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


CONCLUSIONS
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.
van Eijk
Anna M
AM
Centre for Vector Biology and Control Research, Kenya Medical Research Institute, Kisumu, Kenya. vaneijka@zimcdc.co.zw
Ayisi
John G
JG
Slutsker
Laurence
L
Ter Kuile
Feiko O
FO
Rosen
Daniel H
DH
Otieno
Juliana A
JA
Shi
Ya-Ping
YP
Kager
Piet A
PA
Steketee
Richard W
RW
Nahlen
Bernard L
BL
D000328:Adult; D000740:Anemia / Q000453:epidemiology / Q000517:prevention & control*; D000962:Antimalarials / Q000008:administration & dosage; D004338:Drug Combinations; D004359:Drug Therapy, Combination; D005260:Female; D005492:Folic Acid / Q000008:administration & dosage; D018023:HIV Seronegativity; D006679:HIV Seropositivity / Q000150:complications* / Q000453:epidemiology; D006397:Hematinics / Q000008:administration & dosage*; D006801:Humans; D007501:Iron / Q000008:administration & dosage; D007630:Kenya / Q000453:epidemiology; D008288:Malaria / Q000453:epidemiology / Q000517:prevention & control*; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000453:epidemiology / Q000517:prevention & control*; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology / Q000517:prevention & control*; D011263:Pregnancy Trimester, Third; D015995:Prevalence; D011739:Pyrimethamine / Q000008:administration & dosage; D013413:Sulfadoxine / Q000008:administration & dosage; D016896:Treatment Outcome
D000962:Antimalarials; D004338:Drug Combinations; D006397:Hematinics; C001205:fanasil, pyrimethamine drug combination; D013413:Sulfadoxine; D005492:Folic Acid; D007501:Iron; D011739:Pyrimethamine