ASSESSMENT OF KNOWLEDGE AND PRACTICE OF PERICONCEPTIONAL FOLIC ACID SUPPLEMENTATION (PFAS) AMONG CHILDBEARING AGE WOMEN (18-45YEARS) ATTENDING ANTENATAL CLINICS

CHAPTER ONE

•                                                    INTRODUCTION

Folic acid (vitamin B₉₎ is important in a vast number of human metabolic pathways. Examples include; interconversion of amino acids serine to glycine, conversion of homocysteine to methionine, synthesis of purines and pyrimidines, growth and healthy development of a fetus. The nutritional benefits of folic acid were first discovered by Lucy Wills in 1931 but it was finally synthesized in pure form by Bob Stroksand in 1943. Unambiguous evidence has been available for more than two decades on the effectiveness of periconceptional folic acid supplementation (PFAS) in preventing neural tube defects (NTDs). However, though this information exists a large population of its target audience (the childbearing age women) remain blissfully unaware of this very important fact.

Birth defects are documented as the leading cause of infant mortality worldwide and neural tube defects are the third leading birth defects (United States Institute of Medicine [USIM], 1998). Periconceptional folic acid supplementation, the oral ingestion of folic acid supplements of not less than 0.4mg per day; from preconception period to 12 weeks post conception has been proven to reduce the risk of occurrence and 4mg per day the risk of reoccurrence of neural tube defects. Neural tube defects are series of congenital anomalies that result as a consequence of faulty or aberrant neural tube development, which has been shown to be linked to less than optimal maternal blood folate concentration. The most common NTDs are Spina bifida and anencephaly. Spina bifida is the embryologic failure of fusion of one or more vertebral arches, sub-types of Spina bifida are based on degree and pattern of deformity. Two broad types of Spina bifida are Spina bifida occulta and Spina bifida cystica. Basically, the neonate is born with an exposed spinal cord (Pitkin, 2007). Anencephaly on the other hand is a congenital defective development of the brain with absence of bones of the cranial vault and absent or rudimentary cerebral and cerebella hemispheres, brainstem and basal ganglia. This condition is almost invariably fatal.