Title: Reducing Maternal and Neonatal Anemia to Enhance Health
1Reducing Maternal and Neonatal Anemia to Enhance
Health
- ACCESS Program Seminar on Nutrition
- September 12, 2006
- Philip Harvey MPH, PhD
- Bloomberg School of Public Health
- Johns Hopkins University
2Outline
- Multiple causes, prevalence
- Impacts on mortality
- Efficacy effectiveness of iron supplementation
programs - Pregnancy
- Newborns
- Adolescents/WRA
- Tailoring implementation
- Conclusions
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7 8From Stoltzfus RJ, et al (2005)
9From Stoltzfus RJ, et al (2005)
10Individual and combined ORs for maternal death
From Stoltzfus RJ, et al (2005)
11Adapted from Khan et al, Lancet April1 2006
12Individual and combined ORs for perinatal death
From Stoltzfus RJ, et al (2005)
13Final estimates OR associated with a 1 g/dL
increase in Hb
From Stoltzfus RJ, et al (2005)
14- Efficacy and Effectiveness of
- Iron Supplementation Programs
15Prenatal iron supplementation reduces likelihood
of Hb lt 10 g/dL at delivery
Kulier et al. Int J Gyn Obs 1998
16Programming Focus is on Effectiveness
Supplement supply
Delivery system
Compliance
Effectiveness
Supplements taken
Efficacy
Iron status improves
Iron-related health outcomes improve
Adapted from Ekstrom 2002
17Nicaragua Prevalence of anemia in
mothers/caregivers 1993, 2000 2003.
Percentage Hblt12 g/dL
Source SIVIN 2004
18Nicaragua Hb distributions of mothers/care-giver
s with children 1-5 y, 1993, 2000 2003.
Percentage
Source SIVIN 2004
19Characteristics of Effective Programs
- Comprehensive approaches addressed major
preventable causes (ID, malaria, parasitic worms) - Addressed known barriers
- Commitment to action
- Awareness of benefits by both clients providers
- Logistics (supply, tablets packaging)
- Access to quality ANC (motivation, training
supervision) - Communication materials counseling (e.g. memory
prompts, anticipate cope with side-effects) - Tailored to country context
20Improving Iron Status of Newborns
- Improve maternal iron status
- Prevent LBW
- Screen for LBW for supplmt at 2 mo.
- Improve IYCF
- Delay cord clamping, recent results from Mexico
contribute to debate (Chaparro et al, Lancet June
17, 2006)
21Adolescents/Women of Reproductive Age
- Improving iron status before pregnancy
fortification, weekly supplementation, deworming,
diet diversification - Weekly IFA to adolescents improves Hb (UNICEF,
Umang in India), but impact on improving iron
status for subsequent pregnancy is uncertain - Umang data suggest behavioral advantages in this
option (Pers. Comm. Neelam Singh, Jan 2006) - Girls recognize benefit of IFA, more likely to
use IFA when pregnant - Programs provide entry point for other
interventions (e.g. Family Life Education which
may bring behavior change) - Weekly IFA effective in improving iron status of
WRA in three Asian countries (Cavalli-Sforza et
al, Nutrition Reviews 2005)
22Pers. Comm. Neelam Singh, Jan 2006
23Key Factors in Tailoring Interventions
- Balance of benefits and risks
- Balance of costs of interventions and resources
available (Government, donors, NGOs, households) -
- Operational feasibility
- Existing policies programs being implemented
- Capacity, commitment for action of
- Health systems (morale, quality, coverage)
- Communities (participation, empowerment)
- Other issues potentially effecting the above
- Targeting / screening
- Private sector reach, infrastructure
24Conclusions
- Greater commitment and enhanced capacity for
program implementation required at country-level
as a foundation - Universal IFA supplementation for pregnant women
one exception proving the rule that one size
does not fit all? - Components for successful IFA intervention are
well established and will enhance coverage
quality of antenatal care - Anemia interventions require tailoring to
contexts of specific countries and target groups
25Thank you
- Phil Harvey
- pharvey_at_aed.org