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Mildon A, Lopez de Romaña D, Jefferds MED, Rogers LM, Golan JM, Arabi M. Integrating and coordinating programs for the management of anemia across the life course. Ann N Y Acad Sci 2023; 1525:160-172. [PMID: 37194608 PMCID: PMC10918752 DOI: 10.1111/nyas.15002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Anemia is a major global public health concern with a complex etiology. The main determinants are nutritional factors, infection and inflammation, inherited blood disorders, and women's reproductive biology, but the relative role of each varies between settings. Effective anemia programming, therefore, requires evidence-based, data-driven, contextualized multisectoral strategies, with coordinated implementation. Priority population groups are preschool children, adolescent girls, and pregnant and nonpregnant women of reproductive age. Opportunities for comprehensive anemia programming include: (i) bundling interventions through shared delivery platforms, including antenatal care, community-based platforms, schools, and workplaces; (ii) integrating delivery platforms to extend reach; (iii) integrating anemia and malaria programs in endemic areas; and (iv) integrating anemia programming across the life course. Major barriers to effective anemia programming include weak delivery systems, lack of data or poor use of data, lack of financial and human resources, and poor coordination. Systems strengthening and implementation research approaches are needed to address critical gaps, explore promising platforms, and identify solutions to persistent barriers to high intervention coverage. Immediate priorities are to close the gap between access to service delivery platforms and coverage of anemia interventions, reduce subnational coverage disparities, and improve the collection and use of data to inform anemia strategies and programming.
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Affiliation(s)
| | | | | | - Lisa M. Rogers
- Department of Nutrition and Food Safety, World Health Organization, Geneva, Switzerland
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Eleje GU, Ezebialu IU, Enebe JT, Ezeora NC, Ugwu EO, Ake ID, Nwankwo EU, Enyinna PK, Okoro CC, Asuoha CP, Oguejiofor CB, Obi E, Okafor CG, Ugwu AO, Eleje LI, Malachy DE, Ubammadu CE, Igbodike EP, Anikwe CC, Ajuba IC, Ufoaroh CU, Egeonu RO, Okafor LU, Enechukwu CI, Nweje SI, Anaedu OP, Ikpeze OZ, Okpala BC, Emeka EA, Nzeukwu CS, Aniedu IC, Chukwuka EC, Onwuegbuna AA, Ikwuka DC, Chigbo CG, Agbanu CMK, Onwuka CI, Nwankwo ME, Nneji HC, Onyeukwu KA, Odugu BU, Nweze SO, Onyekpa IJ, Eze KC, Chukwurah SN, Ugboaja JO, Ikechebelu JI. Efficacy and safety of Mojeaga remedy in combination with conventional oral iron therapy for correcting anemia in obstetric population: A phase II randomized pilot clinical trial. PLoS One 2023; 18:e0285474. [PMID: 37155690 PMCID: PMC10166496 DOI: 10.1371/journal.pone.0285474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 04/21/2023] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND To our knowledge, there is no prior randomized trial on the efficacy of Mojeaga remedy (a special blend of Alchornea cordifolia, Pennisetum glaucum and Sorghum bicolor extracts) when co-administered with standard-of-care for correction of anemia in obstetrics practice. This study determined the efficacy, safety and tolerability of Mojeaga as adjunct to conventional oral iron therapy for correction of anemia in obstetric population. METHODS A pilot open-label randomized clinical trial. Participants with confirmed diagnosis of anemia in three tertiary hospitals in Nigeria were studied. Eligible participants were randomized 1:1 to either Mojeaga syrups 50 mls (200mg/50mls) administered three times daily in conjunction with conventional iron therapy (Mojeaga group) for 2 weeks or conventional iron therapy alone without Mojeaga (standard-of-care group) for 2 weeks. Repeat hematocrit level were done 2 weeks post-initial therapy. Primary outcome measures were changes in hematocrit level and median hematocrit level at two weeks post therapy. Maternal adverse events and neonatal outcomes (birth anomalies, low birthweight, preterm rupture of membranes and preterm labor) were considered the safety outcome measures. Analysis was by intention-to-treat. RESULTS Ninety five participants were enrolled and randomly assigned to the Mojeaga group (n = 48) or standard-of-care group (n = 47). The baseline socio-demographic and clinical characteristics of the study participants were similar. At two weeks follow-up the median rise in hematocrit values from baseline (10.00±7.00% vs 6.00±4.00%;p<0.001) and median hematocrit values (31.00±2.00% vs 27.00±3.00%;p<0.001) were significantly higher in the Mojeaga group. There were no treatment-related serious adverse events, congenital anomalies or deaths in the Mojeaga group and incidence of other neonatal outcomes were similar (p>0.05). CONCLUSION Mojeaga represents a new adjuvants for standard-of-care option for patients with anemia. Mojeaga remedy is safe for treating anemia during pregnancy and puerperium without increasing the incidence of congenital anomalies, or adverse neonatal outcomes. CLINICAL TRIAL REGISTRATION www.pactr.samrc.ac.za: PACTR201901852059636 (https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=5822).
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Affiliation(s)
- George Uchenna Eleje
- Effective care Research Unit, Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University, Nnewi, Nigeria
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital Nnewi, Nnewi, Anambra State, Nigeria
| | - Ifeanyichukwu Uzoma Ezebialu
- Department of Obstetrics and Gynecology, Chukwuemeka Odumegwu Ojukwu University Teaching Hospital, Awka, Nigeria
| | - Joseph Tochukwu Enebe
- Department of Obstetrics and Gynecology, ESUT Teaching Hospital, Parklane, Enugu, Nigeria
| | | | - Emmanuel Onyebuchi Ugwu
- Department of Obstetrics and Gynaecology, College of Medicine, University of Nigeria Ituku-Ozalla, Enugu, Nigeria
| | - Iffiyeosuo Dennis Ake
- Clinical Trial Division, Drug Evaluation and Research Directorate, NAFDAC, Lagos, Nigeria
| | - Ekeuda Uchenna Nwankwo
- Rural Community Clinical School, School of Medicine, Deakin University, Victoria, Australia
| | | | - Chukwuemeka Chukwubuikem Okoro
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital Nnewi, Nnewi, Anambra State, Nigeria
| | - Chika Prince Asuoha
- Department of Chemical Pathology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria
| | - Charlotte Blanche Oguejiofor
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital Nnewi, Nnewi, Anambra State, Nigeria
| | - Ejeatuluchukwu Obi
- Department of Pharmacology and Therapeutics, Faculty of Medicine, Nnamdi Azikiwe University, Nnewi, Nigeria
| | - Chigozie Geoffrey Okafor
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital Nnewi, Nnewi, Anambra State, Nigeria
| | - Angela Ogechukwu Ugwu
- Department of Haematology and Immunology, College of Medicine, University of Nigeria Ituku-Ozalla, Enugu, Nigeria
| | - Lydia Ijeoma Eleje
- Measurement, Evaluation and Research Unit, Department of Educational Foundations, Nnamdi Azikiwe University, Awka, Nigeria
| | | | | | - Emeka Philip Igbodike
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital Nnewi, Nnewi, Anambra State, Nigeria
| | - Chidebe Christian Anikwe
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital Nnewi, Nnewi, Anambra State, Nigeria
| | - Ifeoma Clara Ajuba
- Department of Haematology, Faculty of Medicine, Nnamdi Azikiwe University, Nnewi, Nigeria
| | | | - Richard Obinwanne Egeonu
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital Nnewi, Nnewi, Anambra State, Nigeria
| | - Lazarus Ugochukwu Okafor
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital Nnewi, Nnewi, Anambra State, Nigeria
| | - Chukwunonso Isaiah Enechukwu
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital Nnewi, Nnewi, Anambra State, Nigeria
| | | | - Onyedika Promise Anaedu
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital Nnewi, Nnewi, Anambra State, Nigeria
| | - Odigonma Zinobia Ikpeze
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital Nnewi, Nnewi, Anambra State, Nigeria
| | - Boniface Chukwuneme Okpala
- Effective care Research Unit, Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University, Nnewi, Nigeria
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital Nnewi, Nnewi, Anambra State, Nigeria
| | - Ekene Agatha Emeka
- Department of Family Medicine, Faculty of Medicine, Nnamdi Azikiwe University, Awka, Nigeria
| | - Chijioke Stanley Nzeukwu
- Department of Obstetrics and Gynecology, Chukwuemeka Odumegwu Ojukwu University Teaching Hospital, Awka, Nigeria
| | - Ifeanyi Chibueze Aniedu
- Department of Obstetrics and Gynecology, Chukwuemeka Odumegwu Ojukwu University Teaching Hospital, Awka, Nigeria
| | - Emmanuel Chidi Chukwuka
- Department of Obstetrics and Gynecology, Chukwuemeka Odumegwu Ojukwu University Teaching Hospital, Awka, Nigeria
| | | | - David Chibuike Ikwuka
- Department of Human Physiology, Nnamdi Azikiwe University, Nnewi, Anambra State, Nigeria
| | - Chisom God’swill Chigbo
- Department of Executive MPH, School of Public Health, University of Port-Harcourt, Port-Harcourt, Rivers State, Nigeria
| | - Chiemezie Mac-Kingsley Agbanu
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital Nnewi, Nnewi, Anambra State, Nigeria
| | - Chidinma Ifechi Onwuka
- Department of Obstetrics and Gynaecology, College of Medicine, University of Nigeria Ituku-Ozalla, Enugu, Nigeria
| | - Malarchy Ekwunife Nwankwo
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital Nnewi, Nnewi, Anambra State, Nigeria
| | - Henry Chinedu Nneji
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital Nnewi, Nnewi, Anambra State, Nigeria
| | | | | | | | | | - Kenneth Chukwudi Eze
- Department of Radiology, Faculty of Medicine, College of Health Sciences, Nnamdi Azikiwe University, Awka, Nigeria
| | - Shirley Nneka Chukwurah
- Department of Internal Medicine, Faculty of Medicine, Nnamdi Azikiwe University, Nnewi, Nigeria
| | - Joseph Odirichukwu Ugboaja
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital Nnewi, Nnewi, Anambra State, Nigeria
| | - Joseph Ifeanyichukwu Ikechebelu
- Effective care Research Unit, Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University, Nnewi, Nigeria
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital Nnewi, Nnewi, Anambra State, Nigeria
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