SEARCHNARRATIVE_REVIEWpublic health, epidemiology

narrative_review·public health, epidemiology, nutrition, pediatrics, neurology·PMC10290612

Barriers and facilitators to the implementation of mandatory folate fortification as an evidence-based policy to prevent neural tube defects

Child's Nervous System · 8 authors, 9 centres

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TL;DR

The central finding is that a lack of policymaker knowledge about the benefits of fortification is a key determinant factor.

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The review synthesized evidence and identified eight barriers and seven facilitators, which were classified as individual, contextual, and external factors. The authors note that despite folic acid fortification being highly effective, safe, and available for decades, over one hundred countries have not adopted it. A key limitation is the lack of cross-disciplinary research. The review concludes that a lack of policymaker knowledge about the benefits of fortification is a critical barrier, and it advocates for science-driven advocacy and stakeholder partnerships to overcome obstacles and promote this public health intervention.

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narrative_review

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public health

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AI pipeline

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ORIGINAL PAPER

PMC10290612

Barriers and facilitators to the implementation of mandatory folate fortification as an evidence-based policy to prevent neural tube defects

Child's Nervous System

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ABSTRACT

Abstract Background Neural tube defects continue to be one of the main congenital malformations affecting the development of the nervous system and a significant cause of disability and disease burden to individuals living with these conditions. Mandatory food fortification with folic acid is, by far, one of the most efficacious, safe, and cost-effective interventions to prevent neural tube defects. However, most countries fail to effectively fortify staple foods with folic acid, impacting public health and healthcare systems and generating dismal disparities. Aim This article discusses the main barriers and facilitators for implementing mandatory food fortification as an evidence-based policy to prevent neural tube defects worldwide. Methods A comprehensive review of the scientific literature allowed the identification of the determinant factors acting as barriers or facilitators for the reach, adoption, implementation, and scaling up of mandatory food fortification with folic acid as an evidence-based policy. Results We identified eight barriers and seven facilitators as determinant factors for food fortification policies. The identified factors were classified as individual, contextual, and external, inspired by the Consolidated Framework for Implementation of Research (CFIR). We discuss mechanisms to overcome obstacles and seize the opportunities to approach this public health intervention safely and effectively. Conclusions Several determinant factors acting as barriers or facilitators influence the implementation of mandatory food fortification as an evidence-based policy worldwide. Notoriously, policymakers in many countries may lack knowledge of the benefits of scaling up their policies to prevent folic acid-sensitive neural tube defects, improve the health status of their communities, and promote the protection of many children from these disabling but preventable conditions. Not addressing this problem negatively affects four levels: public health, society, family, and individuals. Science-driven advocacy and partnerships with essential stakeholders can help overcome the barriers and leverage the facilitators for safe and effective food fortification. Keywords: Neural tube defects, Spina bifida, Anencephaly, Mandatory folate fortification, Determinant factors, Implementation, Barriers, Facilitators, Advocacy

CITATION EXPORT

Kemel A Ghotme, Anastasia Arynchyna-Smith, Pedram Maleknia et al.. Barriers and facilitators to the implementation of mandatory folate fortification as an evidence-based policy to prevent neural tube defects. Child's Nervous System. (2023). https://doi.org/10.1007/s00381-023-05944-x

AUTHORS

8 · 9 CENTRES

Kemel A Ghotme, Anastasia Arynchyna-Smith, Pedram Maleknia, Vijaya Kancherla, Helena Pachon, Philip J Van der Wees, Joseph M Bocchino, Gail L Rosseau

1Translational Neuroscience Research Lab, School of Medicine, Universidad de La Sabana, Campus Universitario Puente del Común, Autopista Norte, Km 7, Chia, Colombia
2Neurosurgery Department, Fundacion Santa Fe De Bogota, Bogota, DC Colombia
3The University of Alabama at Birmingham, Birmingham, AL USA
4School of Medicine, University of Alabama, Birmingham, AL USA
5Rollins School of Public Health, Emory University, Atlanta, GA USA
6The School of Medicine and Health Sciences, The George Washington University, Washington, DC USA
7Radboud Institute of Health Sciences, Nijmegen, Netherlands
8Department of Neurosurgery, The School of Medicine and Health Sciences, The George Washington University, Washington, DC USA
9The Barrow Neurological Institute, Phoenix, AZ USA