INVC NEWS
New Delhi,
The Indian Institutes of Public Health, Hyderabad and Delhi, Public Health Foundation of India hosted a dissemination workshop in the Capital on 5th November, 2016 to share the findings and policy implications of a multicentric research conducted over a period of four years in Delhi and Telangana states. The study consisted of five different components and examined questions related congenital birth defects and to folic acid deficiency across India. A compendium of research evidence titled ‘Public Health Consequences of Folic Acid Deficiency in India” was launched at the workshop. This evidence on congenital defects such as Neural Tube Defects (NTD) and orofacial clefts (OFC) will help to strengthen planning and policy initiatives for childhood disability in India.
Findings from the study indicate a high burden of birth defects: 37 out of 10,000 children (0-6 years) in India have birth defects. While the prevalence of OFC (6 out of 10,000) is comparable to most parts of the developing world, the prevalence for NTDs is higher in India at four out of ten thousand children (4/10,000). The qualitative study component highlighted the lack of awareness at primary health care level and the limited understanding about the periconceptional folic acid supplementation and its dosage.
A mixed methods approach was used to identify the magnitude and determinants of folic acid deficiency, to generate evidence on the population prevalence of birth defects using Key Informant Method (KIM) and to study associated factors of OFC, and the Case Control Method, with an intention to provide hierarchy of evidence.
Data from the study suggest that folic acid deficiency in women of reproductive age group is highly prevalent: 56.8% women have folic acid deficiency and 44.4% have vitamin B12 deficiency, often co-existing. Evidence suggests that folic acid deficiency is associated more with NTDs, while the deficiency in combination with low B-12 is associated with OFCs. A mother with a family history of OFC is more likely to have children with OFC. It also appears that the occurrence is higher in vegetarians but further studies are needed to strengthen this evidence.
Dr. G.V.S. Murthy, the Principal Investigator, noted that the key informant method to generate evidence on the population prevalence of birth defects and childhood disability has been proven to be feasible and effective in detecting children with visible birth defects and disabilities in both rural and resource poor urban settings. The lack of data on the prevalence of specific impairments and childhood disability was identified in 2011 World Report on Disability as a major barrier in designing effective services within integrated health systems. Dr. Murthy said “KIM offers an alternative, affordable and efficient way to estimate prevalence of disability and defects, so crucial to plan effective primary preventive and rehabilitative services in LMICs like India. It is ten times less costlier than house-to-house surveys which are less feasible across a country as large as ours.” This study, along with similar studies in Bangla Desh, shows that it is possible to capture the magnitude of the problem through large scale collaborative studies with grassroots convergence for conducting policy relevant health research. According to Dr. Sunanda Reddy, a collaborator for the community based research site in Delhi, this study exemplified Disability Inclusive Development and Research through the collaborative efforts of multi-disciplinary researchers, health professionals, Anganwadi workers and community workers from CARENIDHI (an NGO).
The event also saw the release of the policy brief which has recommendations for policy makers, program planners and all involved with care provision and capacity building for service delivery in community settings, where resource constraints and paucity of trained manpower need to be overcome.
This research not only strengthens evidence but is a value addition in the domain of policy research embedded in our Health Systems
