Assessment of adherence to iron supplementation among pregnant women in the Yaounde gynaeco-obstetric and paediatric hospital.

INTRODUCTION: Anemia is a global problem affecting 41.8% of pregnant women. Iron deficiency is the leading cause during pregnancy. Its prevalence among Cameroonian pregnant women was estimated at 50.9% in 2004. Few studies have evaluated women's adherence to iron supplementation prescribed during pregnancy. We carried this study in order to evaluate the rate of adherence to iron supplementation and its determinants during pregnancy. METHODS: The study was cross-sectional descriptive, on postpartum women at the Gynaeco-Obstetric and Pediatric Hospital of Yaoundé during three months. Adherence was measured using the 8-item Morisky Medication Adherence Scale (MMAS-8). The total score was classified as low, moderate and high adherence. RESULTS: For a total of 304 recruited women, 16.4% were highly compliant, 27.6% moderately compliant, while 56% were low compliant with iron supplementation during pregnancy. The reasons for non-adherence were side effects (19.7%), forgetting (70.1%) and inaccessibility of iron supplements (20.1%). Up to 85 (or 28%) women found it boring to take medication daily. Women with no side effects were about thrice most likely to adhere to the iron supplementation than those with side effects: OR = 3.73 [2.43-5.71]; P = 0.04. Women aged 25 years and above were more likely to be non-compliant to iron supplementation than those youngers: OR = 0.40 [0.31-0.88]; P = 0.02. CONCLUSION: To improve adherence to antenatal iron supplementation, it is important to increase communication for behavior change and counseling before or during antenatal care. Forgetting being the main reason for non-adherence, women should keep their iron in a place of easy access.

Current and upcoming erythropoiesis-stimulating agents, iron products, and other novel anemia medications.

Treatment for anemia has come a long way in the last 20 years since the first recombinant human erythropoietins were licensed for the management of anemia in chronic kidney disease. The first-generation epoetins were succeeded by the development and production of a longer-acting erythropoietin (EPO) analog, darbepoetin alpha, which allowed less frequent dosing, usually once weekly or once every 2 weeks. More recently, another EPO-related molecule has been manufactured called Continuous Erythropoietin Receptor Activator with an even longer half-life, and although for patent reasons this is not available in the United States, it is licensed and is already being used in Europe. Other molecules are in development or are becoming licensed in Europe, including biosimilar epoetin products/follow-on biologics, and elsewhere in the world there are cheaper-production "copy" epoetins. Indeed, it is estimated that up to 80 such products may be sold in countries with less stringent regulatory control of pharmaceutical products. Two different biosimilar epoetins have already been licensed in Europe, one under 2 different brand names and one under 3 different brand names, and others may follow. Hematide is a synthetic peptide-based EPO receptor agonist that, interestingly, has no structural homology with EPO, and yet is still able to activate the EPO receptor and stimulate erythropoiesis. This agent is currently in phase III clinical trials. Research continues for orally active antianemic therapies, and several strategies are being investigated, although none is imminently available. Two new intravenous iron preparations have recently been developed, one in the United States (Ferumoxytol; AMAG Pharmaceuticals, Inc., Cambridge, MA) and one recently licensed in Europe (ferric carboxymaltose [Ferinject; Vifor Pharma, Zurich, Switzerland]). In conclusion, the development of effective therapies for the treatment of anemia has been a highly active field, both scientifically and economically, over the last two decades.