Berhanu Anene Tesfa, Defar Atkure, Taye Girum, Daba Alemneh Kabeta, Alemayehu Senait, Tessema Bedasa, Zenebe Kalkidan, Opondo Charles, Tollera Getachew, Hailu Mesay, Schellenberg Joanna, Persson Lars Ake, Marchant Tanya, Tessema Masresha
Health Systems and Reproductive Health Department, Ethiopian Public Health Institute, Addis Ababa, Ethiopia.
Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK.
Matern Child Nutr. 2025 Apr;21(2):e13809. doi: 10.1111/mcn.13809. Epub 2025 Jan 31.
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.
在低收入和中等收入国家，满足孕产妇和儿童的营养需求至关重要。产前多种微量营养素补充剂（MMS）有望降低低出生体重和早产率。埃塞俄比亚正在考虑在世卫组织指南的指导下，在产前护理中从提供铁叶酸补充剂过渡到提供MMS。本文探讨了利益相关者在埃塞俄比亚五个地区试点该过渡过程中的早期看法和经验，为未来政策制定和扩大规模提供决策依据。我们采用了一项定性研究，包括访谈和文件审查，以评估MMS试点项目，并使用Nvivo 12软件分析主题。关键信息提供者访谈揭示了供应链问题和资金限制等挑战，以及在现有结构内加强协调等拟议的改进策略。强调了与社区互动以创造需求的重要性，以及利用卫生系统现有工作人员进行能力建设努力并制定持续进修培训明确计划的必要性。最后，加强监测和评价框架，包括设立一个专门的区域支持性监督小组，对于问责制至关重要。总之，优先加强供应链、通过创造需求促进社区参与、协调以及持续为医护人员开展能力建设，被认为是MMS项目取得成功的关键。试验注册：ClinicalTrials.gov标识符：NCT05708183 于2023年2月1日注册——追溯注册，https://classic.clinicaltrials.gov/ct2/show/NCT05708183 。
