Objectives: To investigate the impact of a decade-long program to improve coverage of antenatal
IFA supplementation on child survival in Nepal over a 15 year period from 1996 to 2011.
Methods: We used pooled data of 3 Nepal Demographic and Health Survey (DHS) 2001, 2006
and 2011 with survival information from 13,106 most recent live-born infants. Primary outcomes
were mortality indicators in children <5 years and the main exposure variable was the
implementation of an improved IFA supplementation program. The improved program was
implemented in 70 out of 75 districts in a phased manner at district level starting in 2003-04 and
continuing till 2011. Data was analysed by using STATA 13 and adjusted for the cluster sampling
design. Analyses used multivariate Cox proportional hazards regression adjusted for 22 potential
confounders.
Results: After the phased implementation of the program to improve coverage of IFA
supplementation, the risk of mortality on day 0 (first day of life) and early neonatal mortality (0-7
days) significantly reduced by 56% and 55% respectively compared to before the implementation
of program after the adjustment of other confounders. The protective effect of implementation of
improved IFA supplementation program was also observed in infant (aHR: 0.53, p=0.011) and
under five mortality (aHR: 0.64, p=0.046) compared to before the program started.
Conclusions: An enhanced IFA supplementation program significantly reduces the deaths on first
day of life and in early neonatal period in Nepal. The protective effect of the program was also
seen in infants and in children <5 years of age.