Iron and folic acid supplements and reduced early neonatal deaths in Indonesia.
OBJECTIVE
To examine the relationship between antenatal care, iron and folic acid supplementation and tetanus toxoid vaccination during pregnancy in Indonesia and the risk of early neonatal death (death in days 0-6 of life).


METHODS
We analysed pooled data on neonatal survival in singleton infants born in the 5 years before each of the Indonesian demographic and health surveys of 1994, 1997 and 2002-2003. Only the most recently born infant of each mother was included. Multivariate Cox proportional hazards models were used to identify factors linked to early neonatal death.


RESULTS
Of the 40 576 infants included, 442 experienced early neonatal death. After adjustment, the risk of early neonatal death was significantly reduced for infants of mothers who received either any form of antenatal care (hazard ratio, HR: 0.48; 95% confidence interval, CI: 0.31-0.73), any quantity of iron and folic acid (HR: 0.53; 95% CI: 0.36-0.77) or >or= 2 tetanus toxoid injections (HR: 0.66; 95% CI: 0.48-0.92). When we analysed different combinations of these measures, iron and folic acid supplementation provided the main protective effect: early neonatal deaths were still significantly reduced among infants whose mothers received iron and folic acid supplements but no other form of antenatal care (HR: 0.10; 95% CI: 0.01-0.67), or the supplements but < 2 tetanus toxoid injections (HR: 0.46; 95% CI: 0.29-0.73). Subsequent analysis showed that 20% of early neonatal deaths in Indonesia could be attributed to a lack of iron and folic acid supplementation during pregnancy.


CONCLUSIONS
Iron and folic acid supplementation during pregnancy in Indonesia significantly reduced the risk of early neonatal death and could also do so in other low- and middle-income countries.
Titaley
Christiana R
CR
Sydney School of Public Health, Edward Ford Building (A27), University of Sydney, NSW 2006, Australia. ctitaley@health.usyd.edu.au
Dibley
Michael J
MJ
Roberts
Christine L
CL
Hall
John
J
Agho
Kingsley
K
D001724:Birth Weight; D019587:Dietary Supplements; D005260:Female; D005492:Folic Acid / Q000008:administration & dosage*; D006306:Health Surveys; D006801:Humans; D007214:Indonesia / Q000453:epidemiology; D007231:Infant, Newborn; D007501:Iron / Q000008:administration & dosage*; D008297:Male; D054238:Perinatal Mortality; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology; D011295:Prenatal Care / Q000706:statistics & numerical data*; D012307:Risk Factors; D012737:Sex Factors; D012959:Socioeconomic Factors; D013745:Tetanus Toxoid / Q000008:administration & dosage
D013745:Tetanus Toxoid; D005492:Folic Acid; D007501:Iron