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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
biochemistry, genetics and molecular biology
Decline in the prevalence of neural tube defects following folic acid fortification and its cost-benefit in South Africa
Birth Defects Research Part A - Clinical and Molecular Teratology, Volume 82, No. 4, Year 2008
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Description
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. © 2008 Wiley-Liss, Inc.
Authors & Co-Authors
Sayed, Abdul Rauf
South Africa, Cape Town
University of Cape Town
Bourne, David E.
South Africa, Cape Town
University of Cape Town
Pattinson, Robert Clive
South Africa, Pretoria
University of Pretoria
Nixon, Jo
South Africa, Cape Town
University of Cape Town
Henderson, Bertram D.
South Africa, Bloemfontein
University of the Free State
Statistics
Citations: 219
Authors: 5
Affiliations: 3
Identifiers
Doi:
10.1002/bdra.20442
ISSN:
15420752
Research Areas
Food Security
Health System And Policy
Maternal And Child Health
Study Design
Randomised Control Trial
Cross Sectional Study
Study Locations
South Africa