Barriers and facilitators to the implementation of mandatory folate fortification as an evidence-based policy to prevent neural tube defects

• Type of Material: Article
• Authors: Kemel A Ghotme, Campus Univ Puente Comun; Anastasia Arynchyna-Smith, University of Alabama Birmingham; Pedram Maleknia, University of Alabama Birmingham; Vijaya Kancherla, Emory University; Helena Pachon, Emory University; Philip J van der Wees, George Washington University; Joseph M Bocchino, George Washington University; Gail L Rosseau, George Washington University
• Language: English
• Date: 2023-05-20
• Publisher: SPRINGER
• Publication Version: Final Published Version
• Copyright Statement: © The Author(s) 2023
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1007/s00381-023-05944-x
• Title of Journal or Parent Work: CHILDS NERVOUS SYSTEM
• Volume: 39
• Issue: 7
• Start Page: 1805
• End Page: 1812
• Grant/Funding Information: Open Access funding provided by Colombia Consortium. This manuscript is derived from a doctoral dissertation for the PhD program in Translational Health Science at George Washington University with a research grant to Kemel A. Ghotme, MD, PhD, by University of La Sabana, Grant: MED-327-2022.
• Keywords: Anencephaly; Science & Technology; Advocacy; Determinant factors; Mandatory folate fortification; Life Sciences & Biomedicine; Neural tube defects; FOOD FORTIFICATION; PREVALENCE; Surgery; Clinical Neurology; Pediatrics; Facilitators; Neurosciences & Neurology; FOLIC-ACID FORTIFICATION; SUPPLEMENTS; Barriers; SPINA-BIFIDA; Implementation; Spina bifida
• Research Categories: Health Sciences, Public Health; Biology, Neuroscience; Health Sciences, Medicine and Surgery

Abstract

Background: 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. Aim: This article discusses the main barriers and facilitators for implementing mandatory food fortification as an evidence-based policy to prevent neural tube defects worldwide. Methods: 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. Results: 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. Conclusions: 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.