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Review
. 2022 Sep 17:6:100071.
doi: 10.1016/j.lansea.2022.100071. eCollection 2022 Nov.

The silent tragic reality of Hidden Hunger, anaemia, and neural-tube defects (NTDs) in India

Aśok C Antony  1 , Ravindra M Vora  2 , Santosh J Karmarkar  3
Affiliations
Review

The silent tragic reality of Hidden Hunger, anaemia, and neural-tube defects (NTDs) in India

Aśok C Antony et al. Lancet Reg Health Southeast Asia. .

Abstract

Hidden Hunger arising from nutritional iron-, folate-, and vitamin-B12-deficiencies is exceedingly common in India and has profound negative impacts on anaemia, on pregnancy, and on embryonic-foetal neurodevelopment in utero, which predisposes to NTDs and psychological-psychiatric manifestations in childhood. Whereas younger-to-middle-aged Indians fail to perform at maximum potential, the elderly are at risk for calamitous neurologic events. However, these micronutrient-deficiencies are eminently correctable through food-fortification. Therefore, the Indian Government can no longer afford the luxury of inaction by either denying or downplaying the gravity of this problem. What is critically needed from India's leaders is an urgent, clear-eyed reappraisal and act of anagnorisis-(an often startling self-recognition and discovery of a profoundly serious error and tragic flaw)-in failing to confront this problem for decades. Only when closely followed by a metanoia-(a transformative change of heart that triggers remedial action)-can they help India avoid a catastrophic tryst with destiny.

Keywords: Anaemia; Folate; Food-Fortification; Human development; India; Iron; Neural-tube defects; Pregnancy; Vitamin B12.

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Conflict of interest statement

The authors declare no conflicts of interests with regards to the present study. Authors did not receive any external funding for the study.

Figures

Figure 1
Figure 1
Neural-tube defects among Indian babies. (Upper Row): Multiple views of a baby with anencephaly with complete rachischisis (Reproduced fromRef. 7, with permission). (Lower Left): Large encephalocoele. This encephalocoele contained a very large portion of the brain floating in cerebrospinal fluid, which precluded neurosurgical repair. (Lower Right): Small occipital encephalocoele. This encephalocoele was amenable to neurosurgical repair. (Reproduced fromRef. 11, with permission).
Figure 2
Figure 2
Neural-tube defects (spina bifida cystica) among Indian babies. (Upper Left) Lumbar meningomyelocoele. (Upper Right) Lumbar meningocoele. (Lower Frames) Various grades of lumbar meningomyelocoele.
Figure 3
Figure 3
Neural-tube defect leading to primary hydrocephalus. A stenosis of the aqueduct of Sylvius [between third and fourth ventricles], which caused primary hydrocephalus was managed by placement of a ventriculoperitoneal shunt. (Courtesy of Dr. Sudhakar Jadhav, Paediatric Surgery Centre & Post-Graduate Institute, Sangli, Maharashtra).
Figure 4
Figure 4
A tale of two Indian women. (Left Frame) This woman holding her newborn baby with a NTD was not offered advice about ‘preparation for pregnancy’ and did not use any micronutrient supplement(s) prior to, or during, pregnancy. Her baby, born at term, had lumbosacral spina bifida with exposed neural plaque and cerebrospinal fluid leak, paraparesis, incontinence, and hydrocephalus. Although the delivery took place at a Maharashtra State Government Primary Health Centre, it was left to the parents to transport their baby to a paediatric surgical centre 70-km away, where they were expected to cover all costs for surgical repair. Because of their crippled financial situation, the parents were able to arrange for travel only 8-days later, using public transportation. The baby underwent repair of the open lesion on day 9, but unfortunately succumbed to overwhelming septicaemia. (Right Frame) This woman holding her newborn baby practiced all principles of ‘preparation for pregnancy’. She consumed a well-balanced near-vegetarian Indian diet, exercised every day, and used daily supplemental folate (1-mg), vitamin-B12 (1-mg), and iron (ferrous sulphate 325-mg) initially for 6-months to fill her micronutrient stores a full year before conception. She then substituted daily prenatal vitamins 6-months prior to conception and continued these throughout pregnancy. She delivered a healthy baby at term and continued to use prenatal vitamins in anticipation of another pregnancy.
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References

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