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Maternal Multivitamin

Multiple micronutrient deficiencies often coexist in the populations where PSI works. Micronutrient deficiency in pregnancy is associated with complications for neonatal and maternal health. Micronutrient supplementation for pregnant women can correct multiple micronutrient deficiencies, preventing maternal anemia and low birth weight. PSI programs market a ?one-a-day? multivitamin containing iron, folate, and other essential vitamins to pregnant women.

Unit of interventionper tablet

Formulationvariable

Target populationPregnant women

For more information about how PSI is increasing access to multivitamins to improve health and save lives, visit our website at:
http://www.psi.org/program/prenatal-vitamins/

PSI’s iron folic acid impact model is based on the Lives Saved Tool (LiST). LiST is used to estimate the number of deaths averted with complete coverage of of multivitamins in select countries, representing the projected impact of multivitamins. This number of deaths averted at the population level is translated to deaths averted per multivitamin tablet, using country specific parameters such as population size, number of pregnancies, and mortality rates. Once we have deaths averted per multivitamin tablet, we apply data from the 2010 Global Burden of Disease study to estimate the corresponding number of DALYs averted.

Model Outputs (impact metrics)

Estimates of DALYs averted, deaths averted, CYPs provided, and unintended pregnancies averted represent the projected health impact of the intervention. It is projected because it has not been directly measured.

Examples based distribution of maternal multivitamin in Myanmar in 2015 Statement of modeled results, examples:

In 2015, an estimated 2 deaths and 215 DALYs would be averted from small for gestational age (SGA) births if 1,000,000 multivitamin tablets were distributed in Myanmar.

For more details about how PSI models PSI models multivitamin impact for SGA, see below.

Model Details

Step 1: Running a projection in the Lives Saved Tool (LiST)LiST is a multi-cause mortality model developed by Johns Hopkins Bloomberg School of Public Health that estimates the number of deaths averted (or lives saved) through the scale up of maternal and child health interventions.

PSI begins by running a projection in LiST for select countries. In this projection, household possession of multivitamins is increased from the current, country-specific baseline to 100%. LiST then projects the number of deaths averted among children under five by this increased level of coverage.

Step 1 Output:
Number of additional deaths averted (or lives saved) among children under five if coverage of multivitamins increased from baseline to 100% in select countries

Step 2: Estimating deaths averted per multivitamin tablet among children under five PSI uses the step 1 output (deaths averted at 100% coverage of multivitamins) to estimate the number of deaths averted by a single multivitamin tablet through reducing the number of children who are born small for gestational age (SGA). To do this, we divide the number of deaths averted at 100% coverage by the number of multivitamin tablets needed to reach 100% coverage among pregnant women.

PSI estimates the number of multivitamin tablets needed to reach 100% coverage using a number of parameters, including baseline coverage of multivitamins, the number of pregnant women in a given year, and the average number of tablets needed per woman during pregnancy. We also account for wastage of multivitamins in the supply chain, assumed to be 10% across all interventions.

Step 2 Output:
Deaths averted coefficient for multivitamins among children under five

Step 3: Estimating DALYs averted per multivitamin tablet among children under five A DALY (or disability adjusted life year) includes two components: years of life lost due to premature death (YLL) and years lived with disability (YLD). DALYs averted are in turn comprised of YLLs averted and YLDs averted or, put simply: death and disability that is prevented by PSI interventions.

To estimate YLLs averted per per multivitamin tablet among children under five, PSI first estimates the number of years of life lost per death among children under five due to SGA in select countries. This is equal to the life expectancy at the average age of death from SGA. Age specific life expectancies are taken from the 2010 Global Burden of Disease study (GBD). The number of years of life lost per SGA death is then multiplied by the number of deaths averted per multivitamin tablet among children under five (child deaths averted coefficient), calculated in step 2 above for a selected country. This gives us the YLLs averted per multivitamin tablet.

To estimate YLDs averted per multivitamin tablet among children under five we use a YLD/YLL ratio, based on the 2010 GBD. This ratio represents the relative number of years lived with disability for every year lost due to death from SGA. We apply this ratio to the number of YLLs averted per multivitamin tablet to estimate the number of YLDs averted per multivitamin tablet among children under five.

Finally, YLLs averted and YLDs averted are added together to estimate the number of DALYs averted per multivitamin tablet among children under five.

Step 3 Output:
DALYs averted coefficient for children under five