Enriching food to curb rising cases of hydrocephalus

A change in policy could play a big role in reducing the cases of spina bifida and hydrocephalus in Uganda. The Uganda National Bureau of Standards is creating more awareness of food fortification and training food inspectors in anticipation of the day the government will make food fortification mandatory, writes Esther Nakkazi

Becoming a mother is one of nature’s gifts to a woman, but the joy can be turned into weeping, as was the case with Shamim Nakibuuka a 20-year-old, first time mother whose child was born with the birth defects spina bifida and hydrocephalus.

Spina Bifida is a common disabling birth defect in which the foetal spinal column does not close completely. This causes nerve damage, paralysis or, in 85 per cent of children with spina bifida, hydrocephalus, a buildup of cerebrospinal fluid in the brain. This fluid cushions the brain but when it is too much, it puts pressure on the brain. An unusually large head is the first sign of congenital hydrocephalus.

There are two kinds of hydrocephalus; the congenital type is present at birth and the other is acquired hydrocephalus, which can occur at any age and is caused by infections, tumors, bleeding in the brain and injuries.

Shamim Nakibuuka’s daughter, Lisha Nakiyingi, was born three months ago with the unusually big head and a spinal colon that was not completely closed. She had congenital hydrocephalus, which in many countries arises from infections during the first months of pregnancy.

In Uganda, about 60 per cent of hydrocephalus cases arise from infections after birth, according to Mr. Derek Johnson, the executive director, CURE Children’s Hospital of Uganda based in Mbale.

Mr. Johnson says that experts think the causes could be bacteria infections, especially for women who do not deliver babies from health centres and cultural practices like putting cow dung on the umbrical cord to dry. But malaria may also be a cause. He said further research is needed to provide an answer.

Mr. William Ssali a consultant with the Production & Industry Component MOH-GAIN Food Fortification Project says that 70 per cent of cases of neural tube defects can be prevented by adequate intake of folic acid immediately before and in early pregnancy.

The body needs very little folic acids but lack of these micronutrients can cause disastrous effects,Ssali says.

Experts say that a rigorous programme of public education and fortification of popular foods with folic acid decreases the rate of neural tube defects by about 20 per cent.

Prevention offers much greater rewards

Pregnant women can be encouraged to eat foods rich in folic acid, a vitamin that is needed for cell growth and development of the baby. Folic acid is found in green leafy vegetables, chicken and beef liver, asparagus, papaya, broccoli and eggs.

At the national level, fortifying food with folic acid would be an answer to the problem. Foods like vegetable oil, maize and wheat flour, milk and related products, complementary weaning foods, sugar and beverages can be fortified by adding minerals to them.

Uganda could improve awareness about food fortification, says Mr. Johnson. Currently, fortification is voluntary, and food suppliers may be reluctant to act because it adds costs to their businesses.

At the end of the day, businesses have to be profitable. But we need to try to make it mandatory for commonly consumed foods to be fortified. That way we shall get rid of so many diseases, says Dr Elizabeth Madraa, head of food fortification programme at the Ministry of Health.

Some manufacturers are acting voluntarily, though. The biggest vegetable oil producers, Bidco vegetable oil and Mukwano Industries, are fortifying their products with Vitamin. These two companies account for at least 80 per cent of all vegetable oil in Uganda.