Score:
9/15
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Topper’s Copy
GS3
Science & Technology
15 marks
“Despite the availability of cost-effective preventive interventions, India continues to report a high burden of neural tube defects such as Spina Bifida.”
In this context, examine the role of pre-conceptional folic acid supplementation and food fortification in preventing Spina Bifida in India. Discuss the challenges in implementation and suggest policy measures to address them.
Student’s Answer
Evaluation by SuperKalam
Demand of the Question
- Examine the role of pre-conceptional folic acid supplementation in preventing Spina Bifida
- Examine the role of food fortification in preventing Spina Bifida
- Discuss implementation challenges
- Suggest policy measures to address the challenges
What you wrote:
Neural tube defects like spina bifida affect nearly 4 to 5 per 1000 births in India - significantly higher than the global best practice of <1 per 1000.
Spina bifida, a condition where the spinal column does not close completely, can lead to lifelong paralysis and hydrocephalus.
Neural tube defects like spina bifida affect nearly 4 to 5 per 1000 births in India - significantly higher than the global best practice of <1 per 1000.
Spina bifida, a condition where the spinal column does not close completely, can lead to lifelong paralysis and hydrocephalus.
Suggestions to improve:
- Could briefly mention that this is a preventable condition through proven interventions to create a stronger bridge to the main discussion.
What you wrote:
Role of folic acid in Prevention
- folic acid (vitamin B9) is critical for the closure of the neural tube, which occurs between the 21st and 28th day post-conception.
Pre-conceptional supplementation
- Clinical studies show that 400 mcg of daily folic acid taken before conception can prevent up to 70-90% of NTD cases.
- Supplementation must begin at least one month prior to conception.
food fortification
Countries like the USA and Canada saw a 30-50% reduction in NTDs within years of mandating folic acid fortification in cereal grains (wheat flour, rice).
Role of folic acid in Prevention
- folic acid (vitamin B9) is critical for the closure of the neural tube, which occurs between the 21st and 28th day post-conception.
Pre-conceptional supplementation
- Clinical studies show that 400 mcg of daily folic acid taken before conception can prevent up to 70-90% of NTD cases.
- Supplementation must begin at least one month prior to conception.
food fortification
Countries like the USA and Canada saw a 30-50% reduction in NTDs within years of mandating folic acid fortification in cereal grains (wheat flour, rice).
Suggestions to improve:
- Could elaborate on the biological mechanism of how folic acid aids DNA synthesis and cell division during neural tube formation
- Can mention India's current IFA supplementation under ICDS and ASHA programs but highlight their post-conception timing limitation
What you wrote:
Challenges in implementation in India
- Timing of intervention - Most Indian women begin folic acid (IFA) tablets only after their first antenatal check up, which usually happens in second trimester, when well after the neural tube has already closed.
- Unplanned pregnancies: a significant proportion of pregnancies in India are unplanned.
- High prevalence of vitamin B12 deficiency in India complicates the picture, as high folic acid intake can mask B12 deficiency.
- There is a general lack of public awareness regarding the difference between taking "iron tablets for anemia" and "folic acid for birth defects".
Challenges in implementation in India
- Timing of intervention - Most Indian women begin folic acid (IFA) tablets only after their first antenatal check up, which usually happens in second trimester, when well after the neural tube has already closed.
- Unplanned pregnancies: a significant proportion of pregnancies in India are unplanned.
- High prevalence of vitamin B12 deficiency in India complicates the picture, as high folic acid intake can mask B12 deficiency.
- There is a general lack of public awareness regarding the difference between taking "iron tablets for anemia" and "folic acid for birth defects".
Suggestions to improve:
- Could add socio-economic barriers like rural accessibility (only 52% rural women receive adequate ANC)
- Can mention cultural factors such as delayed disclosure of pregnancy and preference for traditional healers
- Could discuss supply chain challenges in ensuring consistent availability of quality supplements
What you wrote:
Suggested Policy measures:
- To reduce the burden of spina bifida, India needs a transition from 'treatment-oriented' to 'prevention-oriented' maternal health policies.
- Mandatory fortification of PDS/ICDS staple, aligning with WHO standards.
- Reorient the Anemia Mukt Bharat strategy to focus on pre-conceptional health for all women of reproductive age.
- Awareness campaigns emphasizing 'the first month is too late'.
- Strengthen Pradhan Mantri Surakshit Matritva Abhiyan to ensure high quality anomaly scans for early detection.
Suggested Policy measures:
- To reduce the burden of spina bifida, India needs a transition from 'treatment-oriented' to 'prevention-oriented' maternal health policies.
- Mandatory fortification of PDS/ICDS staple, aligning with WHO standards.
- Reorient the Anemia Mukt Bharat strategy to focus on pre-conceptional health for all women of reproductive age.
- Awareness campaigns emphasizing 'the first month is too late'.
- Strengthen Pradhan Mantri Surakshit Matritva Abhiyan to ensure high quality anomaly scans for early detection.
Suggestions to improve:
- Could propose pre-marriage counseling programs integrated with existing health schemes
- Can suggest community health worker training to identify women of reproductive age for supplementation
- Could recommend mobile health (mHealth) interventions for tracking and reminding women about supplementation
What you wrote:
With the national mission awareness campaign and food fortification regarding the prevention from Neural tube defects (NTD) Spina Bifida, can reduce the cases of it.
With the national mission awareness campaign and food fortification regarding the prevention from Neural tube defects (NTD) Spina Bifida, can reduce the cases of it.
Suggestions to improve:
- Could conclude by referencing India's commitment to SDG 3.2 (reducing neonatal mortality) and mention potential for achieving WHO targets through coordinated prevention strategies.
Your answer demonstrates strong medical knowledge and addresses all key demands systematically. The scientific foundation is solid, and you've identified practical implementation challenges well. Consider strengthening policy suggestions with more specific program details and improving the conclusion's impact.
Demand of the Question
- Examine the role of pre-conceptional folic acid supplementation in preventing Spina Bifida
- Examine the role of food fortification in preventing Spina Bifida
- Discuss implementation challenges
- Suggest policy measures to address the challenges
What you wrote:
Neural tube defects like spina bifida affect nearly 4 to 5 per 1000 births in India - significantly higher than the global best practice of <1 per 1000.
Spina bifida, a condition where the spinal column does not close completely, can lead to lifelong paralysis and hydrocephalus.
Neural tube defects like spina bifida affect nearly 4 to 5 per 1000 births in India - significantly higher than the global best practice of <1 per 1000.
Spina bifida, a condition where the spinal column does not close completely, can lead to lifelong paralysis and hydrocephalus.
Suggestions to improve:
- Could briefly mention that this is a preventable condition through proven interventions to create a stronger bridge to the main discussion.
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