Clinical profile of cranial and spinal dysraphism in Lagos, Nigeria

Abstract

Cranial and spinal dysraphisms have different incidence in different parts of the world depending on the geographic region, ethnicity, socioeconomic status of the parents, maternal age and parity. Our aim was to determine the current state of neural tube defects in our environment where there is no policy of food supplementation with folic acid. A prospective study of 47 consecutive patients (and their parents) with neural tube defects who presented at the pediatric and neurosurgical unit of Lagos State University Teaching Hospital, Ikeja, Lagos between August 2006 and July 2007 were studied. Most patients were males. The male to female ratio for myelomeningocoele and encephalocele was 2:1 and 1:1.5, respectively. The most common dysraphism was open spinal dysraphism (77%) and this occurred usually at the lumbosacral region (67%). None of the infants was offspring of consanguineous marriage. Most patients were second born. Presentation of patients to the hospital was after 48 hours of delivery in majority of cases. The average maternal age at conception was 27 years (18?37 years). There was no history of preconception use of folic acid in all the mothers of the patients. There is a need to consider an aggressive approach to periconceptional folic acid supplementation for our women and early referral of patients with cranial and spinal dysraphisms. Policy to encourage fortification of a staple food with folic acid is urgently needed.

Periconceptional folic acid intake: a one year survey among mothers of patients with myelomeningocele in a regional neurosurgical centre in Northwestern Nigeria

“…20,22,30 In our study, none of the participants ingested folic acid in the periconceptional period, consistent with the findings of Idowu et al in Lagos, and other authors. [31][32][33] Even though the majority of the mothers were grand multiparous, none of them took the folic acid preconception, probably due to the low level of antenatal clinic attendance and the fact that periconceptional care where mothers are counseled on the need to take folic acid in the periconceptional period, especially for women that are planning to get pregnant is virtually non-existent in our environment. This low level of awareness calls for more health education of women of childbearing age regarding the benefits of ANC, periconceptional folic acid intake and other NTD preventive measures.…”

“…2,11,18 However, consanguineous marriage was not identified as a risk factor in a study by Idowu et al on the clinical profile of cranial and spinal dysraphism in Lagos, Nigeria. 31 This could be due to a higher rate of consanguineous marriages in the north compared to other parts of Nigeria.…”