# A global survey of neurosurgeons’ awareness of neural tube defect prevalence, prevention strategies, and their clinical time allocation to spina bifida care

## TL;DR

This study surveyed neurosurgeons worldwide about their knowledge of neural tube defects and spina bifida care, finding gaps in awareness and significant differences in clinical time spent between high and non-high-income countries.

## Contribution

The study provides the first global assessment of neurosurgeons' awareness and clinical time allocation related to spina bifida and neural tube defects.

## Key findings

- Approximately 25-28% of neurosurgeons were unaware of NTD prevalence or folic acid fortification effectiveness.
- Neurosurgeons in non-high-income countries were more likely to spend significant time on spina bifida care.
- Supplementation pills and flour fortification were the most cited NTD prevention strategies.

## Abstract

Assess the global neurosurgeon workforce’s awareness of neural tube defect (NTD) prevalence, prevention strategies, and clinical time spent on spina bifida (SB) care.

An online survey was administered to neurosurgeons worldwide between 2021-2022. Categorical responses were analyzed using descriptive analysis. Adjusted and unadjusted logistic regression analyses were conducted to examine the association between the clinical time spent on SB care and NTD prevalence awareness, controlling for sex, income region, pediatric training, and practice years, estimating odds ratios (ORs) and 95% confidence intervals (CIs).

Overall, 234 neurosurgeons (71% participation rate) responded from 64 countries. Respondents included 166 (77%) non-US residents practicing in non-high-income-country (non-HIC) (49%). Most were male (78%), 31-60 years old (80%), and urban-based (76%). Approximately quarter were unaware of the NTD prevalence at the national (28%) or global (24%) level, or the effectiveness of folic acid fortification (FAF) (27%). About 17% reported NTD rates ≥ 20/10,000 live births in their country. Neurosurgeons most often cited supplementation pills (46%) and flour FAF (36%) as the most common strategies to prevent NTD pregnancies. They were more likely to prefer strategies based on flour FAF (48%) and salt FAF (35%). There was a significant positive association between practicing in non-HIC and spending ≥ 20% of clinical time caring for SB (aOR = 6.42, 95% CI = 2.66-15.46, p < 0.001).

This study highlights the need to improve awareness of NTD prevalence and preventive strategies among the neurosurgical community. There is a significant disparity in time spent on SB care between HIC and non-HIC countries.  Neurosurgeons can serve as key advocates for global and local SB prevention efforts, with particular emphasis on FAF.

The online version contains supplementary material available at 10.1007/s00381-025-06894-2.