Comparison of routine prenatal iron prophylaxis and screening and treatment for anaemia: pregnancy results and preliminary birth results from a pragmatic randomised controlled trial (PROFEG) in Maputo, Mozambique

Parkkali, Saara; Abacassamo, Fátima; Nwaru, Bright I.; Salomé, Graça; Augusto, Orvalho; Regushevskaya, Elena; Dgedge, Martinho; Sousa, Cesar; Cliff, Julie; Chilundo, Baltazar; Hemminki, Elina

doi:10.1136/bmjopen-2012-001948

Cited by 8 publications

(18 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The birth outcomes were relatively similar in the two groups. From this pragmatic randomized controlled trial the authors concluded that routine iron prophylaxis during pregnancy did not suggest better maternal and child health (MCH) outcomes than screening and treatment for anemia in a setting of endemic malaria and HIV 87 .…”

Section: Management Of Anemia In Pregnancy Weekly Iron and Folic Acidmentioning

confidence: 99%

Prevalence of Anemia Among Pregnant Women in Ethiopia and Its Management: A Review

Tsegaye¹,

Tesfaye²

2014

Int. Res. J. Pharm.

View full text Add to dashboard Cite

Anemia is a major global health problem, especially in developing countries and is a common and serious problem in pregnancy. It has serious short-and long-term consequences during pregnancy and beyond. This fundamental health issue has not still been solved but continues to exist affecting the health, quality of life and working capacity in billions of people all over the world. The anemic condition is often worsened by the presence of other chronic diseases such as malaria, tuberculosis, HIV, and diabetes. Untreated anemia also leads to increased morbidity and mortality from these chronic conditions as well. Current knowledge indicates that iron deficiency anemia in pregnancy is a risk factor for preterm delivery and subsequent low birth weight, and possibly for inferior neonatal health. Even for women who enter pregnancy with reasonable iron stores, iron supplements improve iron status during pregnancy and for a considerable length of time postpartum, thus providing some protection against iron deficiency in the subsequent pregnancy. This literature review focuses on the prevalence and major causes of anemia seen on a global & Ethiopian scale. Most cases of anemia are due to iron deficiency, which often work in combination with folate deficiency and/or vitamin B12 deficiency as well as with infections. More efforts should be dedicated to tackle this massive problem-we have the tools and we know the ways. Iron fortification of appropriate food items combined with iron supplements in specific population groups has proved to be efficient. Initially, the efforts should be centered on the specific risk groups for iron deficiency anemia, i.e. pregnant women.

show abstract

Section: Management Of Anemia In Pregnancy Weekly Iron and Folic Acidmentioning

confidence: 99%

Prevalence of Anemia Among Pregnant Women in Ethiopia and Its Management: A Review

Tsegaye¹,

Tesfaye²

2014

Int. Res. J. Pharm.

View full text Add to dashboard Cite

show abstract

“…Moreover, the usual definition of PPH (blood loss ≥500 mL during vaginal delivery and ≥1000 mL during cesarean section) may not be clinically relevant in sub‐Saharan Africa, where small amounts of blood loss may have detrimental outcomes in patients with preexisting severe (hemoglobin <7 g/d) or moderate anemia (hemoglobin 7‐9.9 g/d). Although never formally studied, this is important to note, since the prevalence of maternal anemia approaches 80% in some countries, compared to approximately 5% in the United States . Additionally, there is clinical evidence that anemia can increase the risk of surgical bleeding and PPH …”

Section: Introductionmentioning

confidence: 99%

Maternal death and postpartum hemorrhage in sub‐Saharan Africa – A pilot study in metropolitan Mozambique

Lancaster

Barnes

Correia

et al. 2020

Research and Practice in Thrombosis and Haemostasis

View full text Add to dashboard Cite

Background Maternal mortality in sub‐Saharan Africa is approximately 500 to 1000 per 100 000 births (vs. approximately 5‐20 in developed countries). Postpartum hemorrhage (PPH) is deemed responsible for 30% to 50% of the deaths. Objective To study PPH, risk factors, and mortality in metropolitan Mozambique to inform future studies and intervention strategies. Materials/Methods Retrospective cross‐sectional data extraction from all charts available to us (n = 495) recording deliveries between January and June 2018 at Maputo Central Hospital. Data included age, maternal survival, HIV status, parity, delivery mode, complications, vital signs, laboratory values, and maternal/fetal data. PPH was determined by charted diagnosis, interventions for hemorrhaging, placental abruption, transfusion, or blood loss. Autopsy reports from all deceased patients (n = 35) were examined. Results Median age was 29 years with 17% HIV prevalence. Risk factors for PPH (frequency, 12%) included parity (adjusted odds ratios (AORs) for 3+ versus nulliparity, 7.20 (95% confidence interval [CI], 2.46‐21.10), gestation length (AOR, 0.86; CI, 0.81‐0.92 per week), and body temperature (AOR, 1.10; CI, 1.04‐1.16 per 0.1°C). Maternal mortality was strongly associated with PPH (AOR, 5.22; 95% CI, 2.26‐12.08) and HIV (AOR, 11.66; 95% CI, 4.72‐28.78). Laboratory values (n = 241) were available from mothers experiencing complications (approximately 50%). Anemia (prevalence 54%) was a strong predictor of PPH with an inverse relationship between hemoglobin levels on admission (AOR, 0.62; 95% CI, 0.50‐0.77 per g/dL higher hemoglobin) and the probability of later suffering from PPH. Mothers who died following PPH had lower median hemoglobin (6.2 g/dL) than mothers who survived (9.2 g/dL). Protocols to estimate peripartum blood loss were not used; antifibrinolytics and/or cryoprecipitate were unavailable. Conclusion Postpartum hemorrhage is a serious problem even in metropolitan areas of sub‐Saharan Africa, and anemia influenced bleeding and death substantially. To address this problem, it is critical to raise awareness and region‐specific prevention and intervention protocols.

show abstract

“…The details of the PROFEG Trial have been described elsewhere (13,16) . The trial was designed as a pragmatic randomized trial comparing two Fe administration policies on maternal and child health in two health centres (1 o de Maio and Machava) in Maputo: routine Fe (Fe prophylaxis from the first to the last prenatal visit) v. selective Fe (screening and treatment for anaemia).…”

Section: Study Design and Participantsmentioning

confidence: 99%

“…routine Fe supplementation from the first prenatal visit until delivery) v. selective Fe prophylaxis (i.e. screening for anaemia and Fe supplementation only to those found to be anaemic) during pregnancy (13,16) . Pragmatic trials are useful for comparing and informing choices between different treatment policies and are more suitable to study effects in normal clinical practice.…”

mentioning

confidence: 99%

“…There is evidence that Fe may increase the incidence of infections (13)(14)(15) , and this heightens the concern about routine Fe supplementation in malaria-endemic and HIV-prone developing countries. We set out to evaluate the effects of prophylactic Fe supplementation during pregnancy on maternal and child health in Maputo, Mozambique, a malaria-endemic and HIV-prevalent setting (13,16) . Specifically, we carried out a pragmatic randomized controlled trial comparing routine Fe prophylaxis (i.e.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Adherence in a pragmatic randomized controlled trial on prophylactic iron supplementation during pregnancy in Maputo, Mozambique

Nwaru

Salomé

Abacassamo

et al. 2014

Public Health Nutr.

Self Cite

View full text Add to dashboard Cite

Objective: Assessing the level of adherence and its determinants is important in appraising the overall effectiveness of trials. The present study aimed to evaluate the extent of adherence and its determinants in a pragmatic randomized controlled trial of Fe prophylaxis during pregnancy in Maputo, Mozambique. Design: A pragmatic randomized controlled trial. Setting: Two health centres (1 o de Maio and Machava) in Maputo, Mozambique. Subjects: Pregnant women (≥12 weeks' gestation, ≥18 years old, non-high-risk pregnancy; n 4326) attending prenatal care consultations at two health centres were randomized to receive routine Fe (n 2184; 60 mg ferrous sulfate plus 400 μg folic acid daily throughout pregnancy) or selective Fe (n 2142; screening and treatment for anaemia and daily intake of 1 mg folic acid). Results: The level of adherence was 79 % for having two or more visits, 53 % for adequate prenatal care and 67 % for complete intake of Fe/folic acid tablets during the trial. The correlation between the adherence measures ranged between 0·151 and 0·739. Adherence did not differ by trial arm, but there were centre differences in adequate prenatal visits and intake of tablets. Older women (>20 years) and those with a history of abortion were more likely to achieve greater adherence, whereas an increased number of previous births decreased the likelihood of adherence. HIV positivity decreased the likelihood of adherence in one trial centre and increased it in the other. Conclusions: The variation in adherence by trial centre, women's characteristics and outcome measures suggests that adherence in trials fully depends on participants' behaviour and can be increased by paying attention to contextual factors.

show abstract

Comparison of routine prenatal iron prophylaxis and screening and treatment for anaemia: pregnancy results and preliminary birth results from a pragmatic randomised controlled trial (PROFEG) in Maputo, Mozambique

Cited by 8 publications

References 27 publications

Prevalence of Anemia Among Pregnant Women in Ethiopia and Its Management: A Review

Prevalence of Anemia Among Pregnant Women in Ethiopia and Its Management: A Review

Maternal death and postpartum hemorrhage in sub‐Saharan Africa – A pilot study in metropolitan Mozambique

Adherence in a pragmatic randomized controlled trial on prophylactic iron supplementation during pregnancy in Maputo, Mozambique

Contact Info

Product

Resources

About