Assessing Folic Acid Supplementation Adherence Among Pregnant Women in LMICs and its Impact on Neural Tube Defect Incidence: A Systematic Review Protocol

IntroductionNeural tube defects (NTDs) are treatable but incurable birth defects, causing permanent disability and potential mortality if neglected. Despite its global significance, there has not been any systematic review exploring the link between folic acid adherence and NTD incidence in low-and-middle-income countries (LMICs), where its impact is disproportionately felt. This systematic review primarily aims to analyze the impact of folic acid supplementation adherence among expectant mothers on the incidence of NTDs in LMICs. Methods and AnalysisFollowing the PRISMA guidelines, we will conduct a comprehensive search of original research articles and observational studies using the electronic databases of PubMed, Scopus, Medline, and Embase from inception till date. Our search comprises keywords related to our PICO framework and objectives. We will analyze data using tables and diagrams for qualitative presentation and conduct a random-effect Bayesian meta-analysis when applicable. Two reviewers will screen titles and abstracts independently, conduct full-text reviews, and extract study data. In case of disagreements, a third reviewer will resolve them. We will present study details and assess bias risk. We will also assess the overall certainty of evidence using the Grading of Recommendations Assessment, Development, and Evaluation framework. Ethics and DisseminationEthical approval is unnecessary as this study involves a systematic review of published studies. We aim to publish our findings in a peer-reviewed journal.