Quality-driven programming in global surgery: A 30-Year institutional experience delivering safe, timely and effective surgical care

Abstract

databases. Grey literature documents were provided by the Global Alliance for Improved Nutrition (GAIN) and retrieved from nonindexed sources such as the websites of non-governmental organizations (NGOs) and fortified food manufacturers . Outcomes included both quantitative (effectiveness) and qualitative (analysis of programs/ barriers/lessons) measures. As such, our search was not restricted by study design. Inclusion criteriacapturedstudies that evaluate large scale, typically country-wide, fortification efforts in LMICs. Full text retrieval, data abstraction, and quality assessment were completed in duplicate for all studies that passed the screening process. Analysis Statistical analyses were performed using Review Manager Software version 5.3. Meta-analyses were conducted where possible. Findings: A total of 140 quantitative studies were identified as ‘included’, of which 25 pertained to mass fortification with folic acid. Of these 25 studies,14 reported aperinatal/neonatal outcome. In all cases, this referred to one or more type of NTD (spina bifida, anencephaly, or cephalocele). A meta-analysis for each outcomewas conducted in order to determine to risk ratio (RR) ofNTDs after folic acid fortification.When looking at totalNTD rates, the combined RR was 0.65 [95% confidence intervals (CI) 0.530.79], demonstrating a positive association between fortification with folic acid and reduction in NTD prevalence. When examining NTD by type, this reduction in prevalence was also present. The overall RR was 0.53 [95% CI 0.42-0.66] for anencephaly, 0.67 [95% CI 0.48-0.92] for spina bifida, and 0.68 [95% CI 0.48-0.97] for cephalocele. Interpretation: While there were some country-specific variations, the overall impact of mass food fortification led to a significant reduction in risk of NTDs when comparing preand post-fortification periods. Funding: No funding listed. Abstract #: 02ITIS005