Sex-Based Trends in the Incidence, Prevalence, Burden, and Disability Rate of Neural Tube Defects in Sub-Saharan Africa

Introduction: Neural tube defects (NTDs) continue to be a significant source of mortality and morbidity in Sub-Saharan Africa (SSA). Among the multifactorial origins of NTDs, there is increasing evidence supporting the role of sex differences. Historically, NTDs have predominated in female infants and the embryo's gender is linked to variations in the closure of particular regions of the neural tube. To date no study has examined sex-based differences in NTDs among the SSA population. Thus, the aim of this study is to elucidate sex-based trends in NTDs in SSA from 1990-2019.

Methods: Data was collected from the Global Burden of Disease (GBD) database from 1990 to 2019. SSA was divided into four regions, Eastern, Central, Western, and Southern, as defined by the GBD. Age-standardized measures were used for all metrics (reported per 100,000 people). All statistical analyses were done using R Studio (4.2.1) with p< 0.05 indicating statistical significance.

Results: When compared to global rates, the disease burden and mortality for SSA was significantly higher for all regions except Southern SSA. Global incidence and prevalence of NTDs was lower than all regions of SSA. Females had a significantly higher disease burden in Eastern (Female: 357.0, Male: 201.3) and Southern SSA (Female: 202.1, Male: 140.7), while males did not have a higher burden for any region. The prevalence of NTDs in females was significantly higher in all regions of SSA. Lastly, mortality was significantly higher in females for Eastern (Female: 4.2, Male: 2.2) and Southern SSA (Female: 2.2, Male: 1.5) only.

Conclusion : There is a crucial need for heightened awareness among providers both in the prenatal and postnatal period for female newborns. Future studies should focus on the interregional and sex-based disparities among the SSA population.