Lyantonde

This research aims to understand how antenatal multiple micronutrient supplements (MMS) can be effectively implemented and scaled within Uganda's national health system to improve maternal nutrition and birth outcomes. It builds on prior formative research by testing implementation strategies that include MMS product delivery, social behavior change communication (SBCC), capacity building, supply chain support, monitoring, and evaluation. The study also examines the effect of dispensing MMS in different bottle counts on adherence and antenatal care (ANC) attendance, along with cost and budget impact of MMS integration in Uganda's ANC services. The study is a 3-arm quasi-experimental implementation research conducted across eight districts in three regions of Uganda. Pregnant women attending government or private not-for-profit health facilities will receive MMS dispensed in one of three bottle counts: a single 180-count bottle, two 90-count bottles, or six 30-count bottles, depending on their district assignment. ANC providers are trained to counsel women on MMS use supported by a job aid and adherence calendar. Each district is assigned a specific bottle count, and all pregnant women continue with that assigned bottle count throughout pregnancy and postpartum. Participants include pregnant women, ANC providers, family members, healthcare workers, community health volunteers, and decision-makers. Data collection involves qualitative and quantitative methods, sampling multiple facilities per district. Researchers will monitor MMS adherence by tablet consumption amount and frequency, as well as ANC attendance during pregnancy, at 3 and 6 months post-enrollment, and 6 weeks postpartum. The study also tracks acceptability, feasibility, fidelity, coverage, sustainability, and cost outcomes to assess the MMS intervention within Uganda's antenatal care system.