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Antenatal Iron-Folic Acid Supplementation Reduces Neonatal and Under-5 Mortality in Nepal
Yasir Bin Nisar1, Michael J Dibley2, Saba Mebrahtu3
1Sydney School of Public Health, The University of Sydney, Sydney, Australia; yasi8204@uni.sydney.edu.au.
Insights
Antenatal iron-folic acid (IFA) supplementation significantly lowers child mortality in Nepal. Ensuring universal IFA coverage could prevent thousands of under-5 deaths annually.
Area of Science:
- Maternal and Child Health
- Nutritional Epidemiology
- Public Health Interventions
Background:
- Antenatal iron-folic acid (IFA) supplementation is crucial for improving maternal health and pregnancy outcomes.
- Previous research indicates IFA supplementation positively impacts child survival rates.
Purpose of the Study:
- To investigate the impact of antenatal IFA supplementation on childhood mortality risk in Nepal.
- The study period spanned 15 years, from 1996 to 2011.
Main Methods:
- Utilized survival data from 12,891 singleton infants from Nepal Demographic and Health Surveys (2001, 2006, 2011).
- Primary outcomes included mortality indicators for children under 5 years.
- Multivariate Cox proportional hazards regression, adjusted for cluster sampling, was employed for analysis.
Main Results:
- Antenatal IFA significantly reduced early neonatal deaths by 45% and total neonatal deaths by 42%.
- Infant and under-5 mortality risks decreased by 32% and 48%, respectively.
- Early initiation (1-4 months) and adequate intake (150-240 supplements) showed the greatest reduction in mortality.
Conclusions:
- Antenatal IFA supplementation is a key intervention for reducing neonatal and under-5 mortality in Nepal.
- Universal IFA coverage holds the potential to significantly improve child survival rates.
- Targeted interventions for early and consistent IFA intake can maximize benefits for child survival.
Background:
Antenatal iron-folic acid (IFA) supplementation improves maternal anemia and poor pregnancy outcomes. Antenatal use of IFA supplements also has an effect on child survival.
Objective:
The current study investigated the effect of antenatal IFA supplements on the risk of childhood mortality in Nepal over a 15-y period from 1996 to 2011.
Methods:
Survival information of 12,891 singleton most recent live-born infants from pooled 2001, 2006, and 2011 Nepal Demographic and Health Surveys was used. Primary outcomes were mortality indicators in children <5 y of age and the main exposure variable was use of IFA supplements. Data were analyzed by using STATA 13.1 (StataCorp) and were adjusted for the cluster sampling design. Analyses used multivariate Cox proportional hazards regression adjusted for potential confounders.
Results:
Antenatal use of IFA supplements significantly reduced the risk of early neonatal deaths by 45% [adjusted HR (aHR): 0.55; 95% CI: 0.38, 0.79] and total neonatal deaths by 42% (aHR: 0.58; 95% CI: 0.39, 0.85). Similarly, the risk of infant and under-5 mortality was significantly reduced by 32% and 48%, respectively. For mothers who started IFA at 1-4 mo of pregnancy and used 150-240 supplements, neonatal and under-5 mortality were significantly reduced by 55% (aHR: 0.45; 95% CI: 0.24, 0.85) and 57% (aHR: 0.43; 95% CI: 0.23, 0.78), respectively. Population attributable risk estimates found 15% of under-5 deaths were attributed to nonuse of IFA, and 29,000 under-5 deaths could be prevented in the next 5 y with universal IFA coverage.
Conclusions:
Antenatal IFA supplementation significantly reduces the risk of neonatal and under-5 deaths in Nepal. The greatest effect on child survival was found in women who started IFA early in pregnancy and took 150-240 supplements. Universal IFA coverage could improve neonatal and child survival.
