Testing real-world feasibility and acceptability of implementing an intravenous iron intervention for pregnant women with moderate and severe anaemia in Bangladesh: A demonstration project protocol
Authors: Prang Khic-Houy , Rahman A.M Quaiyum , Verbunt Ebony , Sabanovic Hana , Ahmed Shamim , Hasan Mohammed Imrul , Davidson Eliza M. , McLean Alistair R.D , Braat Sabine , Glover-Wright Clare , Carvalho Natalie , Pasricha Sant-Rayn , Hamadani Jena D. , Sarker Bidhan K. 
Published: January 2025

Background

Antenatal anaemia is a significant global health problem, affecting 48% of pregnant women in South Asia. The standard of care in Bangladesh is oral iron and folic acid supplementation. However, access and adherence to oral iron supplementation are subpar. An alternative treatment available to address antenatal anaemia is intravenous (IV) iron. Modern IV iron products are routinely used in high-income clinical settings, including primary and secondary care, to deliver a high dose of iron in a single short infusion. A demonstration project will be conducted to test the real-world feasibility and acceptability of implementing an IV iron intervention to treat pregnant women with moderate and severe anaemia in the primary healthcare setting of Bangladesh. In this protocol paper, we describe the implementation research program that will guide the development, implementation, and evaluation of an IV iron intervention in real-world settings.

Methods

We will use implementation science frameworks to guide the demonstration project. The implementation research program includes three phases: 1) a formative phase in preparation for the implementation of an IV iron intervention involving a review, qualitative research, and readiness assessment; 2) the development and implementation of IV iron intervention care pathways and strategies to support the uptake and delivery of the intervention using a participatory research approach; and 3) a process evaluation of IV iron intervention care pathways and strategies involving qualitative and quantitative assessment of the costs, processes and contextual factors affecting its implementation.

Discussion

Modern IV iron products present a novel opportunity to reduce the disproportionate burden of antenatal anaemia in low-and-middle income countries (LMICs). The demonstration project will ascertain whether an IV iron intervention can be effectively introduced into routine antenatal care in Bangladesh. The extent to which it is considered an acceptable treatment by pregnant women with moderate or severe anaemia receiving the intervention, healthcare providers delivering the intervention, and policymakers will be determined. If successful, understanding how an IV iron intervention will be implemented across several care pathways and its associated costs will inform the scalability of an IV iron intervention in the primary healthcare system of Bangladesh and provide implementation guidance in other LMICs.

Contributions to the literature

Modern IV iron products can quickly restore iron levels, offering a new opportunity to address antenatal anaemia in LMICs.

The demonstration project in Bangladesh will involve pregnant women, local communities, and healthcare workers to co-design anaemia care pathways and strategies for implementing an IV iron program in primary care.

The demonstration project provides access to an alternative treatment, trains healthcare workers, and builds local capacity for anaemia management.

Testing and refining anaemia care pathways and strategies in a real-world setting will offer insights for scaling and adapting these approaches to other regions or population, creating a template for similar initiatives.