Emerging Trends in Folate Deficiency in Ghana and Implications for Birth Defect Prevention and Policy Action

Neural tube defects and orofacial clefts are serious congenital anomalies that can substantially affect a child's survival and long-term well-being. Folate deficiency is a well-established cause of neural tube defects and may also contribute to the risk of orofacial clefts. This narrative review summarises Ghana-relevant evidence on folate deficiency and related birth defects, with attention to prevalence patterns, plausible determinants, and policy and programme responses. Evidence was drawn from peer-reviewed literature and key national and partner reports identified through targeted searches of major biomedical databases and Google Scholar, supplemented by publicly available materials from institutions such as the Ghana Health Service, Ministry of Health, and UNICEF Ghana. National data on folate status are limited. In the only national survey reporting folate biomarkers, 53.8% (47.6–60.0) of non-pregnant women were folate deficient, defined as plasma folate <10 nmol/L. National epidemiological data on neural tube defects and orofacial clefts remain limited and are largely derived from facility-based studies, constraining inference on population-level trends. Current responses include iron–folic acid supplementation for adolescent girls and pregnant women and wheat flour fortification policies, though implementation and compliance challenges persist. Overall, folate deficiency remains an important public health concern in Ghana, supporting the need to strengthen programme coverage and quality, improve monitoring, and advance surveillance for folate status and major folate-related birth defects.