Combined iron/folic acid supplements and malaria prophylaxis reduce neonatal mortality in 19 sub-Saharan African countries.
BACKGROUND
In nonmalaria regions, iron/folic acid supplementation during pregnancy protects newborns against preterm delivery and early neonatal death. Other studies from malaria-endemic areas have reported an adverse effect of iron supplements on malaria prevalence in pregnant women.


OBJECTIVE
We examined the association between iron/folic acid supplements and prenatal antimalaria prophylaxis on neonatal mortality in malaria-endemic countries of sub-Saharan Africa.


METHODS
This analysis used the most recent data from Demographic and Health Surveys of 19 malaria-endemic countries in sub-Saharan Africa. Survival information of 101,636 singleton live-born infants from the most recent delivery of ever-married women < or =5 y before each survey was examined. The effect of each potential predictor on neonatal deaths was analyzed by using Cox proportional hazards regression models.


RESULTS
Infants whose mothers received any iron/folic acid supplements and sulfadoxine-pyrimethamine intermittent preventive treatment (SP-IPT(p)) for malaria during pregnancy were significantly protected from neonatal death [hazard ratio (HR): 0.76; 95% CI: 0.58, 0.99]. The protective effect was not significant in mothers who received only iron/folic acid supplements (HR: 0.90; 95% CI: 0.73, 1.12) or only SP-IPT(p) (HR: 1.08; 95% CI: 0.74, 1.57). Among the sociodemographic and birth characteristics, factors that significantly increased the risk of neonatal death included first-born infants, a birth interval of <2 y, maternal age at delivery of > or =30 y, smaller than average-sized infants, and male infants.


CONCLUSIONS
The use of antenatal iron/folic acid supplements combined with appropriate intermittent preventive treatment of malaria during pregnancy is an important intervention to reduce neonatal mortality in malaria-endemic regions.
Titaley
Christiana R
CR
Sydney School of Public Health, University of Sydney, Sydney, Australia. ctitaley@health.usyd.edu.au
Dibley
Michael J
MJ
Roberts
Christine L
CL
Agho
Kingsley
K
D017954:Africa South of the Sahara / Q000453:epidemiology; D002662:Child Health Services / Q000592:standards; D003695:Delivery of Health Care / Q000592:standards; D003710:Demography; D019587:Dietary Supplements; D005260:Female; D005492:Folic Acid / Q000627:therapeutic use*; D006306:Health Surveys; D006801:Humans; D007226:Infant Mortality / Q000639:trends*; D007231:Infant, Newborn; D007501:Iron / Q000627:therapeutic use*; D008288:Malaria / Q000517:prevention & control*; D008297:Male; D008427:Maternal Health Services / Q000592:standards; D011247:Pregnancy
D005492:Folic Acid; D007501:Iron