BACKGROUND: Spina bifida and anencephaly are major birth defects, and the majority of them can be prevented through maternal intake of folic acid (vitamin B9) during early pregnancy. We estimated the proportion of folic acid-preventable spina bifida and anencephaly (FAP SBA) prevented globally through mandatory folic acid fortification policy in the year 2024 for cereal grains (i.e., wheat flour, maize flour, and rice). METHODS: We used country-specific fortification data from the Food Fortification Initiative for year 2024. Seventy countries had mandatory cereal grain fortification adding folic acid, and of them, 69 had complete data for analysis. Our prevention model assumed > 150 mcg/day of folic acid protects against FAP SBA, and post-fortification prevalence was assumed to reach the prevention target of 0.5 cases per 1000 births. RESULTS: We estimated 63,600 cases of FAP SBA were prevented in the year 2024 in the 69 countries with mandatory fortification of cereal grains with folic acid worldwide. The prevention percent was 24%, indicating only a quarter of all preventable FAP SBA was prevented globally. About 200,000 preventable FAP SBA cases occurred in over 100 countries without fortification policies. CONCLUSION: The 76th World Health Assembly resolution (76.19) passed in 2023 urges countries to implement folic acid fortification of staple foods to prevent FAP SBA. However, a large global disparity in FAP SBA prevention persists in 2024 despite proven fortification effectiveness. Fortification can swiftly and cost-effectively help countries achieve health equity by preventing disability and mortality associated with FAP SBA.
Kancherla et al. (Fri,) studied this question.