Incidence, prevalence, burden, and disability rate of neural tube defects in sub-Saharan Africa, 1990–2021: understanding epidemiology

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OBJECTIVE: Neural tube defects (NTDs) represent a significant global concern, impacting an estimated 300,000 individuals each year. Sub-Saharan Africa (SSA) is considerably affected due to various biopsychosocial factors, dietary issues such as folic acid deficiency, and fumonisin-contaminated maize consumption, and sex-based disparities. This study sought to understand epidemiology and trends in NTD in SSA from 1990 to 2021. METHODS: The Global Burden of Disease database was utilized to obtain epidemiological data on the variables of interest, which included disability-adjusted life years (DALYs), incidence, prevalence, and mortality of patients with NTD in SSA. The countries in SSA were divided into 4 separate regions-Central, Eastern, Western, and Southern-based on the designations by the African Union. Variations in measurements of NTDs between regions in SSA were assessed using R Studio, and statistical significance was determined with a threshold p value of < 0.05. RESULTS: The global burden of NTDs was significantly lower than the burden of NTDs in Central, Eastern, and Western SSA (p < 0.0001). Among the regions, Southern SSA experienced better outcomes in terms of DALYs, mortality, incidence, and prevalence, compared to the other regions of SSA (p < 0.001). When a sex-specific burden analysis was performed, female sex was associated with higher DALYs and mortality of NTDs within SSA, especially in Western SSA (p < 0.0001). Other regions of the world, including North America, Latin America and Caribbean, Europe and Central Asia, and Middle East and Northern Africa, also showed associations between female sex and higher DALYs and mortality of NTDs (p < 0.05). When the incidence and prevalence of NTDs was analyzed, there were mixed results, as female sex was associated with higher and lower rates in different regions of the world. CONCLUSIONS: Understanding the epidemiology of NTDs in SSA underscores the need for quality interventions that not only increase disease awareness and healthcare access but strive for prevention. With identification of the multifaceted factors contributing to NTDs and promotion of proactive health practices, significant strides could be made toward reducing the incidence of NTDs. Partnerships between governments and international agencies are vital to mobilize resources and reduce the burden and related health disparities.

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