Institute of Geographical Sciences and Nature Resources Research, Chinese Academy of Sciences, Beijing100101, PR China.
BMC Public Health. 2009 Oct 16;9:391. doi: 10.1186/1471-2458-9-391.
Birth defects are a major cause of infant mortality and disability in many parts of the world. Neural tube defects (NTDs) are one of the most common types of birth defects. In 2001, the Chinese population and family planning commission initiated a national intervention program for the prevention of birth defects. A key step in the program was the introduction of folic acid supplementation. Of interest in the present study was to determine whether folic acid supplementation has the same protective effect on NTDs under various geographical and socioeconomic conditions within the Chinese population and the nature in which the influence of environmental factors varied after folic acid supplementation.
In this study, Heshun was selected as the region of interest as a surrogate for helping to answer some of the questions raised in this study on the impact of the intervention program. Spatial filtering in combination with GIS software was used to detect annual potential clusters from 1998 to 2005 in Heshun, and Kruskal-wallis test and multivariate regression were applied to identify the environmental risk factors for NTDs among various regions.
In 1998, a significant (p < 0.100) NTDs cluster was detected in the west of Heshun. After folic acid supplementation, the significant clusters gradually moved from west to east. However, during the study period, most of the clusters appeared in the middle region of Heshun where more than 95 percent of the coal mines of Heshun are located. For the analysis, buffer regions of the coal mine zone were built in a GIS environment. It was found that the correlations between environmental risk factors and NTDs vary among the buffer regions.
This suggests that the government needs to adapt the intervention measures according to local conditions. More attention needs to be paid to the poor and to people living in areas near coal mines.
出生缺陷是世界上许多地区婴儿死亡和残疾的主要原因。神经管缺陷（NTDs）是最常见的出生缺陷之一。2001 年，中国人口与计划生育委员会启动了一项全国性的出生缺陷预防干预计划。该计划的一个关键步骤是引入叶酸补充。本研究的兴趣在于确定叶酸补充是否对中国人群中的 NTDs 具有相同的保护作用，以及在叶酸补充后环境因素的影响性质如何变化。
本研究选择和顺作为研究区域，以帮助回答该研究中提出的一些关于干预计划影响的问题。空间滤波与 GIS 软件相结合，用于检测 1998 年至 2005 年和顺的年度潜在聚集，并应用克鲁斯卡尔-沃利斯检验和多元回归来识别不同地区 NTDs 的环境风险因素。
1998 年，和顺西部检测到一个显著的（p<0.100）NTDs 聚集。叶酸补充后，显著聚集逐渐从西向东移动。然而，在研究期间，大多数聚集出现在和顺中部，那里有超过 95%的和顺煤矿。对于分析，在 GIS 环境中建立了煤矿区的缓冲区。结果发现，环境风险因素与 NTDs 之间的相关性在缓冲区之间存在差异。
这表明政府需要根据当地情况调整干预措施。需要更加关注贫困地区和煤矿附近的居民。
