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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
  • Transcript

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