemotherapy ◽  
Pooled Prevalence

Abstract Background: In Ethiopia, soil-transmitted helminthiasis (STHs) infections remain the leading cause of morbidity among school-age children despite the progress in the implementation of control measures. Study findings regarding prevalence of STH among school-age children have been inconsistent and pooled prevalence of STH infections did not account double or triple infections of STH. Therefore, this systematic review and meta-analysis estimates the pooled prevalence of STH by accounting double or triple infections among school-age children in Ethiopia.Methods: Databases and search engines such as PubMed, Web of Science, EMBASE, CINAHL, Google Scholar, Science Direct, and the Cochrane Library were systematically searched. Based on the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was employed to determine the prevalence of STH infections among school-age children. Published articles in the period between 1980 and 2020 were included in the analysis. Three authors independently extracted all data using a data extraction format sheet. STATA Version 16 statistical software was used for analysis. The Cochran’s Q-test was used to evaluate the heterogeneity of the studies and a random-effects model was done to determine pooled prevalence estimate.Results: The overall pooled estimate of STHs was 33% (95% CI:26-39%). The prevalence did not show statistically differ between before, 32.0% (95% CI:25-39%) and after, 33% (95% CI:26-39%) National NTDs control and elimination programme. The pooled prevalence of ascariasis before and after the implementation of NTDs programme was found to be 18% (12.0%, 24%) and 18% (9.0%, 27.0%), respectively with a total pooled estimate of 18.0% (13.0%, 23.0%). The prevalence of trichuris trichuria was also found to be 8.0% (4.0%, 12.0%) before the programme and 15.0% (4%, 26%) after the programme with a total pooled estimate of 10.0% (5.0%, 14.0%). The prevalence of hookworm was 14.0% (9.0%, 19.0%) before the programme and 9.0% (3.0%, 14.0%) after the programme with a total pooled estimate of 12% (8.0%, 17.0%). Conclusion: The overall polled prevalence of STHs in Ethiopia was found at moderate level based on the WHO classification. The recommended control strategies for STHs infections in school-age children at this level of prevalence such as providing preventive chemotherapy or treat all school-age children (enrolled and non-enrolled) once a year, improving sanitation and water supply and providing health education should be strengthen to mee the target of the national and WHO plan.

scholarly journals Prevalence of Spina Bifida among Newborns in Africa: A Systematic Review and Meta-Analysis

Scientifica ◽  
2020 ◽  
Vol 2020 ◽  
pp. 1-12
Author(s):  
Mohammed Oumer ◽  
Molla Taye ◽  
Hailu Aragie ◽  
Ashenafi Tazebew
Keyword(s):  
Systematic Review ◽  
Spina Bifida ◽  
Meta Analysis ◽  
Random Effect ◽  
Random Effect Model ◽  
Fetal Loss ◽  
Cochrane Library ◽  
Forest Plot ◽  
Birth Prevalence ◽  
Pooled Prevalence

Spina bifida is an abnormal closure of the neural tube during the fourth week of development. It is the major cause of fetal loss and considerable disabilities in newborns. The aim of this review is to determine the pooled prevalence of spina bifida among newborns in Africa. PubMed/Medline, Google Scholar, Science Direct, Joanna Briggs Institute (JBI) Library, Cochrane Library, Web of Science, African Journals Online, and Embase databases were systematically searched. Cochran Q test and I2 test statistics were applied to assess heterogeneity across studies. A random-effect model was applied to calculate the pooled prevalence of spina bifida. Forest plot and Galbraith’s plot were used to visualize heterogeneity. Subgroup, sensitivity, meta-regression, and meta-cumulative analyses were performed. All essential data were extracted using a standardized data extraction format, and the JBI quality appraisal checklist was used to assess the quality of studies. Egger’s test and Begg’s test were used in order to detect the publication bias. In the present systematic review and meta-analysis, 6,587,298 births in twenty-seven studies were included. The pooled birth prevalence of spina bifida in Africa was 0.13% with a range between 0.12% and 0.14%. In Africa, the highest burden of spina bifida was detected in Algeria (0.43%), Ethiopia (0.32%), Tanzania (0.26%), Cameron (0.12%), Egypt (0.10%), and South Africa (0.10%). The lowest burden of spina bifida was detected in Libya (0.006%) and Tunisia (0.009%). The high birth prevalence of spina bifida was detected in Africa. There was a significant variation in the prevalence of spina bifida among study countries in Africa. The authors recommend that special awareness creation with the help of health education intervention should be provided for mothers to focus on prevention in order to reduce the burden of spina bifida.

scholarly journals Prevalence of Microorganisms of Public Health Significance in Ready-to-Eat Foods Sold in Developing Countries: Systematic Review and Meta-Analysis

2020 ◽  
Vol 2020 ◽  
pp. 1-9
Author(s):  
Dechasa Adare Mengistu ◽  
Sina Temesgen Tolera
Keyword(s):  
Public Health ◽  
Systematic Review ◽  
Meta Analysis ◽  
Health Concern ◽  
Forest Plot ◽  
Potential Health ◽  
E Coli ◽  
Public Health Significance ◽  
Pooled Prevalence ◽  
Health Significance

Background. The issue of microbial quality and safety of ready-to-eat foods has become a public health concern that needs to be addressed to protect the consumer’s health. Contamination of ready-to-eat foods by enteric pathogens such as Escherichia coli, Salmonella, and Staphylococcus aureus bacteria is associated with potential health risks and can cause foodborne outbreaks. Thus, the systematic review and meta-analysis aimed at determining the overall evidence on the prevalence of microorganisms of public health significance in ready-to-eat foods based on previous studies. Methods. The articles published from 2015 to 2020 were searched from multiple electronic databases such as PubMed, Google Scholar, MEDLINE, CINAHL, Science Direct, Web of Science, and the Directory of Open Access Journals. The JBI critical appraisal tool was applied to the included articles. To determine the heterogeneity among the included articles, I 2 statistics were used while publication bias was evaluated using the visual funnel plot. A Forest plot using the random effect model for meta-analysis was used to estimate the pooled prevalence of E. coli, Salmonella, and S. aureus in ready to eat foods. Results. The pooled prevalence of E. coli, Salmonella, and S. aureus in ready to eat foods was 33.8% (95% CI: 19.9, 51.2; Q   value = 67.080 , I 2 = 89.56 % ), 26.0% (95% CI: 13.8, 43.6%; Q   value = 83.67 , I 2 = 91.63 % ), and 46.3% (95% CI: 24.8, 69.4%, I 2 = 94.9 % ), respectively. Conclusion. The findings show that contamination of ready-to-eat foods with pathogenic microorganisms continues to be a public health risk. Thus, effective food hygiene and safety systems are necessary to protect the health of the consumers and the public as a whole.

scholarly journals Colostrum avoidance and associated factors in Ethiopia: A systematic review and meta-analysis

2020 ◽  
Author(s):  
Jemberu Nigussie ◽  
Bekahegn Girma ◽  
Alemayehu Molla ◽  
Moges Mareg
Keyword(s):  
Systematic Review ◽  
Associated Factors ◽  
Meta Analysis ◽  
Random Effect ◽  
Health Benefit ◽  
Plain Water ◽  
Analysis Model ◽  
Prelacteal Feeding ◽  
Timely Initiation ◽  
Pooled Prevalence

Abstract Background: Colostrum is the first milk produced by the mammary glands during the second half of pregnancy for a few days (3-4) after birth. However, colostrum is a normative standard for infants’ complete form of nutrition, most mothers' giving prelacteal food such as honey, butter, sugar water, and plain water instead of colostrum to their newborn. In Ethiopia, colostrum was seen as abnormal milk causing abdominal problems, and to mitigate this problem most mothers were discarding the portion of the colostrum. Although studies have been conducted on colostrum avoidance and associated factors in Ethiopia, their report was inconsistent regarding the prevalence and associated factors. The main aim of this systematic review and meta-analysis was to estimate the pooled prevalence of colostrum avoidance and associated factors in Ethiopia.Methods: In this systematic review and meta-analysis databases such as Google, Google Scholar, PubMed/Medline, Science Direct, and Hinari were searched. We found a total of 327 records, of which 292 records were excluded due to duplication and unrelated to our objective. Finally, 35 studies were included in this systematic review and meta-analysis. The data were extracted in Microsoft Excel format and exported to STATA Version 14.0 statistical software for analysis. Heterogeneity was checked by the I2 test. A random-effect meta-analysis model was used to estimate the pooled prevalence of colostrum avoidance and associated factors. Egger’s weighted regression and Begg’s rank correlation test were used to assess publication bias. Result: This review revealed that the pooled prevalence of colostrum avoidance in Ethiopia was 20.5% (95% CI; 16.46, 24.45). Ante-natal care (ANC) visits [OR= 0.274 (95% CI; 0.175, 0.428)], place of delivery [OR= 3.8 (95% CI; 2.9, 4.9)], breastfed counselling [OR= 0.261(95% CI; 0.147 - 0.462), timely initiation of breast feeding [OR = 3.8 (95% CI; 1.9, 7.4)] and prelacteal feeding [OR= 5.77 (95% CI; 4.03- 8.22)] were significant factors for colostrum avoidance. Conclusion: This meta-analysis showed that one of five mothers discarded colostrum in Ethiopia. Colostrum avoidance was higher in rural mothers than in urban mothers. Strengthening ANC visits, institutional delivery, breastfed counseling, early initiation of breastfeeding, and avoidance of prelacteal feeding are recommended interventions to reduce colostrum avoidance in Ethiopia. Furthermore, promoting the health benefit of colostrum and its nutritional value also emphasizes to improving colostrum feeding in the community.

scholarly journals THERAPY OF ENDOCRINE DISEASE: Impact of iodine supplementation in mild-to-moderate iodine deficiency: systematic review and meta-analysis

2014 ◽  
Vol 170 (1) ◽  
pp. R1-R15 ◽  
Author(s):  
Peter N Taylor ◽  
Onyebuchi E Okosieme ◽  
Colin M Dayan ◽  
John H Lazarus
Keyword(s):  
Systematic Review ◽  
Iodine Deficiency ◽  
Observational Studies ◽  
Meta Analysis ◽  
School Age Children ◽  
Controlled Trials ◽  
School Age ◽  
Iodine Supplementation ◽  
Infant Neurodevelopment ◽  
Maternal Thyroid

BackgroundAlthough the detrimental effects of severe iodine deficiency are well recognised, the benefits of correcting mild-to-moderate iodine deficiency are uncertain.ObjectivesWe undertook a systematic review of the impact of iodine supplementation in populations with mild-to-moderate iodine deficiency.MethodsWe searched Medline and the Cochrane library for relevant articles published between January 1966 and April 2013, which investigated the effect of iodine supplementation on maternal and newborn thyroid function, infant neurodevelopment and cognitive performance in school-age children. The quality of studies was graded and eligible trials were evaluated in the meta-analysis.ResultsNine randomised controlled trials (RCTs) and eight observational studies met the inclusion criteria. Controlled trials on infant neurodevelopment were lacking; gestational iodine supplementation reduced maternal thyroid volume and serum thyroglobulin and in some studies prevented a rise in serum thyroid-stimulating hormone. None of the intervention trials recorded an excess frequency of thyroid dysfunction in contrast to observational studies. A pooled analysis of two RCTs which measured cognitive function in school-age children showed modest benefits of iodine supplementation on perceptual reasoning (standardised mean difference (SMD) 0.55; 95% CI 0.05, 1.04;P=0.03) and global cognitive index (SMD 0.27; 95% CI 0.10, 0.44;P=0.002) with significant heterogeneity between studies.ConclusionIodine supplementation improves some maternal thyroid indices and may benefit aspects of cognitive function in school-age children, even in marginally iodine-deficient areas. Further large prospective controlled studies are urgently required to clarify these findings and quantify the risk/benefits of iodine supplementation in regions previously believed to be iodine sufficient such as the UK.

scholarly journals Pooled estimate of vitamin D deficiency among pregnant women in India: a systematic review and meta-analysis

2021 ◽  
Vol 40 (1) ◽  
Author(s):  
Angeline Jeyakumar ◽  
Vidhya Shinde ◽  
Reshma Ravindran
Keyword(s):  
Systematic Review ◽  
Vitamin D ◽  
Pregnant Women ◽  
Vitamin D Deficiency ◽  
Meta Analysis ◽  
Health Concern ◽  
Study Quality ◽  
Care Services ◽  
Pooled Prevalence ◽  
Women In India

Abstract Background Vitamin D deficiency among pregnant women is a public health concern globally. In India, individual studies report high prevalence. However, lack of national data masks the true burden. This work determined the pooled prevalence of vitamin D deficiency among pregnant women in India through a systematic review of literature and meta-analysis. Methods Three different search engines yielded 15 eligible articles. Study quality was assessed by 10 different criteria and summary of study quality was categorized as per Cochrane standards. Meta-analysis was performed to estimate pooled prevalence of vitamin D deficiency among healthy pregnant women and heterogeneity among selected studies. A sample of n = 4088 was used to study the pooled prevalence among pregnant women. Results The random effects combined estimate was 32.35% (95% CI, (12.58–117.48). High heterogeneity (tau2 = 0.39, I2 = 100%) and high risk of bias was observed among the selected studies. The test for overall effect was observed to be z = 2.54(P = 0.01). Conclusion Pooled estimate > 30% emphasizes the need for screening through antenatal care services and initiate preventive measures to address the deficiency.

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

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Daniel Atlaw ◽  
Yohannes Tekalegn ◽  
Biniyam Sahiledengle ◽  
Kenbon Seyoum ◽  
Damtew Solomon ◽  
...  
Keyword(s):  
Systematic Review ◽  
Neural Tube ◽  
Meta Analysis ◽  
Random Effect ◽  
Random Effect Model ◽  
Folic Acid Supplementation ◽  
Maternal Exposure ◽  
X Ray ◽  
Effect Model ◽  
Pooled Prevalence

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.

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