Effect of Periconceptional Folic Acid Supplementation for Prevention of Stillbirths Due To Neural Tube Defects in East African countries: A Meta-Analysis

Abstract

Background: In 2015 there were 2.6 million rate of new cases of people at risk of stillbirths globally, with more than 7178 deaths a day. The stillbirth rate in sub-Saharan Africa is approximately 10 times that of developed countries (29 vs.3 per 1000 births) which develop in about 300, 000 pregnancies due to neural tube defect .The major problem regarding this issue in East African countries are: The gap between the commencement of folic acid intervention and occurrence of neural tube defect, and also the effectiveness of folic acid fortification/supplementation are unclear. That is why this study was conducted to bridging the information gap. Objective: The aim of this study was to determine the pooled effect estimate of periconceptional folic acid supplementation for prevention of stillbirths due to neural tube defects in East African countries Methods: A meta-analysis study design was used. Study was conducted from 12th of March to 30th of April 2019. Literature search strategies used were PubMed, Cochrane Library, HINARI, EMBASE, and Google Scholar. Included studies were all cross-sectional and case-control study design. I assessed the quality of primary studies using Joanna Briggs Institute checklist and Newcastle-Ottawa Scale. The study has assessed substantial heterogeneity (I2 greater than approximately 50% and p-value <0.10). Finally results were presented using forest plot. The protocol was registered at (PROSPERO) (http://www.crd.york.ac.uk/PROSPERO/ with registration number: CRD42019128760 .Type of analysis model used was fixed effect model. Result: Meta-analysis of three studies showed that folic acid suplementation is effective in a reduction of 67 % in the prevalence of primary neural tube defects [pooled odds ratio (OR) 0.33; 95 % confidence interval (CI) 0.19-0.55, I squared (I2) =0 %, p-value=0.68 Conclusion and Recommendations: The findings of this study confirmed that periconceptional folic acid supplementation is effective in reducing 67% of the prevalence of primary neural tube defect and also indirectly reduce stillbirth due to NTDs by 72% in East African countries. It is highly recommended for researchers to conduct a meta-analysis versus interventional study design on this title in East African country for further investigation.