Abstract
Neural tube defects (NTDs) is a congenital syndrome which might result in severe disabilities or deaths. Folic fortification in food including rice has been proposed as a prevention of the syndrome. However, the efficacy of the intervention have to be judged based on the baseline incident of the NTDs cases. Thorough analysis of the incident of NTDs cases is needed. Therefore, we proposed an analysis on the spatio - temporal distribution of the NTDs cases in Thailand using 43 folder database and develop a software needed for NTDs surveillance. Objectives: To assess the spatio - temporal distribution of NTDs cases in Thailand and to develop NTDs surveillance system for Thailand Material and Methods: In this study, the 43 folder database of Thai National Health Security Office was retrieved. The inpatient data were filtered with ICD-10 correlated with the diagnosis of NTDs. The hospital codes were then linked to the patient data to identify the probable district that the NTDs cases lived in. The choropleth maps were generated to describe the distribution of the NTDs cases by districts and year. The clustering of cases was assessed using Moran’s I. Results: The total numbers of NTDs cases from year 2014 - 2018 was 11,296 cases, including 4,531 congenital hydrocephalus cases, 2,655 Spina bifida cases, 2,638 Microcephaly cases, 979 Encephalocele cases, 224 Anencephaly and similar malformations cases, and 269 other congenital malformations of spinal cord cases. The district with the most numbers of NTDs cases was Ratchaburana district of Bangkok. There is no temporal trend observed. The average number of cases per year was 2,259 cases per year. The calculated incidence per 10,000 livebirths was 30.67 cases. The spatial autocorrelation by Moran’ s I does not shown any statistically significant clusters except for Bangkok and neighboring area in year 2014. The prototype of the NTDs surveillance program were developed. Conclusion: The incident of NTDs cases in Thailand is relatively high comparing to the incidents in Asian countries. Therefore, continuous NTDs surveillance might be needed. The folic fortification policy did not show a promising result. Therefore, the policy to improve the rate of antenatal care visits should be a better choice to reduce numbers of the NTDs cases in Thailand.
