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Browsing Protocols by Author "Mategula, Elizabeth"

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    Evaluation of intergrating intravenous iron therapyfor treatment of anaemia in pregnant women in Malawi
    (2022-06-06) Mategula, Elizabeth
    Executive Summary Type of Research Study: This is a cross-section study. We will use a mixed-methods approach. We are using a combination of qualitative and quantitative approaches. The problem: Anaemia has significant consequences on both the mother and child's health as it results in maternal haemorrhage, low birth weight, premature delivery, poor organ development, and infections at birth and hence the need for treatment. World Health Organisation defines anaemia in pregnancy as having low haemoglobin of less than 11.0 g/dl. In Malawi, 38% of pregnant women have anaemia. In low-middle income countries, anaemic pregnant women are recommended to take 30 mg to 60 mg of elemental iron daily throughout pregnancy. However, oral iron tablets are often poorly tolerated. A potential alternative to oral iron is intravenous (IV) iron which allows the saturation of the body iron stores quickly Currently, a randomised controlled trial on the Effect of intravenous iron on Anaemia in Malawian Pregnant women (REVAMP) is underway that aims to assess whether pregnant women in Malawi have a single dose of IV ferric carboxymaltose (FCM) iron is safe, efficacious and improves maternal and neonatal health outcomes. Suppose the use of IV iron during pregnancy would be effective in Malawi. In that case, it could change how we treat and manage pregnant women with anaemia and be scaled up throughout Malawi to improve maternal and child health. However, the feasibility and acceptability of implementing IV iron into routine antenatal care in low-income, low resource settings are unknown. Objectives: This research project's broader goal is to determine the acceptability and feasibility of implementing intravenous iron among pregnant Malawian women with moderate to severe anaemia in their third trimester. Specifically, we will i) explore the perceptions of different stakeholder on the use of IV iron. ii) identify factors (behaviour and socio-cultural norms) that impact pregnant women's ability to seek IV iron intervention. iii) to estimate the direct and indirect cost incurred by the pregnant women in accessing IV iron intervention or oral iron. Iv) estimate the cost of delivering IV iron or oral iron to pregnant women at the health facility level. v) examine the relationship of the appropriateness of care to pregnant women’s experiences, preferences, satisfaction, and caregiver support in engaging with health care services in accessing IV iron intervention. Methodology: This is a crosscutting study where we will recruit both providers and end-users to participate. We will do in-depth-interviews policymakers, health managers, health workers, pregnant 06-Jun-2022 REVASMP-IS-4As version1 14/02/2022 VI women, and community members a maximum of 12 participants each category. Data will be recorded, transcribed and imported to NVivo. We will employ thematic analysis to answer the ability of pregnant women to seek and engage with the IV iron intervention. Health economics analysis will explore the health systems/ service delivery costs including costs associated with care seeking and receipt of treatment. Data on cost will be collected from the 8 health facilities of zomba and entered into Microsoft excel for the calculations of averages, proportions and applying test of significance using STATA software Constraints Covid 19: Understanding that the Covid-19 situation has now improved in Malawi so that there are currently few cases in a day, all activities concerning this project will be done physically. However, it will be a must that all personnel working on this project are vaccinated and that all covid 19 measures are followed. Expected findings and dissemination: We expect to find that pregnant women can seek, reach, and engage with IV iron intervention. The health facility system can cover the cost of IV iron intervention delivery. These results will help inform decisions to introduce and implement the intervention of IV iron in Malawi to improve maternal and child health outcomes. The dissemination of our findings will promote evidence-based decision-making on the barriers and facilitators to implementing and upscaling the intervention into routine practice and care. Results will be shared through annual meetings with the District Health Office and collaborators and national research meetings, such as the College of Medicine's yearly research dissemination conference (COMREC) and presented at international research conferences. Results will be prepared for publication in international peer-reviewed scientific journals and shared with COMREC. The significant outcome of this research will be a PhD thesis. 06-Jun-202