{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T22:14:42Z","timestamp":1792188882285,"version":"4.4.0"},"reference-count":35,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2008,3,12]],"date-time":"2008-03-12T00:00:00Z","timestamp":1205280000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Birth Defects Research"],"published-print":{"date-parts":[[2008,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p><jats:bold>BACKGROUND:<\/jats:bold> In October 2003 South Africa embarked on a program of folic acid fortification of staple foods. We measured the change in prevalence of NTDs before and after fortification and assessed the cost benefit of this primary health care intervention. <jats:bold>METHODS:<\/jats:bold> Since the beginning of 2002 an ecological study was conducted among 12 public hospitals in four provinces of South Africa. NTDs as well as other birth defect rates were reported before and after fortification. Mortality data were also collected from two independent sources. <jats:bold>RESULTS:<\/jats:bold> This study shows a significant decline in the prevalence of NTDs following folic acid fortification in South Africa. A decline of 30.5% was observed, from 1.41 to 0.98 per 1,000 births (RR = 0.69; 95% CI: 0.49\u20130.98; <jats:italic>p<\/jats:italic> = .0379). The cost benefit ratio in averting NTDs was 46 to 1. Spina bifida showed a significant decline of 41.6% compared to 10.9% for anencephaly. Additionally, oro\u2010facial clefts showed no significant decline (5.7%). An independent perinatal mortality surveillance system also shows a significant decline (65.9%) in NTD perinatal deaths, and in NTD infant mortality (38.8%). <jats:bold>CONCLUSIONS:<\/jats:bold> The decrease in NTD rates postfortification is consistent with decreases observed in other countries that have fortified their food supplies. This is the first time this has been observed in a predominantly African population. The economic benefit flowing from the prevention of NTDs greatly exceeds the costs of implementing folic acid fortification. Birth Defects Research (Part A), 2008. \u00a9 2008 Wiley\u2010Liss, Inc.<\/jats:p>","DOI":"10.1002\/bdra.20442","type":"journal-article","created":{"date-parts":[[2008,3,12]],"date-time":"2008-03-12T21:51:30Z","timestamp":1205358690000},"page":"211-216","source":"Crossref","is-referenced-by-count":183,"title":["Decline in the prevalence of neural tube defects following folic acid fortification and its cost\u2010benefit in South Africa"],"prefix":"10.1002","volume":"82","author":[{"given":"Abdul\u2010Rauf","family":"Sayed","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Bourne","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Pattinson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jo","family":"Nixon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bertram","family":"Henderson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2008,3,12]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199911113412001"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/bdra.20307"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1467-842X.2006.tb00867.x"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/tera.1420500304"},{"key":"e_1_2_7_6_1","doi-asserted-by":"crossref","first-page":"S40","DOI":"10.1111\/j.1753-4887.2004.tb00073.x","article-title":"The Costa Rican experience: reduction of neural tube defects following food fortification programs","author":"Chen LT","year":"2004","journal-title":"Nutr Rev"},{"key":"e_1_2_7_7_1","volume-title":"March of Dimes, Global Report on Birth Defects","author":"Christianson A","year":"2006"},{"key":"e_1_2_7_8_1","unstructured":"Council for Medical Schemes.2006. 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