Patient outcomes in a Type 1 hybrid implementation research on intravenous iron for anaemia in pregnancy in Nigeria: a mixed methods study.

IntroductionIron deficiency anaemia (IDA) is a common cause of anaemia in pregnancy (AIP), which is highly prevalent in low-and middle-income countries (LMICs). Evidence from LMICs indicates that intravenous (IV) iron formulations such as ferric carboxymaltose (FCM) are safe and effective alternatives to oral iron, and there is emerging data on implementation outcomes. Client outcomes are important additional considerations for successful scale-up of new interventions. We assessed patient experiences and satisfaction among women receiving IV versus oral iron for AIP in Nigeria. MethodsThis mixed-methods study was nested in a hybrid effectiveness-implementation trial that enrolled 1,056 pregnant women at 20-32 weeks gestational age. Participants were randomised to receive either FCM or oral ferrous sulphate (FS). Twenty-five percent of participants were sequentially sampled for interviewer-administered exit surveys and 66 women who received IV iron were purposively selected for in-depth interviews at last study visit. Quantitative data from the two treatment groups were evaluated using the Chi-squared test, while qualitative data were analysed thematically. ResultsWe surveyed 252 participants; 128 treated with FCM and 124 with FS. Significantly higher proportions of the FCM (82.8%) vs FS group (63.7%) perceived their treatment to be "easy" (p = 0.006). Treatment was rated "excellent" by 80.5% of the FCM group compared to 62.1% of the FS group (p = 0.005). Women receiving FCM were more likely to recommend their treatment to a family member than the FS group (70.3% vs 50.0%, p= 0.018). The positive perception, experience and satisfaction with FCM was buttressed in the qualitative findings. ConclusionPositive patient experiences and satisfaction with IV iron positions this formulation as a viable alternative to oral iron for AIP in Nigeria. These patient-reported findings support available evidence on service and implementation outcomes and further support IV iron scale up in Nigeria and other African settings.