Estimating the burden of neural tube defects in low– and middle–income countries

BACKGROUND To provide an estimate for the burden of neural tube defects (NTD) in low- and middle-income countries (LMIC) and explore potential public health policies that may be implemented. Although effective interventions are available to prevent NTD, there is still considerable childhood morbidity and mortality present in LMIC. METHODS A search of Medline, EMBASE, Global Health Library and PubMed identified 37 relevant studies that provided estimates of the burden of NTD in LMIC. Information on burden of total NTD and specific NTD types was separated according to the denominator into two groups: (i) estimates based on the number of live births only; and (ii) live births, stillbirths and terminations. The data was then extracted and analysed. RESULTS The search retrieved NTD burden from 18 countries in 6 WHO regions. The overall burden calculated using the median from studies based on livebirths was 1.67/1000 (IQR = 0.98-3.49) for total NTD burden, 1.13/1000 (IQR = 0.75-1.73) for spina bifida, 0.25/1000 (IQR = 0.08-1.07) for anencephaly and 0.15/1000 (IQR = 0.08-0.23) for encephalocele. Corresponding estimates based on all pregnancies resulting in live births, still births and terminations were 2.55/1000 (IQR = 1.56-3.91) for total NTD burden, 1.04/1000 (IQR = 0.67-2.48) for spina bifida, 1.03/1000 (IQR = 0.67-1.60) for anencephaly and 0.21 (IQR = 0.16-0.28) for encephalocele. This translates into about 190 000neonates who are born each year with NTD in LMIC. CONCLUSION Limited available data on NTD in LMIC indicates the need for additional research that would improve the estimated burden of NTD and recommend suitable aid policies through maternal education on folic acid supplementation or food fortification.