Towards ending the scourge of anaemia in pregnancy in Nigeria

The studies

The IVON TRIAL birthed many studies. The studies were conducted in Lagos and Kano State, the two most densely populated states in Nigeria with significant differences in the sociodemographic and cultural attributes of the women. It looked into who, where, why, how, and what regarding anaemia in pregnancy in Nigeria. According to Dr Ochuwa, “in the first study, we found that 4 out of every 10 pregnant women in Nigeria who had anaemia of moderate or worst severity, had iron deficiency. We also found that diet played a role; consuming soybeans three to four times a week or eating edible kaolin clay almost every day predisposes to a higher risk of having iron deficiency anaemia, whereas eating green leafy vegetables reduces the risk for iron deficiency anaemia by over 60%. Now, we have a better idea how to counsel our pregnant women and advise them on things to avoid.”  

The IVON TRIAL found that taking only one dose of a new intravenous medication called “ferric carboxymaltose” during pregnancy worked faster and better than taking iron tablets three times every day till delivery. For anaemic women who lacked iron, as delivery draws near, giving iron through the vein reduces the risk of being iron deficient or of having iron deficiency anaemia by over 70%. The intravenous iron is as safe as the tablet. Most exciting is that a woman only needs to spend an additional 45-60 minutes in the hospital without formal admission to receive the intravenous iron. Dr Ochuwa says: “the common reasons why some pregnant women remain anaemic despite treatment is because they often forget to take the tablets, or do not tolerate them because of side effects like nausea, vomiting or diarrhoea or they don’t just like the smell or taste of it. Now we have identified an effective and safe alternative and can help our pregnant women better.” Every year many women die as a result of anaemia or its complications, as it can predispose a pregnant woman to a higher risk of having a preterm birth or of excessive bleeding at or soon after childbirth, or even to heart failure. In addition, the baby of an affected woman may fail to achieve the full growth or die in the womb. “Ferric carboxymaltose is new to us here in Nigeria because it was never available before this research, and we know it is the same situation in most parts of sub-Saharan Africa. Now we have better knowledge to help pregnant patients.”

Challenges of conducting clinical trials

“Nothing in life goes without a challenge” says Dr Ochuwa. “The IVON TRIAL was an eye-opener to many challenges associated with clinical trials in low-middle-income countries. During the clinical trial, I was able to understand the dynamics involved, the interplay between research and culture, transcultural barriers to research, and ways to overcome these challenges. We identified the need for male partner involvement in research into women’s health. We identified fear of potential harm as a major problem, especially for research on pregnant women where two lives are involved. Proper counselling did the trick in the IVON TRIAL. People need to understand that it is only through research we can achieve scientific progress.”

Reflections on doctoral training

Ochuwa and Opeyemi are doctoral students at the Department of Global Public Health, Karolinska Institutet, Sweden, and also fortunate to be light PhD students at Institute of Tropical Medicine, Belgium; both funded from the IVON TRIAL grant. Dr Ochuwa says “My doctoral training has expanded my knowledgebase in research and taught me how to do research correctly. It expanded my skills in clinical trials, data analysis, project management, and presentation of research findings to large and diverse audience in difference ways. And it has increased my network.” According to Opeyemi, “The journey has been challenging and inspiring, pushing me to integrate my academic pursuits with my professional and personal responsibilities. However, with my supervisors' unwavering support and guidance, I have honed my research skills, expanded my horizons, and they equipped me with resilience and optimism, fueling my passion for research and academic growth.” A word of advice to upcoming doctoral students from Dr Ochuwa: “You need to be committed, persistent, persevere, have the ability to withstand stress and be willing to learn new skills to achieve a successful doctoral education. Talk to colleagues, ask questions, no one knows it all, this was my approach. Your supervisors are there to guide you, but they are not to do it for you; they are training you to be an independent researcher and this you must achieve to bag your doctoral degree. ”.