Iron supplements could end deaths at birth

Excessive bleeding after birth is the number one killer of women giving birth in Kenya.

Forty years have gone by since the Iron Folic Acid Supplementation (Ifas) was incorporated into what is known as the Focus Antenatal Care (Fanc) in the country’s health system. But the long period has not changed people’s lifestyle as supplementation intake remains low.

“Ifas reduces anaemia by boosting haemoglobin levels in the blood. This is critical especially for pregnant women, who are most affected by the condition,” explains Esther Kariuki of the Micronutrient Initiative.

Anaemia is caused by iron deficiency. Iron is important in carrying oxygen in the blood in the form haemoglobin.

If a pregnant woman is anaemic, explains Dr Kariuki, she is at an increased risk of death from excessive bleeding in childbirth.

In addition, says Kariuki, post-partum haemorrhage (excessive bleeding at birth), linked to anaemia, is the number one killer of women giving birth in Kenya.

A woman need only take a tablet of Ifas a day for the duration of her pregnancy. But up to 30 per cent of pregnant women do not take the supplementation, according to the Kenya Demographic Health Survey (KDHS) of 2008-09.

“We had challenges in the supply of supplements, something the Government has since moved to regularise,” notes Terry Wefwafwa, the deputy chief nutrition officer in the Ministry of Health.

Low intake of iron and folic has previously been attributed to regimen formulation, which required three iron tablets and one folic acid tablet to be taken daily, making adherence an issue. In addition, the medication was unpalatable given the high concentration of iron (200mg) in the tablet. It also made stool dark.

To encourage intake, the iron levels have since been brought down to 60mg, in accordance with World Health Organisation (WHO) recommendations.

In Kenya, pregnant women have the highest prevalence of anaemia – 41.6 per cent of all women visiting the hospital, according to the KDHS. Anaemia prevalence of more than 40 per cent in any cohort, observes Kariuki, is considered severe.

Maternal anaemia is associated with low birth weight (baby weighing less than 2.5kg). This puts newborns at risk of peri-natal (inside the womb) and neo-natal (within the first 28 days of birth) deaths.

What’s more, only 36 per cent of health facilities have the capacity to test for anaemia.

The lack of supplementation could lead to spina bifida – a neuro-tube defect – and hydrocephalus, which is characterised by the accumulation of serous fluid inside the infant’s head due to obstruction of the movement of cerebrospinal fluid.

Spina bifida may consign an individual to a wheelchair for life. A single uncomplicated operation is estimated to cost Sh40,000 according to Anne Mulwa, a paediatric nurse and the administrative director of BethanyKids Africa at the Kijabe Missions Hospital. Complicated cases can cost up to half a million shillings. An individual may require several operations.

On the other hand, hydrocephalus can be rectified by shunting – the inserting of a tube inside the child’s head to drain the fluid.

Improper fusion of the spinal cord during foetus development could lead to the condition.

“Even though the exact cause of the defect is unknown, folic acid deficiency and a family with a history of the condition could be a predisposing factor,” she explains.

Most of the 9,300 spina bifida operations conducted at BethanyKids in 2013 came from Coast and Nyanza regions. It is yet to be established why the two regions lead with these cases.

Emily Mbori, a 34-year-old mother of two knows only too well what it means to raise a child with hydrocephalus as a single parent. Her husband kicked her out of their matrimonial home following the birth of their second child in July 2005.

As a result, Mbori, who makes a living selling cereals alongside her mother in Kibuye Market, was compelled to move from the Mukoroshoni area of Mombasa to live with her mother and sisters in Mountain View Estate in Kisumu.

The boy is a slow learner and has also been diagnosed with epilepsy. Raising children with these conditions is difficult, especially if the parents do not have a source of income. In addition, they are traumatised by the community’s misguided beliefs and myths.

Spina bifida, hydrocephalus and clubfoot, among other conditions have been associated with iron and folic acid deficiency.

Esther Onana, the secretary of the Association for the Physically Disabled of Kenya at Jaramogi Oginga Odinga Teaching and Referral Hospital says they attend to an average of 100 cases every month.

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