Iron/folic acid supplementation during pregnancy prevents neonatal and under-five mortality in Pakistan: propensity score matched sample from two Pakistan Demographic and Health Surveys

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Nisar, Yasir B. ; Dibley, Michael J. (2016)
  • Publisher: Co-Action Publishing
  • Journal: Global Health Action, volume 9 (issn: 1654-9716, eissn: 1654-9880)
  • Related identifiers: pmc: PMC4752592, doi: 10.3402/gha.v9.29621, doi: 10.3402/gha.v%v.29621
  • Subject: Original Article | under-five | child mortality | RA1-1270 | propensity score; antenatal care; iron/folic acid supplements; mortality; neonatal; under-five | Public aspects of medicine | mortality | neonatal | iron/folic acid supplements | antenatal care | child; maternal; supplements; mortality | propensity score

Background: Several epidemiological studies from low- and middle-income countries have reported a protective effect of maternal antenatal iron/folic acid (IFA) on childhood mortality.Objective: The current study aimed to evaluate the effect of maternal antenatal IFA supplementation on childhood mortality in Pakistan.Design: A propensity score–matched sample of 8,512 infants live-born within the 5 years prior to interview was selected from the pooled data of two Pakistan Demographic and Health Surveys (2006/07 and 2012/13). The primary outcomes were childhood mortality indicators and the main exposure variable was maternal antenatal IFA supplementation. Post-matched analyses used Cox proportional hazards regression and adjusted for 16 potential confounders.Results: Maternal antenatal IFA supplementation significantly reduced the adjusted risk of death on day 0 by 33% [adjusted hazard ratio (aHR)=0.67, 95% confidence interval (95% CI) 0.48–0.94], during the neonatal period by 29% (aHR=0.71, 95% CI 0.57–0.88), and for under-fives by 27% (aHR=0.73, 95% CI 0.60–0.89). When IFA was initiated in the first 4 months of pregnancy, the adjusted risk of neonatal and under-five deaths was significantly reduced by 35 and 33%, respectively. Twenty percent of under-five deaths were attributable to non-initiation of IFA in the first 4 months of pregnancy. With universal initiation of IFA in the first 4 months of pregnancy, 80,300 under-five deaths could be prevented annually in Pakistan.Conclusions: Maternal antenatal IFA supplementation significantly reduced neonatal and under-five deaths in Pakistan. Earlier initiation of supplements in pregnancy was associated with a greater prevention of neonatal and under-five deaths.Keywords: propensity score; antenatal care; iron/folic acid supplements; mortality; neonatal; under-five(Published: 11 February 2016) Citation: Glob Health Action 2016, 9: 29621 - http://dx.doi.org/10.3402/gha.v9.29621Supplementary material: To access the supplementary material for this article, please see Supplementary files under ‘Article Tools’
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