Case Study 16: Preventing Neural Tube Defects in Chile
Neural tube defects (NTDs) are the second most common congenital malformation to congenital heart disease and affected 400 babies in Chile annually before a fortification legislation was passed to use fortified flour with folic acid. This fortification reduced spina bifida by 51% and anencephaly by 46% (Levine, 2007). Team One will share answers to questions about this study and research of the problem. The globally astute nurse can provide education and become an advocate to continue to reduce these congenital birth defects through improving the health of women and children and thus all humanity.
In the United States (U.S.) since 1998 the U.S. Food and Drug Administration has mandated that cereals, breads and pastas be “enriched” with 140 micrograms of folic acid per 100 grams of grain. This fortification led to a 19% reduction in birth prevalence of neural tube defects. Although this program worked in the U.S., this approach would not be successful in Chile. Chilean people cannot economically afford to purchase packaged cereals and breads. They do however consume relatively large amounts of flour in the form of bread. The government of Chile sought to implement a program where the wheat flour that was used daily by the Chilean people would be fortified with folic acid, thereby providing the necessary folic acid to the women that are necessary to prevent NTDs. A working group was put together that consisted of the government, academics, health care professionals, and members of the milling industry. The decision was made from this group to fortify the wheat flour, and for a number of reasons. The primary reasons were that 90% of the flour in Chile is consumed as bread, and the bread milling industry has been fortifying wheat flour with other micronutrients since the 1950s. The infrastructure was already in place to implement the fortification process with little delay, and minimal expense. This utilization of existing infrastructure led to an inexpensive way to achieve the intended result of providing additional folic acid to child bearing women. By utilizing an existing system that was known to be working, the milling community offered little resistance to the change, and the costs were kept low enough that the community did not alter their consumption habits (Levine, 2007).
Question 2: Is Chile’s fortification experience replicable in Africa? Why or why not?
In Team One’s opinion, this program would not be easily replicable in Africa. The success of the Chilean program was based on a number of pre-requisites. The people were already purchasing and consuming the wheat flour which was being produced by a small number of mills. These mills were already fortifying the wheat flour with other micronutrients, and required little modification to add the folic acid. The academics and health care professionals were already in the country and were in a position to collect and use the data available to derive the cost effective solution. Other countries without such centralized food supplies, available academics and health care professionals would find it more difficult to implement such a program for the little cost associated with the Chilean program (Levine, 2007).
Question 3: Neural-tube defects affect a fairly small portion of the population compared to diseases like malaria and TB. What are some of the reasons a Minister of Health might choose to address NTDs? Can you think of other disease with a similar profile?
Each year, neural tube defects (NTD’s), the second most common congenital malformation after congenital...