东非神经管缺陷的出生患病率：系统评价和荟萃分析。
Birth prevalence of neural tube defects in eastern Africa: a systematic review and meta-analysis.
机构信息
Department of Public Health Sciences, Penn State Hershey College of Medicine and Milton S. Hershey Medical Center, Hershey, PA, USA.
Center for Neural Engineering, Department of Engineering, Science and Mechanics, The Pennsylvania State University, State College, PA, USA.
出版信息
BMC Neurol. 2022 Jun 1;22(1):202. doi: 10.1186/s12883-022-02697-z.
BACKGROUND
Neural tube defects (NTDs) are associated with high rates of neonatal mortality and morbidity worldwide. The promotion of folic acid fortification and supplementation in pregnant women by the Food and Drug Administration significantly decreased the incidence of NTDs in the United States. This practice is not widely adopted in Eastern Africa countries. We hypothesized that these countries experience a higher burden of NTDs than countries that promote the use of folic acid. We aimed to estimate the birth prevalence of NTDs in the United Nations (UN) Eastern African region.
METHODS
PubMed (Medline), Embase, and Cochrane Library databases were systematically searched from inception to December 17, 2021. We included randomized controlled trials or observational studies that reported the prevalence estimates of NTDs in Eastern Africa. Random effects model was used to pool the effect estimates. The GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach was used to assess the certainty of the evidence. Outcome measures were overall and specific (spina bifida, anencephaly, encephalocele) rates of NTDs per 10,000 births, including live and stillborn cases.
RESULTS
The meta-analysis included 20 studies consisting of 752,936 individuals. The pooled prevalence of all NTDs per 10,000 births in Eastern Africa was 33.30 (95% CI: 21.58 to 51.34). Between-study heterogeneity was high (I = 97%, p < 0.0001), The rate was highest in Ethiopia (60 per 10,000). Birth prevalence of spina bifida (20 per 10,000) was higher than anencephaly (9 per 10,000) and encephalocele (2.33 per 10,000). No studies on NTDs were identified in 70% of the UN Eastern Africa region. Birth prevalence increased by 4% per year from 1983 to 2018. The level of evidence as qualified with GRADE was moderate.
CONCLUSION
The birth prevalence of NTDs in the United Nations region of Eastern Africa is 5 times as high as observed in Western countries with mandatory folic acid supplementation in place. Therefore, mandatory folic acid supplementation of stable foods may decrease the risk of NTDs in Eastern Africa.
背景
神经管缺陷（NTDs）与全球新生儿死亡率和发病率的高发生率有关。美国食品和药物管理局（FDA）提倡在孕妇中进行叶酸强化和补充，这显著降低了美国 NTDs 的发生率。这种做法在东非国家并不广泛采用。我们假设这些国家比提倡使用叶酸的国家面临更高的 NTD 负担。我们旨在估计联合国（UN）东非地区 NTD 的出生流行率。
方法
从成立到 2021 年 12 月 17 日，系统地在 PubMed（Medline）、Embase 和 Cochrane 图书馆数据库中进行了检索。我们纳入了报告东非 NTD 流行率的随机对照试验或观察性研究。使用随机效应模型汇总效应估计值。使用 GRADE（推荐评估、制定与评价）方法评估证据的确定性。结局指标是每 10000 例活产和死产的 NTD 总发生率和特定（脊柱裂、无脑畸形、脑膨出）发生率。
结果
荟萃分析纳入了 20 项研究，共包括 752936 名个体。东非每 10000 例活产的 NTD 总流行率为 33.30（95%CI：21.58 至 51.34）。研究间异质性很高（I=97%，p<0.0001），埃塞俄比亚的发生率最高（每 10000 例 60 例）。脊柱裂（每 10000 例 20 例）的发生率高于无脑畸形（每 10000 例 9 例）和脑膨出（每 10000 例 2.33 例）。在东非 70%的联合国地区没有发现关于 NTD 的研究。1983 年至 2018 年，发病率每年增加 4%。证据质量被 GRADE 评为中级。
结论
联合国东非地区 NTD 的出生流行率是西方国家的 5 倍，西方国家强制补充叶酸。因此，在东非强制补充稳定食物中的叶酸可能会降低 NTD 的风险。
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