Researchers studied over 1,100 newborns in hospitals in Tigray, Ethiopia to understand why some babies are born with neural tube defects—serious birth defects affecting the spine and brain that develop very early in pregnancy. They found that 3 out of every 100 babies had these defects, which is higher than in many other places. The study showed that taking folic acid vitamins before and during pregnancy, eating well, avoiding alcohol, and getting treatment for health problems during pregnancy all help prevent these birth defects. This research is important because Ethiopia has one of the highest rates of these preventable birth defects in Africa.

The Quick Take

  • What they studied: How common are neural tube defects (serious birth defects of the spine and brain) among newborns in Tigray, Ethiopia, and what causes them?
  • Who participated: 1,155 newborns born in public hospitals in Tigray, northern Ethiopia between April and May 2024. The researchers randomly selected hospitals and then systematically chose newborns to study.
  • Key finding: About 3 out of every 100 babies born in these hospitals had neural tube defects. Taking folic acid before and during pregnancy reduced the risk by 86%, while living in rural areas, poor nutrition, and drinking alcohol during pregnancy increased the risk.
  • What it means for you: If you’re a woman of childbearing age in Ethiopia or similar regions, taking folic acid supplements before trying to get pregnant, eating nutritious food, avoiding alcohol, and managing any health conditions during pregnancy can significantly lower your baby’s risk of these serious birth defects. However, this study only looked at hospitals in one region, so results may not apply everywhere.

The Research Details

This was a cross-sectional study, which means researchers looked at a snapshot of newborns at one point in time rather than following them over years. Researchers visited randomly selected public hospitals in Tigray between April 1 and May 30, 2024, and systematically selected 1,155 newborns to examine. They collected information from mothers using structured questionnaires about their pregnancy, diet, vitamin use, alcohol consumption, and any illnesses they had during pregnancy. The researchers then used statistical methods to figure out which factors were most strongly connected to neural tube defects.

This research approach is important because it provides a clear picture of how common neural tube defects are in Tigray hospitals right now, and it identifies specific, preventable risk factors. By understanding what causes these defects, public health officials can create targeted prevention programs. The timing of this study is significant because Tigray experienced recent conflict, making health data from the region especially valuable.

The study used a systematic approach to select participants, which reduces bias. The researchers used pretested questionnaires to ensure consistent data collection. However, because this study only looked at babies born in hospitals, it may miss cases in babies born at home. The study was conducted in one region during a two-month period, so results may not represent all of Ethiopia or other time periods. The researchers used appropriate statistical methods to determine which factors were truly associated with the defects.

What the Results Show

The overall rate of neural tube defects was 3%, meaning 3 out of every 100 newborns had these birth defects. This is notably higher than rates reported in previous studies from other parts of Ethiopia and Africa. The strongest protective factor was taking folic acid supplements before and during pregnancy—women who took folic acid had an 86% lower risk of having a baby with these defects. Women who had no medical illnesses during pregnancy also had a much lower risk (90% lower). Conversely, living in rural areas increased the risk more than threefold. Poor nutrition (measured by food consumption score) and drinking alcohol during pregnancy both roughly tripled the risk of neural tube defects.

The study identified multiple interconnected risk factors rather than a single cause. Rural residence was associated with higher risk, possibly because rural areas may have less access to prenatal care, folic acid supplements, and healthcare services. The strong protective effect of folic acid supplementation suggests that many cases could be prevented through public health interventions. The association with medical illnesses during pregnancy highlights the importance of managing conditions like diabetes and infections. The link between poor nutrition and birth defects suggests that food security and dietary quality are important public health concerns in the region.

The 3% prevalence rate in this study is higher than most previous studies from Ethiopia and sub-Saharan Africa, though some studies have reported similar or higher rates in specific populations. This finding is consistent with Ethiopia being identified as having the highest burden of neural tube defects in sub-Saharan Africa. The protective effect of folic acid supplementation aligns with decades of international research showing that folic acid prevents these defects. The risk factors identified (poor nutrition, alcohol use, untreated medical conditions) are consistent with global research on neural tube defect prevention.

This study only included babies born in public hospitals, so it misses babies born at home or in private facilities—potentially missing cases or including a different population. The study was conducted over just two months, so seasonal variations in nutrition or other factors weren’t captured. The study relied on mothers’ recall of events during pregnancy, which can be inaccurate. The study was conducted in Tigray specifically, so findings may not apply to other regions of Ethiopia or other countries. The cross-sectional design shows associations but cannot prove that one factor directly causes another.

The Bottom Line

Women of childbearing age should take folic acid supplements (400 micrograms daily) before trying to become pregnant and continue through pregnancy—this is supported by strong evidence. Eat a nutritious diet with plenty of fruits, vegetables, and protein-rich foods. Completely avoid alcohol before and during pregnancy. Get regular prenatal care and manage any medical conditions (like diabetes or infections) during pregnancy. These recommendations are appropriate for all women, especially those in areas with limited healthcare access. Confidence level: High for folic acid supplementation; Moderate to High for other factors.

All women of childbearing age, especially those planning pregnancy, should pay attention to these findings. Healthcare providers in Ethiopia and similar regions should prioritize folic acid supplementation programs. Public health officials should focus on rural areas where access to prevention is limited. Women with limited food security or those living in rural areas should be targeted for special support. Men should also care about this information because they can support their partners in taking preventive measures and avoiding alcohol during pregnancy.

Folic acid supplementation should ideally begin at least one month before trying to become pregnant and continue through the first trimester (first three months), when the neural tube is forming. Dietary improvements and lifestyle changes can begin immediately. Benefits of prevention are seen in reduced birth defect rates in the population over time, not in individual pregnancies immediately.

Want to Apply This Research?

  • Track daily folic acid supplement intake (yes/no), daily food consumption (number of food groups eaten), and alcohol avoidance. Users can set a daily reminder to take folic acid and log their prenatal vitamin use. For nutrition, track whether they consumed foods from at least 4 food groups daily (grains, proteins, fruits/vegetables, dairy).
  • Create a ‘Pregnancy Preparation Checklist’ feature that helps women track: (1) Starting folic acid supplements 30 days before trying to conceive, (2) Scheduling prenatal appointments, (3) Improving diet diversity, (4) Setting alcohol avoidance goals, (5) Managing any existing health conditions. Include reminders and educational content about why each step matters.
  • For women planning pregnancy: track supplement adherence weekly and nutrition quality daily. For pregnant women: monitor folic acid intake, food consumption patterns, and prenatal care appointments monthly. Create a dashboard showing ‘Prevention Score’ based on how many protective factors the user is implementing. Include alerts if medical conditions need attention or if alcohol use is logged.

This research describes associations found in one region of Ethiopia and should not be considered medical advice. Neural tube defects are serious conditions that require professional medical care. If you are pregnant or planning to become pregnant, consult with your healthcare provider about appropriate folic acid supplementation (dosage may vary based on individual risk factors), dietary needs, and prenatal care. This study does not replace personalized medical advice from qualified healthcare professionals. Women with specific health conditions or taking medications should discuss supplementation with their doctor before starting. If you have concerns about your pregnancy or a newborn’s health, seek immediate medical attention.