ORIGINAL RESEARCH article
Front. Public Health
Sec. Public Health and Nutrition
This article is part of the Research TopicFrontiers in Food Fortification: Technologies, Delivery Systems, and Public Health OutcomesView all 3 articles
MANDATORY FOOD FORTIFICATION IN THE EASTERN MEDITERRANEAN REGION RESULTS IN REDUCED PREVALENCE OF NEURAL TUBE DEFECTS
Provisionally accepted
Sylvia Roozen1*
Quentin Johnson1E Ibrahim2S Al Maamari3
Barkat Amina4S Al Shammakhi3
Fatimazahra Laamiri5
AGUENAOU Hassan6H Gamih7A Yahyane7A Al Jawaldeh2- 1International Federation for Spina Bifida and Hydrocephalus, Brussel, Belgium
- 2World Health Organisation Regional Office for the Eastern Mediterranean, Cairo, Egypt
- 3Ministry of Health, Department of Nutrition, Muscat, Sultanate of Oman, Muscat, Oman
- 4Universite Hassan 1er, Settat, Morocco
- 5Universite Mohammed V de Rabat Faculte de Medecine et de Pharmacie de Rabat, Rabat, Morocco
- 6Ministry of Health, Rabat, Morocco
- 7Universite Ibn Tofail, Kenitra, Morocco
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Neural Tube Defects (NTDs) are preventable congenital malformations affecting the brain and spinal cord early in pregnancy, often before gestation is recognized. Globally, at least 20 per 10,000 live births are estimated to be affected by NTDs, though the true prevalence may be higher due to unreported miscarriages, elective terminations, and gaps in surveillance. Mandatory fortification of staple foods with folic acid (Vitamin B9) is widely recognized as the most effective and cost-efficient strategy to reduce NTD prevalence, while voluntary dietary supplementation programs have demonstrated limited uptake and impact. Despite clear evidence of fortification effectiveness, estimates of program impact are constrained by heterogeneous data, weak or incomplete surveillance systems, and variable program coverage across countries. Furthermore, successful implementation requires coordinated engagement of public, private, and civic sectors to ensure feasibility, sustainability, and translation of policy into measurable health outcomes. This study provides a situational analysis of mandatory food fortification in the Eastern Mediterranean Region, evaluating its impact on NTD prevention, highlighting implementation challenges, and identifying priority areas for improvement. By integrating epidemiological data with evidence on program effectiveness and multisectoral implementation, this analysis offers insights for strengthening regional fortification efforts and advancing global strategies to reduce the burden of NTDs.
Keywords: Neural Tube Defects, Spina bifida, Folic Acid, preconceptional supplementation, Pregnant Women, Women of reproductive age, Nutrition-specific interventions, Food Fortification
Received: 12 Jul 2025; Accepted: 30 Nov 2025.
Copyright: © 2025 Roozen, Johnson, Ibrahim, Al Maamari, Amina, Al Shammakhi, Laamiri, Hassan, Gamih, Yahyane and Al Jawaldeh. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Sylvia Roozen
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