Perspective: Weekly Iron and Folic Acid Supplementation (WIFAS): A Critical Review and Rationale for Inclusion in the Essential Medicines List to Accelerate Anemia and Neural Tube Defects Reduction

Abstract

Weekly iron and folic acid supplementation (WIFAS) is among the 8 key effective actions for improving adolescent nutrition included by the WHO in the 2018 guidelines. However, at present WIFAS in the WHO-recommended formulation is not included in the Model Essential Medicines List (MEML), limiting the potential for countries to import, produce, and prioritize this formulation as part of their national supply management and procurement plans for medicines. The WHO WIFAS guideline presents evidence that the formulation reduces anemia, but not that folic acid reduces neural tube defects (NTDs), because sufficient evidence was unavailable at the time of the last review. Recently, a 3-arm, parallel-group, randomized, double-blind, placebo-controlled folic acid efficacy trial on WIFAS was conducted to address this evidence gap. The study population included 331 women (18–45 y old), randomly assigned to 3 treatment groups, including a supplement with 60 mg Fe as ferrous fumarate and either 0 mg, 0.4 mg, or 2.8 mg of folic acid, to be consumed once weekly for 16 wk, followed by a 4-wk washout period. In this article we critically review how the outcomes of this folic acid efficacy trial, and how the evidence generated, could potentially be used to inform WHO WIFAS guidelines for the potential inclusion of this formulation on the MEML, and how this, in turn, may affect product availability. If the new evidence on weekly folic acid is assessed as adequately reducing the risk of NTDs, a guideline revision could be warranted and WIFAS could be presented to the MEML for the dual benefits of anemia reduction and NTD prevention. This inclusion could enable acceleration of implementing policies and programs to contribute to global anemia and NTD reduction efforts.

Effects of the Duration of Ying Yang Bao Consumption on Hemoglobin Concentration in Infants and Young Children in Less Developed Areas of China

“…YYB is mainly used to help IYC recover from nutritional anemia, avoid undernutrition, and maintain health [ 19 , 37 ]. Iron, zinc, and folic acid in YYB are all essential nutrients required for the maintenance of basic physiological function of red blood cells [ 42 , 43 , 44 ]. However, when these nutrients are sufficient, the body will not functionally respond to low-dose supplementation with additional elements [ 45 ].…”

Iron Status, Anemia, and Iron Interventions and Their Associations with Cognitive and Academic Performance in Adolescents: A Systematic Review

“…In areas where the prevalence of anemia is 20%, menstruating adult women and adolescent girls are recommended to take WIFAS containing 60 mg elemental iron and 2.8 mg folic acid once weekly for three consecutive months, followed by a period of three months with no supplements or as aligned with the school semester [ 83 ]. The inclusion of folic acid in WIFAS may protect against neural tube defects, should a woman or adolescent girl have an unplanned pregnancy [ 84 , 85 ]; however, this requires continuous consumption on a once weekly basis.…”

Iron-Containing Oral Contraceptives and Their Effect on Hemoglobin and Biomarkers of Iron Status: A Narrative Review

“…This list is used to guide the selection of medicines, including nutritional supplements, for the primary health care needs of the population [ 74 ]. If a formulation is included on this list, it suggests that it should be available (or approved for procurement), in adequate amounts, at the appropriate dosage and price, within a working health care system [ 75 ]. While ICOC are not included on the WHO MEML, oral contraceptives (30 μg ethinyl estradiol + 150 μg levonorgestrel; 35 μg ethinyl estradiol + 1 mg norethisterone; 30 μg levonorgestrel; and 30 μg ulipristal (as acetate)), iron and folic acid (equivalent to 60 mg iron + 400 micrograms folic acid) and iron-only (equivalent to 60 mg iron) tablets are listed.…”