title: Iron and folic acid supplements in pregnancy improve child survival in Indonesia.
abstract: BACKGROUND
  Several trials have shown that iron-folic acid supplements during pregnancy protect newborns against preterm delivery and early neonatal death, but the impact beyond the neonatal period is unclear.
  
  
  OBJECTIVE
  We determined whether live-born children <5 y of age born to mothers who used antenatal iron-folic acid supplements had reduced risk of death.
  
  
  METHODS
  Pooled 1994, 1997, 2002-2003, and 2007 Indonesia Demographic and Health Survey data were used to examine the relation between the use of iron-folic acid supplements and child death in 3 cumulative (0-30 d, 0-11 mo, and 0-4 y) and 4 mutually exclusive (first day of life and 1-30 d, 1-11 mo, and 1-4 y of age) time periods. Risk of death was estimated by using Cox regression to control for 19 potential confounders.
  
  
  RESULTS
  Survival information for 52,917 singleton live-born infants and 1525 deaths of children <5 y of age was examined. After adjustment for potential confounders, risk of death of children <5 y of age was reduced significantly by 34% if the mother consumed any iron-folic acid supplements [adjusted HR (aHR): 0.66; 95% CI: 0.53, 0.81; P < 0.001]. This protective effect was greatest for deaths on the first day of life (aHR: 0.40; 95% CI: 0.21, 0.77; P = 0.005) but was also shown for neonatal deaths on days 1-30 of life (aHR: 0.69; 95% CI: 0.49, 0.97; P = 0.035) and postneonatal deaths (aHR: 0.74; 95% CI: 0.56, 0.99; P = 0.044). There was a strong dose response of greater protection from death of children <5 y of age with increasing numbers of iron-folic acid supplements consumed.
  
  
  CONCLUSIONS
  In developing countries increased use of antenatal iron-folic acid supplements will reduce deaths of children <5 y of age, especially in the first year of life.
authors.affiliation: Sydney School of Public Health, University of Sydney, New South Wales, Australia. michael.dibley@sydney.edu.au
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Dibley
authors.forename: Christiana R
authors.initials: CR
authors.lastname: Titaley
authors.forename: Catherine
authors.initials: C
authors.lastname: d'Este
authors.forename: Kingsley
authors.initials: K
authors.lastname: Agho
mesh_terms: D018798:Anemia, Iron-Deficiency / Q000188:drug therapy* / Q000401:mortality; D046688:Child Mortality; D002675:Child, Preschool; D019587:Dietary Supplements; D005260:Female; D005492:Folic Acid / Q000627:therapeutic use*; D006801:Humans; D007214:Indonesia / Q000453:epidemiology; D007223:Infant; D007226:Infant Mortality; D007501:Iron / Q000627:therapeutic use*; D008297:Male; D018977:Micronutrients / Q000627:therapeutic use; D015999:Multivariate Analysis; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy*; D011295:Prenatal Care; D016016:Proportional Hazards Models
chemical_list: D018977:Micronutrients; D005492:Folic Acid; D007501:Iron