Decline in the prevalence of neural tube defects following folic acid fortification and its cost‐benefit in South Africa
- 12 March 2008
- journal article
- research article
- Published by Wiley in Birth Defects Research Part A: Clinical and Molecular Teratology
- Vol. 82 (4), 211-216
- https://doi.org/10.1002/bdra.20442
Abstract
BACKGROUND: In October 2003 South Africa embarked on a program of folic acid fortification of staple foods. We measured the change in prevalence of NTDs before and after fortification and assessed the cost benefit of this primary health care intervention. METHODS: Since the beginning of 2002 an ecological study was conducted among 12 public hospitals in four provinces of South Africa. NTDs as well as other birth defect rates were reported before and after fortification. Mortality data were also collected from two independent sources. RESULTS: This study shows a significant decline in the prevalence of NTDs following folic acid fortification in South Africa. A decline of 30.5% was observed, from 1.41 to 0.98 per 1,000 births (RR = 0.69; 95% CI: 0.49–0.98; p = .0379). The cost benefit ratio in averting NTDs was 46 to 1. Spina bifida showed a significant decline of 41.6% compared to 10.9% for anencephaly. Additionally, oro‐facial clefts showed no significant decline (5.7%). An independent perinatal mortality surveillance system also shows a significant decline (65.9%) in NTD perinatal deaths, and in NTD infant mortality (38.8%). CONCLUSIONS: The decrease in NTD rates postfortification is consistent with decreases observed in other countries that have fortified their food supplies. This is the first time this has been observed in a predominantly African population. The economic benefit flowing from the prevention of NTDs greatly exceeds the costs of implementing folic acid fortification. Birth Defects Research (Part A), 2008.Keywords
This publication has 18 references indexed in Scilit:
- Decline in the Prevalence of Spina Bifida and Anencephaly by Race/Ethnicity: 1995–2002Pediatrics, 2005
- Reduction of birth prevalence rates of neural tube defects after folic acid fortification in ChileAmerican Journal of Medical Genetics Part A, 2005
- Folic Acid Fortification of Wheat Flour: ChilePublished by Oxford University Press (OUP) ,2004
- The Costa Rican Experience: Reduction of Neural Tube Defects following Food Fortification ProgramsNutrition Reviews, 2004
- Association between folic acid food fortification and congenital orofacial cleftsThe Journal of Pediatrics, 2003
- Periconceptional supplementation with folate and/or multivitamins for preventing neural tube defectsPublished by Wiley ,2001
- Prevention of Neural-Tube Defects with Folic Acid in ChinaNew England Journal of Medicine, 1999
- Prevalence of neural tube defects in Cape Town, South AfricaTeratology, 1994
- Prevention of the First Occurrence of Neural-Tube Defects by Periconceptional Vitamin SupplementationNew England Journal of Medicine, 1992
- Prevention of neural tube defects: Results of the Medical Research Council Vitamin StudyThe Lancet, 1991