Spina bifida management in low- and middle-income countries — a comprehensive policy approach

Abstract

Introduction Globally, spina bifida (SB) occurs more often in low-and middle-income countries, where the healthcare demands are often quite challenging. Several social/societal issues and/or lack of government support makes for incomplete SB management in many areas. Clearly, neurosurgeons should be knowledgeable about initial closure techniques and the basics of SB management, but must also advocate for the patients outside our immediate scope of care. Methods Recently, the Comprehensive Policy Recommendations for the Management of Spina Bifida and Hydrocephalus in Low-and Middle-Income Countries (CHYSPR) and the Intersectoral Global Action Plan on Epilepsy and other Neurological Disorders (IGAP) publications emphasized the need for a more unified approach to SB care. Although both documents discuss other neurological conditions, they support SB as a congenital malformation needing attention. ResultsWe identified several similarities for comprehensive SB care in these approaches -including education, governance, advocacy, and the need for continuum of care. Prevention was recognized as the most important aspect for SB going forward. A significant return of investment was noted, and both documents recommend more active neurosurgical involvement (i.e., folic acid fortification). Conclusion A new call for holistic and comprehensive care for SB management is recognized. Neurosurgeons are called upon to use solid science to educate governments and actively participate to advocate for better care and most importantly, prevention. Folic acid fortification schemes are mandatory and neurosurgeons should advocate for global strategies.

Advances in Folic Acid Biosensors and Their Significance in Maternal, Perinatal, and Paediatric Preventive Medicine

“…It is relatively rare compared to anencephaly, yet presents a high mortality risk [25]. Another common NTD, spina bifida (SB), is a congenital spinal cord malformation, wherein the posterior (caudal) vertebral arch fails to close, resulting in meningocele, myelomeningocele, and/or hydrocephalus [11,26]. In the case of SB, though the mortality rate is relatively lower than anencephaly, the patients are likely to experience neurological disabilities.…”