Provision of antenatal iron folic acid (IFA) supplements is a long established intervention used worldwide to both treat and prevent anemia in women during pregnancy, when risk is especially high. Use of IFA, however, is generally low, especially in resource poor contexts due to a wide variety of issues including reported side effects, lack of awareness and counseling, and often inconsistent supplies. Recently also, growing evidence of the potential increased risk of malaria infection after iron supplementation in children has raised concern around the safety of IFA for pregnant women.
Two speakers, one from a programming and another from a research perspective on IFA use, presented their experiences on antenatal supplementation in Kenya. Micronutrient Initiative launched a program aimed to increase utilization and uptake of IFA using mass media communication, intensive capacity building and community level behavior change interventions (BCI). Esther Kariuki presented the rationale and design of the program developed for Kenya, the experiences in operationalizing the program, and its impact thus far. Recent studies in Tanzania and Kenya have been published on the safety and benefit of IFA for pregnant women. Hans Verhoef from Wageningen University share with attendees the findings from iron supplementation in western Kenya, in terms of improved birth outcomes and no increased risk of Plasmodium infection for the mothers.
Webinar Q&A Responses (PDF 320 KB)
Esther Wambui Kariuki
Ms. Kariuki is a Senior Programme Officer – Maternal Newborn Health and Nutrition for Micronutrient Initiative Kenya. She provides technical and other assistance to the government and key stakeholders to enable them to provide, on a sustainable basis, antenatal and newborn care services to all pregnant mothers. Previously, Esther worked for 3 years with an international development agency, Academy for Educational Development, as a regional nutrition and HIV/AIDS specialist for the USAID funded FANTA-2 project in Kenya and supporting 4 other neighboring African countries including Tanzania, Uganda, Namibia and Zambia. Maternal and child health interventions have been central in her work in the areas of Infant and Young Child Nutrition (IYCN), micronutrient deficiency control, management of moderate and severe malnutrition, diarrhea management, HIV/AIDS, among others. She is currently an active member of several MOH-led coordinating frameworks including: Micronutrient TWG, IFAS Task force, Reproductive Health ICC, Nutrition Information Working Group, Kenya National Food Fortification Alliance, National Micronutrient Deficiency Control Council, Advocacy and Communication Working group and Scaling up Nutrition (SUN) planning committee among other various sub-committees. Esther has a bachelor’s degree in human nutrition and dietetics and is in the process of carrying out her MPH project work at the Kenyatta University.
Dr. Verhoef is a clinical epidemiologist, nutritionist and entomologist with a research interest in micronutrient malnutrition and infectious diseases. He is affiliated with the London School of Hygiene and Tropical Medicine, UK and Wageningen University in The Netherlands. Dr Verhoef conducted or supervised trials to control deficiencies of iron, vitamin A and zinc, including supervising Martin Mwangi’s research on the effect of antenatal iron supplementation on Plasmodium infection in women at parturition in western Kenya (JAMA 2015;314:1009-1020). In an earlier study, he pioneered the use of intermittent treatment with sulfadoxine-pyrimethamine and iron to prevent malaria and to control anemia in young African children (Lancet 2002;360:908-14). This strategy was further developed by a World Health Organization (WHO) lead consortium, resulting in WHO recommending ‘intermittent preventive treatment’ and ‘seasonal chemotherapy’ in selected target groups. He supervised a ground-breaking trial to assess the efficacy of flour fortification in improving iron status of young African children (Lancet 2007;369:1799-806). This work has contributed to the recommendation by WHO that flour should fortified with iron, preferably in the form of NaFeEDTA, and has been seminal in many developing countries adopting mandatory flour fortification. More recently, he supervised a trial showing that supplementation with iron-containing micronutrients can be unsafe in children with initial iron deficiency, while they had no effect in children who were initially iron replete (PLoS Med 2011;8:e1001125). In the early part of his career, Dr Verhoef worked as a medical entomologist for the WHO to provide technical support for the national malaria control program in the Solomon Islands.