This study involved a retrospective analysis of 19094 delivery records of all infants born at the Korle Bu Teaching Hospital in Accra, Ghana, between January 1991 to December 1992. During this two year period, the prevalence of neural tube defects (NTDs) was 1.15/1000 births. Anterior neural tube defects (anencephaly) accounted for 73% and posterior neural tube defects (spina bifida) accounted for 27% of all cases of NTDs. We conclude that NTDs occurs commonly in our subregion. Current available data strongly indicate that periconception folic acid supplementation significantly reduces the prevalence of NTDs. Some of this data is discussed. We strongly recommend preconception folate supplementation in our sub-region.