Maternal and Child Health

In Sub-Saharan Africa, the estimated prevalence of neural tube defects (NTDs) ranges from 1 to 10 per 1,000 live births across different regions - figures that are broadly two to five times higher than those observed in countries where mandatory folic acid fortification of staple foods has been in place for over two decades.¹ In the United States, mandatory fortification of wheat flour introduced in 1998 was followed by a 26–36% reduction in NTD-affected pregnancies; in Canada, the corresponding decline exceeded 40%.² The contrast is sharp. Across most of SSA, fortification programmes either do not exist, are voluntary rather than mandatory, or achieve coverage too partial to generate population-level reductions in NTD prevalence. The result is a largely preventable burden of spina bifida, anencephaly, and encephalocele that falls disproportionately on women with the least access to periconceptional supplementation.

The data are unambiguous, and they are troubling. Across Sub-Saharan Africa, Demographic and Health Survey (DHS) data consistently show that fewer than a quarter of children aged 6–23 months meet the minimum acceptable diet indicator - the composite measure that captures whether a child receives both adequate dietary diversity and adequate meal frequency on a given day. In the 2019 Ethiopia DHS, only 8% of children in this age group met the minimum acceptable diet threshold. In Nigeria, the 2018 DHS recorded 4%. In Mali, a figure barely above 5%. These numbers represent not edge-case inadequacy but the systematic failure of transitional diets across the continent during the period of greatest developmental vulnerability in human life.

Across Sub-Saharan Africa (SSA), approximately 41% of infants under six months of age are exclusively breastfed - a figure that, while slightly above the global average of 38%, still leaves the majority of infants receiving suboptimal nutrition during the most critical developmental window of their lives (Victora et al., 2016, https://doi.org/10.1016/S0140-6736(15)01024-7) . The consequences are not abstract: undernutrition, of which inadequate breastfeeding is a proximate cause, contributes to an estimated 45% of all deaths in children under five globally, translating to over three million child deaths annually (Black et al., 2013, https://doi.org/10.1016/S0140-6736(13)60937-X) . In high-mortality regions of West and Central Africa, where under-five mortality rates in some countries still exceed 100 per 1,000 live births, the potential impact of scaling up exclusive breastfeeding practices is not merely incremental - it is transformative.