Spina bifida, also known as meningomyelocele, is a major birth defect mostly associated with folate deficiency in the mother early in pregnancy. The prevalence of spina bifida is disproportionately high in Ethiopia compared to the global average; about 10,500 liveborn are affected annually. Many affected infants do not receive timely repair surgery. There are a high number of stillbirths, and neonatal, infant, and under‐five deaths. Mandatory fortification of staple foods such as wheat and maize flour with folic acid, a B vitamin, is an effective primary prevention strategy for spina bifida. Survival in those with spina bifida increases if neurosurgical intervention is available soon after birth, along with continuous surgical and clinical aftercare throughout the lifespan. Currently, Ethiopia does not have mandatory food fortification for primary prevention or adequate neurosurgical capacity to meet the need to prevent adverse outcomes associated with spina bifida. We present in this paper two concurrent and complementary policy and practice solutions occurring in Ethiopia through global partnerships: (1) capacity‐building of neurosurgery care through training programs; and (2) promoting national mandatory folic acid fortification of staples for primary prevention of spina bifida. These two policy and practice interventions ensure all affected infants can receive timely pediatric neurosurgery and sustained surgical aftercare through required neurosurgeon availability, and ensure primary prevention of spina bifida. Primary prevention of spina bifida frees up significant neurosurgical capacity in resource‐poor settings that can then be directed to other critical neurosurgical needs thus lowering child mortality and morbidity.

中文翻译：

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叶酸强制食品强化对埃塞俄比亚治疗脊柱裂所需的神经外科能力的预计影响

脊柱裂，也称为脑膜膨出，是一种主要的出生缺陷，主要与母亲在怀孕早期缺乏叶酸有关。与全球平均水平相比，埃塞俄比亚脊柱裂的患病率高得不成比例；每年约有 10,500 名活产儿受到影响。许多受影响的婴儿没有及时接受修复手术。死产、新生儿、婴儿和五岁以下儿童死亡人数很多。对小麦和玉米粉等主食强制添加叶酸（一种 B 族维生素）是脊柱裂的有效初级预防策略。如果在出生后不久就可以进行神​​经外科干预，并在整个生命周期内进行持续的手术和临床善后护理，那么脊柱裂患者的生存率就会增加。目前，埃塞俄比亚没有用于初级预防的强制性食品强化，也没有足够的神经外科能力来满足预防与脊柱裂相关的不良后果的需要。在本文中，我们通过全球合作伙伴关系在埃塞俄比亚提出了两种并行且互补的政策和实践解决方案：（1）通过培训计划进行神经外科护理的能力建设；(2) 推动国家强制性强化主食叶酸，用于脊柱裂的一级预防。这两项政策和实践干预措施确保所有受影响的婴儿都能通过所需的神经外科医生获得及时的儿科神经外科手术和持续的手术后护理，并确保脊柱裂的一级预防。