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 up to half of anemia in developing countries and, if present during pregnancy, also reduces the iron stores in infants at birth and beyond which puts them at risk for permanent cognitive damage and mortality.
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. Providing an integrated package of interventions to address all the parasitic (malaria and hookworm) and nutritional causes of anemia (IFA supplementation) is an effective approach to reducing anemia prevalence among pregnant women and women of reproductive age when the multiple causes of anemia in a population are known or suspected.
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 IFA supplementation for pregnant women;
- Additional iron for anemic 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%;
- Management of complications during pregnancy and delivery including use of active management of the third stage of labor, which recommends delayed cord clamping of 1-3 minutes to maximize iron stores in infants at birth.
- Optimal birth spacing of at least 2 years; and
- Delivering this package to mothers will improve iron status and reduce anemia in mothers and their children.
MCHIP identified opportunities and addressed barriers for integration of maternal anemia in maternal health initiatives to improve anemia control programming and reduce anemia at the country level. The Program provided global leadership, advocated at the global and regional level for an integrated package of interventions to address maternal anemia (IFA supplements, anti-malarials and deworming), and provided technical assistance to countries to move integrated anemia prevention and control forward. MCHIP identified multiple delivery channels for interventions including community-based distribution of IFA supplements where the coverage of at least four antenatal care visits is low.
MCHIP developed a K4Health Toolkit on Integrated Anemia Prevention and Control (see an overview of the contents here), which provides a resource on latest evidence, programming, and controversial issues in anemia. MCHIP’s Nutrition Brown Bag Series also featured several presentations on anemia and other nutrition topics. Additionally, the Program developed several programmatic briefs on delayed cord clamping and community-based IFA distribution.