Neural tube defects as a cause of death among stillbirths, infants, and children younger than 5 years in sub-Saharan Africa and southeast Asia: an analysis of the CHAMPS network

• Type of Material: Article
• Authors: Lola Madrid, London School of Hygiene & Tropical Medicine; Kartavya J Vyas, Emory University; Vijaya Kancherla, Emory University; Haleluya Leulseged, Haramaya University; Parminder Suchdev, Emory University; Quique Bassat, Instituto de Salud Global de Barcelona; Samba O Sow, Ministère de la Santé; Shams El Arifeen, International Centre for Diarrhoeal Disease Research Bangladesh; Shabir A Madhi, University of the Witwatersrand, Johannesburg; Dickens Onyango, Kisumu County Department of Health; Ikechukwu Ogbuanu, Crown Agents; Anthony JG Scott, London School of Hygiene & Tropical Medicine; Dianna Blau, Centers for Disease Control and Prevention; Inacio Mandomando, Centro de Investigação em Saúde de Manhiça CISM; Adama M Keita, Ministère de la Santé; Emily S Gurley, Johns Hopkins Bloomberg School of Public Health; Sana Mahtab, University of the Witwatersrand, Johannesburg; Victor Akelo, Centers for Disease Control and Prevention; Sulaiman Sannoh, Crown Agents; Yenenesh Tilahun, Haramaya University; Rosauro Varo, Instituto de Salud Global de Barcelona; Uma Onwuchekwa, University of Maryland School of Medicine; Afruna Rahman, International Centre for Diarrhoeal Disease Research Bangladesh; Yasmin Adam, University of the Witwatersrand, Johannesburg; Richard Omore, Kisumu County Department of Health; Sandra Lako, Crown Agents; Elisio Xerinda, Centro de Investigação em Saúde de Manhiça CISM; Kazi Munisul Islam, International Centre for Diarrhoeal Disease Research Bangladesh; Amy Wise, University of the Witwatersrand, Johannesburg; Beth A Tippet-Barr, Centers for Disease Control and Prevention; Erick Kaluma, Crown Agents; Sara Ajanovic, Instituto de Salud Global de Barcelona; Karen L Kotloff, University of Maryland School of Medicine; Mohammad Zahid Hossain, International Centre for Diarrhoeal Disease Research Bangladesh; Portia Mutevedzi, University of the Witwatersrand, Johannesburg; Milagritos D Tapia, University of Maryland School of Medicine; Emily Rogena, Jomo Kenyatta University of Agriculture and Technology; Francis Moses, Ministry of Health and Sanitation; Cynthia Whitney, Emory University; Nega Assefa, Haramaya University
• Language: English
• Date: 2023-07-01
• Publisher: Elsevier Ltd
• Publication Version: Final Published Version
• Copyright Statement: © 2023 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY 4.0 license
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/S2214-109X(23)00191-2
• Title of Journal or Parent Work: The Lancet Global Health
• Volume: 11
• Issue: 7
• Start Page: e1041
• End Page: e1052
• Keywords: Ethiopia; Folic Acid; Female; Child; Pregnancy; Mothers; Neural Tube Defects; Cause of Death; Stillbirth; Humans; Infant; Infant, Newborn; Asia, Southeastern
• Research Categories: Health Sciences, Public Health; Health Sciences, Epidemiology

Abstract

Background: Neural tube defects are common birth defects resulting in severe morbidity and mortality; they can largely be prevented with periconceptional maternal intake of folic acid. Understanding the occurrence of neural tube defects and their contribution to mortality in settings where their burden is highest could inform prevention and health-care policy. We aimed to estimate the mortality attributed to neural tube defects in seven countries in sub-Saharan Africa and southeast Asia. Methods: This analysis used data from the Child Health and Mortality Prevention Surveillance (CHAMPS) network and health and demographic surveillance systems from South Africa, Mozambique, Bangladesh, Kenya, Mali, Ethiopia, and Sierra Leone. All stillbirths and infants and children younger than 5 years who died, who were enrolled in CHAMPS, whose families consented to post-mortem minimally invasive tissue sampling (MITS) between Jan 1, 2017, and Dec 31, 2021, and who were assigned a cause of death by a determination of cause of death panel as of May 24, 2022, were included in this analysis, regardless the cause of death. MITS and advanced diagnostic methods were used to describe the frequency and characteristics of neural tube defects among eligible deaths, identify risk factors, and estimate the mortality fraction and mortality rate (per 10 000 births) by CHAMPS site. Findings: Causes of death were determined for 3232 stillbirths, infants, and children younger than 5 years, of whom 69 (2%) died with a neural tube defect. Most deaths with a neural tube defect were stillbirths (51 [74%]); 46 (67%) were neural tube defects incompatible with life (ie, anencephaly, craniorachischisis, or iniencephaly) and 22 (32%) were spina bifida. Deaths with a neural tube defect were more common in Ethiopia (adjusted odds ratio 8·09 [95% CI 2·84–23·02]), among female individuals (4·40 [2·44–7·93]), and among those whose mothers had no antenatal care (2·48 [1·12–5·51]). Ethiopia had the highest adjusted mortality fraction of deaths with neural tube defects (7·5% [6·7–8·4]) and the highest adjusted mortality rate attributed to neural tube defects (104·0 per 10 000 births [92·9–116·4]), 4–23 times greater than in any other site. Interpretation: CHAMPS identified neural tube defects, a largely preventable condition, as a common cause of death among stillbirths and neonatal deaths, especially in Ethiopia. Implementing interventions such as mandatory folic acid fortification could reduce mortality due to neural tube defects. Funding: Bill & Melinda Gates Foundation.