Maternal anemia, even moderate cases, increases the risk of dying during childbirth. The recent Lancet series on maternal and child under-nutrition estimated that 20% of maternal deaths are due to maternal iron-deficiency anemia and stunting in women, thus adding 115,000 deaths to the total maternal deaths from obstetric complications annually. However, despite these consequences, there is little attention given at global and country levels to the burden of maternal anemia. Maternal anemia control programs are the primary maternal nutrition program worldwide, yet they lack adequate funding and have, therefore, failed to significantly reduce maternal anemia in developing countries.
Evidence-Based Interventions to Prevent Maternal Anemia
Integration of evidence-based interventions is critical to maternal anemia prevention and control. Anemia during pregnancy is detrimental to both mothers and fetuses, increasing both maternal and perinatal mortality. Iron deficiency is the cause of about 50% of anemia in developing countries and, if present during pregnancy, also reduces the iron stores in infants and puts them at risk for permanent cognitive damage. Malaria contributes to excessive red blood cell destruction and helminth (worm) infections, like hookworm, can lead to excessive blood loss, which can lead to anemia. Available scientific evidence shows that routine supplementation with iron and folic acid (IFA) in pregnancy is effective in preventing anemia where prevalence is high, yet pregnancy anemia rates in much of the world have not declined. In addition to IFA supplementation, integration of other key, evidence-based interventions (like anti-malarials and deworming) can be an effective means of reducing anemia prevalence among pregnant women and women of reproductive age when the multiple causes of anemia in a population are known (i.e., situation analyses).
Using an Integrated Package to Prevent Maternal Anemia
Because anemia often emanates from nutritional and disease-related causes, such as malaria and/or intestinal helminth infections along with iron deficiency, anemia should be addressed through an integrated package of interventions, including:
Universal daily iron folic-acid supplementation for pregnant women;
Micronutrient fortification of commonly consumed local food products;
Control of malaria in pregnancy by intermittent preventive treatment, long-lasting insecticide treated bed nets, indoor residual spraying, and Artemisinin Combination Therapy;
Control of hookworms through use of deworming medication such as albendazole and mebendazole as a routine part of antenatal care where hookworm prevalence is >20%;
Optimal birth spacing of at least 2 years; and
Weekly iron folic-acid supplementation programs to improve the iron stores of adolescents.
MCHIP identifies opportunities and addresses barriers for integration of maternal anemia in maternal health initiatives to improve anemia control programming and reduce anemia at the country level. MCHIP provides global leadership, advocates at the global and regional level for an integrated package of interventions to address maternal anemia (iron folic acid supplements, antimalarials and deworming), and provides technical assistance (TA), to countries to move integrated anemia prevention and control forward.
To improve maternal anemia and nutrition programming, MCHIP disseminates key messages and evidence-based information about lifesaving nutrition behaviors in Program focus countries, peer-reviewed publications, and programmatic briefs. Providing direct TA to countries such as Egypt, Kenya, Rwanda, Zimbabwe and Yemen has resulted in "pay-for-performance" to increase the number of women receiving iron-folic acid supplements from health workers, and use of cell phones to provide daily reminders for women to take their iron/folic acid supplements.
On the global leadership and advocacy level, MCHIP co-leads an Anemia Task Force with USAID, Strengthening Partnerships, Research, the Innovations Globally (SPRING) Project, and Core Group. MCHIP also spearheaded the development of a K4H toolkit on evidence and key resources for integrated anemia prevention and control programming. The Program also held a nutrition lecture series on state-of-the-art evidence/programming on integration of nutrition into other health areas/ sectors.
At the Global Newborn Health conferences in Dhaka and Johannesburg, MCHIP led two nutrition symposiums on integrated maternal anemia prevention and control and calcium supplementation for prevention of pre-eclampsia. The Program also provided technical advising at the country level to:
Develop a nutrition strategy with the Ministry of Health and lead a program review in Zimbabwe;
Work with the Division of Nutrition in Kenya for integrated nutrition programming in two districts;
Conduct an anemia control program review and (ongoing) secondary analyses of DHS in Rwanda; and
Provide technical input to training curriculums, conduct baseline data collection, and recruit a local nutritionist to MCHIP’s team in Egypt.