According to the US-based NGO, the March of Dimes, there were just 254 children born with NTDs last year in Turmenistan as the 15-year programme has seen locally produced flour fortified with folic acid and iron rise to its current level of 93%.
Local dietary habits have helped, with bread consumption in Turkmenistan one of the highest in the world on a per capita basis.
“Meals are almost always served with bread, and an average of 537 grams of wheat are consumed per person daily,” said the Flour Fortification Initiative (FFI).
Folic acid and iron deficiencies have been linked to an increase in NTDs among women of childbearing and in those that are pregnant. The FFI estimates 22,000 birth defects are prevented every year due folic acid flour fortification.
Turkmenistan also fortifies its salt supply with iodine.
“Seeing the potential for fortified foods to improve the health of the population, the President of Turkmenistan issued a decree on 28 May 1996 for the country to fortify flour with iron and salt with iodine,” the FFI said.
The programme did not become national until UNICEF came onboard and gained increased support from the Ministry of Health and Medical Industry and the National Bread Association (TurkmenGallaonumleri).
UNICEF provided additional dosing machines for mills, an annual stock of premix, and educated millers about fortification standards and technical procedures, along with other quality control procedures.
These actions led to the President in 2006 mandating that flour be fortified with both folic acid and iron.
Yet despite the successes of the programmes, health issues remain with the World Health Organization estimating 47% of non-pregnant women in Turkmenistan have anaemia due to iron deficiency.
In 2008 the government committed to fully funding the fortification programme.
An large body of evidence links folate deficiency in early pregnancy to increased risk of NTDs - most commonly spina bifida and anencephaly - in infants.
Turkmenistan along with Oman, the US and Canada were some of the first countries to fortify their flour supplies. Data indicates such programmes are working with a reported 15-50% reduction in NTD incidence.
A total of 51 countries now have some degree of mandatory fortification of flour with folic acid.
The US Centers for Disease Control and Prevention (CDC) recently listed the prevention of NTDs through flour fortification amongst its list of 10 great health achievements in the US for the last decade.