Letter to the Editor Regarding “Epidemiology of Myelomeningocoele in Africa: An Experience in a Regional Neurosurgical Center in Northern Nigeria”
Year: 2025
Type: letter
Abstract: Dear Editor, We read with great interest the original article entitled “Epidemiology of myelomeningocoele in Africa: An experience in a Regional Neurosurgical Center in Northern Nigeria” by Obanife et al.[1] We want to congratulate the authors for this informative and insightful article and also commend them for the profound findings in this study, which highlights alarming realities regarding the prevalence and risk factors for myelomeningocele especially in low-resource settings. Factors include but are not limited to poverty, low socioeconomic status, maternal persistent heat exposure (commonly from firewood cooking), illiteracy, inadequate maternal folate intake during pregnancy, multiparity, and unhealthy cultural practices in rural communities. Notably, a study by Danzer et al.[2] suggests that low maternal education is the single strongest predictor of having a child with a neural tube defect. Myelomeningocele is a severe type of spina bifida, which is characterized by extrusion of the spinal cord through a spinal canal defect due to improper closure of the neural tube. It is the most common form of spina bifida, often resulting in lifelong disability.[3] The authors also highlight a usage and knowledge gap regarding the role of folic acid in preventing neural tube defects. Folic acid deficiency remains the most widely recognized risk factor which is more common in the low socioeconomic group.[4] A prospective cross-sectional study conducted at Usmanu Danfodiyo University Teaching Hospital in Sokoto, Nigeria, revealed that only 35% of mothers of patients with myelomeningocele had heard of folic acid, and only 30% knew the appropriate timing of its intake to prevent neural tube defects. Alarmingly, none of the mothers ingested folic acid during the periconceptional period.[5] Addressing this problem requires implementing targeted education programs for pregnant women and women of childbearing age, emphasizing folic acid supplementation before and during pregnancy. These education programs should be integrated into antenatal care guidelines and supported by outreach programs in rural and low-resource communities. During a clinical shadowing experience in Nigeria, we encountered a case of a newborn with myelomeningocele, complicated by clubfoot and rectal prolapse. Surgical resection revealed infection, emphasizing the complexity of these cases. The parents of the newborn were from a low socioeconomic background and faced significant educational and financial challenges hence, leading to delays in surgical intervention. This underscores the multifactorial challenges outlined in the study, including low maternal education, poor socioeconomic status, poor maternal nutrition, and unhealthy cultural practices. Finally, the study poignantly illustrates that myelomeningocele management in Nigeria and other developing countries faces systemic obstacles, including delays in accessing health facilities for diagnosis and treatment, limited availability of diagnostic equipment such as magnetic resonance imaging and computed tomography scans, and the financial burdens associated with both diagnostic and surgical interventions. This underscores the need for international collaboration to provide sustainable healthcare solutions, such as the provision of diagnostic equipment and tools, subsidies for surgical procedures, and long-term support for affected families. In conclusion, this research sheds light on the multifactorial etiology of myelomeningocele in Nigeria and other developing countries, indicating the interplay of environmental, socioeconomic, dietary, and educational factors. To mitigate this health crisis, more research should be carried out and interventions should target women of low educational status, including fortifying dietary programs especially folic acid fortification of staple foods, as the practice of periconceptional folic acid supplementation is essential for reducing the prevalence of neural tube defects.[6] Additionally, efforts must aim to improve access to antenatal care. A collaborative approach can ensure that the most vulnerable populations are protected from preventable birth defects and neural tube defects including myelomeningocele. Acknowledgement None. Author contributions All the authors (M.S.I., and I.I.O) have made equal contributions. Data availability statement Not applicable. Ethical policy and Institutional Review Board statement Not applicable. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.
DOI: 10.4103/jpn.jpn_9_25
Authors: Mmesoma Sylvia Ibeh, Inibehe Ime Okon
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W4417333019