Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Aug 15;111(14):958-966.
doi: 10.1002/bdr2.1362. Epub 2018 Aug 2.

Reductions in Child Mortality by Preventing Spina Bifida and Anencephaly: Implications in Achieving Target 3.2 of the Sustainable Development Goals in Developing Countries


Reductions in Child Mortality by Preventing Spina Bifida and Anencephaly: Implications in Achieving Target 3.2 of the Sustainable Development Goals in Developing Countries

Vijaya Kancherla et al. Birth Defects Res. .


Background: There is an opportunity to reduce child mortality by preventing folic acid-preventable spina bifida and anencephaly (FAP SBA) in developing countries. We estimated reductions in FAP SBA-associated child mortality in 69 countries with an immediate potential for mandatory fortification of wheat flour.

Methods: Using data from multiple sources, we estimated the percent reductions in neonatal, infant, and under-five mortality that would have occurred by preventing FAP SBA; and the contributions of these reductions toward each country's Sustainable Development Goals (SDG) for child mortality reduction. We used the combined prevalence of spina bifida and anencephaly in selected countries before fortification, and estimated preventable child mortality associated with FAP SBA, assuming 0.5 per 1,000 live births as minimum achievable prevalence from mandatory fortification.

Results: Annually, 56,785 live births with FAP SBA occurred in the 69 countries examined. Of these, about 49,680 (87%) would have resulted in deaths under age 5 years, and are preventable through mandatory folic acid fortification. On average, compared to current rates, prevention of FAP SBA would have reduced the neonatal, infant, and under-five mortality by 19% (95% uncertainty interval [UI]: 16-24%), 15% (UI: 13-17%), and 14%, (95% UI: 13-17%), respectively. Prevention of FAP SBA seemed to contribute toward achieving SDG on neonatal and under-five mortality in developing countries.

Conclusions: Prevention of FAP SBA will lead to notable and immediate reductions in child mortality. Many countries have an opportunity to effectively move toward child mortality-related SDG targets with existing milling infrastructure for food fortification.

Keywords: anencephaly; child mortality; folic acid; fortification; mortality; spina bifida; sustainable development goals.

Similar articles

See all similar articles



    1. Arth, A., Kancherla, V., Pachón, H., Zimmerman, S., Johnson, Q., & Oakley, G. P. Jr. (2016). A 2015 global update on folic acid-preventable spina bifida and anencephaly. Birth Defects Research, Part A: Clinical and Molecular Teratology, 106(7), 520-529.
    1. Atta, C. A., Fiest, K. M., Frolkis, A. D., Jette, N., Pringsheim, T., St Germaine-Smith, C., … Metcalfe, A. (2016). Global birth prevalence of spina bifida by folic acid fortification status: A systematic review and meta-analysis. American Journal of Public Health, 106(1), e24-e34.
    1. Blencowe, H., Cousens, S., Jassir, F. B., Say, L., Chou, D., Mathers, C., … Lancet Stillbirth Epidemiology Investigator Group. 2016. National, regional, and worldwide estimates of stillbirth rates in 2015, with trends from 2000: A systematic analysis. The Lancet Global Health, 4(2), e98-e108.
    1. Blencowe, H., Kancherla, V., Moorthie, S., Darlison, M. W., & Modell, B. (2018). Estimates of global and regional prevalence of neural tube defects for 2015: A systematic analysis. The Annals of the New York Academy of Sciences, 1414(1), 31-46.
    1. Botto, L. D., Moore, C. A., Khoury, M. J., & Erickson, J. D. (1999). Neural-tube defects. New England Journal of Medicine, 341(20), 1509-1519.

LinkOut - more resources