Maternal and Infant Lives 34 TH SCIENTIFIC CONFERENCE OF NUTRITION - PowerPoint PPT Presentation

Tackling Maternal Anaemia Saves Maternal and Infant Lives 34 TH SCIENTIFIC CONFERENCE OF NUTRITION SOCIETY OF MALAYSIA Dr Faridah bt Abu Bakar Public Health Physician & Director Family Health Development Division

Outline Current situation of anaemia and maternal anaemia • Current indicators and target • Impact of maternal anaemia • Strategies to tackle maternal anaemia • Challenges • Way forward •

WHAT IS Anaemia ? Anaemia is a condition in which the number of red blood cells (and consequently their oxygen- carrying capacity) is insufficient to meet the body’s physiologic needs. MATERNAL ANAEMIA Anemia in pregnancy is defined as a hemoglobin concentration of less than 11 g/dL in venous blood.

The GLOBAL Burden of Anaemia  Anaemia is the world’s second leading cause of disability and thus one of the most serious global public health problems (WHO)  Global health problem that affects about 500 million women in 2011 ◦ 496 million non-pregnant women ◦ 32 million pregnant women Global, regional and national trends in haemoglobin concentration and prevalence of total and severe anaemia in children and pregnant women & non- pregnant women for 1995-2011: a systematic analysis of population representative data, The Lancet 2013  The most recent estimates for 2016 indicate that anaemia affects 33% of women of reproductive age globally (about 613 million women between 15 and 49 years of age)

Why does ANAEMIA matter? Impaired development and learning for children Fatigue and lethargy Impaired economic productivity Reduce Impaired individual’s health and wellbeing quality of life Impair physical capacity and work performance

Prevalence of Anaemia AMONG FEMALE in Malaysia Women of reproductive Pregnant women – at any age (15-49 years old) point during pregnancy (NHMS 2015) 34.7% 29% (NHMS 2016) Milman N (2015) – Iron Deficiency And Anaemia In Milman N (2015) – Iron Deficiency And Anaemia In Pregnant Women in Malaysia – Still a Significant and Pregnant Women in Malaysia – Still a Significant and Challenging Health Problem: J. Preg Child Health 2: Challenging Health Problem: J. Preg Child Health 2: 168. 168. doi:10.4172/2376-127X.1000168 doi:10.4172/2376-127X.1000168 38%-42 % 30.0%

Why does ANAEMIA matter? – Girls and women at higher risk Anaemic girls/women enters their reproductive age in an iron depleted state. Chethan et.al. 2017 - A Review On Anemia In Pregnancy Condition

Iron requirements in women throughout life-cycle *100 mg/day 11 mg/ 9 mg/ day 6 mg/ day 9 mg/ day 11 mg/ day 33 mg/ day 29 mg/day ( non-anemic) day Recommended Nutrients Intake For MALAYSIA, 2017 Note: Based On 10% Bioavailability

WHAT CAUSES ANAEMIA IN PREGNANCY? Nutritional iron deficiency anemia (IDA) is the commonest cause of anaemia in pregnancy Parasites Nutritional Acute or chronic blood loss Physiological deficiencies -GI bleeding adaptation -heavy menses • An overall prevalence rate of anaemia in pregnant mothers 57.4% - a study in Jerteh, Terengganu Chronic diseases • Poor compliance to haematinic intake by Haemoglobinopathies Infections -renal failure -Sickle cell -Malaria mothers was significantly associated with -neoplasia -Thalassaemia -HIV anaemia by the OR of 4.571 Nik Rosmawati et al, 2012 - The Rate and Risk Factors for Anaemia among Pregnant Mothers in Jerteh Terengganu, Malaysia NH Nik Rosmawati1

• Increased risk of maternal death • Increased risk of PPH, decreased ability to tolerate blood loss Mother • Increased risk of sepsis • Heart failure during postpartum • decreased quality of life- increased fatigue, breathlessness, palpitations and infections Impact of • greater stress and depression • less responsive, more controlling and more Maternal “negative” towards their infants  negative implications for infant development Anaemia • Increased perinatal morbidity and mortality • SGA, LBW, Preterm birth • Increased risk of developing diabetes and cardiac Infant disease later in life • Lower iron status in infants • Impaired cognitive developments

Strategies to tackle maternal anaemia Quality Assurance Indicator ◦ National Indicator Approach (NIA) – adopted as QAP in 2013 ◦ State/District Specific Approach ◦ Prevention and control programme for anaemia ◦ Percentage of anaemia among pregnant women at 36 weeks Family planning programme ◦ for birth spacing using modern contraceptive, exclusive breastfeeding Health Promotion to mothers/patient ◦ Healthy diet advice ◦ Cooking demonstration ◦ Self-hygiene

National Indicator Approach for Maternal Anemia Quality Assurance Programme - National Indicator • Approach (NIA) Indicator : Percentage of anemic mothers • (Hb<11gm%) at 36 weeks of gestation

NIA: Percentage of women with anaemia at 36 weeks gestation 35 32.6 28.9 30 26.7 24 25 21.5 20.8 20 16.2 % 14 15 11.8 9.1 10 8.2 7 6.4 6.4 5 0 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 Year Health Informatics Centre MOH 2005 - 2018

Pe Perce rcenta ntage ge of women of women w with ith an anae aemia mia (Hb<11g (Hb<1 1gm%) m%) at 3 at 36 we 6 week eks of ge s of gesta station tion : : Malay Malaysia sia 25.0 20 2017 17 & 201 & 2018 19.2 20.0 16.4 13.8 15.0 12.3 12.0 10.9 10.4 10.2 10.0 9.3 9.3 9.2 9.2 10.0 7.8 6.9 6.8 6.5 6.4 6.4 6.2 6.1 5.8 5.5 5.3 5.3 5.0 5.0 4.8 4.7 4.7 4.5 4.5 4.4 4.2 3.8 5.0 3.7 3.6 3.2 0.0 Sem.Mal Malaysia P'lis Kdah P.Pnang Perak KL P'jaya S'gor N9 Mlaka Jhor Phang Tganu Klntan Lbuan Sbah Srwk M'sia aysia Timur 2017 19.2 4.5 5.0 6.1 5.0 7.8 4.8 9.2 12.0 4.7 4.7 3.6 6.2 6.5 10.4 10.0 6.4 5.5 10.2 2018 16.4 4.4 4.5 9.2 3.8 6.8 5.3 12.3 13.8 3.7 4.2 3.2 5.3 9.3 10.9 6.9 6.4 5.8 9.3 2017 2018

Strategies to tackle maternal anaemia Pre-pregnancy care ◦ Intervention of anaemia among women of reproductive age (adolescents and menstruating women) before embarking on pregnancy Supplementations for pregnant women and postpartum mothers ◦ Intermittent iron and folate supplementations among pregnant women even with normal haemoglobin level Comprehensive management of anemia in pregnancy and postpartum ◦ Multidisciplinary involvement ◦ Close monitoring of haemoglobin level throughout pregnancy and postnatal, and among family planning users National Control and Prevention Programme of Thalassemia ◦ To combat non-nutritional anaemia

Percentage of women with anaemia during 1 st Antenatal Visit 2009-2015 80 66.9 70 65.1 60 50 40 % 31.1 29.3 30 22.1 16.6 20 14.6 10 0 2009 2010 2011 2012 2013 2014 2015 YEAR National Obstetrics Registry (Malaysia) 2009 – 2015

Percentage of women with anaemia during admission for delivery 2009-2015 30 25.2 24.3 25 20 15 13 % 10 7.3 6.08 5.6 5.3 5 0 2009 2010 2011 2012 2013 2014 2015 Year National Obstetrics Registry (Malaysia) 2009 – 2015

Percentage of Anaemia at Booking 1 , 36 Weeks 2 POG & at Delivery 1 80 66.9 Booking 70 65.1 36 weeks 60 Delivery 50 % 40 31.1 29.3 30 25.2 24.3 22.1 21.5 20.8 16.6 20 16.2 14.6 14 13 11.8 9.1 8.2 7.3 10 6.08 5.6 5.3 0 2009 2010 2011 2012 2013 2014 2015 1 National Obstetrics Registry 2009 – 2015 2 Health Informatics Centre MOH 2009-2015

Early Antenatal Booking (less than 12 weeks POG) 2011-2018 83.6 82.51 79.1 78.4 75.6 75.6 71.2 66.2 target >70% Early ANC (NHMS2016) 69.1% : 1 st Trimester Milman N (2015) – Iron Deficiency And Anaemia In Pregnant Women in 28.5% : 2 nd Trimester Malaysia – review paper – concluded that …’efforts should focus on better implementation of early oral iron and vitamin prophylaxis, early diagnosis of anaemia and on increasing the low compliance women to the prophylaxis program” 2011 2012 2013 2014 2015 2016 2017 2018p Source of data : Health Informatics Centre, MOH

No. of clinic equipped with : - Haematology analyser : 660 (61%) - Heamoglobin Analyser (100%) Quality Assurance for Haematology Analyser: - Internal Quality Control (IQC) - External Quality Assurance (EQA)

Percentage of Anaemia Detected among Form 4 (16yr old) Thalassaemia Screening 2016 - 2018 25 Percentage of Anemia detected 19.3 20 17.8 15.8 15 10 5 3.2 2.8 2.7 0 2016 2017 2018 Male students 2.8 2.7 3.2 Female Students 15.8 17.8 19.3

Percentage Anaemia detected by Gender by State 2017 30.0 25.0 Percentage 20.0 15.0 10.0 5.0 0.0 Pulau WP N Tere WP Perlis Keda Perak Selan WPK Mela Johor Paha Kelan Saba Sara Mala Pinan Putra Semb ngga Labu h gor L ka ng tan h wak ysia g jaya ilan nu an Male Students 4.3 2.5 3.0 3.7 3.2 3.4 2.8 4.8 3.1 2.9 2.2 2.8 2.9 3.1 1.8 1.1 2.9 Female Students 23.5 18.7 19.1 18.6 20.2 17.5 19.8 22.8 19.2 19.4 17.2 14.5 16.0 22.2 13.1 26.0 18.6

Prevalence of Anaemia AMONG FEMALE in Malaysia (various years and sources) 17.8% 34.7% 14.6% 8.2% 5.3% Pregnant Anaemia women at 36 Female Anaemia Women of at weeks in Adolescent at booking government delivery reproductive (NOR) 2015 (16 year old clinics (NOR 2015) age school girls) (PIK 2015) (NHMS 2015) (Thalassemia Screening Program 2017) 29% Pregnant women (NHMS 2016)