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We conducted a review of published literature and surveillance systems to examine challenges in estimating an overall global prevalence estimate for NTD. Our review showed that most low\u2010 and middle\u2010income countries do not track NTD and indicate a high prevalence of these malformations where data are available. Challenges in global NTD prevalence estimation include (1) quality of surveillance methods, (2) existing risk factors (including geographic or socioeconomic factors, availability and use of folic acid, and racial\u2013ethnic and genetic factors), and (3) limitations in education and access to care. We recommend population\u2010based surveillance systems tracking all pregnancy outcomes and major risk factors. Countries should invest in sustainable, multisource surveillance systems, in parallel to folic acid interventions, for gaining a more accurate knowledge of global prevalence of NTD than we currently have. Such efforts will assist in both global prevention of NTD and periodic evaluation of folic acid interventions for NTD reduction. Global NTD prevalence data can drive political will and accelerate the implementation and evaluation of NTD prevention programs.<\/jats:p>","DOI":"10.1111\/nyas.13601","type":"journal-article","created":{"date-parts":[[2018,3,13]],"date-time":"2018-03-13T08:25:11Z","timestamp":1520929511000},"page":"20-30","source":"Crossref","is-referenced-by-count":33,"title":["Historical perspective on folic acid and challenges in estimating global prevalence of neural tube defects"],"prefix":"10.1111","volume":"1414","author":[{"given":"Vijaya","family":"Kancherla","sequence":"first","affiliation":[{"name":"Department of Epidemiology Emory University  Rollins School of Public Health Atlanta Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert E.","family":"Black","sequence":"additional","affiliation":[{"name":"Department of International Health Johns Hopkins University  Bloomberg School of Public Health Baltimore Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,3,13]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199911113412006"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/bdra.20536"},{"key":"e_1_2_11_4_1","unstructured":"WHO\/CDC\/ICBDSR.2014.Birth defects surveillance: atlas of selected congenital anomalies.Geneva: World Health Organization."},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/ajmg.a.36324"},{"key":"e_1_2_11_6_1","unstructured":"Christianson A.L. 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