High Potential for Reducing Folic Acid-Preventable Spina Bifida and Anencephaly, and Related Stillbirth and Child Mortality, in Ethiopia

Abstract

Background: Recent studies in Ethiopia show a profoundly large epidemic of spina bifida and anencephaly: two common, severe, and life-threatening birth defects. Reductions can be achieved in stillbirth and child mortality rates in Ethiopia by preventing folic acid-preventable spina bifida and anencephaly through effective interventions. Methods: We estimated percent reductions in stillbirth, neonatal, infant, and under-five child mortality rates that would have occurred in Ethiopia in year 2016 had all folic acid-preventable spina bifida and anencephaly been prevented. We also estimated the contributions of these reductions toward Ethiopia's Year 2030 Every Newborn Action Plan goal on stillbirth, and Sustainable Development Goal on child mortality rates. Based on recent data from Ethiopia, we considered the current prevalence of spina bifida and anencephaly in Ethiopia to be 13 per 1,000 total births, and the preventable rate to be 12·5 per 1,000 total births. Findings: Folic acid interventions would have prevented about 41,610 cases of folic acid-preventable spina bifida and anencephaly-affected pregnancies and a related 31,830 stillbirths and 7,335 under-five child deaths. These reductions contribute to the reduction in stillbirths needed to achieve Ethiopia's Every Newborn Action Plan goal addressing stillbirth and reductions in neonatal and under-five mortality, needed to achieve the Sustainable Development Goals addressing preventable child mortality. Interpretation: Prevention of spina bifida and anencephaly can immediately reduce stillbirth and child mortality rates in Ethiopia. Folic acid fortification of wheat, maize, and especially salt, can be highly effective in controlling the current epidemic of spina bifida and anencephaly. Funding: None. Declaration of Interest: MD, VK, TM, AM, GPO have no financial relationships relevant to this article. Ethical Approval: Not needed.