Posted on: Thu 27-02-2025

A new research has highlighted the urgent need for effective treatment options beyond traditional iron tablets for anaemia in pregnant and postpartum women in the country.

According to the findings in a recent implementation research for intravenous (IV) iron use in Nigeria by IVON-IS released in Lagos, anaemia in pregnancy is a major public health challenge, affecting over 50 per cent of expectant mothers, contributing to 30 per cent of maternal deaths worldwide, particularly in low- and middle-income countries like Nigeria.

The Principal Investigator of IVON-IS Research, Prof Bosede Afolabi, said anaemia also increases the risk of infections, postpartum depression, poor wound healing, and cognitive impairments in newborns.

She said recognising these dire consequences, the IVON-IS research emphasised the routinisation of screening for anaemia using point-of-care tests, which deliver haemoglobin concentration results within minutes.

Speaking on the prevalence of anaemia among expectant mothers, Afolabi noted that while the national average for moderate to severe cases falls between 10 per cent and 20 per cent, certain regions record higher rates, reaching up to 30 per cent to 40 per cent.

“Anemia in pregnancy is a major health concern in Nigeria, often linked to poor nutrition, malaria, and inadequate prenatal care. Left untreated, it can lead to complications such as preterm birth, low birth weight, and increased maternal mortality,” she stated.

Afolabi, who is also the Director of the Centre for Clinical Trials, Research, and Implementation Science at the University of Lagos (CCTRIS), said the research advocates the use of intravenous iron therapy, particularly ferric carboxymaltose, as a more effective treatment for moderate to severe anaemia.

Afolabi said the IVON-IS research not only identifies effective interventions but also focuses on integrating these treatments into Nigeria’s healthcare system.

She said by standardising anaemia screening and treatment; maternal morbidity and mortality rates could see significant reductions. She further confirmed that the entirety of this 20 per cent demographic qualifies for treatment under the IVON-IS programme, which is aimed at addressing maternal health challenges associated with anaemia.

The Co-Investigator IVON-IS, Consultant Obstetrician and Gynecologist at Lagos University Teaching Hospital, Dr Opeyemi Akinajo, noted that 45 per cent of pregnant women in Nigeria need an effective treatment for maternal anaemia. She explained that maternal anaemia remains a significant public health concern globally, with severe implications for both mothers and newborns.

According to her, the condition has been linked to complications such as stillbirths and postpartum haemorrhage, with 80 per cent of postpartum haemorrhage cases in Nigeria resulting in mortality, if left untreated.

She said the conventional treatment for maternal anaemia has been oral iron supplements, which, despite their availability and affordability, are often underutilised due to side effects or the burden of daily intake.

This, she said, has led to increasing prevalence and rising complications associated with the condition. Akinajo said in the clinical trial, initiated in 2020, compared the efficacy of intravenous iron therapy with oral iron supplements, the results demonstrated that the intravenous method was highly effective, with minimal to no side effects, making it a viable alternative for pregnant women.

Additionally, a subsequent trial among postpartum women confirmed its effectiveness in newly delivered mothers. Akinajo said that unlike oral iron, this treatment requires only a single intravenous dose, which effectively corrects anaemia within 15 to 20 minutes, significantly reducing associated risks.

The co-investigator on the IVON-IV project, Dr Mobolanle Balogun, highlighted the cost-effectiveness of intravenous iron therapy compared to blood transfusions, which require longer monitoring periods and are often constrained by limited blood supply.

“Many people are reluctant to donate or receive blood, making intravenous iron a more practical and economical alternative. While it may not be suitable for all cases, for stable women with moderate to severe anaemia, it presents a viable and efficient treatment option,” she stated.

Balogun, who led the participatory approach across six healthcare facilities in Lagos State to institutionalise the use of intravenous iron therapy, said the study found that many women struggle with oral iron supplementation due to compliance issues, poor absorption, or side effects.

According to her, intravenous iron therapy offers a one-time solution that works faster and reduces the likelihood of requiring a blood transfusion, reinforcing its practicality in real-world settings.

She said the introduction of intravenous iron therapy could mark a significant step forward in reducing maternal anaemia-related complications and improving the well-being of mothers and babies nationwide.

The Assistant Professor at Dalhousie University, Halifax, Canada, Dr Ejemai Eboreime, explained that while the efficacy of IV iron in treating anaemia is well established, the challenge in Nigeria lies in its implementation.

Eboreime, who is also a Public Health Physician and Implementation Science Strategist, highlighted a key hurdle in the project, which was overcoming resistance from healthcare providers, who are often unfamiliar with new treatment approaches. He said in Nigeria, patients rely heavily on doctors’ recommendations, noting that when physicians are unsure about a treatment, it leads to patient hesitancy.

He said through education and strategic communication, the project instilled confidence among medical professionals, ensuring they could effectively advocate for the therapy.

Eboreime said by institutionalising the treatment within Nigeria’s healthcare system, the initiative is setting a precedent for bridging the gap between scientific evidence and everyday medical practice.

SOURCE: GUARDIAN NEWSPAPER

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