Objectives
The objective of our study was to estimate the percent reduction in neonatal, infant, and under-five mortality rates in India if we prevented folic acid-preventable spina bifida and anencephaly (FAP SBA), and the proportional contribution of this reduction in achieving India’s health-related Sustainable Development Goals (SDG) for 2030.
Methods
Using reputable data sources we calculated for India during year 2012: 1) number of neonatal, infant, and under-five deaths among those born with FAP SBA; 2) number of deaths that can be prevented in each of the three mortality categories through mandatory folic acid fortification; and 3) proportional contribution of FAP SBA prevention towards achieving SDG.
Results
In the year 2012, 128,200 babies (5 per 1,000 live births) were affected with spina bifida and anencephaly in India; 90% of them folic acid preventable. The total number of preventable deaths associated with FAP SBA were 72,120 in the neonatal period (100% anencephaly; 25% spina bifida), 86,540 in the first year of life (100% anencephaly; 50% spina bifida), and 100,965 in the under-five years age category (100% anencephaly; 75% spina bifida). Primary prevention of FAP SBA can achieve a reduction of 9.1%, 7.7%, and 7.0% in the current neonatal, infant, and under-five mortality rates, respectively, in India.
Conclusions
Total prevention of FAP SBA could lead to 7-9% reduction in child mortality and 13-16% of the reduction needed for India to achieve SDG for child mortality. Mandatory folic acid fortification programs for primary prevention of FAP SBA are both proven and cost-effective, and urgently needed in India.
