EPIDEMIC OF NEURAL TUBE DEFECTS IN UKRAINE, OR WHY CHILDREN`S DEATH AND DISABILITIES ARE NOT PREVENTED

Abstract

Ukraine suffers from the neural tube defects epidemic. According to“Omni-Net” data (“Omni-Net” is the only Ukrainian International Charitable Organization that runs population-based monitoring of birth defects according to the international standarts and is a member of EUROCAT and ICBDSR) the rates of NTD in Northen and Western regions of Ukraine in 20002014 on Polissia territories reached 21 up to 25 per 10,000 live births, and on non-Polissia territories – from 14 to 18 per 10000 live births. This data was published in the European Journal of Medical Genetics in 2016 and these rates are the highest in Europe. 75% of all NTD cases in every country can be prevented by periconceptional (during 3 months before pregnancy and fi rst 2-3 months of pregnancy) intake of foic acid. Starting from 1999 USA and Canada implemented fl our fortifi cation with folic acid because of because of ineffectiveness of supplementation policy. Only ¼ – 1/3 of women took folic acid before pregnancy in Canada and USA, in Ukraine this number reaches only 7%. Since 1999, the prevalence of NTD decreased by 46% in Canada, and in USA there was observed a 38% reduction in prevalence for spina bifi da. Economic analysis showed a signifi cant benefi t from fortifi cation: as it is estimated by experts that all direct and indirect, medical and not medical cost for one child with spina bifi da are 20 times higher than fl our fortifi cation costs. Every year after fortifi cation policy was implemented, Health care system in USA saves appox. $508 mln. Ukraine already fortifi es fl our with folic acid and other microelemets but only for export. For example, in 2003 Ministery of Health of Indonesia implemented fortifi cation standarts for all fl our that is sold and consumed in their country, including mandatory folic acid fortifi cation (2ppm). Ukraine is second biggest exporter of fl our for Indonesia. But fortifi ed fl our is not sold in Ukraine… Every year in Ukraine approx. 23% of live birth children with NTD die. 99% of survivors are disabled. And this is happening while there is an effective way to prevent this tragedy. Experts estimate that 800 children born with NTD in Ukraine every year can be born healthy if fl our fortifi cation policy with folic acid is implemented.

Keywords

• spina bifida, anencephaly, flour fortifi cation, folic acid, prevention