Maternal anaemia care in Kano state, Nigeria: an exploratory qualitative study of experiences of uptake and provision

Background: Maternal anaemia (anaemia in pregnancy, childbirth, and the postpartum period) remains a persistent challenge, particularly in Kano State, Nigeria, which has the highest prevalence of maternal anaemia globally, at 72%. Methods: We conducted a qualitative study in Murtala Muhammad Specialist Hospital in Kano State, Nigeria. We aimed to identify factors constraining uptake and provision of maternal anaemia care, exploring perspectives across different stakeholders. We carried out 10 key informant interviews with policymakers and hospital managers, 28 in-depth interviews with healthcare providers and pregnant women using antenatal services and four focus group discussions with pregnant women’s husbands and mothers-in-law. Data were analysed thematically. Results: Issues with provision include a lack of provider training and guidelines specific to maternal anaemia and blood transfusion, insufficient staff to meet increasing demand, and inadequate resources. Issues with uptake include the inability to afford informal user fees, distrust in health services and the blood transfusion process, and a lack of understanding of the causes, consequences, and treatment for anaemia, resulting in poor uptake of care and adherence to treatment. Conclusions: This study recommends the implementation of standardized guidelines and training sessions to better support healthcare providers in offering quality services and increasing funding allocated to supporting maternal anaemia care. Education initiatives for service users and the public are also recommended to build public trust in health services and to improve understanding of maternal anaemia.

[1]  A. Tura,et al.  Compliance with Iron and Folic Acid Supplementation (IFAS) and associated factors among pregnant women in Sub-Saharan Africa: A systematic review and meta-analysis , 2021, PloS one.

[2]  P. Ramachandran Prevention & management of anaemia in pregnancy: Multi-pronged integrated interventions may pay rich dividends. , 2021, The Indian journal of medical research.

[3]  S. Kimani,et al.  Effect of a community-based approach of iron and folic acid supplementation on compliance by pregnant women in Kiambu County, Kenya: A quasi-experimental study , 2020, PloS one.

[4]  T. Alaro,et al.  Hidden Costs of Hospital-Based Delivery Among Women Using Public Hospitals in Bale Zone, Southeast Ethiopia , 2019, Journal of primary care & community health.

[5]  S. Zeger,et al.  Development of summary indices of antenatal care service quality in Haiti, Malawi and Tanzania , 2019, BMJ Open.

[6]  P. Suchdev,et al.  Anemia epidemiology, pathophysiology, and etiology in low‐ and middle‐income countries , 2019, Annals of the New York Academy of Sciences.

[7]  A. Ahmed,et al.  Determinants of voluntary blood donation among adults in communities of north central region of Nigeria , 2019, Research Journal of Health Sciences.

[8]  Maimbolwa C. Margaret,et al.  Evaluation of quality of antenatal care services in selected healthcare centres of Mumbwa and Lusaka districts of Zambia: Pregnant womens perspectives , 2019, International Journal of Nursing and Midwifery.

[9]  T. Akande,et al.  Knowledge of blood donation among adults in north-central Nigeria , 2019 .

[10]  A. M. Lupindu,et al.  Knowledge and Attitude of Pregnant Women in Rural Tanzania on Prevention of Anaemia. , 2018, African journal of reproductive health.

[11]  J. Thakur,et al.  Cost effectiveness of mHealth intervention by community health workers for reducing maternal and newborn mortality in rural Uttar Pradesh, India , 2018, Cost Effectiveness and Resource Allocation.

[12]  P. Lumbiganon,et al.  Risk of maternal mortality in women with severe anaemia during pregnancy and post partum: a multilevel analysis. , 2018, The Lancet. Global health.

[13]  Marleen Temmerman,et al.  Provision of medical supply kits to improve quality of antenatal care in Mozambique: a stepped-wedge cluster randomised trial , 2017, The Lancet. Global health.

[14]  E. Barasa,et al.  Examining the Implementation of the Free Maternity Services Policy in Kenya: A Mixed Methods Process Evaluation , 2017, International journal of health policy and management.

[15]  C. Homer,et al.  The operations of the free maternal care policy and out of pocket payments during childbirth in rural Northern Ghana , 2017, Health Economics Review.

[16]  H. Ullum,et al.  Blood donors' perceptions, motivators and deterrents in Sub‐Saharan Africa – a scoping review of evidence , 2017, British Journal of Haematology.

[17]  S. Subramanian,et al.  Factors associated with compliance to recommended micronutrients uptake for prevention of anemia during pregnancy in urban, peri-urban, and rural communities in Southeast Nigeria , 2016, Journal of Health, Population and Nutrition.

[18]  N. Onyeneho,et al.  Anaemia is typical of pregnancies: capturing community perception and management of anaemia in pregnancy in Anambra State, Nigeria , 2016, Journal of Health, Population and Nutrition.

[19]  A. Delpisheh,et al.  Maternal Anemia and Pregnancy outcomes: a Systematic Review and Meta-Analysis , 2016 .

[20]  S. Straus,et al.  Low- and middle-income countries face many common barriers to implementation of maternal health evidence products. , 2016, Journal of clinical epidemiology.

[21]  A. Portela,et al.  What Prevents Quality Midwifery Care? A Systematic Mapping of Barriers in Low and Middle Income Countries from the Provider Perspective , 2016, PloS one.

[22]  Jeevan Acharya Are Free Maternity Services Completely Free of Costs? , 2015, Osong public health and research perspectives.

[23]  A. Ekanem,et al.  Maternal knowledge, food restriction and prevention strategies related to anaemia in pregnancy: a cross-sectional study , 2015 .

[24]  A. Malata,et al.  Midwifery and quality care: findings from a new evidence-informed framework for maternal and newborn care , 2014, The Lancet.

[25]  E. Ugwu,et al.  Determinants of compliance to iron supplementation among pregnant women in Enugu, Southeastern Nigeria. , 2014, Nigerian journal of clinical practice.

[26]  Jai K Das,et al.  Can available interventions end preventable deaths in mothers, newborn babies, and stillbirths, and at what cost? , 2014, The Lancet.

[27]  Gretchen A. Stevens,et al.  Global, regional, and national trends in haemoglobin concentration and prevalence of total and severe anaemia in children and pregnant and non-pregnant women for 1995–2011: a systematic analysis of population-representative data , 2013, The Lancet. Global health.

[28]  Bismark Dwumfour-Asare,et al.  Anaemia awareness, beliefs and practices among pregnant women: A baseline assessment at Brosankro community in Ghana. , 2013 .

[29]  C. Pell,et al.  Social and Cultural Factors Affecting Uptake of Interventions for Malaria in Pregnancy in Africa: A Systematic Review of the Qualitative Research , 2011, PloS one.

[30]  G. Lindmark,et al.  How good is the quality of antenatal care in the Colombo district of Sri Lanka in diagnosing and treating anaemia? , 2011, Quality in primary care.

[31]  B. Audu,et al.  Anaemia in pregnancy at booking in Gombe, North-eastern Nigeria , 2008, Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology.

[32]  K. Osungbade,et al.  Content of antenatal care services in secondary health care facilities in Nigeria: implication for quality of maternal health care. , 2007, International journal for quality in health care : journal of the International Society for Quality in Health Care.

[33]  Suhaila H Khan,et al.  Free does not mean affordable: maternity patient expenditures in a public hospital in Bangladesh , 2005, Cost effectiveness and resource allocation : C/E.

[34]  G. Lindmark,et al.  Quality assessment of the antenatal program for anaemia in rural Tanzania. , 2002, International journal for quality in health care : journal of the International Society for Quality in Health Care.