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Free Content Effect of haematinic supplementation and malaria prevention on maternal anaemia and malaria in western Kenya

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Abstract:

Summary Objective  To evaluate the effect of routine antenatal haematinic supplementation programmes and intermittent preventive treatment (IPT) with sulphadoxine–pyrimethamine (SP) in Kenya. Methods  Anaemia [haemoglobin (Hb) <11 g/dl), severe anaemia (Hb <8 g/dl) and placental malaria were compared among women with known HIV status who delivered at a provincial hospital after study enrolment in the third trimester during three consecutive periods: period 1, no routine intervention (reference); period 2, routine haematinic supplementation (60 mg elementary iron three times/day, folic acid 5 mg once daily) and period 3, haematinics and IPT with SP. Results  Among 3108 participants, prevalence of placental malaria, anaemia and severe anaemia postpartum was 16.7%, 53.6% and 12.7%, respectively. Compared with period 1, women in period 2 were less anaemic [adjusted odds ratio (AOR), 95% confidence interval anaemia: 0.56, 0.47–0.67; severe anaemia 0.37, 0.28–0.49] and shared a similar prevalence of placental malaria (AOR 1.07, 0.86–1.32). Women in period 3 were also less anaemic (AOR anaemia: 0.43, 0.35–0.53 and severe anaemia: 0.43, 0.31–0.59), and had less placental malaria (AOR 0.56, 0.42–0.73). The effect of intervention did not differ significantly by HIV status. Conclusion  The haematinic supplementation programme was associated with significant reductions in anaemia in HIV-seropositive and HIV-seronegative women. The subsequent introduction of IPT was associated with halving of malaria, but no additional haematological benefit over haematinics.

French
Objectif 

Evaluer l'effet des programmes de supplémentation hématinique prénatales de routine et celui du traitement préventif intermittent (TPI) au sulfadoxine–pyriméthamine (SP) au Kenya. Méthodes 

L'anémie simple (hémoglobine [Hb] <11 g/dl), l'anémie sévère (Hb < 8 g/dl), et la malaria placentaire ont été comparées chez des femmes au statut VIH connu qui ont accouché dans un hôpital provincial après leur inclusion dans l’étude au cours du 3 trimestre selon trois périodes consécutives. Période 1: aucune intervention de routine (référence), période 2: supplémentation hématinique de routine (60 mg de fer élémentaire 3 fois/jour, 5 mg d'acide folique par jour), période 3: supplémentation hématinique et TPI au SP. Résultats 

Chez les 3108 participants, les prévalences de malaria placentaire, d'anémie simple et d'anémie sévère post-partum étaient de 16,7%; 53,6% et 12,7% respectivement. Comparées à la période 1, les femmes dans la période 2 étaient moins anémiques (rapport de cotes ajustés [AOR] pour l'anémie simple = 0,56 avec une intervalle de confiance [IC] 95%: 0,47–0,67 et pour l'anémie sévère AOR = 0,37, IC95%: 0,28–0,49) et partageaient une prévalence similaire de malaria placentaire (AOR = 1,07, IC95%: 0,86–1,32). Les femmes dans la période 3 étaient également moins anémiques (AOR pour l'anémie = 0,43; IC95%: 0,35–0,5 et pour l'anémie sévère: 0,43; IC95%: 0,31–0,59) et avaient moins de malaria placentaire (AOR = 0,56; IC95%: 0,42–0,73). Il n'y avait pas différence significative dans l'effet de l'intervention selon le statut VIH. Conclusion 

Le programme de supplémentation hématinique était associéà des réductions significatives de l'anémie chez les femmes VIH-séropositives et VIH-séronégatives. L'introduction du TPI en plus a été associée à une réduction de moitié de la malaria, mais aucun avantage hématologique additionnel n'a été observé pour les hématiniques.

Keywords: Kenia; Kenya; anaemia; anemia; anémie; embarazo; grossesse; haematinic supplementation; malaria; pregnancy; sulfadoxina–pirimetamina; sulfadoxine–pyriméthamine; sulphadoxine–pyrimethamine; suplementación hematínica; supplémentation hématinique

Document Type: Research Article

DOI: http://dx.doi.org/10.1111/j.1365-3156.2006.01787.x

Affiliations: 1:  Centre for Vector Biology and Control Research, Kenya Medical Research Institute, Kisumu, Kenya 2:  Liverpool School of Tropical Medicine, Liverpool, UK 3:  Global Aids Program, Centers for Disease Control and Prevention, Harare, Zimbabwe 4:  Kenya Ministry of Health, Kisumu, Kenya 5:  Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA 6:  Department of Infectious Diseases, Tropical Medicine and AIDS, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands

Publication date: March 1, 2007

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