Multiple‐micronutrient supplementation: Evidence from large‐scale prenatal programmes on coverage, compliance and impact

Abstract

Micronutrient deficiencies during pregnancy pose important challenges for public-health, given the potential adverse outcomes not only during pregnancy but across the life-course. Provision of iron-folic acid (IFA) supplements is the strategy most commonly practiced and recommended globally. How to successfully implement IFA and multiple micronutrient supplementation interventions among pregnant women and to achieve sustainable/permanent solutions to prenatal micronutrient deficiencies remain unresolved issues in many countries. This paper aims to analyse available experiences of prenatal IFA and multiple micronutrient interventions to distil learning for their effective planning and large-scale implementation. Relevant articles and programme-documentation were comprehensively identified from electronic databases, websites of major-agencies and through hand-searching of relevant documents. Retrieved documents were screened and potentially relevant reports were critically examined by the authors with the aim of identifying a set of case studies reflecting regional variation, a mix of implementation successes and failures, and a mix of programmes and large-scale experimental studies. Information on implementation, coverage, compliance, and impact was extracted from reports of large-scale interventions in Central America, Southeast Asia, South Asia, and Sub-Saharan Africa. The WHO/CDC Logic-Model for Micronutrient Interventions in Public Health was used as an organizing framework for analysing and presenting the evidence. Our findings suggest that to successfully implement supplementation interventions and achieve sustainable-permanent solutions efforts must focus on factors and processes related to quality, cost-effectiveness, coverage, utilization, demand, outcomes, impacts, and sustainability of programmes including strategic analysis, management, collaborations to pilot a project, and careful monitoring, midcourse corrections, supervision and logistical-support to gradually scaling it up.

Review of the evidence regarding the use of antenatal multiple micronutrient supplementation in low‐ and middle‐income countries

“…Insufficient nutrient intakes before and during pregnancy, combined with increased metabolic demands during pregnancy, can result in individuals suffering from one or more micronutrient deficiencies, especially in low‐ and middle‐income countries (LMICs). Supplementation with multiple micronutrient supplements (MMS) that include iron and folic acid (IFA) during pregnancy is practiced in some countries, including the United States and South Africa, to increase micronutrient intakes and improve pregnancy outcomes . However, IFA supplementation is currently the recommended standard of care for pregnant women in many countries.…”

“…Supplementation with multiple micronutrient supplements (MMS) that include iron and folic acid (IFA) during pregnancy is practiced in some countries, including the United States and South Africa, to increase micronutrient intakes and improve pregnancy outcomes. 1,2 However, IFA supplementation is currently the recommended standard of care for pregnant women in many countries.…”

“…This work was commissioned by the Bill & Melinda Gates Foundation and organized by the New York Academy of Sciences. As a direct outcome of the task force, the objectives of the current review are to (1) review the evidence on the burden of micronutrient deficiencies in women of reproductive age (WRA) and associated adverse pregnancy outcomes; (2) update the evidence base on the effects of MMS on pregnancy outcomes; (3) assess the costs and cost-effectiveness of shifting from IFA to MMS during pregnancy; and (4) provide indicators based on the updated evidence base that might be considered by governments deciding whether IFA or MMS is the most appropriate supplement for their contexts.…”

Integrating Calcium Supplementation into Facility-Based Antenatal Care Services in Western Kenya: A Qualitative Process Evaluation to Identify Implementation Barriers and Facilitators

“…Based on ANC providers’ suggestions, task-shifting approaches could be considered for improving the delivery of calcium supplementation. Community health workers have counselled women and dispensed supplements in micronutrient supplementation programs ( 3 , 20 ) and specifically for calcium supplementation ( 6 , 7 ). Second, providers desired additional training about calcium supplementation.…”

Multiple micronutrient supplements in pregnancy: Implementation considerations for integration as part of quality services in routine antenatal care. Objectives, results, and conclusions of the meeting

“…Authors extracted information on implementation, coverage, compliance ,and impact from reports of large scale interventions in Central America, Southeast Asia, South Asia, and Sub‐Saharan Africa. Findings suggested that to successfully implement supplementation interventions and achieve sustainable, permanent solutions efforts must focus on factors and processes related to quality, cost‐effectiveness, coverage, utilisation, demand, outcomes, impacts, and sustainability of programmes including strategic analysis, management, collaborations to pilot a project, careful monitoring, mid‐course corrections, supervision, and logistical support to gradually scaling it up (Berti, Gaffey, Bhutta, & Cetin, ).…”