Perspective: Weekly Iron and Folic Acid Supplementation (WIFAS): A Critical Review and Rationale for Inclusion in the Essential Medicines List to Accelerate Anemia and Neural Tube Defects Reduction.
Study Goal
The researchers aimed to evaluate whether weekly iron and folic acid supplementation (WIFAS) could reduce neural tube defects (NTDs) and inform potential inclusion in the WHO Model Essential Medicines List (MEML).
Results Summary
The study found that WIFAS reduced anemia, but evidence on folic acid's efficacy for NTD prevention was insufficient at the time of the last review. A recent trial assessed different folic acid dosages to address this gap.
Population
331 women aged 18-45 years.
Effective Dosage
60 mg Fe as ferrous fumarate with 0 mg, 0.4 mg, or 2.8 mg folic acid, consumed once weekly.
Duration
16 weeks of supplementation followed by a 4-week washout period.
Interactions
None mentioned
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
Weekly iron and folic acid supplementation (WIFAS) | decrease | anemia | - | - | reduces | #1 |
folic acid | no change | neural tube defects (NTDs) | - | sufficient evidence was unavailable | not that folic acid reduces | #2 |
weekly folic acid | decrease | NTDs | - | - | adequately reducing the risk of | #3 |
WIFAS | decrease | anemia reduction and NTD prevention | - | - | dual benefits of | #4 |
Weekly iron and folic acid supplementation (WIFAS) is among the 8 key effective actions for improving adolescent nutrition included by the WHO in the 2018 guidelines. However, at present WIFAS in the WHO-recommended formulation is not included in the Model Essential Medicines List (MEML), limiting the potential for countries to import, produce, and prioritize this formulation as part of their national supply management and procurement plans for medicines. The WHO WIFAS guideline presents evidence that the formulation reduces anemia, but not that folic acid reduces neural tube defects (NTDs), because sufficient evidence was unavailable at the time of the last review. Recently, a 3-arm, parallel-group, randomized, double-blind, placebo-controlled folic acid efficacy trial on WIFAS was conducted to address this evidence gap. The study population included 331 women (18-45 y old), randomly assigned to 3 treatment groups, including a supplement with 60 mg Fe as ferrous fumarate and either 0 mg, 0.4 mg, or 2.8 mg of folic acid, to be consumed once weekly for 16 wk, followed by a 4-wk washout period. In this article we critically review how the outcomes of this folic acid efficacy trial, and how the evidence generated, could potentially be used to inform WHO WIFAS guidelines for the potential inclusion of this formulation on the MEML, and how this, in turn, may affect product availability. If the new evidence on weekly folic acid is assessed as adequately reducing the risk of NTDs, a guideline revision could be warranted and WIFAS could be presented to the MEML for the dual benefits of anemia reduction and NTD prevention. This inclusion could enable acceleration of implementing policies and programs to contribute to global anemia and NTD reduction efforts.