Project Summary

This project addresses the high prevalence of Neural Tube Defects (NTDs) in eastern Ethiopia, a region with substantial folate deficiency among women of reproductive age. In the first two years of CHAMPS, NTDs were the second most prevalent cause of death, with a mortality rate 104.0 per 10,000 births. By using the Kersa, Haramaya, and Harar Health and Demographic Surveillance Systems (HDSS) sites, the project aims to investigate the population-based burden of NTDs and inform evidence-based interventions with 3 main objectives; determine the prevalence and outcomes of NTDs in abortions, stillbirths, and children under 15 years, investigate determinants of folic acid insufficiency in women of reproductive age, and explore community perceptions and feasibility of food fortification programs. The study seeks to provide comprehensive insights into the burden of NTDs, contribute to the development of evidence-based strategies to prevent NTDs and improve maternal and child health outcomes in the region.  SALT consists four components: NTD surveillance and follow up , folate study , and qualitative study


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PIs: Dr. Lola Madrid, Prof. Nega Assefa

Lead Institutions: Haramaya University, London School of Hygiene and Tropical Medicine, and Ethiopian Public Health Institute

Sponsor: Bill and Melinda Gates foundation  

Implementation Year: 2022

Status of the project: Ongoing

PhD student: Helina Heluf

See SALT Data
NTD surveillance and follow up

The main aim is to determine the prevalence of NTDs in abortions, stillbirths and children aged below 15 years in Kersa, Harar and Haramaya HDSS sites identified through the already initiated CHAMPS pregnancy surveillance (PS) at the three HDSS sites (Harar, Kersa and Haramaya) as well as the ongoing CHAMPS mortality and clinical surveillances.

In this part of the project, children with NTDs who are treated at Hiwot Fana Comprehensive Specialized Hospital (HFCSH) are being followed to determine the outcomes (death/disability).

In addition to that, the project facilitates linkage of children to the hospital for surgery and follow up of the children in the pediatric neurosurgery follow up clinic. Furthermore, the project took part in the establishment of a center of excellence for children with spina bifida and hydrocephalus at HFCSH. The project is committed to ensuring the long term sustainability beyond the research activities, with the ultimate goal of improving the quality of life for children affected by NTDs.

folate study

The main aim is to determine the prevalence and determinants of folic acid insufficiency and deficiency in women of reproductive age in Kersa, Harar and Haramaya HDSS sites. Women of reproductive age who meet the inclusion criteria have been selected using simple random sampling from the HDSS datasets and subsequently approached for informed consent. Following consent, a venous blood sample is collected for serum and red blood cell folate assessment, along with a finger prick blood sample for hemoglobin (Hb) level determination. Sample collection is conducted at the nearest convenient healthcare facility for each participant. During the visit, vital signs are measured, and a comprehensive questionnaire is administered to collect sociodemographic, clinical, environmental, and dietary data to identify potential determinants of folate deficiency/insufficiency. Following collection, blood samples are processed and then transported to the laboratory within the College of Health and Medical Sciences.

qualitative study

This component of the study explores community perceptions about NTD, acceptability and feasibility of food fortification programs in HHR catchment area. Besides, in collaboration with SBS team, the qualitative team performs community engagement activities to raise awareness about neural tube defects