{"id":40535,"date":"2019-12-03T13:32:08","date_gmt":"2019-12-03T18:32:08","guid":{"rendered":"https:\/\/www.healthynewbornnetwork.org\/?post_type=news-item&p=40535"},"modified":"2023-11-21T12:35:07","modified_gmt":"2023-11-21T17:35:07","slug":"could-adding-folic-acid-to-salt-curb-ethiopias-sky-high-rate-of-spinal-cord-deformities","status":"publish","type":"news-item","link":"https:\/\/www.healthynewbornnetwork.org\/news-item\/could-adding-folic-acid-to-salt-curb-ethiopias-sky-high-rate-of-spinal-cord-deformities\/","title":{"rendered":"Could adding folic acid to salt curb Ethiopia\u2019s sky-high rate of spinal cord deformities?"},"content":{"rendered":"

This article was originally posted on ScienceMag<\/em><\/p>\n

By Meredith Wadman<\/strong><\/em><\/h2>\n

Tony Magana, chief of neurosurgery at Mekelle University School of Medicine in Ethiopia\u2019s Tigray province, confronts his country\u2019s high prevalence of neural tube defects nearly every day. His team operates on more than 400 babies annually to repair these severe, often lethal birth malformations, in which babies can be born without brains or with their spinal cords protruding from their backs. \u201cProbably every other day we see a child that is so bad we can\u2019t help them,\u201d Magana says. The holes where the spinal cord protrudes \u201care so big that you can\u2019t close them.\u201d<\/p>\n

This month, a team of nutrition experts converged in Addis Ababa to lay groundwork for an unproven but possibly highly effective intervention: fortifying Ethiopia\u2019s salt supply with folic acid, a synthetic form of the B vitamin folate. In the first 4 weeks of pregnancy, folate is essential to proper closure of the neural tube, which gives rise to the brain and spinal cord, and since the mid-1990s, more than 80 countries have mandated flour fortification with folic acid. Ethiopia, where fewer than one-third of people eat flour, is not among them.<\/p>\n

Last year, a pair of studies that surveyed births at 11 public hospitals there shook the global health community. The studies\u2014one co-authored by Magana\u2014found that among every 10,000 births, between 126 and 131 babies suffered from neural tube defects (NTDs). That\u2019s seven times their global prevalence and 26 times the prevalence in high-income, flour-fortifying countries such as the United States. According to Ethiopian government data, 84% of Ethiopian women of reproductive age have folate levels in their red blood cells that put them at risk of giving birth to a child with an NTD.<\/p>\n

\u201cThese numbers from Ethiopia are some of the worst anywhere and ever,\u201d says Marinus Koning, a retired surgeon who is founder of ReachAnother Foundation, a charity based in Bend, Oregon, that has supported the training of dozens of Ethiopian neurosurgeons in the past 10 years. \u201cEverybody knows something needs to be done about it.\u201d<\/p>\n

At the invitation of the Ethiopian Ministry of Health, Koning and scientists from the United States, Canada and the Netherlands began to work with experts at the Ethiopian Public Health Institute (EPHI) to develop a plan to address the high NTD incidence. The result was an issue brief released by EPHI in May, titled \u201cPreventing Neural Tube Defects in Ethiopia\u201d, that recommended the government consider salt fortification.<\/p>\n

The prospect is winning praise from affected families. \u201cWe need prevention more than any intervention,\u201d says Beza Haile, founder of the Addis Ababa\u2013based advocacy group HOPE-Spina Bifida and Hydrocephalus. Haile\u2019s 4-year-old son, Hezkiel, who has an NTD, can\u2019t talk, walk, sit, or eat, except foods that are the consistency of soft porridge.<\/p>\n

A method of fortifying salt\u2014spraying it with buffered folic acid solution\u2014had already been developed by chemical engineer Levente Diosady and colleagues at the University of Toronto in Canada. The same spraying equipment used for iodization of salt, already mandated in Ethiopia to prevent intellectual disabilities and thyroid disease, can deliver the folate. \u201cOne of the main reasons this project is moving forward and there is a lot of political support for it is it requires few adaptations,\u201d says Christine McDonald, a micronutrient scientist at Children\u2019s Hospital Oakland Research Institute in California.<\/p>\n

McDonald was part of the team that visited Addis Ababa this month. There, the team met with potential funders and with Hakan Koleno\u011flu, chief executive of the country\u2019s leading salt processor, SVS Salt Production PLC in Semera. Koleno\u011flu on the spot promised to fortify, free of charge, 40 tons of salt for preliminary studies.<\/p>\n

With initial funding from ReachAnother (more will be needed from other funders, the team says), researchers will test whether folate-fortified salt is stable in Ethiopian environmental conditions and whether its sensory qualities, including a slight yellowish tinge, are acceptable to Ethiopians. If the answers are encouraging, fortified salt\u2019s effects on the gold standard measurement of folate sufficiency\u2014red blood cell folate levels\u2014will be put to the test in a randomized, controlled, double-blind trial of hundreds of women of reproductive age.<\/p>\n

\u201cThere is no scientific evidence that adding [folic acid] to salt could improve the folate status of women,\u201d says Masresha Tessema, a nutritionist at EPHI\u2019s Food Science and Nutrition Research Directorate who was first author on the issue brief and is the Ethiopian lead on the studies. \u201cThe ministry needs evidence.\u201d<\/p>\n

If salt supplementation works, it could be game-changing for Ethiopia: A meta-analysis this year concluded that large-scale folic acid food fortification in low- and middle-income countries has lowered the risk of NTDs by 41%. \u201cWe have an amazing opportunity to do a lot of good,\u201d says Kenneth Brown, the lead U.S. scientist on the team that met in Addis Ababa. Brown, an emeritus professor at the University of California, Davis, who was until recently a senior nutrition scientist at the Bill & Melinda Gates Foundation, adds: \u201cIt\u2019s shovel ready. We know what the problem is. We know how to fix it.\u201d<\/p>\n

Other experts hope an Ethiopian success story could spur efforts in more than 110 other countries that don\u2019t mandate food fortification. Says Nicholas Wald, an epidemiologist at University College London, who in a seminal 1991 paper established that taking 4 milligrams of folic acid daily, before and in early pregnancy, reduces the risk of NTDs by about 80%: \u201cIt\u2019s a global issue of which Ethiopia is an extreme example. Loads of countries should be fortifying a staple food with folic acid and aren\u2019t.\u201d<\/p>\n","protected":false},"author":7211,"featured_media":40539,"template":"","acf":[],"yoast_head":"\nHealthy Newborn Network<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.healthynewbornnetwork.org\/news-item\/could-adding-folic-acid-to-salt-curb-ethiopias-sky-high-rate-of-spinal-cord-deformities\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Could adding folic acid to salt curb Ethiopia\u2019s sky-high rate of spinal cord deformities? - Healthy Newborn Network\" \/>\n<meta property=\"og:description\" content=\"This article was originally posted on ScienceMag By Meredith Wadman Tony Magana, chief of neurosurgery at Mekelle University School of Medicine in Ethiopia\u2019s Tigray province, confronts his country\u2019s high prevalence of neural tube defects nearly every day. 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However, there are many opportunities during pregnancy to reduce these risks.<\/h2>\n<p>While traditional antenatal care (ANC) is understood mainly to focus on obstetrical issues, contacts with pregnant women also provide important opportunities to deliver other preventive clinical interventions as well as counseling and health education on birth preparedness, danger signs and appropriate response, key practices at household level during and after pregnancy, and family planning.[\/vc_column_text][\/vc_column][vc_column width=\"1\/2\" el_class=\"issue-stats\"][vc_row_inner content_placement=\"middle\"][vc_column_inner el_class=\"text-red\" width=\"1\/3\"][vc_column_text]<\/p>\n<h1 style=\"text-align: center;\"><strong><span class=\"ticker\">88<\/span><\/strong><\/h1>\n<p>[\/vc_column_text][\/vc_column_inner][vc_column_inner width=\"2\/3\"][vc_column_text css=\".vc_custom_1690993922335{padding-top: 10px !important;padding-bottom: 10px !important;}\"]<\/p>\n<h3 style=\"text-align: center;\">percent of women age 15-49 who received at lease one ANC visit during pregnancy globally (2016-2021)<\/h3>\n<p>[\/vc_column_text][\/vc_column_inner][\/vc_row_inner][vc_separator][vc_row_inner content_placement=\"middle\"][vc_column_inner el_class=\"text-yellow\" width=\"1\/3\"][vc_column_text]<\/p>\n<h1 style=\"text-align: center;\"><strong><span class=\"ticker\">65<\/span><\/strong><\/h1>\n<p>[\/vc_column_text][\/vc_column_inner][vc_column_inner width=\"2\/3\"][vc_column_text css=\".vc_custom_1690993939923{padding-top: 10px !important;padding-bottom: 10px !important;}\"]<\/p>\n<h3 style=\"text-align: center;\">percent of women age 15-49 who received four or more ANC visits during pregnancy globally (2016-2021)<\/h3>\n<p>[\/vc_column_text][\/vc_column_inner][\/vc_row_inner][vc_separator][vc_row_inner content_placement=\"middle\"][vc_column_inner][vc_column_text]<\/p>\n<h6 style=\"text-align: center;\"><em>All data on this page represents the most recent data available, unless otherwise noted. Please visit our\u00a0<a href=\"https:\/\/www.healthynewbornnetwork.org\/numbers\/\">Newborn Numbers<\/a>\u00a0page and download the Excel spreadsheet to explore the data further.<\/em><\/h6>\n<p>[\/vc_column_text][\/vc_column_inner][\/vc_row_inner][\/vc_column][\/vc_row][vc_row][vc_column][vc_text_separator title=\"Opportunities for ANC\"][\/vc_column][\/vc_row][vc_row][vc_column][vc_column_text]The prioritization of specific ANC interventions should vary by setting. For example, in areas of high malaria risk, intermittent presumptive treatment and use of insecticide-treated mosquito nets are very important. How we reach pregnant women with services and messages must also vary by setting. There are certainly advantages to having fully-qualified health professionals like nurses or nurse-midwives provide services; however many aspects of the needed services could be provided by cadres of health auxiliaries with less training. In some settings, greater reach is achieved by providing services on an outreach basis. Over the past 15 years, the standard model for ANC has been \u201cfocused ANC,\u201d a four-visit schedule. In 2016 the World Health Organization reviewed this model and issued new recommendations.[\/vc_column_text][vc_text_separator title=\"Key Resources\"][vc_column_text]<\/p>\n<ul>\n<li><a href=\"https:\/\/www.healthynewbornnetwork.org\/news-item\/updated-who-recommendations-for-malaria-chemoprevention-among-children-and-pregnant-women-who\/\" target=\"_blank\" rel=\"noopener\">Updated WHO recommendations for malaria chemoprevention among children and pregnant women<\/a> (2022)<\/li>\n<li><a href=\"https:\/\/www.healthynewbornnetwork.org\/resource\/ending-preventable-maternal-mortality-epmm-a-renewed-focus-for-improving-maternal-and-newborn-health-and-wellbeing\/\" target=\"_blank\" rel=\"noopener\">Ending Preventable Maternal Mortality (EPMM): A Renewed Focus for Improving Maternal and Newborn Health and Wellbeing<\/a> (2021)<\/li>\n<li><a href=\"https:\/\/www.healthynewbornnetwork.org\/resource\/recommendations-antenatal-care-positive-pregnancy-experience\/\">WHO recommendations on antenatal care for a positive pregnancy experience<\/a> (2016) + Executive Summary<\/li>\n<\/ul>\n<p>[\/vc_column_text][\/vc_column][\/vc_row]<\/p>\n","post_title":"Antenatal care","post_excerpt":"","post_status":"publish","comment_status":"closed","ping_status":"closed","post_password":"","post_name":"antenatal-care","to_ping":"","pinged":"","post_modified":"2023-08-02 12:32:20","post_modified_gmt":"2023-08-02 16:32:20","post_content_filtered":"","post_parent":0,"guid":"http:\/\/www.healthynewbornnetwork.org\/?post_type=issue&p=114","menu_order":0,"post_type":"issue","post_mime_type":"","comment_count":"0","filter":"raw"}],"regions":[{"ID":247,"post_author":"7211","post_date":"2015-11-22 21:37:22","post_date_gmt":"2015-11-22 21:37:22","post_content":"","post_title":"Africa","post_excerpt":"","post_status":"publish","comment_status":"closed","ping_status":"closed","post_password":"","post_name":"africa","to_ping":"","pinged":"","post_modified":"2016-02-11 21:42:43","post_modified_gmt":"2016-02-11 21:42:43","post_content_filtered":"","post_parent":0,"guid":"http:\/\/www.healthynewbornnetwork.org\/?post_type=region&p=247","menu_order":0,"post_type":"region","post_mime_type":"","comment_count":"0","filter":"raw"}],"countries":[{"ID":9,"post_author":"7211","post_date":"2015-09-29 14:31:18","post_date_gmt":"2015-09-29 14:31:18","post_content":"[vc_row][vc_column css=\".vc_custom_1453305596740{padding-top: 30px !important;padding-bottom: 30px !important;}\"][vc_text_separator title=\"Leading causes of neonatal deaths in Ethiopia (2020)\" el_class=\"transform:upperclass\"][vc_row_inner][vc_column_inner][vc_round_chart type=\"doughnut\" stroke_width=\"1\" stroke_color=\"custom\" values=\"%5B%7B%22title%22%3A%222%25%20Diarrhoea%22%2C%22value%22%3A%222%25%22%2C%22color%22%3A%22vista-blue%22%7D%2C%7B%22title%22%3A%220%25%20Tetanus%22%2C%22value%22%3A%220%25%22%2C%22color%22%3A%22mulled-wine%22%2C%22custom_color%22%3A%22%23ff9900%22%7D%2C%7B%22title%22%3A%2212%25%20Pneumonia%22%2C%22value%22%3A%2212%25%22%2C%22color%22%3A%22peacoc%22%7D%2C%7B%22title%22%3A%2236%25%20Preterm%20birth%20complications%22%2C%22value%22%3A%2236%25%22%2C%22color%22%3A%22blue%22%7D%2C%7B%22title%22%3A%2226%25%20Intrapartum%20related%20events%22%2C%22value%22%3A%2226%25%22%2C%22color%22%3A%22turquoise%22%7D%2C%7B%22title%22%3A%227%25%20Sepsis%20and%20other%20infectious%20conditions%20of%20the%20newborn%22%2C%22value%22%3A%227%25%22%2C%22color%22%3A%22pink%22%7D%2C%7B%22title%22%3A%225%25%20Congenital%20abnormalities%5Ct%22%2C%22value%22%3A%225%25%22%2C%22color%22%3A%22violet%22%7D%2C%7B%22title%22%3A%2211%25%20Other%20conditions%22%2C%22value%22%3A%2211%25%22%2C%22color%22%3A%22chino%22%7D%5D\" custom_stroke_color=\"#f6f6f4\" css=\".vc_custom_1685990079292{padding-right: 30px !important;padding-left: 30px !important;background-position: center !important;background-repeat: no-repeat !important;background-size: contain !important;}\"][\/vc_column_inner][\/vc_row_inner][vc_column_text]\r\n<h6 style=\"text-align: left;\">Source: Estimates for causes of death 2000-2020 generated by the WHO and Maternal and Child Epidemiology Estimation Group (MCEE) 2023 and downloaded from <a href=\"http:\/\/data.unicef.org\/\" target=\"_blank\" rel=\"noopener noreferrer\" data-saferedirecturl=\"https:\/\/www.google.com\/url?q=http:\/\/data.unicef.org&source=gmail&ust=1551964625737000&usg=AFQjCNFsFTtu9FzS8H64YC88NPOzQVbPwQ\">http:\/\/data.unicef.org<\/a><\/h6>\r\n[\/vc_column_text][\/vc_column][\/vc_row][vc_row full_width=\"stretch_row\" gap=\"5\" css=\".vc_custom_1453306441839{background-image: url(\/\/www.healthynewbornnetwork.org\/hnn-content\/uploads\/country-stat-bkgr.jpg?id=389) !important;background-position: center !important;background-repeat: no-repeat !important;background-size: cover !important;}\"][vc_column css=\".vc_custom_1453306493120{margin-top: 30px !important;margin-bottom: 30px !important;}\"][vc_text_separator title=\"key indicators\" el_class=\"transform:uppercase text-white\"][vc_row_inner][vc_column_inner width=\"1\/4\"][vc_column_text css=\".vc_custom_1685989919562{margin-bottom: -5px !important;}\"]\r\n<h1 style=\"text-align: center;\"><span style=\"color: #e05533;\"><strong><span class=\"ticker\">26.2<\/span><\/strong><\/span><\/h1>\r\n[\/vc_column_text][vc_column_text el_class=\"text-white\"]\r\n<h5 style=\"text-align: center;\">Newborn mortality rate (deaths per 1,000 live births)<\/h5>\r\n[\/vc_column_text][\/vc_column_inner][vc_column_inner width=\"1\/4\"][vc_column_text css=\".vc_custom_1685989936549{margin-bottom: -5px !important;}\"]\r\n<h1 style=\"text-align: center;\"><span style=\"color: #d9a23b;\"><strong><span class=\"ticker\">2.9<\/span><\/strong><\/span><\/h1>\r\n[\/vc_column_text][vc_column_text el_class=\"text-white\"]\r\n<h5 style=\"text-align: center;\">Annual reduction in newborn mortality rate 2000-2021 (%)<\/h5>\r\n[\/vc_column_text][\/vc_column_inner][vc_column_inner width=\"1\/4\"][vc_column_text css=\".vc_custom_1685989982771{margin-bottom: -5px !important;}\"]\r\n<h1 style=\"text-align: center;\"><span style=\"color: #41aaab;\"><strong><span class=\"ticker\">57<\/span><\/strong><\/span><\/h1>\r\n[\/vc_column_text][vc_column_text el_class=\"text-white\"]\r\n<h5 style=\"text-align: center;\">Proportion of under-5 child deaths that are newborn (%)<\/h5>\r\n[\/vc_column_text][\/vc_column_inner][vc_column_inner width=\"1\/4\"][vc_column_text css=\".vc_custom_1685989962626{margin-bottom: -5px !important;}\"]\r\n<h1 style=\"text-align: center;\"><span style=\"color: #e05533;\"><strong><span class=\"ticker\">20.6<\/span><\/strong><\/span><\/h1>\r\n[\/vc_column_text][vc_column_text el_class=\"text-white\"]\r\n<h5 style=\"text-align: center;\">Stillbirth rate (deaths per 1,000 births)<\/h5>\r\n[\/vc_column_text][\/vc_column_inner][\/vc_row_inner][vc_row_inner][vc_column_inner width=\"1\/4\"][vc_column_text css=\".vc_custom_1685990024862{margin-bottom: -5px !important;}\"]\r\n<h1 style=\"text-align: center;\"><span style=\"color: #d9a23b;\"><strong><span class=\"ticker\">49.8<\/span><\/strong><\/span><\/h1>\r\n[\/vc_column_text][vc_column_text el_class=\"text-white\"]\r\n<h5 style=\"text-align: center;\">Skilled birth attendance (%)<\/h5>\r\n[\/vc_column_text][\/vc_column_inner][vc_column_inner width=\"1\/4\"][vc_column_text css=\".vc_custom_1650465472020{margin-bottom: -5px !important;}\"]\r\n<h1 style=\"text-align: center;\"><span style=\"color: #41aaab;\"><strong><span class=\"ticker\">72\r\n<\/span><\/strong><\/span><\/h1>\r\n[\/vc_column_text][vc_column_text el_class=\"text-white\"]\r\n<h5 style=\"text-align: center;\">Early initiation of breastfeeding (%)<\/h5>\r\n[\/vc_column_text][\/vc_column_inner][vc_column_inner width=\"1\/4\"][vc_column_text css=\".vc_custom_1698694270558{margin-bottom: -5px !important;}\"]\r\n<h1 style=\"text-align: center;\"><span style=\"color: #e05533;\"><strong><span class=\"ticker\">12.9<\/span><\/strong><\/span><\/h1>\r\n[\/vc_column_text][vc_column_text el_class=\"text-white\"]\r\n<h5 style=\"text-align: center;\">Preterm birth rate (births <37 weeks per 100 live births)<\/h5>\r\n[\/vc_column_text][\/vc_column_inner][vc_column_inner width=\"1\/4\"][vc_column_text css=\".vc_custom_1685989998281{margin-bottom: -5px !important;}\"]\r\n<h1 style=\"text-align: center;\"><span style=\"color: #d9a23b;\"><strong><span class=\"ticker\">267<\/span><\/strong><\/span><\/h1>\r\n[\/vc_column_text][vc_column_text el_class=\"text-white\"]\r\n<h5 style=\"text-align: center;\">Maternal mortality ratio (deaths per 100,000 live births)<\/h5>\r\n[\/vc_column_text][\/vc_column_inner][\/vc_row_inner][vc_column_text css=\".vc_custom_1453307990481{margin-top: 20px !important;}\"]\r\n<h5 style=\"text-align: center;\"><span style=\"color: #ffffff;\">Visit our<\/span> <a href=\"https:\/\/www.healthynewbornnetwork.org\/numbers\/\">Newborn Numbers<\/a> <span style=\"color: #ffffff;\">page to explore the most recent data further<\/span><\/h5>\r\n[\/vc_column_text][\/vc_column][\/vc_row]","post_title":"Ethiopia","post_excerpt":"","post_status":"publish","comment_status":"closed","ping_status":"closed","post_password":"","post_name":"ethiopia","to_ping":"","pinged":"","post_modified":"2023-10-30 15:29:58","post_modified_gmt":"2023-10-30 19:29:58","post_content_filtered":"","post_parent":0,"guid":"http:\/\/www.healthynewbornnetwork.org\/?post_type=country&p=9","menu_order":0,"post_type":"country","post_mime_type":"","comment_count":"0","filter":"raw"}]},"_links":{"self":[{"href":"https:\/\/www.healthynewbornnetwork.org\/wp-json\/wp\/v2\/news-item\/40535"}],"collection":[{"href":"https:\/\/www.healthynewbornnetwork.org\/wp-json\/wp\/v2\/news-item"}],"about":[{"href":"https:\/\/www.healthynewbornnetwork.org\/wp-json\/wp\/v2\/types\/news-item"}],"author":[{"embeddable":true,"href":"https:\/\/www.healthynewbornnetwork.org\/wp-json\/wp\/v2\/users\/7211"}],"version-history":[{"count":0,"href":"https:\/\/www.healthynewbornnetwork.org\/wp-json\/wp\/v2\/news-item\/40535\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.healthynewbornnetwork.org\/wp-json\/wp\/v2\/media\/40539"}],"wp:attachment":[{"href":"https:\/\/www.healthynewbornnetwork.org\/wp-json\/wp\/v2\/media?parent=40535"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}