1. Technical Consultation: Folate Status in Women and NTD Risk-Reduction
Homero Martinez, MD, PhD
Senior Advisor
Micronutrient Forum
PUSH! Executive Committee Teleconference
22 June 2017

2. Presentation
Overview
Consultative process
Outcomes
Next steps

3. Overview Background Challenges
Significant opportunity to decrease the toll of birth defects and neonatal mortality globally
Prevention through relatively simple nutritional interventions directed at improving folate status in the population
Implementing interventions globally has proven challenging
Micronutrient Forum, with support from the Bill & Melinda Gates Foundation , convened consultation ( )
Current global data on folate status and NTDs are lacking
Obstacles and challenges remain to deliver folic acid to populations
Use of reliable laboratory methods to assess folate status are needed
Better methods and innovations are needed to assess folate status, deliver interventions, and monitor NTDs and other outcomes
Background:

4. Consultative Process
Charge
Objectives
To address challenges with particular attention given to low- and middle-income countries (LMIC)
To develop a roadmap for LMIC to better inform and prioritize investments in NTD risk-reduction
To help guide implementation efforts in terms of feasibility of interventions and the potential for acceleration
To identify the knowledge gaps that remain including addressing any questions on safety and efficacy of folic acid interventions

5. Consultative Process Structure Execution Core Steering Group
Committee: Small, well-balanced, objective multi- and inter-disciplinary
Global experts in nutrition, clinical pediatrics, epidemiology, policy translation, public health program implementation, folate assessment, economics, and industry
Engaged experts external to the committee
Meeting One: December 2016, to consider the data and evidence related to folate status in women and NTD risk-reduction
Teleconference: February 2017, included presentations from additional external experts in the areas of innovative technologies in private industry, advocacy, and approaches to estimating global NTD burden
Meeting Two: April 2017, to review and discuss the draft technical sections, further define options for action, and outline a key decisions framework for implementation
Two phased review process (SME and stakeholder)

6. Outcomes Development of foundational framework
Based on eight technical sections
NTD burden, folate status, surveillance, B12 considerations, safety of folic acid, laboratory harmonization, fortification & innovation, economics of prevention
Provides a global roadmap for action in LMIC to better inform and prioritize investments and help guide implementation efforts in terms of feasibility of interventions and potential for acceleration

7. Outcomes Foundational Framework:
Defines options for action for folate status assessment and NTD risk-reduction in LMIC
Folate status assessment
NTD surveillance
Effective interventions
Outlines a way forward to implement a time-bound global action plan for NTD risk-reduction
Help prioritize existing donor funds
Stand-up a global body to develop and coordinate a global action plan
Engage additional donors and stakeholders in NTD risk-reduction on a global scale

8. Outcomes A partner collaboration group was established
Folate Status Systematic Review
Global Estimates of NTD Burden
A partner collaboration group was established
CDC, Nutrition International, University of Georgia, Micronutrient Forum, WHO
To describe global folate status in women of reproductive age
Global Experts were commissioned
London School of Hygiene and Tropical Medicine
To develop and execute a method to bracket the burden of NTDs and deliver global estimates for NTDs

9. Next Steps Move implementation of the roadmap for action forward
Establish the Task Force/Technical Advisory Group to guide the implementation
Emphasis on advancing the roadmap by promoting activities on both global and national scales
Implement a global action plan
Global: Creating and disseminating global public goods around the consequences of folate insufficiency and fortification
National: Take a “nested egg” approach to prioritize countries

10. Questions?
Thank you!