Poster Topical Area: Community and Public Health Nutrition

Location: Auditorium

Poster Board Number: 84

P06-063 - Effect of iron-folic acid supplementation starting in early trimester of pregnancy on neonatal mortality: Findings from a large community-based randomized controlled trial

Monday, Jun 11
8:00 AM – 3:00 PM

Objectives: We evaluated the effect of early availability and promotion of IFA supplements during pregnancy on neonatal mortality. The primary hypothesis is that in a community-based, cluster randomized controlled trial (cRCT) of women from rural Bangladesh, daily supplementation with 60 mg elemental iron and 400μg folic acid starting in the first trimester of pregnancy, and sustained for at least 180 days, will reduce neonatal mortality by 25% from 33/1000 to 24.8/1000 live births compared to usual iron-folic acid supplementation programs.

We conducted the cRCT in five districts in Dhaka Division, Bangladesh with a combined population of >10 million. In the intervention clusters trained BRAC village volunteers identified pregnant women and provided consenting women with capsules (Eskayef Bangladesh Ltd) containing 60 mg of elemental iron and 400µg of folic acid. We measured ground water iron levels in all study households. We compared the neonatal mortality rates and their 95% confidence intervals adjusted for clustering in each ground water iron-level group. We used Cox proportional hazards mixed models for mortality outcomes as well as using household ground water iron level as an interaction term in the mortality models.

We recruited a total number of 36,532 pregnant women. Overall the enhanced distribution of iron/folic acid did not reduce neonatal mortality (HR 0.94, 0.78 to 0.1.12, P=0.521). However in the sub-population with low ground water iron levels (N=5896), iron/folic acid significantly reduced risk of neonatal mortality by 42% (HR 0.58, 0.37 to 0.90, P=0.015). Neonatal mortality was not reduced in sub-populations with medium (HR 1.05, 0.83 to 1.32, P=0.671) or with high ground water iron levels (HR 1.01, 0.74 to 1.38, P=0.940).

In rural populations in Bangladesh where the ground water iron level is less than 0.5 mg iron/L, early antenatal supplementation with iron/folic acid approximately halved neonatal mortality compared with the usual program. This effect was removed with ground water iron levels of >0.5 mg iron/L. Our results indicate a causal role of iron in reducing neonatal mortality in deficient populations.

Funding Source: National Health and Medical Research Council (of Australia) funded this study
Trial flow chart


CoAuthors: Mohammad Masudur Rahman – Norman J Arnold School of Public Health University of South Carolina; Shahreen Raihana – The University of Sydney; Sajia Islam – International Centre for Diarrhoeal Disease Research, Bangladesh; Tazeen Tahsina – Internatonal Centre of DIarrhoeal Disease Research, Bangladesh; Ashraful Alam – The University of Sydney; Kingsley Agho – Western Sydney University; Sabrina Rasheed – International Centre for Diarrhoeal Disease Research, Bangladesh; Alison Hayes – The University of Sydney; Mohd Anisul Karim – University of Oxford; Qazi Sadequr Rahman – International Centre for Diarrhoeal Disease Research, Bangladesh; Md Moinuddin – International Centre for Diarrhoeal Disease Research, Bangladesh; Md. Abu Bakkar Siddique – International Centre for Diarrhoeal Disease Research, Bangladesh; Lucky Ghose – Health Nutrition and Population Programme, BRAC; Kaosar Afsana – Health Nutrition and Population Programme, BRAC; Morseda Chowdhury – The University of Sydney; Camille Raynes-Greenow – The University of Sydney; Shams El Arifeen – International Centre for Diarrhoeal Disease Research, Bangladesh; Michael DIbley – The University of Sydney

Tanvir M. Huda

Research Fellow
University of Sydney
Sydney, New South Wales, Australia