Local conceptions of the role of folate in neural tube defects in Zambia

Jeffrey W Chen; Nathan A Shlobin; Arnold Bhebhe; Shilin Zhao; Chevis N Shannon; Kachinga Sichizya; Christopher M Bonfield; Rebecca A Reynolds

doi:10.3171/2022.11.PEDS22217

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Local conceptions of the role of folate in neural tube defects in Zambia

Journal article

Peer reviewed

Local conceptions of the role of folate in neural tube defects in Zambia

Jeffrey W Chen, Nathan A Shlobin, Arnold Bhebhe, Shilin Zhao, Chevis N Shannon, Kachinga Sichizya, Christopher M Bonfield and Rebecca A Reynolds

Journal of neurosurgery. Pediatrics, Vol.31(3), pp.268-274

03/01/2023

DOI: 10.3171/2022.11.PEDS22217

PMID: 36681960

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Abstract

In sub-Saharan Africa, neural tube defects (NTDs) are the second most common birth defect, occurring eight times more frequently than in the US. The objective of this study was to assess baseline Zambian caregiver understanding of folate and NTDs and the effectiveness of an NTD prevention educational program. This prospective survey-based study included Zambian caregivers of children born with NTDs who completed pre- and post-educational program surveys between January 2020 and January 2021. The verbal survey was administered in English or local Zambian dialects. The 1-hour educational program administered by local Zambian research nurses sought to facilitate understanding of the direct relationship between prenatal folate supplementation and NTDs. Sixty-one eligible caregivers with a median age of 20 (IQR 24-29) years completed the survey. Participants were predominantly from regions outside of Lusaka Province (68%, 41/60) rather than the capital city, Lusaka (32%, 19/60). Most had received prenatal care (91%, 57/61), and 80% (47/59) reported folate use in pregnancy. Of the mothers who took folate during pregnancy, 24% (11/45) reported use within the first 4 weeks after conception, while 76% (34/45) started thereafter. Myelomeningocele was the most common NTD (74%, 32/43), followed by meningocele (14%, 6/43). Prior to the educational program, 52% (29/56) of caregivers reported that NTDs were caused by a vitamin deficiency, which improved to 98% (55/56) after the program (p < 0.001). Furthermore, only 54% (33/61) of caregivers believed that folate should be taken before conception on the baseline survey evaluation, which improved to 95% (58/61, p < 0.001) after the program. All survey participants (58/58) found the educational session helpful. This study found that a high proportion of Zambian caregivers had received prenatal care and even had taken folate during pregnancy, but none had taken it prior to pregnancy. An educational program effectively improved understanding about the role and timing of perinatal folate administration in NTD prevention. This result also emphasizes the need for folate fortification and folate education for not only mothers but also primary care providers.

Adult

Child

Female

Folic Acid

Humans

Meningocele - complications

Neural Tube Defects - etiology

Pregnancy

Prospective Studies

Young Adult

Zambia

Details

Title: Subtitle: Local conceptions of the role of folate in neural tube defects in Zambia
Creators: Jeffrey W Chen - Vanderbilt University
Nathan A Shlobin - Northwestern University
Arnold Bhebhe - University Teaching Hospital
Shilin Zhao - Vanderbilt University Medical Center
Chevis N Shannon - University of Alabama at Birmingham
Kachinga Sichizya - University of Zambia
Christopher M Bonfield - Monroe Carell Jr. Children's Hospital
Rebecca A Reynolds - Departments of8Neurological Surgery and
Resource Type: Journal article
Publication Details: Journal of neurosurgery. Pediatrics, Vol.31(3), pp.268-274
DOI: 10.3171/2022.11.PEDS22217
PMID: 36681960
ISSN: 1933-0707
eISSN: 1933-0715
Language: English
Date published: 03/01/2023
Academic Unit: Neurosurgery
Record Identifier: 9984446425702771

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