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[Anencephaly related infant mortality in Argentina: spatial and temporal analysis (1998-2007)]
Rubén Bronberg1, Emma Alfaro, Estela Chaves
1Área de Genética Médica y Poblacional, Servicio de Neonatología, Hospital General de Agudos Dr. José María Ramos Mejía, Ciudad de Buenos Aires. rabronberg@intramed.net
Insights
Folic acid fortification significantly reduced infant mortality from anencephaly (53%) in Argentina, but regional disparities persist. Further research into geographic risk factors is recommended to improve prevention strategies.
Area of Science:
- Public Health
- Epidemiology
- Reproductive Health
Context:
- Anencephaly is a severe birth defect with significant infant mortality implications.
- Folic acid fortification is a key public health strategy to prevent neural tube defects.
- Argentina implemented mandatory folic acid fortification during the study period (1998-2007).
Purpose:
- To analyze the spatial and temporal distribution of infant mortality due to anencephaly in Argentina.
- To assess the impact of mandatory folic acid fortification phases on anencephaly-related infant mortality.
- To identify geographical clusters and potential risk factors for anencephaly.
Summary:
- Infant mortality due to anencephaly decreased by 53% nationally following folic acid fortification.
- Significant regional variations in mortality decline were observed, with Cuyo showing the greatest reduction (69%) and the Northeast the least (35%).
- A distinct cluster of high anencephaly-related infant mortality was identified in northeastern Buenos Aires province.
Impact:
- The study demonstrates the effectiveness of folic acid fortification in reducing anencephaly-related infant mortality.
- Persistent spatial disparities highlight the need for targeted interventions and further investigation into environmental and genetic risk factors.
- Findings support the continued use and refinement of fortification policies and primary prevention strategies for neural tube defects.
Objective:
Analyze the spatial and temporal distribution of infant mortality by anencephaly in Argentina in relation with folic acid fortification phases.
Population And Methods:
Data came from certificates of live births and deaths in children under 1 year, for the 1998-2007 period (Argentine Ministry of Health). The infant mortality rate attributable to anencephaly for Argentina, geographical regions, provinces and departments were estimated according to the different phases of mandatory fortification with folic acid. Secular trend of infant mortality rate attributable to anencephaly and death risk due to anencephaly, spatial distribution by infant mortality rate attributable to anencephaly cluster and its correlation to latitude and longitude were also analyzed.
Results:
Reduced risk of mortality due to anencephaly (53%) was observed at national level. The greatest decline occurred in Cuyo (69%) and lowest in the Northeast (35%) at regional level. Considerable infant mortality rate attributable to anencephaly heterogeneity was found at departmental level and less at provincial level. A cluster of 5.15/10 000 infant mortality rate attributable to anencephaly was identified in the northeast of Buenos Aires province, consisting of 29 departments, significantly different from the rest of the country.
Conclusions:
While there was a statistically significant negative secular trend of infant mortality rate attributable to anencephaly, spatial disparities persist. The geographical distribution of anencephaly would guide the search for environmental/ genetic risk factors and strengthen primary prevention strategies, through mandatory fortification, folate intake and folic acid supplementation.
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