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Cited by 55Global Maternal and Child HealthMalaria Research and ControlMaternal and Neonatal Healthcare

Combined iron/folic acid supplements and malaria prophylaxis reduce neonatal mortality in 19 sub-Saharan African countries

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Titaley, Christiana R, Dibley, Michael J, Roberts, Christine L, Agho, Kingsley·2010·The American Journal of Clinical Nutrition
DOI 10.3945/ajcn.2009.29093
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Abstract

Background In nonmalaria regions, iron/folic acid supplementation during pregnancy protects newborns against preterm delivery and early neonatal death. Other studies from malaria-endemic areas have reported an adverse effect of iron supplements on malaria prevalence in pregnant women.Objective We examined the association between iron/folic acid supplements and prenatal antimalaria prophylaxis on neonatal mortality in malaria-endemic countries of sub-Saharan Africa.Design This analysis used the most recent data from Demographic and Health Surveys of 19 malaria-endemic countries in sub-Saharan Africa. Survival information of 101,636 singleton live-born infants from the most recent delivery of ever-married women < or =5 y before each survey was examined. The effect of each potential predictor on neonatal deaths was analyzed by using Cox proportional hazards regression models.Results Infants whose mothers received any iron/folic acid supplements and sulfadoxine-pyrimethamine intermittent preventive treatment (SP-IPT(p)) for malaria during pregnancy were significantly protected from neonatal death [hazard ratio (HR): 0.76; 95% CI: 0.58, 0.99]. The protective effect was not significant in mothers who received only iron/folic acid supplements (HR: 0.90; 95% CI: 0.73, 1.12) or only SP-IPT(p) (HR: 1.08; 95% CI: 0.74, 1.57). Among the sociodemographic and birth characteristics, factors that significantly increased the risk of neonatal death included first-born infants, a birth interval of <2 y, maternal age at delivery of > or =30 y, smaller than average-sized infants, and male infants.Conclusion The use of antenatal iron/folic acid supplements combined with appropriate intermittent preventive treatment of malaria during pregnancy is an important intervention to reduce neonatal mortality in malaria-endemic regions.

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  • The administration of iron alone had a negative impact on malaria prevalence in pregnant women in some studies.

    “While the administration of iron alone had a negative impact on malaria prevalence in pregnant women in some studies, the combination of iron/folic acid supplements with SP-IPTp appears to have a protective effect against neonatal death [161], as summarized in (Additional file 6:Table S6).”

    From Current update on malaria in pregnancy: a systematic review (2025) · cites this paper as [161]

  • The combination of iron/folic acid supplements with SP-IPTp appears to have a protective effect against neonatal death.

    “While the administration of iron alone had a negative impact on malaria prevalence in pregnant women in some studies, the combination of iron/folic acid supplements with SP-IPTp appears to have a protective effect against neonatal death [161], as summarized in (Additional file 6:Table S6).”

    From Current update on malaria in pregnancy: a systematic review (2025) · cites this paper as [161]

  • The combination of iron and folic acid supplements with SP-IPTp has been associated with a significant reduction in neonatal mortality in malaria-endemic countries in sub-Saharan Africa.

    “The combination of iron and folic acid supplements with SP-IPTp has been associated with a significant reduction in neonatal mortality in malaria-endemic countries in sub-Saharan Africa [161].”

    From Current update on malaria in pregnancy: a systematic review (2025) · cites this paper as [161]

  • Preventive interventions targeted to pregnant women, e.g. intermittent preventive treatment, are associated with a reduction in neonatal mortality up to 60%.

    “This is confirmed by the reduction neonatal mortality, up to 60%, observed after the implementation of preventive interventions targeted to pregnant women, e.g. intermittent preventive treatment.56–57”

    From Malaria in pregnancy. (2013) · cites this paper as [56]

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Authors
Titaley, C. R., Dibley, M. J., Roberts, C. L., & Agho, K.
Affiliations
The University of Sydney (AU)
ORCID
Venue
The American Journal of Clinical Nutrition
Publisher
Elsevier BV
Published
2010-07
Volume
92
Issue
1
Pages
235-243
ISSN
0002-9165 (ISSN-L)
DOI
10.3945/ajcn.2009.29093
OpenAlex
W2134602011
Cited by
55
References
43
Citations by year
2026: 1 · 2025: 3 · 2024: 5 · 2022: 2 · 2021: 5 · 2020: 4 · 2019: 3 · 2018: 2 · 2017: 3 · 2016: 2 · 2015: 2 · 2014: 5 · 2013: 4 · 2012: 9
FWCI
5.21
Type
journal article
Language
en
Open access
Licence
Locations
  • American Journal of Clinical Nutrition (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Malaria Research and Control
  • Health Sciences › Health Professions › General Health Professions › Maternal and Neonatal Healthcare
Keywords
iron and folic acid supplementation, prenatal supplementation, neonatal mortality, malaria prophylaxis, sulfadoxine-pyrimethamine, malaria endemic areas, sub-Saharan Africa, infant survival, birth interval, maternal age, birth size
MeSH terms
Child Health Services, Delivery of Health Care, Demography, Female, Folic Acid, Health Surveys, Humans, Infant Mortality, Infant, Newborn, Iron, Malaria, Male, Maternal Health Services, Pregnancy, Africa South of the Sahara, Dietary Supplements

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