Evaluating the health and economic impact of switching from multiple micronutrient supplementation to iron and folic acid in south africa: cost-benefit analysis and scenario outcomes
1
Wits Reproductive Health and HIV Institute (Wits RHI), Johannesburg, South Africa
Popul. Med. 2026;8(Supplement Supplement 1):A2251
ABSTRACT
BACKGROUND:
Iron and folic acid (IFA) is part of the standard antenatal supplementation intervention in South Africa (SA). Despite this, SA continues to face a high burden of maternal micronutrient deficiencies, and anaemia remains common. This is driven by multiple factors and comorbidities and is linked to poor birth outcomes such as preterm birth, low birthweight, and small for gestational age. Multiple micronutrient supplementation (MMS) has been shown to improve maternal nutrition and reduce the risk of low birth weight and preterm birth. Uncertainty regarding the cost-effectiveness of MMS, particularly in settings using higher-dose IFA supplementation such as SA, has been highlighted globally. This analysis assesses the health and economic value of transitioning to MMS within SA’s health system.
METHODS:
An incremental cost-benefit and cost-effectiveness analysis was conducted using the Nutrition International MMS Cost-Benefit Tool (2025 update). Using SA-specific demographic, epidemiological, and economic inputs, the model compared IFA and MMS, estimating DALYs averted and child deaths prevented, from meta-analysed effect sizes across five scenarios varying programme duration, coverage, unit costs and transition costs. Costs and benefits were discounted at 3%, and economic returns were expressed as incremental cost per DALY averted and benefit-cost ratios.
RESULTS:
Across all scenarios, MMS outperformed IFA. In the base case (50% coverage, 10 years), MMS averted approximately 696000 DALYs and prevented over 10500 child deaths (benefit-cost ratio: 286). Even under conservative assumptions, benefit-cost ratios exceeded 100. The optimistic scenario (90% coverage ,10 years, low unit costs) delivers the largest benefits.
CONCLUSIONS:
Transitioning from IFA to MMS during pregnancy in SA is cost-effective across a wide range of scenarios, even under conservative or high-cost assumptions. To maximise impact, the focus should be on reaching more women, securing affordable MMS prices, and embedding MMS into existing antenatal care services, while keeping implementation costs as low as possible.
Iron and folic acid (IFA) is part of the standard antenatal supplementation intervention in South Africa (SA). Despite this, SA continues to face a high burden of maternal micronutrient deficiencies, and anaemia remains common. This is driven by multiple factors and comorbidities and is linked to poor birth outcomes such as preterm birth, low birthweight, and small for gestational age. Multiple micronutrient supplementation (MMS) has been shown to improve maternal nutrition and reduce the risk of low birth weight and preterm birth. Uncertainty regarding the cost-effectiveness of MMS, particularly in settings using higher-dose IFA supplementation such as SA, has been highlighted globally. This analysis assesses the health and economic value of transitioning to MMS within SA’s health system.
METHODS:
An incremental cost-benefit and cost-effectiveness analysis was conducted using the Nutrition International MMS Cost-Benefit Tool (2025 update). Using SA-specific demographic, epidemiological, and economic inputs, the model compared IFA and MMS, estimating DALYs averted and child deaths prevented, from meta-analysed effect sizes across five scenarios varying programme duration, coverage, unit costs and transition costs. Costs and benefits were discounted at 3%, and economic returns were expressed as incremental cost per DALY averted and benefit-cost ratios.
RESULTS:
Across all scenarios, MMS outperformed IFA. In the base case (50% coverage, 10 years), MMS averted approximately 696000 DALYs and prevented over 10500 child deaths (benefit-cost ratio: 286). Even under conservative assumptions, benefit-cost ratios exceeded 100. The optimistic scenario (90% coverage ,10 years, low unit costs) delivers the largest benefits.
CONCLUSIONS:
Transitioning from IFA to MMS during pregnancy in SA is cost-effective across a wide range of scenarios, even under conservative or high-cost assumptions. To maximise impact, the focus should be on reaching more women, securing affordable MMS prices, and embedding MMS into existing antenatal care services, while keeping implementation costs as low as possible.
| eISSN: | 2654-1459 |
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