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 - material: To access the supplementary material for this article, please see Supplementary files under ‘Article Tools’
  • References (51)
    51 references, page 1 of 6

    1. UNICEF, World Health Organization, The World Bank, United Nations, UN Inter-agency Group for Child Mortality Estimation (2014). Levels & Trends in Child Mortality Report 2014. New York: UNICEF.

    2. National Institute of Population Studies (NIPS) [Pakistan], Macro International Inc (2013). Pakistan Demographic and Health Survey 2012 13. Islamabad, Pakistan: NIPS, Macro International Inc.

    3. Bhutta ZA, Chopra M, Axelson H, Berman P, Boerma T, Bryce J, et al. Countdown to 2015 decade report (2000 10): taking stock of maternal, newborn, and child survival. Lancet 2010; 375: 2032 44.

    4. Khan A, Kinney MV, Hazir T, Hafeez A, Wall SN, Ali N, et al. Newborn survival in Pakistan: a decade of change and future implications. Health Policy Plan 2012; 27: iii72 iii87.

    5. Haider BA, Olofin I, Wang M, Spiegelman D, Ezzati M, Fawzi WW; Nutrition Impact Model Study Group (anaemia). Anaemia, prenatal iron use, and risk of adverse pregnancy outcomes: systematic review and meta-analysis. BMJ 2013; 346: f3443.

    6. Imdad A, Bhutta ZA. Routine iron/folate supplementation during pregnancy: effect on maternal anaemia and birth outcomes. Paediatr Perinat Epidemiol 2012; 26(Suppl 1): 168 77.

    7. World Health Organization (2012). Guideline: daily iron and folic acid supplementation in pregnant women. Geneva: World Health Organization.

    8. Zeng L, Cheng Y, Dang S, Yan H, Dibley MJ, Chang S, et al. Impact of micronutrient supplementation during pregnancy on birth weight, duration of gestation, and perinatal mortality in rural western China: double blind cluster RCT. BMJ 2008; 337: a2001.

    9. Titaley CR, Dibley MJ. Antenatal iron/folic acid supplements, but not postnatal care, prevents neonatal deaths in Indonesia: analysis of Indonesia Demographic and Health Surveys 2002/ 2003 2007 (a retrospective cohort study). BMJ Open 2012; 2: e001399.

    10. Titaley CR, Dibley MJ, Roberts CL, Agho K. Combined iron/ folic acid supplements and malaria prophylaxis reduce neonatal mortality in 19 sub-Saharan African countries. Am J Clin Nutr 2010; 92: 235 43.

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