Antenatal iron/folic acid supplements, but not postnatal care, prevents neonatal deaths in Indonesia: analysis of Indonesia Demographic and Health Surveys 2002/2003–2007 (a retrospective cohort study)

Abstract Purpose The aim of this study was to examine the association between periconceptional folic acid (FA) supplementation and risk of preterm birth. Methods We conducted a retrospective cohort study in women aged 18–49 who participated in the NFPHEP from 2010 to 2018, and had a singleton livebirth in 129 counties in southwest China. Participants were divided into four groups according to the time period starting FA use: no use, after the last menstrual period, at least 1–2 months before the last menstrual period, at least 3 months before the last menstrual period. The outcomes were preterm birth (gestation < 37 weeks) and early preterm birth (gestation < 34 weeks). Results 201,477 women were included and 191,809 (95.2%) had taken FA during periconception. Compared with women who did not take FA, women who started taking FA 1–2 months before their last menstrual period had a 15% lower risk of preterm birth (aOR = 0.85, 95% CI 0.79–0.92), and women who started taking FA at least 3 months before their last menstrual period had a 20% lower risk of preterm birth (aOR = 0.80, 95% CI 0.75–0.87), but women who started taking FA after their last menstrual period did not appear to reduce the risk of preterm birth. Conclusions In this study of 200,000 Chinese women, periconceptional supplementation with FA was associated with a lower risk of preterm birth. Women who started taking FA at least 3 months before their last menstrual period were more likely to reduce the risk of preterm birth.

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International retrospective cohort study of neural tube defects in relation to folic acid recommendations: are the recommendations working?

BMJ ◽

10.1136/bmj.38336.664352.82 ◽

2005 ◽

Vol 330 (7491) ◽

pp. 571 ◽

Cited By ~ 160

Author(s):

Lorenzo D Botto ◽

Alessandra Lisi ◽

Elisabeth Robert-Gnansia ◽

J David Erickson ◽

Stein Emil Vollset ◽

...

Keyword(s):

Cohort Study ◽

Folic Acid ◽

Neural Tube ◽

Neural Tube Defects ◽

Retrospective Cohort Study ◽

Retrospective Cohort

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Can an Enhanced Iron-Folic Acid Supplementation Program Reduce Neonatal Mortality? Analysis of Pooled Nepal Demographic and Health Surveys

Current Developments in Nutrition ◽

10.1093/cdn/nzaa053_028 ◽

2020 ◽

Vol 4 (Supplement_2) ◽

pp. 823-823

Author(s):

Michael Dibley ◽

Yasir Nisar ◽

Shahreen Raihana ◽

Patrick Kelly

Keyword(s):

Folic Acid ◽

Neonatal Mortality ◽

Health Surveys ◽

Neonatal Period ◽

Cox Proportional Hazards ◽

Cluster Sampling ◽

Demographic And Health Surveys ◽

Risk Of Death ◽

Iron Folic Acid ◽

The Impact

Abstract Objectives Nepal has improved the national antenatal iron-folic acid (IFA) supplementation program through the ‘Iron Intensification Project’ (IIP) between 2003 and 2011. This study assesses the effect of this enhanced IFA supplementation on the risk of neonatal mortality over a 20-year period in Nepal. Methods For the impact evaluation, we used a non-randomized stepped wedge study design, using survival information from 16,159 most recent live births from the pooled data from four Nepal Demographic and Health Surveys (2001, 2006, 2011 and 2016). The primary outcomes were neonatal mortality indicators. The use of any antenatal care (ANC) services and antenatal IFA supplements were the secondary outcomes. The main exposure variable was the status of the IIP in the district of the mother's residence at the time of birth. Analyses used multivariate Cox proportional hazards regression, adjusted for up to 22 potential confounders, and the cluster sampling design. Results After the IIP, the risk of death on the first day of life was significantly reduced by 35% [adjusted hazard ratio (aHR) 0.65, 95% confidence interval (95% CI) 0.43 to 0.97], in the early neonatal period by 32% (aHR 0.68, 95% CI 0.48 to 0.96), and in the neonatal period by 29% (aHR 0.71, 95% CI 0.51 to 0.99). After the IIP, there was a significant reduction of the odds of non-use of ANC services and IFA supplements. Conclusions An enhanced IFA supplementation program was associated with a significant reduction in neonatal mortality in Nepal. Funding Sources Ph.D. scholarship from the University of Sydney.

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Earlier Initiation and Use of a Greater Number of Iron-Folic Acid Supplements during Pregnancy Prevents Early Neonatal Deaths in Nepal and Pakistan

PLoS ONE ◽

10.1371/journal.pone.0112446 ◽

2014 ◽

Vol 9 (11) ◽

pp. e112446 ◽

Cited By ~ 14

Author(s):

Yasir Bin Nisar ◽

Michael J. Dibley

Keyword(s):

Folic Acid ◽

Neonatal Deaths ◽

Folic Acid Supplements ◽

Iron Folic Acid ◽

Early Neonatal Deaths

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Factors associated with place of death for children in South Yorkshire: a retrospective cohort study

BMJ Supportive & Palliative Care ◽

10.1136/bmjspcare-2018-001584 ◽

2018 ◽

Vol 10 (1) ◽

pp. e10-e10

Author(s):

Kate Renton ◽

Anton-Paul Thomas Mayer ◽

Lilias Alison ◽

Daniel Yeomanson

Keyword(s):

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Child Death ◽

Hospital Setting ◽

Service Planning ◽

Place Of Death ◽

Limited Data ◽

Neonatal Deaths ◽

Hospital Deaths

ObjectivesPlace of death (POD) is considered a key quality indicator for adult end of-life care, but paediatric evidence is limited. Data from Child Death Overview Panel (CDOP) databases provides an opportunity to describe trends in POD as regional paediatric palliative medicine (PPM) options have increased. Aims were to identify and describe trends in POD for children in South Yorkshire.MethodsRetrospective cohort study. Anonymised data extracted from five CDOP databases 2008–2015. Data included age, gender, ethnicity, postcode (outward code only), POD, classification and category of death. Descriptive statistical analysis using χ2 test was used to assess intergroup differences.Results748 deaths were notified from 2008 to 2015. Neonatal deaths were excluded, 46% (n=345). Of non-neonatal deaths (n=403), 58% (n=232) were ‘expected’. Of expected deaths (n=232), 19% (n=45) died in home, 19% (n=45) died in hospice and 61% (n=141) died in hospital. This was significantly different from comparable national data which showed considerably more hospital deaths. There was no significant change in POD over time.ConclusionHospital remains the POD for most children, whether deaths are ‘expected’ or not, suggesting specialised PPM should be expanded into the hospital setting. More research is needed regarding preference for POD. This study may help inform future service planning for PPM and hospice development.

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Iron+folic acid distribution and consumption through antenatal care: identifying barriers across countries

Public Health Nutrition ◽

10.1017/s1368980015001652 ◽

2015 ◽

Vol 19 (4) ◽

pp. 732-742 ◽

Cited By ~ 16

Author(s):

Celeste Sununtnasuk ◽

Alexis D’Agostino ◽

John L Fiedler

Keyword(s):

Folic Acid ◽

Antenatal Care ◽

Pregnant Women ◽

Health Surveys ◽

Demographic And Health Surveys ◽

Policy Makers ◽

The Past ◽

Iron Folic Acid ◽

The Ideal

AbstractObjectiveThe prevalence of maternal anaemia remains unacceptably high in developing countries. At the same time, the percentage of women who consume one or more Fe+folic acid (IFA) tablets during pregnancy remains persistently low. The objective of the present study was to identify where, within antenatal care (ANC) programmes, pregnant women falter in obtaining and consuming an ideal minimum of 180 IFA tablets.DesignData from Demographic and Health Surveys were used to develop a schematic which identifies four sequential ‘falter points’ to consuming 180 IFA tablets: ANC attendance, IFA receipt or purchase, IFA consumption and the number of tablets consumed.SettingTwenty-two countries with high burdens of undernutrition.SubjectsA sample of 162 958 women, 15 to 49 years of age, with a live birth in the past 5 years.ResultsAcross all countries, 83 % of all pregnant women had at least one ANC visit, 81 % of whom received IFA tablets. Of those receiving IFA tablets, 95 % consumed at least one. Overall adherence to the ideal supplementation regimen, however, was extremely low: only 8 % consumed 180 or more IFA tablets. There were only two countries in which the percentage of pregnant women consuming 180 or more tablets exceeded 30 %.ConclusionsWhile most women receive and take some IFA tablets, few receive or take enough. The analysis identifies where ANC-based distribution of IFA falters in each country. It enables policy makers to design and prioritize follow-up activities to more precisely identify barriers, an essential next step to improving IFA distribution through ANC.

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