{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T12:15:14Z","timestamp":1790684114915,"version":"4.1.0"},"reference-count":19,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2020,12,14]],"date-time":"2020-12-14T00:00:00Z","timestamp":1607904000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Birth Defects Research"],"published-print":{"date-parts":[[2021,3,15]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Spina bifida, also known as meningomyelocele, is a major birth defect mostly associated with folate deficiency in the mother early in pregnancy. The prevalence of spina bifida is disproportionately high in Ethiopia compared to the global average; about 10,500 liveborn are affected annually. Many affected infants do not receive timely repair surgery. There are a high number of stillbirths, and neonatal, infant, and under\u2010five deaths. Mandatory fortification of staple foods such as wheat and maize flour with folic acid, a B vitamin, is an effective primary prevention strategy for spina bifida. Survival in those with spina bifida increases if neurosurgical intervention is available soon after birth, along with continuous surgical and clinical aftercare throughout the lifespan. Currently, Ethiopia does not have mandatory food fortification for primary prevention or adequate neurosurgical capacity to meet the need to prevent adverse outcomes associated with spina bifida. We present in this paper two concurrent and complementary policy and practice solutions occurring in Ethiopia through global partnerships: (1) capacity\u2010building of neurosurgery care through training programs; and (2) promoting national mandatory folic acid fortification of staples for primary prevention of spina bifida. These two policy and practice interventions ensure all affected infants can receive timely pediatric neurosurgery and sustained surgical aftercare through required neurosurgeon availability, and ensure primary prevention of spina bifida. Primary prevention of spina bifida frees up significant neurosurgical capacity in resource\u2010poor settings that can then be directed to other critical neurosurgical needs thus lowering child mortality and morbidity.<\/jats:p>","DOI":"10.1002\/bdr2.1857","type":"journal-article","created":{"date-parts":[[2020,12,15]],"date-time":"2020-12-15T17:49:20Z","timestamp":1608054560000},"page":"393-398","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":27,"title":["Projected impact of mandatory food fortification with folic acid on neurosurgical capacity needed for treating spina bifida in <scp>Ethiopia<\/scp>"],"prefix":"10.1002","volume":"113","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2803-8030","authenticated-orcid":false,"given":"Vijaya","family":"Kancherla","sequence":"first","affiliation":[{"name":"Department of Epidemiology Emory University Rollins School of Public Health  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan","family":"Koning","sequence":"additional","affiliation":[{"name":"ReachAnother Foundation Nederland  Delft The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hagos","family":"Biluts","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Addis Ababa University  Addis Ababa Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mersha","family":"Woldemariam","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Addis Ababa University  Addis Ababa Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zewdie","family":"Kibruyisfaw","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Addis Ababa University  Addis Ababa Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Addisalem","family":"Belete","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Addis Ababa University  Addis Ababa Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marinus","family":"Koning","sequence":"additional","affiliation":[{"name":"ReachAnother Foundation  Bend Oregon USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,12,14]]},"reference":[{"issue":"1","key":"e_1_2_7_2_1","first-page":"104","article-title":"Pattern of neurosurgical procedures in Ethiopia: Experience from two major neurosurgical centres in Addis Ababa","volume":"16","author":"Abebe M.","year":"2011","journal-title":"East and Central African Journal of Surgery"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/bdra.23100"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2017-3730"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2015.302902"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0206212"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/nyas.13548"},{"issue":"7","key":"e_1_2_7_8_1","first-page":"CD012150","article-title":"Fortification of wheat and maize flour with folic acid for population health outcomes","volume":"7","author":"Centeno Tablante E.","year":"2019","journal-title":"The Cochrane Database of Systematic Reviews"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/bdr2.1584"},{"key":"e_1_2_7_10_1","volume-title":"Ethiopian national micronutrient survey report","author":"Ethiopian Public Health Institute","year":"2016"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1155\/2018\/4829023"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00268-017-4307-x"},{"key":"e_1_2_7_13_1","first-page":"1","article-title":"The global neurosurgical workforce: A mixed\u2010methods assessment of density and growth","author":"Mukhopadhyay S.","year":"2019","journal-title":"Journal of Neurosurgery"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.wneu.2015.12.048"},{"key":"e_1_2_7_15_1","unstructured":"Rosseau G.(2020). Global Neurosurgery WHO and the growing Global Surgery Movement. Retrieved fromhttps:\/\/aansneurosurgeon.org\/inside\u2010neurosurgeon\/global\u2010neurosurgery\u2010who\u2010and\u2010the\u2010growing\u2010global\u2010surgery\u2010movement\/."},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.3171\/2016.7.PEDS16296"},{"key":"e_1_2_7_17_1","unstructured":"Spina Bifida Association. (2018).Guidelines for the care of people with spina bifida. Retrieved fromhttps:\/\/www.spinabifidaassociation.org\/wp\u2010content\/uploads\/Guidelines\u2010for\u2010the\u2010Care\u2010of\u2010People\u2010with\u2010Spina\u2010Bifida\u20102018.pdf."},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1097\/JU.0000000000000141"},{"key":"e_1_2_7_19_1","unstructured":"UNICEF. (2019).Iodized salt consumption. Retrieved fromhttps:\/\/data.unicef.org\/resources\/dataset\/iodized-salt-consumption\/."},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.wneu.2013.01.022"}],"container-title":["Birth Defects Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/bdr2.1857","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/bdr2.1857","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/bdr2.1857","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,2]],"date-time":"2023-09-02T14:47:05Z","timestamp":1693666025000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/bdr2.1857"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,12,14]]},"references-count":19,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2021,3,15]]}},"alternative-id":["10.1002\/bdr2.1857"],"URL":"https:\/\/doi.org\/10.1002\/bdr2.1857","archive":["Portico"],"relation":{},"ISSN":["2472-1727","2472-1727"],"issn-type":[{"value":"2472-1727","type":"print"},{"value":"2472-1727","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,12,14]]},"assertion":[{"value":"2020-11-07","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-12-04","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-12-14","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}