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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
Authors: Yasir B. Nisar, and Michael J. Dibley
Source: Global Health Action, 9:29621. doi: 10.3402/gha.v9.29621
Topic(s): Antenatal care
Child health
Children under five
Infant mortality
Iron supplements
Maternal health
Neonatal mortality
Country: Asia
Published: FEB 2016
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. Design 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. Keywords: propensity score, antenatal care, iron/folic acid supplements, mortality, neonatal, under-five