The Unresolved Tragedy of Neural-Tube Defects in India

The silent tragic reality of Hidden Hunger, anaemia, and neural-tube defects (NTDs) in India

“…Thus, NTDs continue to remain a ‘silent endemic tragedy’ arising from the intersection of the deafening silence from a culpable Ministry of Health charged with the responsibility of ensuring the health and welfare of Indian women and children, an inexplicably nescient Indian news media on this important topic, and a dearth of champions to advocate on behalf of India's forgotten children with NTD. 11 In this context, we provide two reasons for a deliberate semantic change in referring to the silent tragedy of NTDs in India as a ‘endemic’ problem—rather than the more scientifically precise term ‘epidemic’. First, to highlight the unexplained fact that that the Indian Government has not even acknowledged the seriousness of the problem of NTDs—i.e., of well over 3-million babies born with NTDs in India over the past three decades.…”

“…For each 325-mg ferrous sulphate tablet containing 65-mg of elemental iron, ∼25-mg can be absorbed and utilized. Although combined iron-folate tablets are distributed by the Indian Government, an intractable and as-yet-unsolved problem is that oral iron has notoriously unpleasant adverse side effects leading to poor compliance in ∼75% Indian women 11 , 17 ; an unintended outcome is that these women do not get their critical quota of folate, which contributes to anaemia, risk of NTDs, and other consequences as discussed below.…”

“… 54 , 55 ] suggests NTDs may be widespread across India. 11 Extrapolation of data from China-US studies 45 , 50 projects that for Indian women with a high prevalence of folate and vitamin-B 12 deficiency, 17 , 33 , 34 reduction of NTDs by vitamin supplements via food-fortification would be closer to 90%—i.e., resulting in the prevention of 115,000 Indian babies born with NTDs each year. 56 In spite of these data, India has not taken appropriate steps to protect women from these devastating complications during pregnancy.…”

“…This encephalocoele was amenable to neurosurgical repair. ( Reproduced from Ref. 11 , with permission ).…”

“…First, to highlight the unexplained fact that that the Indian Government has not even acknowledged the seriousness of the problem of NTDs—i.e., of well over 3-million babies born with NTDs in India over the past three decades. Indeed, as outlined recently, 11 it appears as if the Indian Ministry of Health has relegated the high incidence of NTD in India to the level of a “nondescript entity”, one that is even lower in priority to other endemic diseases in India (like mosquito-borne and human-to-human or waterborne [diarrheal] illnesses) that are at least documented in the official record. Second, to urge the Government of India to take a more proactive stance against the problem of vitamin-preventable NTDs—‘ on a war footing ’—in the same way a highly commendable nationwide effort was recently mobilized in vaccination against poliomyelitis to prevent an impending epidemic.…”