Piloting Multiple Micronutrient Supplementation Within the Routine Antenatal Care System in Ethiopia: Insights From Stakeholders

Abstract

In low and middle-income countries, addressing maternal and child nutrition needs is crucial. Prenatal multiple micronutrient supplementation (MMS) holds promise in reducing low birthweight and preterm births. Ethiopia is considering a transition from the provision of iron-folate supplementation to the provision of MMS in antenatal care, guided by WHO guidelines. This paper explores stakeholders' early perceptions and experiences in piloting that transition in five Ethiopian regions, informing decision making about future policy and scale-up. We used a qualitative study involving interviews and document reviews to assess the MMS pilot, analyzing themes with Nvivo 12 software. Key informant interviews revealed challenges such as supply chain issues and funding constraints, along with proposed improvement strategies such as closer coordination within existing structures. The importance of engaging with communities to create demand was emphasized, as was the need for capacity-building efforts utilizing existing staff in the health system with a clear plan for ongoing refresher training. Finally, enhancing the monitoring and evaluation framework, including a dedicated regional team for supportive supervision, was vital for accountability. In conclusion, prioritizing supply chain strengthening, community engagement through demand creation, coordination, and continuous capacity building for healthcare workers were thought to be crucial for the MMS program's success. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05708183 Registered 01 February 2023-Retrospectively registered, https://classic.clinicaltrials.gov/ct2/show/NCT05708183.

Keywords: antenatal care; capacity‐building; child nutrition; maternal nutrition; micronutrient deficiencies; program implementation; stakeholder perceptions.