Fifteen years of experience has shown that fortifying flour with folic acid is a reliable method of significantly reducing the incidence of neural tube defects (NTDs) such as spina bifida, anencephaly, and encephalocele. In 1996, Oman was the first country to achieve national-scale fortification of flour with folic acid to prevent these permanently disabling or fatal birth defects. Also in 1996, the United States and Canada were beginning to add folic acid to flour, but these larger countries did not achieve nationwide coverage until the end of 1997. By 2008, an estimated 22,000 birth defects were prevented due to this intervention, and by 2011 this vitamin was required to be added to flour in 57 countries.
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