Perceptions and experiences of intravenous iron treatment for anaemia in pregnancy in Malawi: a formative qualitative study

Abstract

Background: The study objective was to explore opinions, identify experiences, and describe perspectives on the acceptability of intravenous (IV) iron to treat anaemia in pregnancy and identify potential barriers and facilitators of introducing IV iron in the Malawian healthcare system. Methods: We conducted 15 in-depth interviews and two focus group discussions with pregnant women, and seven in-depth interviews with health workers at a community-based health centre in Blantyre and a tertiary hospital in Zomba. Results: Most women who used IV iron treatment during the second trimester of pregnancy reported feeling better and stronger after receiving the intervention. Women perceived that IV iron treatment worked faster and increased their haemoglobin count. However, cultural beliefs that IV iron treatment will cause miscarriage and the perception that study procedures involved Satanism and vampirism practices were barriers to acceptability. Health workers found IV iron treatment easy to administer because it is a single-dose treatment, simultaneously reducing the burden for pregnant women taking daily oral iron tablets. However, health workers expressed concerns about the costs and the need to train health workers before the large-scale implementation and integration of IV iron treatment into Malawi’s routine care. Conclusions: Despite the perceived concerns and challenges experienced in participating in the first IV iron infusion trial in Malawi, participants’ reflections suggest that IV iron infusion is acceptable for treating iron-deficiency anaemia in pregnancy. Participant advocate groups can offer a peer-to-peer education approach to sensitize and engage community members on the benefits of treatment and dispel concerns when the country contemplates integrating IV iron infusion for treating anaemia in pregnancy in Malawi.

Factors and strategies influencing implementation of an intravenous iron intervention for antenatal anaemia: A mixed‐methods systematic review

“…The scores of included studies varied widely using the QuaDS criteria—Smith‐Wade et al 38 = 92%, Manda‐Taylor et al 39 = 90%, Mayson et al 40 = 87%, Mohan et al 41 = 72%, Niveditha et al 42 = 54% and Divakar 43 = 38%. All studies performed strongly on a clear statement of research aims, a clear description of the research setting and target population, appropriate study design descriptions to address the stated aims and a description of the data collection methods.…”

“…Four studies were conducted in the LMICs, India 41–43 and Malawi, 39 and two studies were conducted in the HIC, Australia 38,40 . Most studies captured the perspective of healthcare providers, 38–40,42,43 with some studies capturing the perspective of pregnant women 39,41 . Four studies were observational 38,41–43 and two were qualitative 39,40 .…”

“…Most studies captured the perspective of healthcare providers, 38–40,42,43 with some studies capturing the perspective of pregnant women 39,41 . Four studies were observational 38,41–43 and two were qualitative 39,40 . Studies were conducted within the context of IV iron already being implemented in the public health system, apart from the study by Manda‐Taylor et al, 39 which was conducted in the context of a large randomised controlled trial of the effect of IV iron on anaemia in Malawian pregnant women (REVAMP) 22 …”

“…Four studies identified the high cost of IV iron intervention in pregnancy as a barrier to implementation 38–40,43 . In Mayson et al, 40 doctors discussed how they felt about the cost of the intervention— ‘It is more expensive… I mean not for the patient; they'll just pay the co‐payment…but for the pharmacy’ .…”

Comparing outcomes of ultra-low-cost hearing aids to programmable, refurbished hearing aids for adults with high frequency hearing loss in Malawi: A feasibility study

“…However, an item referring to hearing aid cost and an item referred to telephone use were removed as the hearing aids were issued at no cost in this study, and the LoCHAid is not suitable to use with the telephone. As all questionnaires were originally written and validated in English and the lack of hearing related outcome measures in the Malawian national language of Chichewa, the questionnaires were translated to Chichewa by a qualified Malawian translator with had previously translated for research studies (Manda-Taylor et al, 2022;Singal et al, 2021). Forward and backward translation processes were implemented (Hall et al, 2018), and the Malawian audiology team were involved to assisted to ensure accurate translation of audiology specific technical terms.…”