Department of Epidemiology, Emory University, Rollins School of Public Health, Atlanta, Georgia.
Department of Neurosurgery, School of Medicine, College of Health Sciences, Mekelle University, Mekelle, Ethiopia.
Birth Defects Res. 2019 Nov 15;111(19):1513-1519. doi: 10.1002/bdr2.1584. Epub 2019 Aug 19.
Recent surveillance studies in Ethiopia show an epidemic of spina bifida and anencephaly, two major neural tube birth defects that are severe and life-threatening. Our objective was to estimate proportional reductions in current stillbirth and child mortality rates in Ethiopia through folic acid-based interventions to prevent spina bifida and anencephaly.
Using secondary data from multiple sources, we estimated percent reductions in stillbirth, neonatal, infant, and under-five child mortality rates that would have occurred in Ethiopia in the year 2016 had all folic acid-preventable spina bifida and anencephaly been prevented; and the contributions of these reductions toward Ethiopia's Year 2030 Every Newborn Action Plan (ENAP) goal on stillbirth, and sustainable development goal (SDG) on child mortality rates. The 2016 prevalence of spina bifida and anencephaly in Ethiopia was assumed as 13 per 1,000 total births, with the prevention goal reaching 0.5 per 1,000 total births.
Folic acid interventions in Ethiopia would have prevented about 41,610 cases of folic acid-preventable spina bifida and anencephaly-affected pregnancies during the year 2016. We estimate that this prevention is associated with reduction of 31,830 stillbirths and 7,335 under-five child deaths annually. The proportional contribution of this prevention toward achieving Ethiopia's ENAP goal is 54% for stillbirth, and toward SDG is 4.5% for neonatal- and 6.8% for under-five mortality.
Spina bifida and anencephaly contribute to substantial stillbirths and child death in Ethiopia. Large-scale fortification of foods like wheat flour and salt can help achieve Ethiopia's ENAP and SDG targets addressing preventable stillbirth, neonatal, and under-five mortality.
最近在埃塞俄比亚进行的监测研究表明，神经管缺陷疾病（包括脊柱裂和无脑畸形）的流行率正在上升，这两种疾病是严重且危及生命的出生缺陷。我们的目标是通过叶酸干预措施来预防脊柱裂和无脑畸形，从而估计目前在埃塞俄比亚发生的死产和儿童死亡率的比例降低。
我们使用来自多个来源的二手数据，估计了如果所有可预防的叶酸相关脊柱裂和无脑畸形都得到预防，埃塞俄比亚在 2016 年将发生的死产、新生儿、婴儿和五岁以下儿童死亡率的百分比降低；以及这些降低对埃塞俄比亚的 2030 年“每个新生儿行动计划”（ENAP）目标关于死产和可持续发展目标（SDG）关于儿童死亡率的贡献。假设 2016 年埃塞俄比亚脊柱裂和无脑畸形的患病率为每 1000 例总出生数 13 例，预防目标为每 1000 例总出生数 0.5 例。
埃塞俄比亚的叶酸干预措施本可以预防 2016 年大约 41610 例叶酸可预防的脊柱裂和无脑畸形相关妊娠。我们估计，这一预防措施每年可减少 31830 例死产和 7335 例五岁以下儿童死亡。这种预防措施对实现埃塞俄比亚 ENAP 目标的贡献比例为 54%，对 SDG 的贡献比例为 4.5%（新生儿）和 6.8%（五岁以下儿童）。
脊柱裂和无脑畸形导致埃塞俄比亚大量死产和儿童死亡。大规模强化食品（如小麦粉和盐）可以帮助埃塞俄比亚实现 ENAP 和 SDG 目标，以解决可预防的死产、新生儿和五岁以下儿童死亡率问题。
