(P17-005-23) Predicted Impacts of Bouillon Fortification With Folic Acid on Neural Tube Defect-Related Deaths in Burkina Faso, Nigeria and Senegal

Objectives: We aimed to model the potential impacts of folic acid-fortified bouillon cubes on neural tube defect (NTD) cases and NTD-related deaths in Burkina Faso, Nigeria and Senegal.

Methods: Numbers of NTD cases and NTD deaths averted by folic acid (FA) fortification were calculated using a model (Expanded LiST #2; Luo et al., Adv Nutr, 2021) linking changes in dietary adequacy to changes in NTD cases. Estimates of apparent folate inadequacy among nonpregnant women of reproductive age (WRA) were calculated from national Household Consumption and Expenditure Surveys from Burkina Faso, Nigeria and Senegal by the nutrient density method. Demographic data were generated from the Lives Saved Tool. Hypothetical bouillon fortification levels from 0 to 120 µg FA/g bouillon were modeled, accounting for existing wheat flour (all countries) and maize flour (Nigeria) FA fortification programs, at current compliance levels.

Results: Prevalence of folate inadequacy among WRA was 29% in Burkina Faso, 34% in Nigeria and 90% in Senegal. Among WRA consumers, average bouillon consumption was 1.5g/d in Burkina Faso, 2.4g/d in Senegal and 3.5g/d in Nigeria. For 2023, the model predicted 319 FA preventable NTD deaths in Senegal, 445 in Burkina Faso and 4,399 in Nigeria. Existing fortification programs prevent 3%, 24% and 44% of these FA-attributable NTD deaths in Burkina Faso, Nigeria and Senegal, respectively. The impacts of FA fortification were non-linear: in Burkina Faso and Senegal, impact of bouillon fortification (plus existing programs) increased with increasing bouillon fortification levels until reaching a plateau at 80 µg FA/g bouillon, which would prevent ~76% of FA-attributable NTD deaths in Burkina Faso and ~90% in Senegal. In Nigeria, impact of bouillon fortification plus existing programs was maximized beginning at 40 µg FA/g bouillon, preventing ~98% of FA-attributable deaths.

Conclusions: Bouillon fortification with FA has potential to decrease NTD-related deaths among children in Burkina Faso, Nigeria and Senegal. Levels of fortification predicted to maximize impacts vary by country, depending on dietary patterns and existing programs.

Funding Sources: Funded by a grant to the University of California, Davis from Helen Keller International through support from the Bill & Melinda Gates Foundation