Evaluating the impact of mandatory folic acid fortification programme on the prevalence of Spina Bifida in Southern Region of Malawi: A central hospital based secondary data study
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Date
2020-12-01
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Kamuzu University of Health Sciences
Abstract
Without evidence, we can not know if a Malawian fortification programme of 2015 has been effective. We conducted the study to evaluate the impact of folic acid fortification programme on the prevalence of spina bifida in the southern region of Malawi. We used a pre post case-control quasi experimental comparative study design. We assessed the total number of births for the southern region, Mw in 2014. Then we reviewed case notes of spina bifida patients who presented to QECH from the southern region, Mw in that year (2014). We did the same for 2018. Spina bifida cases were defined as a documented confirmed case note diagnosis of spina bifida, myelomeningocele or meningocele. The control group comprised of case notes of patients who presented to QECH from the southern region with conditions like sepsis, malaria and diarrhea. To obtain prevalence, we divided the number of cases with the total number of births, expressed per 10,000 live births. The prevalence for 2014 and 2018 were compared to assess the programme’s impact. We performed logistic regression to assess the odds of spina bifida before and after the programme using; gender, birth weight; tribe; maternal age at delivery; number of children by mother; district of residence; pre-natal use of folic acid and use of chronic medications. The before and after odds were compared to assess for accuracy of prevalence. We used Z test to assess the significance of the odds at 95% confidence interval and 0.05 marginal error. SPSS software version 20 was used. The prevalence increased by 13.6% from the pre-fortification to the post-fortification period. Occurrence of spina bifida was statistically associated with female gender (OR 2.51 (1.019-6.198) p= 0.45), absent history of spina bifida (OR 0.191 (0.41-.884) p=0.034), mean birth weight of 2850g, family size 72% ≤3 children and maternal age 77% ≤ 30 years. The study showed that the mandatory folic acfortification programme in Malawi might have not been effective in reducing the prevalence of spina bifida.