In DepthPUBLIC HEALTH

Beset by neural tube defects, Ethiopia may fortify salt

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Science  06 Dec 2019:
Vol. 366, Issue 6470, pp. 1177-1178
DOI: 10.1126/science.366.6470.1177

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Summary

Tony Magana, chief of neurosurgery at Mekelle University School of Medicine in Ethiopia's Tigray province, confronts his country's high prevalence of neural tube defects (NTDs) nearly every day. His team operates on more than 400 babies annually to repair these severe, often lethal birth malformations, in which babies can be born without brains or with their spinal cords protruding from their backs. "Probably every other day we see a child that is so bad we can't help them," Magana says. Ethiopia may have the highest global prevalence of NTDs: Papers published last year reported that 126 to 131 babies are affected for every 10,000 births—26 times the rate in some wealthy nations, where fortification of flour with folic acid, which is essential for proper formation of the brain and spinal cord, has sent NTD rates plummeting. Many Ethiopians don't eat flour. But last month, a team of nutritionists and other public health experts converged in Addis Ababa to lay the groundwork for an unproven but possibly highly effective intervention: fortifying Ethiopia's salt supply with folic acid, a synthetic form of the B vitamin folate. "We have an amazing opportunity to do a lot of good," says Kenneth Brown, an emeritus professor at the University of California, Davis, and the lead U.S. scientist on the team.

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