Iron and folic acid supplements and reduced early neonatal deaths in Indonesia

Titaley, Christiana Rialine; Dibley, Michael J.; Roberts, Christine L.; Hall, John; Agho, Kingsley

doi:10.2471/blt.09.065813

Cited by 76 publications

(86 citation statements)

References 16 publications

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“…These trials, supported by a careful analysis of observational data from a large series of births in Indonesia, found that receipt of IFA supplements during pregnancy was significantly protective against early neonatal death, after adjusting for receipt of other antenatal care interventions (30). Similarly, in data from 19 sub-Saharan African countries, receipt of IFA supplements along with intermittent presumptive treatment for malaria was associated with significant protection from neonatal death, although either intervention alone was not protective (31).…”

Section: Healthy Newbornsmentioning

confidence: 84%

Iron Interventions for Women and Children in Low-Income Countries,

Stoltzfus

2011

The Journal of Nutrition

117

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The WHO estimates that 41% of women and 27% of children suffer from anemia due to iron deficiency. The consequences of iron deficiency anemia include suboptimal mental and motor development in young children, increased risk of maternal mortality, and decreased economic productivity of adults. Recent research also provides evidence that maternal iron deficiency in pregnancy increases neonatal morbidity and mortality. This short review briefly highlights how iron interventions might be positioned within 4 global health initiatives: making pregnancy safer, saving newborn lives, infant and young child feeding, and fortification. The importance of iron nutrition is recognized in the context of child nutrition, fortification, and biofortification, and it is likely that meaningful advances will be made through these initiatives in the coming decade. However, iron nutrition is not yet well integrated into the programmatic agendas for reducing morbidity and mortality of pregnant women and neonates. Iron supplementation in pregnancy has been advocated for decades as a means of controlling anemia, but this outcome has not been sufficient to motivate strong programs and policies, and the evidence base is still sparse for high-priority clinical outcomes. To act on the current evidence for maternal and neonatal health will require stronger advocacy within circles that have not traditionally included nutritionists. Successful implementation will require greater attention to antenatal care for pregnancy women and prioritization of iron-promoting actions (including iron supplementation and deworming) within that platform.

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Section: Healthy Newbornsmentioning

confidence: 84%

Iron Interventions for Women and Children in Low-Income Countries,

Stoltzfus

2011

The Journal of Nutrition

117

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“…Furthermore, such analyses using existing datasets can be performed in contexts where few trials have been carried out and where anaemia is prevalent; taking advantage of large sample sizes which offer power of detect population-level associations of IFA on birth outcomes. Recent examples include an analysis of nationally representative data from Zimbabwe that showed that IFA was associated with a significant increase in birth weight after adjustment for confounders (13); analyses of nationally representative data from Indonesia which found that IFA was significantly associated with a 47% reduction in early neonatal mortality (14) and a 34% reduction in risk of child death <5 y old (15).…”

Section: Introductionmentioning

confidence: 98%

Maternal Iron and Folic Acid Supplementation Is Associated with Lower Risk of Low Birth Weight in India1–3

Balarajan¹,

Subramanian

Fawzi

2013

The Journal of Nutrition

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Improving maternal nutrition is an important step toward reducing low birth weight (LBW) and its sequelae. In India, an estimated 7.5 million babies are born each year with LBW, which accounts for more than one-third of the global burden. In this context, little is known about the population-level association of iron and folic acid supplementation (IFA) during pregnancy and reducing the outcome of LBW. Using pooled data from the nationally representative 1998/1999 and 2005/2006 National Family Health Surveys of India, we examined the association of IFA with LBW and birth weight using multivariable logistic and linear regression models, respectively (n = 22,648). We found that IFA during pregnancy was negatively associated with LBW after adjustment for socioeconomic status [OR = 0.77 (95% CI: 0.68, 0.87); P < 0.001] and further adjustment for antenatal care (ANC) utilization [OR = 0.82 (95% CI: 0.72, 0.94); P < 0.001]. This corresponded to a 41-g [(95% CI: 2 g, 80 g); P < 0.05] increase in birth weight, which attenuated to 28 g [(95% CI: -12 g, 68 g); P = 0.71] after additional adjustment for ANC. At the population level in a context where the burden of anemia is severe (prevalence ≥40%), IFA during pregnancy was significantly associated with decreased LBW. Measures to improve the implementation of this simple intervention should help to address India's burden of LBW.

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“…Around 42% of pregnant women experienced anemia and around 50% are due to iron deficiency [3]. The effect of iron deficiency anemia on women and infant have been reported, including increased risk of maternal and neonatal mortality [4][5][6]. One of the interventions globally conducted to prevent iron deficiency anemia among pregnant women is by providing iron/folic acid (IFA) supplements during pregnancy.…”

Section: Introductionmentioning

confidence: 99%

Association Between Knowledge and Compliance of Taking Iron/Folic Acid Supplements During Pregnancy

Titaley

Rahayu

Damayanti

et al. 2017

Asian J Pharm Clin Res

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Objective: In Indonesia, pregnant women are recommended to take a minimum of 90 tablets of iron/folic acid (IFA), to prevent iron deficiency anemia. Our analysis aimed at examining the extent to which improved knowledge on IFA supplementation is associated with women's compliance with taking a minimum of 90 IFA tablets during their last pregnancy in four districts in Indonesia.Methods: Data were derived from a cross-sectional study conducted in four districts, that is, Lebak and Pandeglang District (Banten Province) as well as Purwakarta and Subang District of West Java Province, Indonesia on June 2014. We used information from 436 mothers who delivered their baby in the last 6 months from the time of the survey and received at least 90 IFA tablets during her last pregnancy. Logistic regression analysis was used to examine the role of knowledge after controlling for confounders and other significant predictor on compliance with taking a minimum of 90 IFA tablets during pregnancy.Result: Significant association was found between knowledge of IFA supplements and compliance. Compared to women with poor knowledge of IFA supplementation, the odds of taking a minimum of 90 IFA tables increased by almost 100% in women with moderate knowledge (adjusted odd ratio [aOR]=1.96, 95% confidence interval [CI]: 1.17-3.30, p=0.011); and by more than four times (aOR=5.42, 95% CI: 1.76-16.68, p=0.003) in women with good knowledge of IFA supplementation. Other factors associated with compliance was attendance in at least four antenatal services (aOR=5.71, 95% CI: 1.28-25.53, p=0.023) and pregnant women experience of no side effects resulting from taking IFA tablets during pregnancy (aOR=2.70, 95% CI: 1.63-4.46, p<0.001). Conclusions:Efforts to increase women's knowledge on IFA supplementation through community-based education will increase women's compliance of taking IFA supplements. Strengthening counseling services on potential side effects of IFA supplementation and ways to manage them will also help to improve compliance.

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Iron and folic acid supplements and reduced early neonatal deaths in Indonesia

Cited by 76 publications

References 16 publications

Iron Interventions for Women and Children in Low-Income Countries,

Iron Interventions for Women and Children in Low-Income Countries,

Maternal Iron and Folic Acid Supplementation Is Associated with Lower Risk of Low Birth Weight in India1–3

Association Between Knowledge and Compliance of Taking Iron/Folic Acid Supplements During Pregnancy

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