{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T06:26:09Z","timestamp":1792650369107,"version":"4.5.0"},"update-to":[{"DOI":"10.12688\/gatesopenres.13631.1","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2024,3,8]],"date-time":"2024-03-08T00:00:00Z","timestamp":1709856000000}},{"DOI":"10.12688\/gatesopenres.13631.2","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2024,3,8]],"date-time":"2024-03-08T00:00:00Z","timestamp":1709856000000}},{"DOI":"10.12688\/gatesopenres.13631.3","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2024,3,8]],"date-time":"2024-03-08T00:00:00Z","timestamp":1709856000000}}],"reference-count":36,"publisher":"F1000 Research Ltd","license":[{"start":{"date-parts":[[2024,3,8]],"date-time":"2024-03-08T00:00:00Z","timestamp":1709856000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["OPP1169939"],"award-info":[{"award-number":["OPP1169939"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"publisher","award":["1158696"],"award-info":[{"award-number":["1158696"]}],"id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["gatesopenresearch.org"],"crossmark-restriction":false},"short-container-title":["Gates Open Res"],"abstract":"<ns3:p>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 than oral iron tablets 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\u2019s routine care. Conclusions Despite the perceived concerns and challenges experienced in participating in the first IV iron infusion trial in Malawi, participants\u2019 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.<\/ns3:p>","DOI":"10.12688\/gatesopenres.13631.4","type":"journal-article","created":{"date-parts":[[2024,3,8]],"date-time":"2024-03-08T11:50:08Z","timestamp":1709898608000},"page":"66","update-policy":"https:\/\/doi.org\/10.12688\/gatesopenres.crossmark-policy","source":"Crossref","is-referenced-by-count":10,"title":["Perceptions and experiences of intravenous iron treatment for anaemia in pregnancy in Malawi: a formative qualitative study"],"prefix":"10.12688","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8149-0897","authenticated-orcid":false,"given":"Lucinda","family":"Manda-Taylor","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6737-2218","authenticated-orcid":false,"given":"Macdonald","family":"Kufankomwe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gertrude","family":"Chatha","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Effie","family":"Chipeta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisabeth","family":"Mamani-Mategula","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8358-4448","authenticated-orcid":false,"given":"Martin N.","family":"Mwangi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Magaret","family":"Kelaher","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khic-Houy","family":"Prang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1014-0432","authenticated-orcid":false,"given":"Ricardo","family":"Ata\u00edde","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sant-Rayn","family":"Pasricha","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kamija Samuel","family":"Phiri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2560","published-online":{"date-parts":[[2024,3,8]]},"reference":[{"key":"ref-1","doi-asserted-by":"publisher","DOI":"10.1093\/cdn\/nzaa053_035","article-title":"Global, regional, and national prevalence of anemia and its causes in 204 countries and territories, 1990-2019.","volume":"4","author":"W Gardner","year":"2020","journal-title":"Curr Dev Nutr."},{"key":"ref-2","doi-asserted-by":"publisher","first-page":"e16-e25","DOI":"10.1016\/S2214-109X(13)70001-9","article-title":"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\u20132011: a systematic analysis of population-representative data.","volume":"1","author":"G Stevens","year":"2013","journal-title":"Lancet Glob Health."},{"key":"ref-3","first-page":"232-240","article-title":"Association 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G., University College of Medical Sciences and Guru Teg Bahadur Hospital, New Delhi, Delhi, 21 Jun 2023, version 2, 1 approved, 1 approved with reservations","URL":"https:\/\/gatesopenresearch.org\/articles\/6-66\/v2#referee-response-33726","order":1,"name":"referee-response-33726","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"<b>Lucinda Manda-Taylor<\/b>; \n<i>Posted: 24 Jun 2023<\/i>; Dear Dr Radikha  Thank you very much for your peer review. We appreciate your questions and queries and hope to respond to them satisfactorily. &nbsp;  Could the authors provide the demographic details of the women who participated in the IDIs? Was the perception in some way related to their education status?   Response: The demographic details of the pregnant women who participated in the IDIs are provided in Table 1. However, what was not collected in the education status of these pregnant women, and therefore no inferences can be drawn from their perception of the intervention. &nbsp;  Were the perceptions also related to the experiences witnessed by these women among peers who had received this treatment?   Response: Only one woman reported having been influenced by her peers, and we have included this in the results section under strategies to consider when introducing IV iron infusion, and it relates well to the discussion on conditions supporting the acceptability of IV iron infusion specifically as we discuss the usefulness of participant advocates.  \u201cYes, I was very happy because I wanted to be given IV iron therapy and experience what my friend told me. I believed that my health would be improved as soon as possible, and indeed, it happened as I thought\u201d (IDI PW 30 ZA). &nbsp;  Were the multiparas\/others asked about IDAs in previous pregnancies\/events? Details would be helpful.   Response: Yes, seven women had previous pregnancies, n=4 had one previous pregnancy, and n-3 had multiple previous pregnancies. These women were asked to compare their experiences between oral iron tablets and IV iron infusion. Most reported preferring IV iron infusion because it is a single-dose administration that rapidly restores their iron stores.  \u201cThis is the best and very good pregnancy I have ever had. You know, \u201cIn all the pregnancies I have had, I have been having challenges as I was experiencing several illnesses you talk of swollen of the legs, my skin was becoming pale, having frequent dizziness and losing appetite to food and my husband I was always feeling sorry for me every time I became pregnant, but with this pregnancy, since the time I was given IV iron therapy I am a strong woman and healthier than ever\u201d so I am so happy with this drug. I have seen that, in the past two pregnancies, I was falling sick more often, unlike in this pregnancy. Since receiving IV iron therapy, I am not feeling ill anymore. Even my friends are witnessing this by saying, &quot;\n<i>i-i-i-I Mimba zina zija ndiye mumavetsa chisoni<\/i>\n<i>\u201d<\/i> (We felt for you during your previous pregnancies because you had to deal with problems). However, now you look good, are not falling sick, and are still doing household chores as if you are not pregnant\u201d (IDI PW 30 ZA).  We will add previous pregnancy experiences to conditions supporting the administration of IV iron infusion. &nbsp;  Were family members supportive of this treatment?    Response: All pregnant women were asked who supported their decision-making process. Most women reported that their husbands helped them decide to enter the research study.  One woman had this to say,  \u201cMy husband assisted me in deciding to participate in this study. When I told him that I was anaemic, he encouraged me to participate in the program because, looking at that I am pregnant, there was no way we could do but participate in the program. Even if some say against us, a new program always has challenges. We could not proceed with participating in this study, but because my husband and I agreed not to listen to people, I am still in this study\u201d (IDI PW-26-ZA)  \u201cThey wanted to see to what extent the medication would help\u201d (P4-FGD-PW-BT).  One woman informed us that initially, her husband was unsupportive, but because he had attended her ANC visit and received information from the nurses during the recruitment and enrolment period.  \u201cYes, I did explain to my husband, but he was also not in support at first as he thought it might not be good. I asked him why he was thinking like that, but he accepted that I should participate in the study because he saw how I had been suffering from anaemia. The good thing was that we were together at the health facility, so the time nurses were explaining to me that we were together, and he understood everything well. When we arrived home, I also asked his views; he said it was okay and that I should go to this health facility \u201c(IDI-PW-02-BT).   The support from spouses, especially when women receive ANC treatment and care, is crucial in our context and can inform the level of uptake and acceptability of an intervention. Therefore, spouses' roles in decision-making are conditions that support the administration of IV iron infusion.  We have added these reflections and quotes in the results section and included a reflection on the role of male involvement in decision-making for health.  We hope that through these additions, we have addressed your primary concerns and strengthened the results.  Yours sincerely,  Lucinda Manda-Taylor, PhD.","URL":"https:\/\/gatesopenresearch.org\/articles\/6-66\/v4#referee-comment-3624","order":2,"name":"referee-comment-3624","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.21956\/gatesopenres.16157.r35563, Stephanie Best, University of Melbourne, Melbourne, VIC,, 06 Mar 2024, version 3, indexed","URL":"https:\/\/gatesopenresearch.org\/articles\/6-66\/v3#referee-response-35563","order":3,"name":"referee-response-35563","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"<b>Lucinda Manda-Taylor<\/b>; \n<i>Posted: 06 Mar 2024<\/i>; Dear Associate Prof Best,  Thank you for reviewing our manuscript and for your helpful suggestions and comments. We have taken care of your questions.&nbsp;  Abstract: \u201c\n<i>Women perceived that IV iron treatment worked faster<\/i>\u2026.\u201d Faster than what?  \n<b>Response: <\/b>We have added the words \u201cthan oral iron tablets\u201d. &nbsp;  Introduction: Fifth paragraph\u2014Having a really good approach to tackling anaemia\u2026 delete \u2018really\u2019\u2014it\u2019s a little informal.   \n<b>Response: <\/b>We have deleted the word &quot;really&quot;.  Sixth paragraph\u2014However, this study's main results have\n<i> yet to be published<\/i>\u2026. Revise \u2018main\u2019 to clinical.  \n<b>Response: <\/b>We have revised &quot;main&quot; and replaced it with &quot;clinical&quot;.  Methods:&nbsp;\n<i>The article draws on qualitative data collected in<\/i>\u2026. add in \u2018\n<i>two of<\/i>&nbsp;\u2018Malawi\u2019s districts\u2026\u2019.  \n<b>Response:<\/b> We have added the number &quot;two.&quot;  Data collection: The second paragraph clarifies whether focus groups were online or in person.  \n<b>Response:<\/b> The focus group discussions were conducted in person and face-to-face. We have made this clarification in the third paragraph.  Discussion. Health system implementation barriers second paragraph.&nbsp;\n<i>There is a lack of literature on implementing evidence-based practice in rural and remote settings<\/i>\u2026 add in \u2018\n<i>in lower- and middle-income countries<\/i>\u2019.  \n<b>Response: <\/b>We have added &quot;in lower-and-middle income countries&quot;.  Discussion: Conditions supporting the acceptability of IV iron infusion second paragraph. Revise the sentence \u2018\n<i>Elsewhere colleagues and I articulate<\/i>\u2026\u201d This paper has several co-authors, and it is unclear who \u2018I\u2019 is.  \n<b>Response:<\/b> We have removed this statement altogether.  Once again, thank you very much for taking the time to review and enhance our manuscript.  Lucinda Manda-Taylor","URL":"https:\/\/gatesopenresearch.org\/articles\/6-66\/v4#referee-comment-3676","order":4,"name":"referee-comment-3676","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.21956\/gatesopenres.16803.r39001, Sunil Bhandari, Nephrology and Transplant Medicine, Hull University Teaching Hospitals NHS Trust and Hull York Medical School (Ringgold ID: 4020), Hull, England, 11 Dec 2024, version 4, indexed","URL":"https:\/\/gatesopenresearch.org\/articles\/6-66\/v4#referee-response-39001","order":5,"name":"referee-response-39001","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"<b>Lucinda Manda-Taylor<\/b>; \n<i>Posted: 11 Dec 2024<\/i>; Thank you, Dr Bhandari,  We appreciate the time you took to review our manuscript. Your comments on the value of our article are positively pleasing. However, allow me to respond to some of your concerns, namely,&nbsp;  1.&nbsp;I would normally expect the main paper results on efficacy and safety to be published first before any secondary papers, as is normal practice for a trial. I would recommend the authors check this carefully.  Response: We need to be informed of a hard and fast rule about when secondary papers should be ready. Qualitative research is used at all trial development and reporting stages, and publishing qualitative study results is also permissible at these stages.  Given that this was a formative qualitative study using an exploratory design, it was appropriate to share preliminary insights into challenges and opportunities. Clinical trial data analysis tends to happen after the final trial participant completes the follow-up visit. Qualitative research is used at all stages of trial development and reporting. They can be particularly helpful in developing and evaluating complex interventions. Besides, our work was independent of the clinical trial team, with clear objectives for reporting the participants\u2019 concerns and experiences. We wanted to understand whether the intervention could and should be implemented by assessing their acceptability to intervention by users and healthcare professionals.&nbsp;  2. The data is from 2020, so I am surprised that the main paper is still pending.  Response: The results of the main papers and subsequent papers are available. I've included two citations below.&nbsp;  Ferric carboxymaltose versus standard-of-care oral iron to treat second-trimester anaemia in Malawian pregnant women: a randomised controlled trial Pasricha, Sant-Rayn et al. The Lancet, Volume 401, Issue 10388, 1595 - 1609 (May 2023) Postpartum maternal and infant haematological effects of second-trimester ferric carboxymaltose versus standard-of-care oral iron in Malawi: longitudinal follow-up of a randomised controlled trial Mzembe, Glory et al. The Lancet Global Health, Volume 12, Issue 12, e2049 - e2058 (December 2024)  We submit our responses for you to review and will be open to further thoughts.&nbsp;  Thank you.  Yours sincerely,  Lucinda Manda-Taylor","URL":"https:\/\/gatesopenresearch.org\/articles\/6-66\/v4#referee-comment-3756","order":6,"name":"referee-comment-3756","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.21956\/gatesopenres.16803.r38760, Tanmay Bagade, The University of Newcastle, Callaghan, New South Wales, 14 Dec 2024, version 4, indexed","URL":"https:\/\/gatesopenresearch.org\/articles\/6-66\/v4#referee-response-38760","order":7,"name":"referee-response-38760","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"This work was supported by the Bill and Melinda Gates Foundation under the REVAMP clinical trial [OPP1169939]; and the Australian National Health and Medical Research Council Career Development Fellowship [ID 1158696]. However, the funders had no role in the study design, data collection and analysis, decision to publish, or manuscript preparation. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.","order":8,"name":"grant-information","label":"Grant Information"},{"value":"This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.","order":0,"name":"copyright-info","label":"Copyright"}]}}