Lyantonde

This research focuses on understanding how antenatal multiple micronutrient supplements MMS can be effectively introduced and expanded within Ugandas national health system to improve maternal nutrition and birth outcomes. The study evaluates the implementation strategies including MMS product delivery, social behavior change communication, capacity building, supply chain support, monitoring, and evaluation. It also investigates the impact of dispensing MMS in different bottle counts on adherence and antenatal care attendance, along with the cost and budget implications of integrating MMS into antenatal care services. The study is a three-arm quasi-experimental implementation research conducted in eight districts across three regions of Uganda. Pregnant women attending antenatal care at government or private not-for-profit facilities will receive MMS in one of three bottle-count options a single 180-count bottle, two 90-count bottles dispensed at different times, or six 30-count bottles dispensed monthly. Each district is assigned one bottle-count group, and all women receive counseling using a novel job aid and adherence calendar. The intervention covers full MMS implementation in public and PNFP facilities within these districts. Participants include pregnant women, healthcare providers, family members, and health system stakeholders. Data collection involves mixed methods with qualitative and quantitative approaches at multiple health facilities per district. Researchers will assess MMS adherence by amount and frequency of tablets consumed, antenatal care attendance, acceptability among women and providers, fidelity of MMS delivery, and cost impact. Evaluations occur at 3 and 6 months post-enrollment and at 6 weeks postpartum. The study is led by Johns Hopkins Bloomberg School of Public Health and runs from June 2025 to December 2026.