Anemia Interventions in Low Iron Deficiency Settings - Low-dose Pre-natal Iron Supplementation - PowerPoint Presentation

Slide1

Anemia Interventions in Low Iron Deficiency Settings - Low-dose Pre-natal Iron Supplementation and MNPs

Technical Briefs prepared for Sierra Leone Ministry of Health and Sanitation

Dr. Denish Moorthy, Team Lead, Anemia, USAID-funded SPRING project

November 2018

Structure of the Briefs

Purpose: Assist the Government of Sierra Leone (GoSL) in development of anemia strategy

Summarizes current anemia situation in Sierra LeoneDiscusses pros and cons of:

Low dose pre-natal iron supplementation (with folic acid) in pregnant women MNP as an anemia intervention for pre-school children

Other topics covered: Efficacy and safety of pre-natal iron supplementation

Brief

summary of the efficacy of MNP, as well as a review of potential safety issues with regard to

malaria

Iron-folic acid in Pregnancy

“Daily oral iron and folic acid (IFA) supplementation with 30 mg to 60 mg of elemental iron and 400 µg (0.4 mg) folic acid is recommended for pregnant women to prevent maternal anaemia, puerperal sepsis, low birth weight, and preterm

birth and reduce the risk of and associated mortality from maternal hemorrhage “

Iron-folic acid in Pregnancy - efficacy

Peña-Rosas JP, De-Regil LM, Garcia-Casal MN, Dowswell

T. Daily oral iron supplementation during pregnancy.Cochrane Database of Systematic Reviews 2015, Issue 7. Art. No.: CD004736. DOI: 10.1002/14651858.CD004736.pub5.

Peña-Rosas JP, De-Regil LM, Garcia-Casal MN, Dowswell

T. Daily oral iron supplementation during pregnancy.Cochrane Database of Systematic Reviews 2015, Issue 7. Art. No.: CD004736.

DOI: 10.1002/14651858.CD004736.pub5.

Iron-folic acid in Pregnancy - efficacy

Sangare´ L, et al. (2014) The Association between Malaria and Iron Status or Supplementation in Pregnancy: A Systematic Review and Meta-Analysis. PLoS ONE 9(2): e87743 .

Iron-folic acid in Pregnancy - Safety

Iron

deficiency associated

with diminished risk of malaria

Sangare´ L, et al. (2014) The Association between Malaria and Iron Status or Supplementation in Pregnancy: A Systematic Review and Meta Analysis. PLoS ONE 9(2):

e87743

Iron-folic acid in Pregnancy - Safety

Iron supplementation did not

increase the risk of infection

Low-dose iron-folic acid in Pregnancy

Range of doses provided: 9 mg – 900 mg (6 trials provided 30 mg)

Iron supplementation improves maternal haematological outcomes independent of dosageIntake > 60 mg of iron or more per day - higher Hb values at or near end of term

of pregnancyIntake > 60 mg more likely to report side effects (diarrhoea) as compared to intake of lower dose

Peña-Rosas JP, De-Regil LM, Garcia-Casal MN, Dowswell T. Daily oral iron supplementation during pregnancy.Cochrane Database of Systematic Reviews 2015, Issue 7. Art. No.: CD004736

.

DOI

: 10.1002/14651858.CD004736.pub5.

Low-dose iron-folic acid in Pregnancy

Peña-Rosas JP, De-Regil LM, Garcia-Casal MN, Dowswell T. Daily oral iron supplementation during pregnancy.Cochrane Database of Systematic Reviews 2015, Issue 7. Art. No.: CD004736

. DOI 10.1002/14651858.CD004736.pub5.

Low-dose iron-folic acid in Pregnancy

Peña-Rosas JP, De-Regil LM, Garcia-Casal MN, Dowswell T. Daily oral iron supplementation during pregnancy.Cochrane Database of Systematic Reviews 2015, Issue 7. Art. No.: CD004736

. DOI: 10.1002/14651858.CD004736.pub5.

Peña-Rosas JP, De-Regil LM, Garcia-Casal MN, Dowswell T. Daily

oral iron supplementation during pregnancy.Cochrane Database of Systematic Reviews 2015, Issue 7. Art. No.: CD004736

.

DOI 10.1002

/14651858.CD004736.pub5.

Prenatal Low-dose iron-folic acid in Pregnancy

The efficacy and safety IFA in reducing anemia and iron deficiency is well established

The prevalence of anemia and malaria remain high in Sierra Leone, and evidence of infection is high in children—though there are not data for pregnant womenUse of bednets (50%) and IPT during pregnancy (just under 50%) suggest reasonable malaria program success; 70% of women reported receiving deworming during their last pregnancy

Iron deficiency (per adjusted ferritin levels) was low (8%)Low dose prenatal iron supplementation (reduced from 60mg/d to 30 mg/d) appear justified

MNP Use with Low Prevalence of Iron Deficiency

Potential benefits of MNP:Reduction in anemia in children, particularly young children with the highest anemia

rates26% reduction in anemia 52% reduction in iron deficiency

Higher hemoglobin concentrationReduction in iron deficiency and iron deficiency anemia among those deficientProvision of a new platform through which other infant and young child feeding practices can be promoted

MNP Use with Low Prevalence of Iron Deficiency

Potential consequences of using MNP:Small risk of adversely affecting the infectious disease pattern, particularly the potential risk of exacerbating malaria in areas where the malaria control activities are not effectively implemented.

Possibility of limited impact due to the low prevalence of iron deficiencyStrain on resources due to the need to establish a logistic supply chain for the program to deliver MNP  

MNP Use with Low Prevalence of Iron Deficiency

The Sierra Leone National Multi-sectoral Strategy to Prevent and Control Anaemia 2017–2025 does not include MNP as a prioritized intervention

Should resources for this intervention should instead be devoted to other elements of the anemia prevention and control programming?Effective intervention to reduce anemia and iron deficiency with low risk of exacerbating malaria

Low prevalence of iron deficiency in Sierra Leone raise the question of whether MNP would actually have an impact on anemia prevalence

Blunted effectiveness

Inflammation markers suggest high levels of inflammation in Sierra Leone, in part due to malariaInflammation can cause anemia, can reduce iron absorption, and can affect serum ferritin (causing underestimation of iron deficiency, though most studies correct for inflammation)

While MNPs would likely be beneficial to women and children with iron deficiency anemia, population-based interventions may not be efficient given the low prevalence of IDA

Evidence-based Policy Making

Government of Sierra Leone is considering low-iron prenatal IFA supplement in pregnancy, in partnership with UNICEFMNPs are not included as an intervention in the “

Sierra Leone National Multi-Sectoral Strategy to Prevent and Control Anemia

Thank you! For more info, please contact:

denish_moorthy@jsi.com