Title : Risk factors for neural tube defects in conflict-impacted Tigray, Ethiopia: Findings from a case–control study
Abstract:
Neural tube defects (NTDs) continue to pose a major global public health challenge, with prevalence and risk factors differing widely by region. In Tigray, the ongoing war and siege have severely disrupted the health system, heightening pregnancy-related complications and contributing to increased rates of NTDs. This study examines sociodemographic, obstetric, and conflict-related determinants of NTDs during the crisis period.
A case-control study was carried out from December 2023 to January 2024, involving 103 NTD cases and 205 controls. Data were collected using a WHO-adapted birth defects survey and ODK/KOBO tools. Analyses were performed using SPSS version 27, employing descriptive statistics to summarize participant characteristics and logistic regression to identify significant predictors of NTDs (p < 0.05).
Among the 308 participants, stillbirths constituted 79.7% of NTD cases. Anencephaly was the most frequently observed defect, followed by spina bifida and encephalocele. Of the affected fetuses, 23.3% were male, 18.4% female, and 58.3% had undetermined sex. Co-occurring anomalies were relatively infrequent and included hydrocephalus (2.9%), clubfoot, omphalocele, and cleft palate (1–1.9%).
Several factors were significantly associated with NTDs, including younger maternal age, low educational attainment, prior abortion or stillbirth, and absence of prenatal care. Conflict-related conditions such as exposure to violence, unintended pregnancies, limited access to health services, and widespread food insecurity further intensified the burden. Many women reported reliance on aid or subsistence farming and consuming fewer than two meals per day.
Overall, the study highlights the strong link between NTDs particularly anencephaly and elevated stillbirth rates. High proportions of unidentified fetal sex, limited detection of associated anomalies, and inadequate prenatal care reflect diagnostic and service-delivery challenges. The ongoing conflict has amplified maternal health risks and may be contributing to the heightened prevalence of NTDs in the region.
These findings emphasize the urgent need to strengthen maternal health services, expand preventive interventions, and ensure access to high-quality care, especially in conflict-affected settings.
