Nepal's National Scale-up of The Iron Intensification Program Improved Iron Folic Acid Supplementation Coverage in Pregnancy and Showed Potential for Reducing Anemia.

ABSTRACT

Objectives: A national scale-up of an integrated facility and community-based delivery of iron and folic acid (IFA) supplements in Nepal spanned almost ten years through the Iron Intensification Program (IIP), over which time national coverage of IFA in pregnant women increased from 23% to 80%. The objective of this research was to estimate the potential effect of duration of district-level exposure to IIP on IFA coverage, and on anemia in mothers in Nepal. Methods: With data of the 2006 and 2011 Demographic Health Surveys (DHS), we used multiple regression modelling and controlled for IIP district exposure, age, pregnancy status, wealth, religion, parity in the last 5 years, weight, education, and ecological region (Terai, Hills & Mountain regions). Results: In 2006, women who had given birth during the intervention implementation period (n=5,110) exposed to the intervention for 1-3 years had a 7% reduced the odds of having anemia (OR 0.93; 95CI 0.91, 0.95). In 2011, among women who had given birth in the previous 5 years in the Terai (n=864), intervention exposure for 3-5 years suggested a 45% reduction in the odds of having anemia (OR 0.55; 95CI 0.31, 0.99). Intervention exposure also suggested benefits in likelihoods of mothers receiving IFA (6-11%), and de-worming (12-28%). Conclusions: These results suggest that the IIP had a role in increasing IFA and de-worming coverage and may have protected against anemia. Nepal's example suggests that large scale national programs with long term commitment can successfully impact IFA coverage and potentially impact anemia.