Neural tube defects in Ghana, current trends and relevant strategies for policy actions

Background and objectives: Neural tube defects (NTDs) are among the commonest congenital malformation affecting over 300,000 births globally each year. NTDs are one of the health consequences of Folate (Vitamin B9) deficiency. NTDs are prevalent globally but there is little documentation on them. In Ghana, the NTD prevalence of 1.15/1000 births (in 1993 for KorleBu Teaching Hospital) and 1.6/1000 births (in 2017 for Tamale Teaching Hospital) have been reported. This study assessed the current trends of neural tube defects in Ghana. Methods: Data were sourced from the District Health Information Management System (DHIMS2) of the Ghana Health Service, google scholar and PubMed searches as well as key-informant interviews. The ANOVA test was used to assess differences in NTD cases across the regions over 5 years period. Results: The National NTD were 430, 441, 468, 483, and 420 cases between 2017 to 2021. There were no significant differences in the number of cases over the years (p-value = 0.976). However, there were significant (p-value < 0.001) regional disparities with the highest cases found in Ashanti, Greater Accra, Eastern and Central Regions. Savannah Region recorded the least cases. There is ongoing iron and folate supplementation for adolescent girls and pregnant women in Ghana. However, there is no direct surveillance targeting folic acid deficiency and its associated birth defects. Conclusions: The current National prevalence NTDs is unknown/unreported. The prevalence of NTDs has not reduced over the years and this is an issue of public health concern. These NTD cases are likely under-reported in hospitals where the data was taken due to stigma and ignorance. There is a need for targeted surveillance by including folate assessment in the periodic surveillance by the Ghana Demographic Health Survey and research focusing on alternative economical assessment techniques as well as the extent of folate fortification of cereals and staples.