Need for prevention of spina bifida :
NTDs are birth defects that occur very early in pregnancy. The defect develops between the 17th to 30th day after conception, usually before woman knows she is pregnant. During this critical time of pregnancy, the proper formation and closure of the neural tube, which later becomes the spinal cord, brain and bones surrounding the spinal cord normally takes place. A NTD occurs when neural tube fails to close properly. Spina bifida is the most common NTD. Spina bifida occurs when the lower end of the neural tube fails to close. As a result the spinal cord and backbones do not develop properly. 80-90% of infants born with spina bifida survive despite varying degree of disability, many lead long successful and productive lives.

Both prevention and treatment of spina bifida are important. Spina bifida impacts not only the life of child and those of his or her family but the community as well. As a child with spina bifida grows older he or she faces unique economic, educational, medical, health and emotional issues. Paralysis of the legs and bowel and bladder problems are common with spina bifida. These problems may affect a person's health, self-esteem, personal interaction, work and recreational opportunities.

Although, medical care has greatly improved the survival rate and quality of life of children of spina bifida, the children and the families affected live with varying degrees of physical and social challenges for life. So we hope to look into this programme of prevention of NTDs by folic acid supplementation with serious concern.

Global Burden
Neural tube defect is the most common congenital malformation of central nervous system. However its prevalence varies greatly from place to place, population to population. The highest incidence of NTD has been reported from Ireland and Wales (6.38-14.92 per 1000 births) whereas it's incidence in other European countries has been only 0.1-0.6 per 1000 births. The prevalence of NTD in the US and worldwide is about 1 per 1000. Other parts of the world with high prevalence of NTD are northern India, Northern China, Egypt and Lebanon. Its prevalence in Palestinians too has reported to be high. Interestingly compared to northern provinces in China the prevalence of NTD in southern China is only 1 per 1000. Its prevalence in Japan is also low.

Indian scenario
The prevalence of NTD from different parts of India has been reported to vary from 0.5 to 11 per 1000 births. In general the prevalence in northern states namely Punjab, Delhi, Haryana, Rajasthan, UP and Bihar has been much higher (3.9 to 9 per 1000) compared to eastern, western and southern parts of country (0.5-2.64 per 1000). One exception to this statement is the reported high incidence of NTD from Davangere in Karnataka (8-9). With this data if we take the incidence of spina bifida to be 5-7, then with present rate of population increase; around 107814 newborns are born every year with NTD in India.

Primary and secondary prevention of NTDs
In considering the prevention of a disease, a distinction must be made between primary and secondary prevention. Primary prevention is effected by measures, which prevent the development of NTD in the embryo. Secondary prevention is brought about through screening and the option of selective termination of pregnancy and has been available for nearly twenty years. The opportunity to introduce primary preventive measures is a major medical and social advance.

Primary prevention
One of the nearly emerging areas in the field of clinical genetic is the concept of primary prevention. It implies prevention of the birth of affected child prior to its occurrence in any family. Primary prevention requires targeting of preventive measures to entire population or to high-risk individual. NTD has emerged as an ideal condition for primary prevention.