TY - JOUR T1 - Countries with an immediate potential for primary prevention of spina bifida and anencephaly: Mandatory fortification of wheat flour with folic acid. A1 - Kancherla,Vijaya, Y1 - 2018/03/13/ PY - 2018/01/03/received PY - 2018/02/09/revised PY - 2018/02/21/accepted PY - 2018/3/14/pubmed PY - 2019/5/14/medline PY - 2018/3/14/entrez KW - anencephaly KW - epidemiology KW - flour fortification KW - folic acid KW - prevention KW - spina bifida SP - 956 EP - 965 JF - Birth defects research JO - Birth Defects Res VL - 110 IS - 11 N2 - OBJECTIVES: Mandatory fortification of flour with folic acid has been proven to be a highly effective way to prevent spina bifida and anencephaly. Yet, over 100 countries worldwide do not implement this intervention. Our objectives were to identify countries with an immediate potential for mandatory fortification of wheat flour with folic acid and to estimate the number of preventable cases of spina bifida and anencephaly that would be averted each year through the intervention. METHODS: We examined folic acid fortification characteristics in countries as of September 2017. Country selection criteria included current fortification status, existing industrial capacity for flour production, fortification coverage, and daily grams of per capita wheat flour available for human consumption. We estimated the country-specific number of preventable cases of spina bifida and anencephaly by calculating the difference between the observed prevalence (prefortification) and expected prevalence that can be achieved postfortification (0.5 per 1,000 live births). RESULTS: We identified 71 countries with an immediate potential for mandatory fortification of 145 million metric tons of wheat flour with folic acid. Fortification in identified countries would avert approximately 57,000 live births associated with folic acid-preventable spina bifida and anencephaly annually and increase global prevention from the current rate of 13% to a new rate of 34%. CONCLUSIONS: Fortification can be achieved immediately in many countries with existing industrial milling infrastructure. Effective fortification interventions can accelerate global primary prevention efforts of folic acid-preventable spina bifida and anencephaly, especially in developing countries with a high prevalence of neural tube defects and associated morbidity and mortality. SN - 2472-1727 UR - https://www.unboundmedicine.com/medline/citation/29532629/Countries_with_an_immediate_potential_for_primary_prevention_of_spina_bifida_and_anencephaly:_Mandatory_fortification_of_wheat_flour_with_folic_acid_ L2 - https://doi.org/10.1002/bdr2.1222 DB - PRIME DP - Unbound Medicine ER -