Eliminating anaemia in pregnancy can reduce maternal mortality by 30%, says UNILAG don

Bosede Afolabi, professor of obstetrics and gynaecology at the College of Medicine, University of Lagos (UNILAG), says the burden of maternal mortality in Africa will reduce if anaemia in pregnancy is eliminated.

Speaking with journalists in Lagos on Monday during the stakeholders’ dissemination workshop on implementation research for intravenous iron use in pregnant and postpartum Nigerian women (IVON-IS), Afolabi said anaemia in pregnancy accounts for up to 30 percent of maternal mortality worldwide, especially in low and middle-income countries like Nigeria.

Afolabi said the groundbreaking implementation research study has identified effective strategies to strengthen anaemia screening and institutionalise intravenous (IV) iron administration in Nigerian healthcare facilities, reducing anaemia-related morbidity and mortality among pregnant and Nigerian women.

“The research came about from the realisation that anaemia in pregnancy is very high. The prevalence is high in low- and middle-income countries, including Nigeria. The prevalence is over 50% in Nigeria,” she said.

“One of the things we’ve seen with that is that anaemia predisposes to maternal death and different problems like infections and depression in the mother. It also carries over to their babies, and babies born to anaemic women have a risk of having impairments in their cognitive functions.

“Anaemia is of major public health importance. So, it should be treated and screened for. A lot of the time, some institutions, doctors, and women don’t even know when to screen for anaemia and how to treat it appropriately apart from using table iron.

“So, this research was borne out of the fact that we realised that it is important to have options to treat anaemia apart from iron tablets. In this case, we routinised the screening and treatment of anaemia in pregnancy using a point-of-care test — and also how to routinise the treatment of anaemia in pregnancy using intravenous iron and this involves quality improvement cycles. It’s a research project where you look at what is effective and find out how to routinise it within the healthcare system.

“This research is crucial because anaemia in pregnancy accounts for up to 30% of maternal mortality worldwide, especially in low and middle-income countries like Nigeria. What that means is that if we could eliminate the issue of anaemia in pregnancy, we could reduce maternal mortality by 30%, which is huge.

“Moderate to severe anaemia accounts for up to 20% of all pregnant women in total. In some areas, it gets up to 30 to 40%. In general, within Nigeria, we have between 10 and 20% of women having moderate to severe anaemia.”

Afolabi, who is also the director of the Centre for Clinical Trials, Research and Implementation Science (CCTRIS) and principal investigator of the study, said the implementation research for intravenous iron use in pregnant and postpartum Nigerian women (IVON-IS) commenced in 2022 and was funded by the Gates Foundation.

She added that it was conducted in six healthcare facilities in Lagos state.

At the dissemination workshop, key stakeholders, including policymakers, healthcare providers, and community leaders, discussed 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 study noted that adherence to oral iron is reportedly low in Nigeria because of side effects and forgetfulness. The study added that intravenous (IV) iron such as ferric carboxymaltose, which can be given as a single dose, might help overcome some issues relating to adherence, but the possibility of implementing its use in our setting needs to be evaluated.

Stakeholders pledged to work together to implement the study’s recommendations, ensuring that all pregnant and postpartum women have access to quality anaemia care.