Translational Neuroscience Research Lab, School of Medicine, Universidad de La Sabana, Campus Universitario Puente del Común, Autopista Norte, Km 7, Chia, Colombia.
Neurosurgery Department, Fundacion Santa Fe De Bogota, Bogota, DC, Colombia.
Childs Nerv Syst. 2023 Jul;39(7):1805-1812. doi: 10.1007/s00381-023-05944-x. Epub 2023 May 20.
Neural tube defects continue to be one of the main congenital malformations affecting the development of the nervous system and a significant cause of disability and disease burden to individuals living with these conditions. Mandatory food fortification with folic acid is, by far, one of the most efficacious, safe, and cost-effective interventions to prevent neural tube defects. However, most countries fail to effectively fortify staple foods with folic acid, impacting public health and healthcare systems and generating dismal disparities.
This article discusses the main barriers and facilitators for implementing mandatory food fortification as an evidence-based policy to prevent neural tube defects worldwide.
A comprehensive review of the scientific literature allowed the identification of the determinant factors acting as barriers or facilitators for the reach, adoption, implementation, and scaling up of mandatory food fortification with folic acid as an evidence-based policy.
We identified eight barriers and seven facilitators as determinant factors for food fortification policies. The identified factors were classified as individual, contextual, and external, inspired by the Consolidated Framework for Implementation of Research (CFIR). We discuss mechanisms to overcome obstacles and seize the opportunities to approach this public health intervention safely and effectively.
Several determinant factors acting as barriers or facilitators influence the implementation of mandatory food fortification as an evidence-based policy worldwide. Notoriously, policymakers in many countries may lack knowledge of the benefits of scaling up their policies to prevent folic acid-sensitive neural tube defects, improve the health status of their communities, and promote the protection of many children from these disabling but preventable conditions. Not addressing this problem negatively affects four levels: public health, society, family, and individuals. Science-driven advocacy and partnerships with essential stakeholders can help overcome the barriers and leverage the facilitators for safe and effective food fortification.
神经管缺陷仍然是影响神经系统发育的主要先天畸形之一，也是导致患有这些疾病的个体残疾和疾病负担的重要原因。迄今为止，强制性叶酸食品强化是预防神经管缺陷最有效、最安全、最具成本效益的干预措施之一。然而，大多数国家未能有效地用叶酸强化主食，这影响了公共卫生和医疗保健系统，并产生了令人沮丧的差距。
本文讨论了在全球范围内实施强制性食品强化作为预防神经管缺陷的循证政策的主要障碍和促进因素。
对科学文献进行全面回顾，确定了作为强制性叶酸食品强化作为循证政策的实施、采用、实施和扩大的障碍和促进因素的决定因素。
我们确定了 8 个障碍和 7 个促进因素作为食品强化政策的决定因素。所确定的因素被分为个体、环境和外部因素，这是受实施研究综合框架（CFIR）的启发。我们讨论了克服障碍和抓住机会安全有效地实施这一公共卫生干预措施的机制。
有几个作为障碍或促进因素的决定因素影响了全球范围内强制性食品强化作为循证政策的实施。许多国家的政策制定者显然缺乏扩大政策以预防叶酸敏感神经管缺陷、改善其社区健康状况以及促进许多儿童免受这些可预防但致残疾病影响的知识。不解决这个问题会对公共卫生、社会、家庭和个人四个层面产生负面影响。以科学为导向的宣传和与重要利益攸关方的合作可以帮助克服障碍，利用促进安全有效的食品强化的因素。
