Prevention of spina bifida: folic acid intake during pregnancy in Gulu district, northern Uganda.

Femke Bannink,Rita Larok,Geert Van Hove,Lieven Bauwens,Peter Kirabira

doi:10.11604/pamj.2015.20.90.5338

Femke Bannink, Rita Larok + Show 3 more

Open Access

https://doi.org/10.11604/pamj.2015.20.90.5338

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Abstract

IntroductionThe intake of folic acid before conception and during the first trimester of pregnancy can prevent spina bifida. This paper describes folic acid intake in women in Gulu district in northern Uganda.MethodsStructured interviews were held with 394 women attending antenatal care (ANC), 15 mothers of children with spina bifida, and 35 health workers in 2012 and 2013. SPSS16 was used for data analysis.Results1/4 mothers of children with spina bifida took folic acid during late pregnancy, none preconception. None had knowledge about folic acid and spina bifida prevention. 33.5% of women attending ANC had ever heard about spina bifida, 1% knew folic acid intake can prevent spina bifida. 42.4% took folic acid supplements in late pregnancy, 8.1% during the first trimester, none preconception. All women said to have eaten food rich in folic acid. None were aware about fortified foods. 7% of health workers understood the importance of early folic acid intake. All health workers recommended folic acid intake to women attending ANC. 20% of the health workers and 25% of the women said folic acid supplements are not always available.ConclusionFolic acid intake is limited in northern Uganda. This is attributed to limited education and understanding of women and health workers about the importance of early folic acid intake, late presentation of women at ANC, poor supply chain and dilapidated health services caused by war and poverty. A combination of food fortification, sensitization of health workers, women, and improving folic acid supply is recommended.

Highlights

The intake of folic acid before conception and during the first trimester of pregnancy can prevent spina bifida
Of the 15 mothers of children with spina bifida interviewed, only a fourth took folic acid supplements during pregnancy, and none of them took these in the first semester
Our findings show that knowledge about the preventative effect of folic acid on spina bifida, and folate intake before and during the first weeks of pregnancy is very limited in northern Uganda

Summary

Introduction

The intake of folic acid before conception and during the first trimester of pregnancy can prevent spina bifida. All health workers recommended folic acid intake to women attending ANC. The World Health Organization (WHO) recommends that all women of childbearing age consume 400 μg of folic acid daily and that women with pregnancies previously affected by NTDs consume 5000 μg of FA daily [16]. Women should consume these amounts in the periconceptional period as it takes 8 weeks to reach the optimal level of serum folate [17]. Countries fortifying the flour with at least folic acid see an average 46% reduction of NTD prevalence [20]

Methods

Results

Conclusion