Introduction

Addressing Maternal Anaemia through Evidence and Innovation

Anaemia is a widespread global health challenge, particularly affecting pregnant women and young children. It has profound consequences on health, development, and economic productivity. According to the World Health Organization (WHO), anaemia affects 37% of women of reproductive age globally, with over 32 million women experiencing anaemia during pregnancy.

Postpartum anaemia is equally concerning—up to 80% of women may be anaemic within 48 hours after delivery. The leading cause is iron deficiency, which accounts for over 60% of anaemia cases globally. In sub-Saharan Africa, where the burden is especially high, up to 44% of pregnant women are anaemic, and between 20% and 37% continue to experience iron deficiency after childbirth.

The health risks of maternal anaemia are significant. Iron Deficiency Anaemia (IDA) is associated with poor pregnancy outcomes such as premature birth, low birth weight, intrauterine growth restriction, stillbirth, and even maternal death. The consequences extend into the postpartum period, affecting both maternal recovery and infant health.

Current global recommendations advise the use of 60mg of elemental iron daily during pregnancy until haemoglobin (Hb) reaches normal levels. While oral iron is widely used and affordable, it often causes gastrointestinal side effects like diarrhoea and abdominal discomfort, which limit adherence. Intravenous (IV) iron—especially Ferric Carboxymaltose (FCM)—has emerged as a more effective alternative, offering rapid correction of anaemia with fewer side effects.

Evidence from studies conducted in Nigeria, including the IVON trial, has shown that FCM is both safe and effective. It significantly reduced iron deficiency and IDA during pregnancy by 73% and 78%, respectively, compared to oral iron. Its single-dose administration, high bioavailability, and ease of use make it particularly well-suited for health systems with limited capacity.

In many Nigerian health facilities, anaemia in pregnancy is still managed primarily through iron and folic acid (IFA) supplements. However, moderate to severe anaemia often goes undiagnosed, and mild anaemia—which can progress into more severe forms—is frequently overlooked due to limited screening capacity.

Alongside FCM, Multiple Micronutrient Supplementation (MMS) is another promising intervention. MMS provides a combination of essential vitamins and minerals, including iron and folic acid, and has been shown to reduce the risk of low birth weight, preterm births, small-for-gestational-age babies, and stillbirths. Although MMS contains a lower dose of iron than IFA, its broader nutritional benefits offer significant advantages for maternal health, especially in resource-limited settings.

Building on evidence from IVON, IVON-PP, and IVON-IS, the CAPREMAN study will scale these interventions across a wider range of states and facilities in Nigeria. Key gaps identified—such as unclear treatment pathways, weak postpartum follow-up, and lack of standardized screening protocols—will be directly addressed.

By co-designing a comprehensive, evidence-based guideline that integrates Hemocue point-of-care testing, FCM, and MMS, CAPREMAN seeks to create a robust, scalable framework for preventing and managing maternal anaemia in Nigeria. This initiative has the potential to transform maternal health services and reduce anaemia-related complications across the country.