title: Prevention of spina bifida: folic acid intake during pregnancy in Gulu district, northern Uganda.
abstract: BACKGROUND
  The intake of folic acid before conception and during the first trimester of pregnancy can prevent spina bifida. This paper describes folic acid intake in women in Gulu district in northern Uganda.
  
  
  METHODS
  Structured interviews were held with 394 women attending antenatal care (ANC), 15 mothers of children with spina bifida, and 35 health workers in 2012 and 2013. SPSS16 was used for data analysis.
  
  
  RESULTS
  1/4 mothers of children with spina bifida took folic acid during late pregnancy, none preconception. None had knowledge about folic acid and spina bifida prevention. 33.5% of women attending ANC had ever heard about spina bifida, 1% knew folic acid intake can prevent spina bifida. 42.4% took folic acid supplements in late pregnancy, 8.1% during the first trimester, none preconception. All women said to have eaten food rich in folic acid. None were aware about fortified foods. 7% of health workers understood the importance of early folic acid intake. All health workers recommended folic acid intake to women attending ANC. 20% of the health workers and 25% of the women said folic acid supplements are not always available.
  
  
  CONCLUSIONS
  Folic acid intake is limited in northern Uganda. This is attributed to limited education and understanding of women and health workers about the importance of early folic acid intake, late presentation of women at ANC, poor supply chain and dilapidated health services caused by war and poverty. A combination of food fortification, sensitization of health workers, women, and improving folic acid supply is recommended.
authors.affiliation: Ghent University, Faculty of Psychology and Educational Sciences, Ghent University Henry Dunantlaan 2, B 9000 Ghent, Belgium.
authors.forename: Femke
authors.initials: F
authors.lastname: Bannink
authors.affiliation: International Health Sciences University, Kampala, Uganda.
authors.forename: Rita
authors.initials: R
authors.lastname: Larok
authors.affiliation: International Health Sciences University, Kampala, Uganda.
authors.forename: Peter
authors.initials: P
authors.lastname: Kirabira
authors.affiliation: International Federation for Spina Bifida and Hydrocephalus, Cellebroersstraat 16 - 1000 Brussels, Belgium.
authors.forename: Lieven
authors.initials: L
authors.lastname: Bauwens
authors.affiliation: Ghent University, Faculty of Psychology and Educational Sciences, Ghent University Henry Dunantlaan 2, B 9000 Ghent, Belgium.
authors.forename: Geert
authors.initials: G
authors.lastname: van Hove
mesh_terms: D000293:Adolescent; D000328:Adult; D003625:Data Collection; D019587:Dietary Supplements; D005260:Female; D005492:Folic Acid / Q000008:administration & dosage*; D005527:Food, Fortified; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel / Q000706:statistics & numerical data; D006801:Humans; D016742:Preconception Care / Q000379:methods; D011247:Pregnancy; D011295:Prenatal Care / Q000379:methods; D016135:Spinal Dysraphism / Q000517:prevention & control*; D014454:Uganda; D055815:Young Adult
chemical_list: D005492:Folic Acid
keywords: Folic acid; Uganda; antenatal care; pregnancy; spina bifida