ABSTRACT
Objectives: Intermittent antenatal iron supplementation is an attractive alternative to daily dosing during pregnancy, however the impact of this strategy on infant outcomes remains unclear. We compared the effect of intermittent antenatal iron supplementation with daily iron supplementation on maternal and infant outcomes in rural Vietnam. Methods: This cluster randomised trial was conducted in Ha Nam province, Vietnam. 1,258 pregnant women in 104 communes were assigned to daily iron-folic acid (IFA), twice weekly IFA, or twice weekly multiple micronutrient (MMN) supplementation. Primary outcome was birth weight. Results: There was no difference in birth weights of infants of women receiving twice weekly IFA compared to daily IFA (mean difference [MD] 28 g; 95% CI -22 to 78), or twice weekly MMN compared to daily IFA (MD -36.8 g; 95% CI -82 to 8.2). At 32 wk gestation, maternal ferritin was lower in women receiving twice weekly compared to daily IFA (geometric mean ratio (GMR) 0.73; 95% CI 0.67 to 0.80), and in women receiving twice weekly MMN compared to daily IFA (GMR 0.62; 95% CI 0.57 to 0.68), with no difference in hemoglobin levels. Infants of mothers who received twice weekly IFA had higher cognitive scores at 6 mo of age compared to those who received daily IFA (MD 1.89; 95% CI 0.23 to 3.56). Conclusions: Twice-weekly antenatal IFA supplementation achieved similar mean birthweight, and improved cognitive scores in infants at 6 months of age, compared to daily IFA supplementation, and should be considered for use in settings with low anemia prevalence.
ABSTRACT
Objectives: Weekly iron-folic acid supplementation (WIFS) and regular deworming for women of reproductive age (WRA) is an effective way of preventing anaemia and iron deficiency in a population but long-term sustainability is challenging. The objectives of this study were to: 1) Determeine the effectiveness of a free WIFS and biannual deworming program for WRA that has been implemented in rural Vietnam for six years. 2) Assess compliance and identify challenges and barriers to ongoing sustainability. Methods: In July 2012, we conducted a follow-up survey in this rural mountainous province to evaluate haematological parameters (haemoglobin and ferritin), soil transmitted helminth burden and compliance in a cohort of women first recruited in 2005, and who have had access to an externally funded WIFS/deworming program since May 2006. Results: Of the original cohort of 389, 256 (65.8%) women attended the survey. Mean haemoglobin had increased to from 122 g/L [95% C.I. 120, 124] to 135g/L [95% C.I. 133g/L, 138g/L] and anaemia prevalence reduced from 37.8% [95% C.I. 31.0%, 44.7%] to 14.3% [95% C.I. 9.5%, 19.1%]. The prevalence of hookworm infection was lower at 10.2% [95% C.I. 5.4%, 15.0%]. Seventy two per cent of survey participants continued to take the weekly supplements regularly. Without further support the WIFS program will cease in 2014. Conclusions: Anaemia rates continued to fall duringr the six year period, and soil transmitted helminth infections have been eliminated as a public health risk. Complianace was well maintained but sustainability is a major challenge. The issues surrounding long term sustainability of WIFS for WRA will be discussed.