PRENATAL SCREENING FOR NEURAL-TUBE DEFECTS IN SOUTH-AFRICA - AN ASSESSMENT

  • 1 January 1981
    • journal article
    • research article
    • Vol. 60  (8) , 324-329
Abstract
Neural tube defects (NDT) occur in at least 1 in every 1000 babies born in South Africa. The incidence is uncertain but appears to be highest in whites and coloreds and lowest in blacks. Spina bifida is a particularly serious problem because many affected babies survive and require extensive, costly treatment and care. A high maternal serum .alpha.-fetoprotein (AFP) level may indicate that the fetus has an NTD. Enzyme-linked immunosorbent assay is well suited to mass screening of maternal sera. The Natal population is used as a model here and it is calculated that of 122,000 pregnancies annually, 38,725 might be screened. Of 98 expected fetuses with an NTD, 32 (16 with anencephaly and 16 with spina bifida) should be detected. The cost of treating a nondetected child and the screening cost are discussed. Financially, the introduction of mass screening of maternal serum AFP is justified but before this can be done adequate ultrasound facilities must be provided and a permanent health visitor must be available to trace women at risk and arrange their further investigation. A public education campaign should also be introduced. Some ethical and legal implications of mass screening for NTD are discussed briefly.