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Predicted folate concentration (the mean of the prediction distribution) based on serum folate (A) and RBC folate (B) in women of reproductive age in Ethiopia. Created using ArcGIS 10.4.1. ESRI ArcGIS Desktop: Release 10. Environmental Systems Research Institute, Redlands (2011).
Source publication
Background
Folate is essential for the synthesis and integrity of DNA, normal cell formation and body growth. Folate deficiency among women of reproductive age (WRA) increases the risk of poor birth outcomes including neural tube defect (NTD) affected pregnancies. Folate status is largely dependent on dietary intakes.
Objectives
To explore the spa...
Contexts in source publication
Context 1
... variograms for RBC folate and serum folate (Supplemental Figure 1) showed spatial dependence at distances of ≤ 300 km and ≤ 200 km, respectively. The cross-validation errors for the model fitted to the estimates using Matheron (43) appeared to be normally distributed (Supplemental Figure 2), with a median standardized squared prediction error (SSPE) of 0.39 for serum folate and 0.33 for RBC folate. The values of SSPE fell within the (95% CI: 0.33, 0.58) expected value, and so we used the variogram models based on Matheron's estimator for both variables. ...
Context 2
... spatially correlated variance showed dependence up to a distance of ∼3 times the distance parameter. Figure 2 shows the predicted serum and RBC folate concentrations for WRA across Ethiopia obtained by ordinary kriging. High concentrations of serum folate were observed in the northwest, west, south, and southeast including Amhara, Benshangul-Gumuz, Gambella, Addis Ababa, and southwest Oromia, whereas low serum folate concentrations were observed in northern, northeastern, and southern parts including Tigray, Afar, and southern Oromia. ...
Similar publications
The fortification of flour with folic acid for the prevention of neural tube defects (NTD) is currently mandated in over eighty countries worldwide, hence compelling its consumption by the greater part of the world’s population. Notwithstanding its beneficial impact on rates of NTD, pervasive folic acid supplementation has invariably led to additiv...
Citations
... Previous studies conducted in Ethiopia revealed inappropriate child feeding practices (5), poor vitamin A-rich food intake (14), and dietary diversity (22,23) among children was distributed non-randomly across Ethiopia's regions. Spatial variation of folate nutrition (24) and crop diversity in agroforestry home gardens (25) was observed between farming systems in Ethiopia. A study conducted using the 2019 Ethiopian mini-demographic and health survey data revealed that factors such as middle and rich household wealth quintile, 25-34 maternal age, Muslim religion, having more than four ANC visits during pregnancy, children in the age group of 12-23 months negatively and being married, and health facility delivery positively associated significantly with children's ZVF consumption (11). ...
... The observed variation in the consumption of fruits and vegetables can be attributed to multiple factors. The type of food consumed and the concentration of micronutrients in Ethiopia can be greatly influenced by a variety of factors, including variations in farming systems across the regions, affordability, utilization, food preferences, lack of nutrition education and storage facilities, and differences in residential food availability (24,(44)(45)(46), as well as by the seasonality of fresh vegetables and fruits that are available (3). In addition, prices are rapidly increasing, both in real terms and when compared to cereal. ...
Background
After 6 months, nutrient-dense, varied diets containing fruits and vegetables are crucial to supplement breastfeeding. Like many other low-income countries, Ethiopia has very low FV consumption. Zero vegetable or fruit (ZVF) consumption has been shown to significantly raise the risk of non-communicable diseases and has been ranked among the top 10 risk factors for mortality. And it is associated with poor health, an increased risk of obesity, and a higher risk of non-communicable diseases. Thus, this study’s goal was to investigate the spatial distribution of ZVF consumption and its spatial determinants among children aged 6–23 months in Ethiopia.
Methods
A cross-sectional study design was employed. A total of 1,489 weighted samples were included from kids’ datasets from the 2019 Ethiopian mini-demographic and health survey. STATA version 16, ArcGIS version 10.8, Kuldorff’s SaTScan version 9.6, and MGWR version 2.0 software were used for analysis. Spatial regression analyses (geographical weighted regression and ordinary least squares analysis) were conducted. Models were compared using AICc and adjusted R². A p-value of less than 0.05 was used to declare statistically significant spatial predictors, and the corresponding local coefficients were mapped.
Results
The spatial distribution of ZVF consumption among children aged 6–23 months was non-random in Ethiopia. Spatial scan analysis revealed a total of 120 significant clusters. Maternal education, wealth status, age of the child, place of delivery, number of under-five children in the house, and current pregnancy status were significant predictors of the spatial variation of ZVF consumption.
Conclusion
Significant geographic variation in ZVF consumption was found in this study throughout Ethiopia’s regions. Significant predictors of the spatial variation in ZVF consumption were maternal education, wealth status, child age, place of delivery, number of under-five children in the home, and status as a pregnant woman at the time of birth. Therefore, in order to improve children’s adequate consumption of fruit and vegetables, area-based interventions that can consider these significant factors into account are needed.
... Folic acid is considered a public health priority when more than 5% of reproductive-age women have a deficiency [20,21]. An analysis conducted in 2018 found that more than 20% of reproductive-age women have a folic acid deficiency in most low-income countries, while it is less than 5% in high-income countries [22]. Similarly, a recent estimate conducted in Ethiopia found that 20.8% of reproductiveage women had folate deficiency, indicating the public health importance of the problem [21]. ...
... The World Health Organization recommends supplementation with folic acid during the periconceptional period, continuing until 3 months after pregnancy. Furthermore, many nations mandate mass folic acid fortification of staple cereals, whereas in Ethiopia, fortification of commonly consumed food vehicles was mainly voluntary [20,22]. But more recently, in 2022, the Ethiopian Government endorsed the mandatory fortification of edible oil and wheat flour with folic acid [23]. ...
Neural tube defects are serious birth defects of the central nervous system that result from a multifaceted disruption of normal embryogenesis of the nervous system. Although largely preventable, they nonetheless pose a serious threat to global morbidity, disability, mortality, and financial expenses. Despite this, it has been neglected and has only been the subject of limited research until recently. Furthermore, surveillance efforts for neural tube defects remain limited, and no decline in defects has been documented in less developed countries. Here, we report two cases of craniorachischisis and one case of discordant twins for anencephaly. Moreover, the relevant works of literature that are necessary to understand and address this unrelenting phenomenon are provided.
... 107 108 Additionally, ecologically, the burden is disproportionately concentrated in the highland sorghum khat mixed farming system. 109 In this context, the eastern parts of the county, including the Somali and Harari regions, are grouped under the aforementioned farming system, which may have contributed to a high burden of NTDs. With regards to the Tigray region, the risk of NTDs is higher as compared with the remaining part of the country, partly explained by the high prevalence of folate deficiency among women of reproductive age. ...
Abstract
Objective This study aims to estimate the prevalence of neural tube defects (NTDs) and to identify potential risk factors in the Ethiopian context.
Study design Systematic review and meta-analysis.
Study participants A total of 611 064 participants were included in the review obtained from 42 studies.
Methods PubMed (Medline), Embase and Cochrane Library databases in combination with other potential sources of literature were systematically searched, whereby studies conducted between January 2010 and December 2022 were targeted in the review process. All observational studies were included and heterogeneity between studies was verified using Cochrane Q test statistics and I2 test statistics. Small study effects were checked using Egger’s statistical test at a 5% significance level.
Result The pooled prevalence of all NTDs per 10 000 births in Ethiopia was 71.48 (95% CI 57.80 to 86.58). The between-study heterogeneity was high (I2= 97.49%, p<0.0001). Birth prevalence of spina bifida (33.99 per 10 000) was higher than anencephaly (23.70 per 10 000), and encephalocele (4.22 per 10 000). Unbooked antenatal care (AOR 2.26, 95% CI (1.30 to 3.94)), preconception intake of folic acid (AOR 0.41, 95% CI (0.26 to 0.66)), having chronic medical illness (AOR 2.06, 95% CI (1.42 to 2.99)), drinking alcohol (AOR 2.70, 95% CI (1.89 to 3.85)), smoking cigarette (AOR 2.49, 95% CI (1.51 to 4.11)), chewing khat (AOR 3.30, 95% CI (1.88 to 5.80)), exposure to pesticides (AOR 3.87, 95% CI (2.63 to 5.71)), maternal age ≥35 (AOR 1.90, 95% CI (1.13 to 3.25)), maternal low educational status (AOR 1.60, 95% CI (1.13 to 2.24)), residing in urban areas (AOR 0.75, 95% CI (0.58 to 0.97))and family history of NTDs (AOR 2.51, 95% CI (1.36 to 4.62)) were associated with NTD cases.
Conclusion The prevalence of NTDs in Ethiopia is seven times as high as in other Western countries where prevention measures are put in place. Heredity, maternal and environmental factors are associated with a high prevalence of NTDs. Mandatory fortification of staple food with folic acid should be taken as a priority intervention to curb the burden of NTDs. To smoothen and overlook the pace of implementation of mass fortification, screening, and monitoring surveillance systems should be in place along with awareness-raising measures.
... They result from genetic mutations or maternal exposure to environmental factors including maternal folate deficiency, infections, and exposure to drugs like antiepileptic drugs and other teratogens. 1 Folic acid deficiency accounts for about 70% of cases of NTD; 2 and folic acid deficiency is highly prevalent in women of reproductive age in Ethiopia. 3,4 NTDs affect approximately one in every 500 births globally and their prevalence exceeds one in every 100 births in low income countries where there is no adequate provision of folic acid to women of reproductive age. 5 Currently, the prenatal diagnosis of NTDs mainly relies on ultrasound evaluation and alpha-fetoprotein levels in the maternal serum and amniotic fluid. Recently, different novel serum biomarkers have been evaluated for NTD screening although they have limitations for routine clinical use. ...
... Dovepress supplementation prevents the occurrence of neural tube defects significantly; 5,20 however, about 30% of NTDs are still not preventable by consumption of folic acid. 2 Ethiopia faces a high level of folate deficiency among women; 3 a recent study revealed that 78% of women of reproductive age in Ethiopia had low folate status. 4 WHO recommends that all women, from the moment they begin trying to conceive until 3 months of gestation, should receive folic acid supplementation. Moreover, a woman who has a fetus diagnosed with NTD or has given birth to a child with NTD should receive information on the risk of recurrence, be advised on the protective effect of periconceptional folate supplementation and be offered high-dose supplementation. ...
Background
There is a huge burden of neural tube defect (NTD) in Ethiopia, and surgical management is not readily available. We aimed to assess the clinical profile and hospital outcome of children with NTD that were operated in Hawassa University Comprehensive Specialized Hospital, Hawassa, Ethiopia.
Methods
A retrospective cross-sectional study on 250 children with NTD that were treated in a tertiary hospital from March 2016 to May 2020 was conducted to describe the clinical profile and treatment outcome at discharge. Logistic regression analysis was carried out to evaluate factors that determine mortality.
Results
Out of the 250 children, 50.4% were male. Myelomeningocele was the most common type of NTD (77.2%) followed by meningocele (10.4%). Only 3 mothers (1.2%) received periconceptional folic acid. Prenatal diagnosis of NTD was made in only 22 (8.8%) cases. 52.8% of the NTDs were ruptured at presentation and 50.8% had associated sepsis. At presentation, 42.4% were ≤72 hours of age and only 18 neonates (7.2%) were operated within 72 hours of admission. 54% had associated hydrocephalus, 31.6% had Chiari II malformation and 19.6% had club foot. Surgical site infection, post MMC repair hydrocephalus, and meningitis were seen in 8%, 14% and 16.8% of the participants, respectively. The mean duration of hospitalization was 24 ± 14.4 days. Twenty patients (8%) died before discharge from hospital. Prematurity [AOR: 26 (95% CI: 8.01, 86.04), P < 0.001] and the presence of meningitis [AOR: 3.8 (95% CI: 1.12,12.9), P = 0.03]were determinants of mortality.
Conclusion
NTDs are substantial health problem in this part of the country. Periconceptional folic acid supplementation is almost non-existent. Prenatal detection of NTDs is very low and management is delayed in the majority of cases. Myelomeningocele is the most common type of NTD. There is high in-hospital mortality, and prematurity and the presence of meningitis are its determinants.
... Serum folate was assessed using a microbiologic assay. The methodology for preparation and analysis of serum samples for folate is described in detail elsewhere (Sisay et al. 2022) (49) . ...
... Serum folate was assessed using a microbiologic assay. The methodology for preparation and analysis of serum samples for folate is described in detail elsewhere (Sisay et al. 2022) (49) . ...
Anemia is characterized by low hemoglobin (Hb) concentration. Despite being a public health concern in Ethiopia, the role of micronutrients and non-nutritional factors as a determinant of Hb concentrations has been inadequately explored. This study focused on the assessment of serum micronutrient and Hb concentrations and a range of non-nutritional factors; to evaluate their associations with the risk of anemia among the Ethiopian population (n=2046). It also explored the mediation effect of zinc (Zn) on the relation between selenium (Se) and Hb. Bivariate and multivariate regression analyses were performed to identify the relationship between serum micronutrients concentration, inflammation biomarkers, nutritional status, presence of parasitic infection and socio-demographic factors with Hb concentration. (n=2046). Sobel-Goodman test was applied to investigate the mediation of Zn on relations between serum Se and Hb. In total, 18.6% of participants were anemic, 5.8% had iron deficiency, 2.6% had iron deficiency anemia and 0.6% had tissue iron deficiency. Younger age, household head illiteracy, and low serum concentrations of ferritin, cobalt, Copper, and folate were associated with anemia. Serum Se had an indirect effect that was mediated by Zn, with a significant effect of Se on Zn (p<0.001) and Zn on Hb (p<0.001). The findings of this study suggest the need for designing a multi-sectorial intervention to address anemia based on demographic group.
... Serum folate was assessed using a microbiologic assay. The methodology for preparation and analysis of serum samples for folate is described in detail elsewhere (Sisay et al. (49) ). ...
