title: Iron/folic acid supplementation during pregnancy prevents neonatal and under-five mortality in Pakistan: propensity score matched sample from two Pakistan Demographic and Health Surveys.
abstract: BACKGROUND
  Several epidemiological studies from low- and middle-income countries have reported a protective effect of maternal antenatal iron/folic acid (IFA) on childhood mortality.
  
  
  OBJECTIVE
  The current study aimed to evaluate the effect of maternal antenatal IFA supplementation on childhood mortality in Pakistan.
  
  
  METHODS
  A propensity score-matched sample of 8,512 infants live-born within the 5 years prior to interview was selected from the pooled data of two Pakistan Demographic and Health Surveys (2006/07 and 2012/13). The primary outcomes were childhood mortality indicators and the main exposure variable was maternal antenatal IFA supplementation. Post-matched analyses used Cox proportional hazards regression and adjusted for 16 potential confounders.
  
  
  RESULTS
  Maternal antenatal IFA supplementation significantly reduced the adjusted risk of death on day 0 by 33% [adjusted hazard ratio (aHR)=0.67, 95% confidence interval (95% CI) 0.48-0.94], during the neonatal period by 29% (aHR=0.71, 95% CI 0.57-0.88), and for under-fives by 27% (aHR=0.73, 95% CI 0.60-0.89). When IFA was initiated in the first 4 months of pregnancy, the adjusted risk of neonatal and under-five deaths was significantly reduced by 35 and 33%, respectively. Twenty percent of under-five deaths were attributable to non-initiation of IFA in the first 4 months of pregnancy. With universal initiation of IFA in the first 4 months of pregnancy, 80,300 under-five deaths could be prevented annually in Pakistan.
  
  
  CONCLUSIONS
  Maternal antenatal IFA supplementation significantly reduced neonatal and under-five deaths in Pakistan. Earlier initiation of supplements in pregnancy was associated with a greater prevention of neonatal and under-five deaths.
authors.affiliation: United Nations Office for Project Services, Islamabad, Pakistan; drbin01@hotmail.com.
authors.forename: Yasir B
authors.initials: YB
authors.lastname: Nisar
authors.affiliation: Sydney School of Public Health, University of Sydney, Sydney, Australia.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Dibley
mesh_terms: D046688:Child Mortality; D002675:Child, Preschool; D003710:Demography; D019587:Dietary Supplements; D005260:Female; D005492:Folic Acid / Q000008:administration & dosage* / Q000494:pharmacology; D006306:Health Surveys; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D007501:Iron / Q000008:administration & dosage* / Q000494:pharmacology; D008297:Male; D009035:Mothers; D010154:Pakistan; D011247:Pregnancy; D011295:Prenatal Care; D057216:Propensity Score
chemical_list: D005492:Folic Acid; D007501:Iron
keywords: antenatal care; iron/folic acid supplements; mortality; neonatal; propensity score; under-five