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Reducing Maternal and Neonatal Anemia to Enhance Health

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Title: Reducing Maternal and Neonatal Anemia to Enhance Health


1
Reducing 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

2
Outline
  • Multiple causes, prevalence
  • Impacts on mortality
  • Efficacy effectiveness of iron supplementation
    programs
  • Pregnancy
  • Newborns
  • Adolescents/WRA
  • Tailoring implementation
  • Conclusions

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  • Impacts on Mortality

8
From Stoltzfus RJ, et al (2005)
9
From Stoltzfus RJ, et al (2005)
10
Individual and combined ORs for maternal death
From Stoltzfus RJ, et al (2005)
11
Adapted from Khan et al, Lancet April1 2006
12
Individual and combined ORs for perinatal death
From Stoltzfus RJ, et al (2005)
13
Final 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

15
Prenatal iron supplementation reduces likelihood
of Hb lt 10 g/dL at delivery
Kulier et al. Int J Gyn Obs 1998
16
Programming 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
17
Nicaragua Prevalence of anemia in
mothers/caregivers 1993, 2000 2003.
Percentage Hblt12 g/dL
Source SIVIN 2004
18
Nicaragua Hb distributions of mothers/care-giver
s with children 1-5 y, 1993, 2000 2003.
Percentage
Source SIVIN 2004
19
Characteristics 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

20
Improving 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)

21
Adolescents/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)

22
Pers. Comm. Neelam Singh, Jan 2006
23
Key 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

24
Conclusions
  • 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

25
Thank you
  • Phil Harvey
  • pharvey_at_aed.org
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