Addressing Anemia Full Spectrum_Benavente_5.11.11


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  • The BIMCP received TA from CDC and financial support from USAID/PMI for the development of EG’s HIS
  • IRS started in early 2004 and ITN distribution in late2007
  • Surveys include parasitemia (RDT, validades confirmed by PCR in selected locations) and HB (Hemocue)
  • Proportion with anemia –by severity- and age
  • Excluding Moka- an island withinand island
  • Variables: age, parasitemia and hemoglobin (as a continuous variable)
  • Variables: year, age group, parasitemia and anemia
  • ANC coverage fluctuated widely during BIMCP-I, possibly reflecting availability of SP and other supplies. ANC seems to protect against marked-severe anemia but not against mild-moderate anemia
  • Before the BIMCP distributed bednets in late 07 consistent use by pregnant women was infrequent.% of pregnant women sleeping under an ITN the night prior to the survey was 53% in 2008 and 27% in 2009. Since 2009 ANC distribute ITNs to all pregnant women.
  • Consistent net use had a weak association with parasitemia, none with anemia
  • During routine ANC visits fever was a poor predictive of malarial infection, only headache, similar studies in Nigeria and Madagascar have show low specificity of fever to predict malarial parasitemia
  • Fe supplements seem to protect against marked-severe anemia but not against mild-moderate anemia
  • Parasitemia strongly associated to anemia, particularly marked-severe. National ANC guidelines, consistent with WHO’s , request testing for uncommon conditions but not testing of asymptomatic pregnant women for malaria parasites
  • Variables: year, maternal marked-severe anemia and Pf parasitemia
  • Addressing Anemia Full Spectrum_Benavente_5.11.11

    1. 1. Impact of Malaria Control activities on Anemia on Bioko Island, Equatorial Guinea<br />Luis Benavente1/ Immo Kleinschmidt2<br />1 Director, Improving Malaria Diagnostics Project, Medical Care Development International<br />2 London School of Hygiene and Tropical Medicine<br />
    2. 2. Pre-intervention period <br />March 1999 to Feb 2004 <br />Intervention period starting March 2004 <br />Malaria Indicator,<br />Under 5 mortality<br /> and serology<br />survey<br />Annual malaria indicator surveys<br />Baseline Malaria Indicator &<br /> under 5<br />mortality survey<br />2004 2005 2006 2007 2008 2009 2010<br />Year<br />March 1999<br />Timelines of intervention and monitoring activities, 2004 to 2010<br />Malaria indicator surveys<br />
    3. 3.
    4. 4. Monitoring and evaluation:<br />18 sentinel sites<br />
    5. 5. Elevation above sea level <br /> Lowlands, < 1000 meter Highlands 1300+m<br />Non anemic: ≥ 11 (children 12-59mo); ≥ 11.4<br /> ≥11.5 (children 5-11y); ≥ 11.9<br /> ≥ 12 (children 12-14y) ≥ 12.4<br />Mild-moderate anemia <cut-off, > 7.9 <br />Marked anemia 6 – 7.9 <br />Severe anemia <6 <br />Critical <4 <br />
    6. 6.
    7. 7.
    8. 8.
    9. 9.
    10. 10. Marked to severe anemiain children 6 months to < 5 years Bioko Island, E. Guinea<br />
    11. 11. Impact: All cause under 5 mortality by year<br />Pre-intervention period<br />Intervention period<br />
    12. 12.
    13. 13. ANC, anemia during preg-nancy, Bioko Island 2006 <br />
    14. 14. Net use by women pregnant prev yr., found pregnant during annual survey , BIMCP 2006 <br />
    15. 15. Net use by women found pregnant during annual survey and outcomes, BIMCP 2006 <br />P=0.052 <br />
    16. 16. Net use and maternal parasitemia in Benin <br />N.S. <br />N.S. <br />Source: Huyhn et al Malaria Journal 2011, 10:72 <br />
    17. 17. Iron suppl. and anemia during pregnancy Bioko Island, 2006 <br />
    18. 18. IPT2 and parasitemia among women found pregnant (2nd- 3rd trimesters), BIMCP 2006 <br />
    19. 19. Parasitemia and anemia during pregnancy, Bioko Island 2006 <br />Parasitemic women had five times more risk of being markedly-severely anemic. <br />P=0.000 <br />
    20. 20. Marked-severe anemia (Hb< 8 g/dl) and parasitemia in pregnant women Bioko Island, E. G.<br />
    21. 21. Dietary counseling: Fe-rich foods<br />If the diet is low in Fe-rich foods, iron supplements are more important than ever<br />
    22. 22. Anemia classification and management<br />at community level<br />200 mg iron sulphate / day + folic acid<br />Double dose of iron sulphate x 3 months<br />Continue 200 mg FeSO4/day<br />No symptoms: as above Symptoms: refer as below<br />Refer to level capable to do safe transfusions<br />
    23. 23. Credits and acknowledgements<br /> Project funded by a consortium led by Marathon Oil Corp: Noble Energy, Atlantic Methanol, Sonagas, GEP, SK of Korea, and the Government of Equatorial Guinea.<br /> PDA survey program written by D. Jituboh, C. Schwabe and A. Wolkon (CDC). <br /> Survey data collected by enumerators and supervisors, too many to name. <br />Survey data analyzed by LB, IK, C. Schwabe, L. Segura, G. Baltazar, and M. Worges.<br />