TACKLING ANAEMIA IN PREGNANCY: A QUALITY IMPROVEMENT STRATEGY FOR PRIMARY CARE

Abstract

Introduction. Anaemia among pregnant women in Penampang, Sabah increase over four years, peaking at 12.1% in 2023. In 2024, a quality improvement (QI) initiative was introduced, resulting in a marked reduction to 5.7% (54/940 cases), surpassing the state target of less than 8.0%. this study describes the interventions implemented and their impact on anaemia outcomes. Methods.

This was a retrospective QI intervention study conducted at Klinik Kesihatan Penampang and its affiliated clinics. Data on haemoglobin lecel at 36 weeks’ gestation were extracted from antenatal records between January and December 2024. The primary outcome was the proportion of pregnant women with anaemia (Hb<11.0g/dl). No formal statistictical testing was performed; data were analysed descriptively. Interventions included switching form intramuscular to intravenous (IV) Cosmofer iron therapy for cases unresponsive to oral iron, administered between 16 and 30 weeks of gestation. An Excel-based calculator was developed to guide the administration of IV iron dosing. Continuous medical education was conducted for medical officers and nurses. Nurses were empowered to initiate Zincofer when indicated. Anaemic mothers received early referral for nutritional counselling and were enrolled in mother-friendly classes. Anaemic cases were also discussed regularly in high-risk meetings. Results. Anaemia prevalence dropped form 12.1% in 2023 to 5.7% in 2024. The Excel calculator improved dosing accuracy and facilitated early intervention, while traing and team-based care enhanced overall management. Conclusion This QI initiative, supported by digital tool and team-based strategies, effectively reduced antenatal anaemia and may served as a scalable model for similar primary care settings.