Interventions for Neural Tubal Defect

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Age Cohort: Pregnancy and newborn

Health Promotion	Disease Prevention	Diagnostic	Curative	Rehabilitative	Palliative
Community Level
Educate adolescent girls and mothers to have a healthy diet including adequate dietary intake of vegetables and fruit; vitamins and minerals particularly folic acid; and maintain a healthy weight Community awareness on addressing stigma attached with congenital abnormalities Information education and communication on harmful substances, particularly alcohol and tobacco; exposure of pregnant women to medications	Adequate dietary intake of vitamins and minerals, folic acid, variety of vegetables and fruit, and maintain a healthy weight for adolescent’s girls and mothers Avoid harmful substances, particularly alcohol and tobacco during pregnancy Reduce or eliminating environmental exposure to hazardous substances (such as heavy metals or pesticides) during pregnancy;	Recognition of neural tubal defect signs and symptoms	Immediate transfer of suspected NTD to a higher-level health care facility	Physical rehabilitation Family or caregiver educational training	Psychological and social support to patients and families of babies with birth-related complications
Primary Care
Educate adolescent girls and mothers to have a healthy diet including adequate dietary intake of vegetables and fruit; vitamins and minerals particularly folic acid; and maintain a healthy weight Educating and counselling parents and community on addressing stigma attached with congenital abnormalities Information education and communication on harmful substances, particularly alcohol and tobacco; exposure of pregnant women to medications or medical radiation Educate community health workers on promoting prevention and early identification of congenital defects	Folic acid/multiple micronutrient supplementation in early pregnancy * Avoiding teratogenic medications during pregnancy Preconception care: glycaemic control	Recognition of neural tubal defect signs and symptoms	Immediate transfer of correctable NTD to a higher-level health care facility	Long term rehabilitation support including physical therapy, speech therapy, occupational therapy Family or caregiver educational training	Psychological and social support to patients and families of babies with birth-related complications Assess to detect and manage any signs of neurologic dysfunction such as delayed developmental milestones
Referral Facility: General
	Folic acid/multiple micronutrient supplementation in early pregnancy * Avoiding teratogenic medications during pregnancy Preconception care: glycaemic control	History Physical examination Alpha fetoprotein (AFP) Ultrasound	Counselling for NTD identified prenatally Immediate transfer of correctable NTD to a higher-level health care facility	Long term rehabilitation support including physical therapy, speech therapy, occupational therapy	Psychological and social support to patients and families of babies with birth-related complications Assess to detect and manage any signs of neurologic dysfunction such as delayed developmental milestones
Referral Facility: Specialist
	Folic acid/multiple micronutrient supplementation in early pregnancy * Avoiding teratogenic medications during pregnancy Preconception care: glycaemic control	History Physical examination Serum Alpha fetoprotein (AFP) Amniotic Alpha fetoprotein (AFP) Ultrasound	Neonatal surgical repair	Long term rehabilitation support including physical therapy, speech therapy, occupational therapy Family or caregiver educational training Provide assistive products	Psychological and social support to patients and families of babies with birth-related complications Assess to detect and manage any signs of neurologic dysfunction such as delayed developmental milestones

Age Cohort: < 5 years

Health Promotion	Disease Prevention	Diagnostic	Curative	Rehabilitative	Palliative
Community Level
Educate adolescent girls and mothers to have a healthy diet including adequate dietary intake of vegetables and fruit; vitamins and minerals particularly folic acid, and maintain a healthy weight Community awareness on addressing stigma attached with congenital abnormalities Information education and communication on harmful substances, particularly alcohol and tobacco, exposure of pregnant women to medications	Adequate dietary intake of vitamins and minerals, folic acid, variety of vegetables and fruit, and maintain a healthy weight for adolescent’s girls and mothers Avoid harmful substances, particularly alcohol and tobacco during pregnancy Reduce or eliminating environmental exposure to hazardous substances (such as heavy metals or pesticides) during pregnancy;	Recognition of neural tubal defect signs and symptoms	Immediate transfer of suspected NTD to a higher-level health care facility	Physical rehabilitation Family or caregiver educational training	Psychological and social support to patients and families of babies with birth-related complications
Primary Care
Educate adolescent girls and mothers to have a healthy diet including adequate dietary intake of vegetables and fruit, vitamins and minerals particularly folic acid, and maintain a healthy weight Educating and counselling parents and community on addressing stigma attached with congenital abnormalities Information education and communication on harmful substances, particularly alcohol and tobacco, exposure of pregnant women to medications or medical radiation	Folic acid/multiple micronutrient supplementation in early pregnancy * Avoiding teratogenic medications during pregnancy Preconception care: glycaemic control	Recognition of neural tubal defect signs and symptoms	Immediate transfer of correctable NTD to a higher-level health care facility	Long term rehabilitation support including physical therapy, speech therapy, occupational therapy Family or caregiver educational training Provide assistive products	Psychological and social support to patients and families of babies with birth-related complications Assess to detect and manage any signs of neurologic dysfunction such as delayed developmental milestones
Referral Facility: General
Health education on prevention and early identification of congenital defects	Folic acid/multiple micronutrient supplementation in early pregnancy * Avoiding teratogenic medications during pregnancy Preconception care: glycaemic control	History Physical examination Alpha fetoprotein (AFP) Ultrasound	Counselling for NTD identified prenatally Immediate transfer of correctable NTD to a higher-level health care facility	Long term rehabilitation support including physical therapy, speech therapy, occupational therapy	Psychological and social support to patients and families of babies with birth-related complications Assess to detect and manage any signs of neurologic dysfunction such as delayed developmental milestones
Referral Facility: Specialist
Health education on prevention and early identification of congenital defects	Folic acid/multiple micronutrient supplementation in early pregnancy * Avoiding teratogenic medications during pregnancy Preconception care: glycaemic control	History Physical examination Serum Alpha fetoprotein (AFP) Amniotic Alpha fetoprotein (AFP) Ultrasound	Neonatal surgical repair	Long term rehabilitation support including physical therapy, speech therapy, occupational therapy Family or caregiver educational training Provide assistive products	Psychological and social support to patients and families of babies with birth-related complications Assess to detect and manage any signs of neurologic dysfunction such as delayed developmental milestones