Cost-Effectiveness of MMS in Bangladesh and Burkina Faso

Article Title: Replacing iron-folic acid with multiple micronutrient supplements among pregnant women in Bangladesh and Burkina Faso: costs, impacts, and cost-effectiveness

Publication Date: May 27, 2019

Authors: Reina Engle-StoneSika M Kumordzie, Laura Meinzen-DickStephen A Vosti

Multiple micronutrient supplements (MMS) are highly beneficial during pregnancy, though they cost more than iron folic acid (IFA) supplements. But does the extra cost confer extra benefits? This study addressed that question in Bangladesh and Burkina Faso. Both countries have a high prevalence of nutritional deficiencies.

The answer is a resounding Yes.

Several studies have shown that MMS reduces the risk of low birthweight and other related complications. Currently, the WHO recommends that only countries with a high prevalence of nutritional deficiencies should consider MMS if the MMS includes iron-folic acid and the benefits outweigh the costs of this change.

This study replaced IFA supplements with MMS over one year to determine the marginal effectiveness of this replacement. While many studies have looked at the efficacy of MMS, this study is unique because it also looked at the cost-effectiveness of this change which is incredibly important to low and middle-income countries.

After retrieving baseline demographics from LiST and effect sizes from a meta-analysis, researchers calculated the effects of the replacement on mortality, disability-adjusted life years averted, and adverse birth outcomes. Researchers found that replacing IFA with MMS would avert 15,000 annual deaths and 30,000 cases of preterm birth in Bangladesh and 5,000 deaths and 5,000 cases of preterm birth annually in Burkina Faso. They found that the cost per death averted in Bangladesh was $175-185, and the cost per death averted in Burkina Faso was $112-125.

This study from UC Davis, led by Dr. Reina Engle-Stone is crucial to the future of nutrition supplementation in countries like Burkina Faso and Bangladesh. It can help low and middle-income countries determine if the benefits of this transition are worth the additional costs. It can also support further research into MMS Supplementation to limit nutritional deficiencies and adverse birth outcomes. Given the findings, this study has the potential to set off a domino effect of efficacy studies in other countries to determine if it is time to change the way we look at maternal supplementation in the future.

To read the full study, click here


Engle-Stone R, Kumordzie SM, Meinzen-Dick L, Vosti SA. Replacing iron-folic acid with multiple micronutrient supplements among pregnant women in Bangladesh and Burkina Faso: costs, impacts, and cost-effectiveness. Ann N Y Acad Sci. 2019;1444(1):35-51. doi:10.1111/nyas.14132
1 reply
  1. Rajiv Rimal
    Rajiv Rimal says:

    Great to see yet another study showing the evidence that taking multiple micronutrients is beneficial in so many ways! Very informative article. Thank you.


Leave a Reply

Want to join the discussion?
Feel free to contribute!

Leave a Reply

Your email address will not be published. Required fields are marked *