Project: Maternal Health

To reduce the risk of complications during and following pregnancy, the World Health Organization (WHO) recommends elemental iron and folic acid supplements (IFAS) as part of antenatal care. However, anaemia and subsequent birth complications continue to be an issue in developing countries. The International community has been exploring other interventions to target this issue, including Multiple micronutrient (MMS) supplements. The evidence collected to date however does not provide a final recommendation on the choice between IFAS and MMS. As a result, the most recent WHO guidelines at the time of this project left the choice between IFAS and MMS to countries, without providing any methodology or guidance on how to make this decision.

Limestone was hired by Nutrition International to develop a cost-effectiveness analysis model capable of helping countries choose between IFAS and MMS. Limestone’s work resulted in a probabilistic analytical model to answer this question. The results of this work have so far been presented at the New York Academy of Sciences and the Society for Benefit-Cost Analysis. To effectively advise the client, Limestone conducted the following:

  • Situation analysis
  • Systematic review of existing evidence
  • Cost-effectiveness analysis
  • Probabilistic analysis using Monte-Carlo simulations
  • Development of a web-based dashboard
  • Writing an academic manuscript for publication
  • The analytical model has so far been used in the following contexts: Pakistan, Bangladesh, and India.

Outcomes of our study: The effectiveness of IFAS relative to MMS during pregnancy was compared using eight health outcomes reported in two meta-analyses published in 2017 (Cochrane and The Lancet). Despite discrepancies in the overall effect of MMS depending on the meta-analysis used, MMS is cost-effective and generates positive health outcomes for both infants and pregnant women. While the effectiveness of MMS is sensitive to the prevalence of certain health outcomes under the conservative scenario (Cochrane), MMS nevertheless averts more DALYs than IFAS with high certainty and should re-enter public health discussion in Pakistan, India, and Bangladesh.

The paper produced for this project has been accepted for publication by the Journal of Nutrition. We will post a link to the journal when it becomes available.

Clients / Partners

Timeline

June-July

2017

Research
  • Conducted comprehensive research regarding IFAS and MMS effectiveness and costs
  • Developed deterministic and probabilistic model to compare supplement modalities
  • Created visual model interface for clients future use in other contexts
  • Produced final report summarizing model outcomes and implications
August-Present

2017-2018

Model Development, Final Report, Visualizations
  • Developed deterministic and probabilistic model to compare supplement modalities
  • Created visual model interface for clients future use in other contexts
  • Produced final report summarizing model outcomes and implications
December-Present

2017-2018

Publication
  • Drafted a manuscript to be submitted for academic publication