Maternal Anemia: Technologies for Health Consultative Meeting - MNCH Pathways

In countries where anemia prevalence during pregnancy is high (≥40 percent), women should continue taking IFA for three months after delivery. Several factors can limit the effectiveness of iron supplementation interventions, including inadequate political support, lack of program integration with insufficient bundling of interventions, poor supply management and inadequate supplies, low utilization and lack of demand for antenatal care, insufficient adherence counseling, non-adherence among mothers, cultural issues and taboos, inadequate community involvement, weak systems for program monitoring and evaluation, and lack of convincing evidence of effectiveness. Research from eight countries found that a primary reason women were not taking IFA was because they had not received iron pills through the health system. This was due to a number of factors, including women's late attendance for antenatal care and lack of supplies. Most women took their IFA when they had adequate counseling. For practical and cultural reasons, women preferred pills that were small, red, film-coated, and with protective packaging. Iron-fortified foods include salt, sugar, rice, flour, milk, coffee/tea, juice, water, condiments, cereals, biscuits, and bread rolls, among many others. The World Health Organization recommends the use of iron-fortified salt, which can be double fortified with iron as well as iodine. Iron-fortified flour is also commonly used, and it is often fortified with zinc, folic acid, and other B vitamins such as niacin and riboflavin. Several technologies have been developed to improve the delivery of iron supplements and fortification of foods. The gastric delivery system is a technology that incorporates ferrous sulfate into a hydrocolloid matrix that becomes buoyant on exposure to gastric secretions, allowing for prolonged periods of iron absorption. Ultra Rice and NutriRice are two technologies that use rice fortification to deliver micronutrients, including iron, zinc, and folic acid. Sprinkles is a microencapsulated micronutrient powder that contains iron, folic acid, and calcium, and is packaged in individual single-dose sachets for easy use.