Integrating a single-dose intravenous iron therapy (ferric carboxymaltose) for maternal anaemia in Nigeria: Insights from stakeholder engagement

Abstract

Background: Maternal anaemia contributes to high maternal morbidity and adverse birth outcomes in Nigeria. Oral iron supplementation is common but limited by poor adherence, side effects and systemic barriers. Ferric carboxymaltose (FCM), a single-dose intravenous iron formulation, offers a promising alternative, yet its routine use in Nigeria remains limited. Policymakers, providers and community leaders influence adoption of health services, making their perspectives key to successful integration. Aim: To explore stakeholder perspectives on integrating FCM for maternal anaemia into routine maternal health services. Setting: The study was conducted in Lagos State, Nigeria. Methods: A qualitative descriptive study was conducted. Thirty-three purposively selected stakeholders participated, representing government agencies, healthcare providers, academic institutions, non-governmental organisations, professional associations and community leaders. Participants were grouped by affiliation and roles to encourage open dialogue. Discussions followed a semi-structured guide, were audio-recorded, transcribed verbatim and thematically analysed using an inductive approach. Results: Three interrelated themes emerged: (1) health workers are not sufficiently prepared for intravenous iron delivery but could be through sensitisation, reorientation and resourcing; (2) sociocultural and religious influences, alongside misconceptions, require targeted community engagement and (3) affordability is a barrier but could be addressed through strategic policy levers. Conclusion: Successful integration of FCM requires investment in health system capacity, sustained community engagement and alignment with financing and policy frameworks. Contribution: The findings illustrate how stakeholder-informed analysis can reveal the practical, cultural and financial conditions necessary for sustainable uptake of FCM, advancing understanding of how maternal health innovations can be integrated within fragmented health systems.