Earlier initiation and use of a greater number of iron-folic acid supplements during pregnancy prevents early neonatal deaths in Nepal and Pakistan.
BACKGROUND
Early neonatal deaths account for 75% of neonatal deaths globally. Antenatal iron-folic acid (IFA) supplementation has significantly reduced the risk of early neonatal deaths in China and Indonesia. We investigated the impact of antenatal IFA supplements on the risk of early neonatal deaths in Nepal and Pakistan during the last decade.


METHODS
Data from the most recent singleton live-births of 8,186 from two Nepal Demographic and Health Surveys (DHS) and 13,034 from two Pakistan DHS were selected for the current study. The primary outcome was early neonatal deaths and the main study variable was antenatal IFA supplementation. Analyses used multivariate Cox proportional regression, adjusted for the cluster sampling design and for 18 potential confounders.


RESULTS
The adjusted risk of early neonatal deaths was significantly reduced by 51% (aHR = 0.49, 95% CI = 0.32-0.75) in Nepal and 23% (aHR = 0.77, 95% CI = 0.59-0.99) in Pakistan with any use of IFA compared to none. When IFA supplementation started at or before the 5th month of pregnancy, the adjusted risk of early neonatal mortality was significantly reduced by 53% in Nepal, and 28% in Pakistan, compared to no IFA. When >90 IFA supplements were used and started at or before 5th months, the adjusted risk of early neonatal deaths was significantly reduced by 57% in Nepal, and 45% in Pakistan. In Nepal 4,600 and in Pakistan 75,000 early neonatal deaths could be prevented annually if all pregnant women used >90 IFA supplements and started at or before the 5th month of pregnancy.


CONCLUSIONS
Any use of IFA supplements was significantly associated with reduced risk of early neonatal deaths in Nepal and Pakistan. The greatest mortality sparing effect of IFA on early neonatal deaths in both countries was with early initiation and use of a greater number of supplements.
Sydney School of Public Health, The University of Sydney, Australia.
Yasir Bin
YB
Nisar
Sydney School of Public Health, The University of Sydney, Australia.
Michael J
MJ
Dibley
D019587:Dietary Supplements; D005260:Female; D005492:Folic Acid / Q000627:therapeutic use*; D006801:Humans; D007231:Infant, Newborn; D007501:Iron; D009390:Nepal / Q000453:epidemiology; D010154:Pakistan / Q000453:epidemiology; D066087:Perinatal Death; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology* / Q000517:prevention & control*; D015995:Prevalence; D012111:Residence Characteristics; D012959:Socioeconomic Factors
D005492:Folic Acid; D007501:Iron