{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T04:40:49Z","timestamp":1773808849060,"version":"3.50.1"},"reference-count":26,"publisher":"Wiley","issue":"19","license":[{"start":{"date-parts":[[2019,8,19]],"date-time":"2019-08-19T00:00:00Z","timestamp":1566172800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Birth Defects Research"],"published-print":{"date-parts":[[2019,11,15]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Recent surveillance studies in Ethiopia show an epidemic of spina bifida and anencephaly, two major neural tube birth defects that are severe and life\u2010threatening. Our objective was to estimate proportional reductions in current stillbirth and child mortality rates in Ethiopia through folic acid\u2010based interventions to prevent spina bifida and anencephaly.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Using secondary data from multiple sources, we estimated percent reductions in stillbirth, neonatal, infant, and under\u2010five child mortality rates that would have occurred in Ethiopia in the year 2016 had all folic acid\u2010preventable spina bifida and anencephaly been prevented; and the contributions of these reductions toward Ethiopia's Year 2030 Every Newborn Action Plan (ENAP) goal on stillbirth, and sustainable development goal (SDG) on child mortality rates. The 2016 prevalence of spina bifida and anencephaly in Ethiopia was assumed as 13 per 1,000 total births, with the prevention goal reaching 0.5 per 1,000 total births.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Folic acid interventions in Ethiopia would have prevented about 41,610 cases of folic acid\u2010preventable spina bifida and anencephaly\u2010affected pregnancies during the year 2016. We estimate that this prevention is associated with reduction of 31,830 stillbirths and 7,335 under\u2010five child deaths annually. The proportional contribution of this prevention toward achieving Ethiopia's ENAP goal is 54% for stillbirth, and toward SDG is 4.5% for neonatal\u2010 and 6.8% for under\u2010five mortality.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Spina bifida and anencephaly contribute to substantial stillbirths and child death in Ethiopia. Large\u2010scale fortification of foods like wheat flour and salt can help achieve Ethiopia's ENAP and SDG targets addressing preventable stillbirth, neonatal, and under\u2010five mortality.<\/jats:p><\/jats:sec>","DOI":"10.1002\/bdr2.1584","type":"journal-article","created":{"date-parts":[[2019,8,19]],"date-time":"2019-08-19T13:50:10Z","timestamp":1566222610000},"page":"1513-1519","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["High potential for reducing folic acid\u2010preventable spina bifida and anencephaly, and related stillbirth and child mortality, in Ethiopia"],"prefix":"10.1002","volume":"111","author":[{"given":"Meredith","family":"Dixon","sequence":"first","affiliation":[{"name":"Department of Epidemiology Emory University, Rollins School of Public Health  Atlanta Georgia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2803-8030","authenticated-orcid":false,"given":"Vijaya","family":"Kancherla","sequence":"additional","affiliation":[{"name":"Department of Epidemiology Emory University, Rollins School of Public Health  Atlanta Georgia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tony","family":"Magana","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery School of Medicine, College of Health Sciences, Mekelle University  Mekelle Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Afework","family":"Mulugeta","sequence":"additional","affiliation":[{"name":"Department of Nutrition and Dietetics School of Public Health, College of Health Sciences, Mekelle University  Mekelle Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"suffix":"Jr.","given":"Godfrey P.","family":"Oakley","sequence":"additional","affiliation":[{"name":"Department of Epidemiology Emory University, Rollins School of Public Health  Atlanta Georgia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2019,8,19]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2015.302902"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0206212"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199911113412001"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(15)00275-2"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/nyas.13548"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1017\/S1368980012003576"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.g4554"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(15)00954-X"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa067103"},{"key":"e_1_2_6_11_1","first-page":"213","article-title":"Anencephalus and spina bifida in Belfast (1964\u20101968)","volume":"42","author":"Elwood J. 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