title: Effect of haematinic supplementation and malaria prevention on maternal anaemia and malaria in western Kenya.
abstract: 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.
authors.affiliation: Centre for Vector Biology and Control Research, Kenya Medical Research Institute, Kisumu, Kenya. vaneijka@zimcdc.co.zw
authors.forename: Anna M
authors.initials: AM
authors.lastname: van Eijk
authors.forename: John G
authors.initials: JG
authors.lastname: Ayisi
authors.forename: Laurence
authors.initials: L
authors.lastname: Slutsker
authors.forename: Feiko O
authors.initials: FO
authors.lastname: Ter Kuile
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Rosen
authors.forename: Juliana A
authors.initials: JA
authors.lastname: Otieno
authors.forename: Ya-Ping
authors.initials: YP
authors.lastname: Shi
authors.forename: Piet A
authors.initials: PA
authors.lastname: Kager
authors.forename: Richard W
authors.initials: RW
authors.lastname: Steketee
authors.forename: Bernard L
authors.initials: BL
authors.lastname: Nahlen
mesh_terms: 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
chemical_list: D000962:Antimalarials; D004338:Drug Combinations; D006397:Hematinics; C001205:fanasil, pyrimethamine drug combination; D013413:Sulfadoxine; D005492:Folic Acid; D007501:Iron; D011739:Pyrimethamine