ArticlePeerJ2026
The burden of neural tube defects in Southern Ethiopia: trends, hotspots, and public health implications.
Article in PeerJ, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Neural tube defects (NTDs) are complex multifactorial disorders in the neurulation of the brain and spinal cord that occur between 21 and 28 days after conception. Limited evidence exists regarding the burden of NTDs in Ethiopia, particularly in southern areas. This study aimed to assess the burden, spatial and temporal distribution, and public health implications of neural tube defects in southern Ethiopia. Methods: This multicenter retrospective study used a structured checklist to collect data from records of women who gave birth in the selected hospitals from January 2017 through December 2021. Birth prevalence of NTDs was calculated per 10,000 births, and temporal trends were assessed using the extended Mantel-Haenszel chi-square test. Spatial analysis was performed to identify hotspot areas. Data were analyzed using SPSS version 25 and ArcGIS version 10.1. Results: A total of 199,353 babies were delivered at the selected hospitals during the study period, and 320 had NTDs. The overall prevalence of NTDs was 16.1 (95% CI [14.34-17.91]) per 10,000 births. Halaba Kulito General Hospital and Worabe Comprehensive Specialized Hospital reported the highest and second-highest prevalence, at 52.1 and 43.3 per 10,000 births, respectively. Anencephaly was the most frequent type (8.6 per 10,000), followed by spina bifida (6.5 per 10,000). Hotspot clusters, ranging from 16.0 to 46.1 per 10,000 births, were identified in the Halaba, Meskan, and Konso districts of southern Ethiopia. Only 36.6% of NTDs were diagnosed by ultrasound during pregnancy. NTDs were more common in females (61.3%) than males, and approximately three-quarters of affected babies were stillborn. Conclusion: NTDs represent a significant public health concern in southern Ethiopia, with anencephaly and spina bifida being the most prevalent types. No significant linear trend was observed over the five-year period. Most hotspot districts are located within Ethiopia's Great Rift Valley. Strengthening prenatal NTD screening, establishing a national digital birth and birth defect registry, and promoting periconceptional folic acid supplementation alongside nutrition education are critical for reducing the burden of NTDs in Ethiopia.
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