NTDs (neural Tube Defects) are one of the most distressing conditions in a newborn child. Defects in the vertebral column and the spinal cord lead to a spectrum of disabilities which includes lower limb weakness and paralysis; loss of control of bladder and bowel movements; and accumulation of water in the brain (hydrocephalus). It would be a rare lucky child who does not have many neurological complications and who requires only a single surgery for correction. Most of them undergo multiple operations and almost a lifetime of care involving a multidisciplinary approach (Paediatric surgeons, Paediatricians, Neurologists, Neurosurgeons, Orthopaedic surgeons, Physiotherapists, Rehabilitation therapists, and so on). The physical, financial, emotional, and psychological burdens on the patient and the family are heavy beyond the imagination of a layperson and beyond a methodological calculation. In fact, so grave is the burden to the patient and the caregivers that it is almost a norm and an accepted protocol across the world to terminate the pregnancy if detected in the early part of the pregnancy.
At a very conservative estimate of 4.1 live births of this condition per 1000 births, almost 100,000 babies are born annually across India afflicted with Neural Tube Defects. To gain a perspective about the financial burden, the lifetime costs for a baby with NTD in the US is approximately $791,900 (translating into 5,85, 34,000 rupees per baby). Even if medical care costs are one hundredth of US in India, it still is a significant financial burden to the primary wage earner of the family. Dr Ravindra Vora and Dr Asok Antony, in a well-argued editorial (Journal of Indian Association of Paediatric Surgeons, January 2022) show a brilliant solution to this distressing problem.
It is amazing that many times the simplest reason is the root of the most complex problems. The cause of Neural Tube Defects is a deficiency of Folic acid in the mother during the time of conception. Worldwide, there is a confirmation of the fact that this humble vitamin given prophylactically to women planning to conceive reduces the risk of NTD to almost 80%. One of the best preventive programs would be to supplement folic acid to women of child bearing age. The US tried first by recommending and supplying this in tablet form but poor compliance led to the policy of fortifying wheat flour with the correct dose of folic acid. The annual rate of NTDs came drastically down.
Authors Dr Vora and Dr Antony suggest a simple but practical solution in India. Differences in eating practices and methods of procuring the food material would make a central fortification scheme difficult for women in the remote villages. They suggest fortifying tea, commonly used across India, and generally with central production distributed peripherally, with folic acid and Vitamin B12, both found deficient in Indian women of child bearing age. Interestingly, this deficiency is irrespective of the food habits. The Indian non-vegetarian food is ‘near’ vegetarian, in fact, the authors write. This is perhaps a simple and safe solution to an extremely difficult problem taking a heavy toll on the afflicted patient, the families, the healthcare professionals, and the governments too. In their pilot studies, they have found this method to be extremely effective in Maharashtra. Though the authors are communicating with the central planning agencies and the tea boards to make this feasible, it is perfectly possible for individual state governments to start the program on a smaller and more manageable scale. It would also be a great idea if tea marketing and mainstream advertising incorporates this idea of supplying tea bags fortified with folic acid and Vitamin B12 specifically targeting potential mothers.
It would be a great idea if the media and health departments of individual states take forward this proposal of tea fortification in what could be a cheap and effective preventive strategy. The vitamins are non-toxic in the doses recommended and being water soluble, the kidneys handle any excess by simply throwing it out in urine.
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