Reducing Burden of Anemia in Pregnant Women

To combat Nigeria’s high maternal mortality and morbidity rates, the Centre for Clinical Trials, Research and Implementation Science teamed up with the Maternal and Reproductive Health Collective and the University of Lagos’ College of Medicine, in 2023, to conduct a two-year implementation research plan for ‘intravenous iron’ use in pregnant and postpartum Nigerian women, using six healthcare facilities in Lagos State. Two years later, they hosted a stakeholders’ meeting to share their findings on the implementation research exercise known as the IVON-IS study. Sunday Ehigiator reports

Iron deficiency anaemia is a major concern in Sub-Saharan Africa, including Nigeria, in pregnancy, childbirth, and postpartum.

According to the World Health Organisation (WHO), in 2019, global anaemia prevalence was 29.9 per cent in women of reproductive age, 29.6 per cent in non-pregnant women of reproductive age, and 36.5 per cent in pregnant women. This translates to over half a billion women aged 15–49.

The WHO also revealed that in the same year, global anaemia prevalence was 39.8 per cent in children aged 6-59 months, equivalent to 269 million children with anaemia. The prevalence of anaemia in children under five was highest in the African Region, at 60.2 per cent.

In Nigeria, the Centre for Clinical Trials, Research and Implementation Science (CCTRIS) revealed that over 55.5 per cent of pregnant women have anaemia, while routine anaemia screening and use of oral iron supplements for anaemia treatment during pregnancy and postpartum is limited by poor compliance and other health system factors.

The IVON-IS Project

Against the above backdrop was the need for the implementation of research for intravenous iron use in pregnant and postpartum Nigerian Women, referred to as the IVON-IS Program, which recently held its Stakeholders’ Dissemination Workshop in Ikejathe area of Lagos State.

The project aimed to test strategies to strengthen routine screening for anaemia during and immediately after pregnancy and conditions necessary within the health system to deliver IV iron to pregnant and post-partum women with moderate to severe anaemia.

According to CCTRIS, adherence to oral iron is reportedly low in Nigeria because of side effects and forgetfulness. Hence, ‘Intravenous (IV) iron’ such as ‘ferric carboxymaltose’, which can be given as a single dose, could help overcome some issues relating to adherence but the possibility of implementing its usage in the Nigerian setting, needs to be evaluated.

The research which commenced in 2022 was funded by the Gates Foundation and was conducted in six healthcare facilities in Lagos State Namely, Federal Medical Center Ebute-Metta Hospital, Harvey Road General Hospital, Ebute-Metta General Hospital, Akerele Primary Healthcare Center, Kensington Adebukunola Adebutu Foundation Medical Laboratory and Maternity Center, and Havana Specialist Hospital Limited.

Key stakeholders, including policymakers, healthcare providers, and community leaders, gathered at the dissemination workshop to discuss the study’s findings and implications for improving anaemia care in Nigeria.

The workshop featured presentations from the research team, panel discussions, and interactive sessions, providing a platform for stakeholders to share their experiences, challenges, and suggestions for scaling up effective interventions.

The study’s findings highlighted significant improvements in anaemia screening rates and IV iron administration among pregnant and postpartum women at the study’s healthcare facilities, demonstrating the potential for sustainable impact.

 The Research

Providing more insight on the research, the Professor of Obstetrics and Gynecology at the College of Medicine, University of Lagos, also the Director of CCTRIS, Prof. Bosede Afolabi, noted that, “The research is about the use of intravenous iron as well as for treating anaemia in pregnant women, as well as in women who have just delivered, postpartum women, and it’s also about the routinisation of screening for anaemia in pregnancy. “The research came about from the realisation that anaemia in pregnancy is very high. The prevalence is very high in low and middle-income countries, including Nigeria.

“The prevalence of anaemia in pregnancy is very high in Nigeria, totalling more than 50 per cent in prevalence, and one of the things that we’ve seen with that is that anaemia predisposes to maternal deaths, and it also predisposes to a lot of different problems like infections in the mother, depression, poor wound healing, and it also carries over to their babies, and babies born to anaemic women have a risk of having impairments in their cognitive functions when they’re born.

“So, anaemia is of major public health importance, and it should be treated and at least even screened for, because before you treat it, you have to be able to diagnose it and screen for it, and a lot of the time, some institutions, doctors, women themselves, don’t even know when to screen for this anaemia, and also how to treat it appropriately apart from using tablet iron.

“So, this research was born out of the fact that we realised that, one, it’s important to screen for anaemia, and two, it’s also important to be able to have options for treating anaemia apart from just iron tablets.”

Lagos State Commitment

Expressing the state’s commitment, the Special Adviser to Lagos State Governor on Health, Dr. Kemi Ogunyemi, represented by the Senior Special Assistant to the Governor on Health, Dr. Oluwatomi Adeyemi, noted that Governor Babajide Sanwo-Olu is very happy that, “we’re having this dissemination because research findings like this contribute, they go a long way in helping us to inform policies.

“The urgent need to address anaemia in Lagos remains very germane. We know that anaemia is already a significant public health challenge. It contributes significantly to our poor maternal mortality indices and even our maternal morbidity indices here in Lagos and even in Nigeria as a whole.

“The burden of this maternal anaemia has far-reaching consequences, contributing to increased risk of this maternal morbidity and mortality. It even contributes to poor birth outcomes and long-term developmental issues for our newborns.  Therefore, it’s very important to address this challenge.

“For decades, the treatment of anaemia has relied heavily on iron supplements. However, the use of this iron supplement for anaemia treatment during pregnancy and the postpartum period is limited because of poor compliance and other health system factors.

“IV iron therapy, as we have mentioned away from the last presentation, has emerged as a very effective alternative to iron supplements. It offers rapid replenishment of iron stores, it gives better patient tolerance and improved health outcomes.

“It has the potential to revolutionize how we approach anaemia treatment here in Lagos and even in Nigeria, especially for women that are at risk of moderate to severe anaemia.

“The IVION-IS study tested strategies to improve preventive and treatment interventions for anaemia during pregnancy and the postpartum period. The study has generated invaluable insights into the adoption, accessibility, and effectiveness of ion therapy.

“As we reflect on the findings of this very important research, it is essential that we now focus on the uptake of emerging evidence to drive change and improve the livelihood of our mothers and babies. To achieve these goals, governments cannot do on their own.

“Therefore, we call upon, first of all, all government agencies that are present here, even our healthcare professionals, researchers, donors, and the private sector to come together so that we can collectively work together and see how this can be implemented and scaled up in our states.”