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Akinajo OR, Babah OA, Banke-Thomas A, Beňová L, Sam-Agudu NA, Balogun MR, Adaramoye VO, Galadanci HS, Quao RA, Afolabi BB, Annerstedt KS. Acceptability of IV iron treatment for iron deficiency anaemia in pregnancy in Nigeria: a qualitative study with pregnant women, domestic decision-makers, and health care providers. Reprod Health 2024; 21:22. [PMID: 38347614 PMCID: PMC10863081 DOI: 10.1186/s12978-024-01743-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 01/18/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Anaemia in pregnancy causes a significant burden of maternal morbidity and mortality in sub-Saharan Africa, with prevalence ranging from 25 to 45% in Nigeria. The main treatment, daily oral iron, is associated with suboptimal adherence and effectiveness. Among pregnant women with iron deficiency, which is a leading cause of anaemia (IDA), intravenous (IV) iron is an alternative treatment in moderate or severe cases. This qualitative study explored the acceptability of IV iron in the states of Kano and Lagos in Nigeria. METHODS We purposively sampled various stakeholders, including pregnant women, domestic decision-makers, and healthcare providers (HCPs) during the pre-intervention phase of a hybrid clinical trial (IVON trial) in 10 healthcare facilities across three levels of the health system. Semi-structured topic guides guided 12 focus group discussions (140 participants) and 29 key informant interviews. We used the theoretical framework of acceptability to conduct qualitative content analysis. RESULTS We identified three main themes and eight sub-themes that reflected the prospective acceptability of IV iron therapy. Generally, all stakeholders had a positive affective attitude towards IV iron based on its comparative advantages to oral iron. The HCPs noted the effectiveness of IV iron in its ability to evoke an immediate response and capacity to reduce anaemia-related complications. It was perceived as a suitable alternative to blood transfusion for specific individuals based on ethicality. However, to pregnant women and the HCPs, IV iron could present a higher opportunity cost than oral iron for the users and providers as it necessitates additional time to receive and administer it. To all stakeholder groups, leveraging the existing infrastructure to facilitate IV iron treatment will stimulate coherence and self-efficacy while strengthening the existing trust between pregnant women and HCPs can avert misconceptions. Finally, even though high out-of-pocket costs might make IV iron out of reach for poor women, the HCPs felt it can potentially prevent higher treatment fees from complications of IDA. CONCLUSIONS IV iron has a potential to become the preferred treatment for iron-deficiency anaemia in pregnancy in Nigeria if proven effective. HCP training, optimisation of information and clinical care delivery during antenatal visits, uninterrupted supply of IV iron, and subsidies to offset higher costs need to be considered to improve its acceptability. Trial registration ISRCTN registry ISRCT N6348 4804. Registered on 10 December 2020 Clinicaltrials.gov NCT04976179. Registered on 26 July 2021.
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Affiliation(s)
- Opeyemi R Akinajo
- Department of Obstetrics and Gynaecology, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria.
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.
| | - Ochuwa A Babah
- Department of Obstetrics and Gynaecology, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
- Department of Obstetrics and Gynaecology, Faculty of Clinical Sciences, College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria
| | - Aduragbemi Banke-Thomas
- Maternal, Adolescent, Reproductive and Child Health (MARCH), Centre, London School of Hygiene and Tropical Medicine, London, UK
| | - Lenka Beňová
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Nadia A Sam-Agudu
- International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Nigeria
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, USA
| | - Mobolanle R Balogun
- Department of Community Health and Primary Care, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Victoria O Adaramoye
- Department of Obstetrics and Gynaecology, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
| | - Hadiza S Galadanci
- African Center of Excellence for Population Health and Policy, Bayero University, Kano, Nigeria
- Department of Obstetrics and Gynaecology, College of Health Sciences Bayero University Kano/ Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Rachel A Quao
- The Centre for Clinical Trials, Research, and Implementation Science (CCTRIS), University of Lagos, Idi-Araba, Lagos, Nigeria
| | - Bosede Bukola Afolabi
- Department of Obstetrics and Gynaecology, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
- Department of Obstetrics and Gynaecology, Faculty of Clinical Sciences, College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria
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Afolabi BB, Babah OA, Akinajo OR, Adaramoye VO, Adeyemo TA, Balogun M, Banke-Thomas A, Quao RA, Olorunfemi G, Abioye AI, Galadanci HS, Sam-Agudu NA. Intravenous versus oral iron for iron deficiency anaemia in pregnant Nigerian women (IVON): study protocol for a randomised hybrid effectiveness-implementation trial. Trials 2022; 23:763. [PMID: 36076211 PMCID: PMC9454388 DOI: 10.1186/s13063-022-06690-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 08/24/2022] [Indexed: 11/26/2022] Open
Abstract
Background Anaemia in pregnancy is highly prevalent in African countries. High-dose oral iron is the current recommended treatment for pregnancy-related iron deficiency anaemia (IDA) in Nigeria and other African countries. This oral regimen is often poorly tolerated and has several side effects. Parenteral iron preparations are now available for the treatment of IDA in pregnancy but not widely used in Africa. The IVON trial is investigating the comparative effectiveness and safety of intravenous ferric carboxymaltose versus oral ferrous sulphate standard-of-care for pregnancy-related IDA in Nigeria. We will also measure the implementation outcomes of acceptability, feasibility, fidelity, and cost-effectiveness for intravenous ferric carboxymaltose. Methods This is an open-label randomised controlled trial with a hybrid type 1 effectiveness-implementation design, conducted at 10 health facilities in Kano (Northern) and Lagos (Southern) states in Nigeria. A total of 1056 pregnant women at 20–32 weeks’ gestational age with moderate or severe anaemia (Hb < 10g/dl) will be randomised 1:1 into two groups. The interventional treatment is one 1000-mg dose of intravenous ferric carboxymaltose at enrolment; the control treatment is thrice daily oral ferrous sulphate (195 mg elemental iron daily), from enrolment till 6 weeks postpartum. Primary outcome measures are (1) the prevalence of maternal anaemia at 36 weeks and (2) infant preterm birth (<37 weeks’ gestation) and will be analysed by intention-to-treat. Maternal full blood count and iron panel will be assayed at 4 weeks post-enrolment, 36 weeks’ gestation, delivery, and 6 weeks postpartum. Implementation outcomes of acceptability, feasibility, fidelity, and cost will be assessed with structured questionnaires, key informant interviews, and focus group discussions. Discussion The IVON trial could provide both effectiveness and implementation evidence to guide policy for integration and uptake of intravenous iron for treating anaemia in pregnancy in Nigeria and similar resource-limited, high-burden settings. If found effective, further studies exploring different intravenous iron doses are planned. Trial registration ISRCTN registry ISRCTN63484804. Registered on 10 December 2020 Clinicaltrials.govNCT04976179. Registered on 26 July 2021 The current protocol version is version 2.1 (080/080/2021). Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06690-2.
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Affiliation(s)
- Bosede B Afolabi
- Department of Obstetrics & Gynaecology, Faculty of Clinical Sciences, College of Medicine, University of Lagos, P.M.B. 12003, Idi-Araba, Lagos, Nigeria. .,Department of Obstetrics and Gynaecology, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria.
| | - Ochuwa A Babah
- Department of Obstetrics & Gynaecology, Faculty of Clinical Sciences, College of Medicine, University of Lagos, P.M.B. 12003, Idi-Araba, Lagos, Nigeria.,Department of Obstetrics and Gynaecology, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
| | - Opeyemi R Akinajo
- Department of Obstetrics and Gynaecology, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
| | - Victoria O Adaramoye
- Department of Obstetrics and Gynaecology, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
| | - Titilope A Adeyemo
- Department of Haematology & Blood Transfusion, Faculty of Clinical Sciences, College of Medicine, University of Lagos and Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
| | - Mobolanle Balogun
- Department of Community Health & Primary Care, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Aduragbemi Banke-Thomas
- Global Maternal and Newborn Health Hub, Institute of Lifecourse Development, University of Greenwich, London, UK
| | - Rachel A Quao
- IVON trial, College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria
| | - Gbenga Olorunfemi
- Division of Epidemiology and Biostatistics, School of Public Health, University of Witwatersand, Johannesburg, South Africa
| | - Ajibola I Abioye
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Hadiza S Galadanci
- African Center of Excellence for Population health and Policy, Bayero University Kano, Kano, Nigeria.,Department of Obstetrics and Gynaecology, College of Health Sciences Bayero University Kano/Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Nadia A Sam-Agudu
- International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Nigeria.,Institute of Human Virology, University of Maryland School of Medicine, Baltimore, USA
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Okunade KS, Makwe CC, Akinajo OR, Owie E, Ohazurike EO, Babah OA, Okunowo AA, Omisakin SI, Oluwole AA, Olamijulo JA, Adegbola O, Anorlu RI, Afolabi BB. Good clinical practice advice for the management of pregnant women with suspected or confirmed COVID-19 in Nigeria. Int J Gynaecol Obstet 2020; 150:278-284. [PMID: 32557562 PMCID: PMC9087626 DOI: 10.1002/ijgo.13278] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 06/11/2020] [Accepted: 06/15/2020] [Indexed: 12/22/2022]
Abstract
The impact on healthcare services in settings with under-resourced health systems, such as Nigeria, is likely to be substantial in the coming months due to the COVID-19 pandemic, and maternity services still need to be prioritized as an essential core health service. The healthcare system should ensure the provision of safe and quality care to women during pregnancy, labor, and childbirth, and at the same time, maternity care providers including obstetricians and midwives must be protected and prioritized to continue providing care to childbearing women and their babies during the pandemic. This practical guideline was developed for the management of pregnant women with suspected or confirmed COVID-19 in Nigeria and other low-resource countries.
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Affiliation(s)
- Kehinde S. Okunade
- Department of Obstetrics and GynecologyFaculty of Clinical SciencesCollege of MedicineUniversity of LagosLagosNigeria
- Department of Obstetrics and GynecologyLagos University Teaching HospitalLagosNigeria
| | - Christian C. Makwe
- Department of Obstetrics and GynecologyFaculty of Clinical SciencesCollege of MedicineUniversity of LagosLagosNigeria
- Department of Obstetrics and GynecologyLagos University Teaching HospitalLagosNigeria
| | - Opeyemi R. Akinajo
- Department of Obstetrics and GynecologyLagos University Teaching HospitalLagosNigeria
| | - Emmanuel Owie
- Department of Obstetrics and GynecologyLagos University Teaching HospitalLagosNigeria
| | - Ephraim O. Ohazurike
- Department of Obstetrics and GynecologyLagos University Teaching HospitalLagosNigeria
| | - Ochuwa A. Babah
- Department of Obstetrics and GynecologyFaculty of Clinical SciencesCollege of MedicineUniversity of LagosLagosNigeria
- Department of Obstetrics and GynecologyLagos University Teaching HospitalLagosNigeria
| | - Adeyemi A. Okunowo
- Department of Obstetrics and GynecologyFaculty of Clinical SciencesCollege of MedicineUniversity of LagosLagosNigeria
- Department of Obstetrics and GynecologyLagos University Teaching HospitalLagosNigeria
| | - Sunday I. Omisakin
- Department of Obstetrics and GynecologyFaculty of Clinical SciencesCollege of MedicineUniversity of LagosLagosNigeria
- Department of Obstetrics and GynecologyLagos University Teaching HospitalLagosNigeria
| | - Ayodeji A. Oluwole
- Department of Obstetrics and GynecologyFaculty of Clinical SciencesCollege of MedicineUniversity of LagosLagosNigeria
- Department of Obstetrics and GynecologyLagos University Teaching HospitalLagosNigeria
| | - Joseph A. Olamijulo
- Department of Obstetrics and GynecologyFaculty of Clinical SciencesCollege of MedicineUniversity of LagosLagosNigeria
- Department of Obstetrics and GynecologyLagos University Teaching HospitalLagosNigeria
| | - Omololu Adegbola
- Department of Obstetrics and GynecologyFaculty of Clinical SciencesCollege of MedicineUniversity of LagosLagosNigeria
- Department of Obstetrics and GynecologyLagos University Teaching HospitalLagosNigeria
| | - Rose I. Anorlu
- Department of Obstetrics and GynecologyFaculty of Clinical SciencesCollege of MedicineUniversity of LagosLagosNigeria
- Department of Obstetrics and GynecologyLagos University Teaching HospitalLagosNigeria
| | - Bosede B. Afolabi
- Department of Obstetrics and GynecologyFaculty of Clinical SciencesCollege of MedicineUniversity of LagosLagosNigeria
- Department of Obstetrics and GynecologyLagos University Teaching HospitalLagosNigeria
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