Iron is the key to reducing infant mortality in China

Nov 7 2008

A team of investigators from the Xi'an Jiaotong University, and The George Institute for International Health and the School of Public Health, the University of Sydney, have been involved in a new study in China that has revealed the significant impact of iron supplements during pregnancy on preventing deaths in infants under four weeks of age.

Professor Hong Yan, Principal Investigator of this study, Xi'an Jiaotong University College of Medicine said, "Our research demonstrates that nutrient supplements for pregnant women in developing countries need to have an adequate amount of iron to prevent premature births and reduce infant mortality."

The study, which took place over four years in two poor rural counties in northwest China, assessed the impact of taking iron/folic acid and multiple micronutrient supplements (containing 15 minerals and vitamins) during pregnancy, compared with folic acid alone.

While the World Health Organisation (WHO) and the United Nations Children's Fund (UNICEF) have proposed the use of multiple micronutrient supplements during pregnancy, this study found that although multiple micronutrients did improve birth weight more than iron folic acid, this greater increase in birth weight did not translate into reductions in neonatal mortality (infant deaths in the first month following birth).

"After comparing our results with other studies in Indonesia, India, the United States, and Bangladesh, it appeared the reduction in neonatal mortality was related to the increased duration of pregnancy from the iron in the supplements," Associate Professor Michael Dibley, School of Public Health and George Institute for International Health at the University of Sydney said.

In China, the most populated developing country in the world, neonatal mortality accounts for more than 50 per cent of the deaths of children under five. Children with low birth weight are at a higher risk of mortality, and one of the major causes of low birth weight in developing countries is the poor nutritional status of the mother before and during pregnancy.

"It is estimated that 1.2 million low weight babies are born each year in China, however there are not yet any specific policies or programs for the distribution of multiple micronutrient or iron/folic acid supplements during pregnancy, even to disadvantaged women," A/Professor Michael Dibley added.

The research team collaborated with the local health services at the county, township and village levels, and local government, to implement the study. This approach has provided a suitable model to upscale the intervention on a larger scale in the future.

"This research will provide vital evidence to the Ministry of Health to assist in formulating China's public health policy on nutrient supplementation in pregnancy, which will hopefully result in a significant reduction in the number of infant deaths," said Professor Lingzhi Kong, the deputy director of disease control, Ministry of Health, China.

The project was supported by grants from UNICEF and the National Natural Science Foundation of China.

The research team included:

• Professor Hong Yan, Dr. Lingxia Zeng, Dr. Yue Cheng, Dr Shaonong Dang from the Department of Public Health, Xi'an Jiaotong University College of Medicine, Xi'an, China;
• Associate Professor Suying Chang from the Chinese Centre for Disease Control and Prevention, China;
• Associate Professor Michael Dibley, School of Public Health and The George Institute for International Health, University of Sydney, Sydney Australia.

The study will be published in the BMJ Journal website on Friday, November 7, 2008.