{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T20:36:57Z","timestamp":1784234217324,"version":"3.55.0"},"reference-count":18,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2025,2,11]],"date-time":"2025-02-11T00:00:00Z","timestamp":1739232000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100006641","name":"UNICEF","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100006641","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Maternal &amp;amp; Child Nutrition"],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:p>Iron and folic acid deficiency is a significant public health concern, especially in low and middle\u2010income countries, particularly among women of reproductive age, leading to adverse maternal and child health outcomes. In Pakistan, approximately 41.7% of women of reproductive age have iron deficiency. For this research, we conducted 33 key informant interviews and 32 focus group discussions with stakeholders from all four provinces and the two federally administered regions of Pakistan for in\u2010depth and representative bottleneck assessment. The modified Tanahashi model was used to inform the determinant codes and for coding reliability thematic analysis using NVivo 14. On the supply side, barriers relate to effective forecasting, procurement, and distribution of Iron Folic Acid supplements to the recipients. The demand\u2013supply gap widened due to the supply bottlenecks, impacting the community's trust in the frontline health worker. These factors were gravely impacted by the governance challenges of ensuring sustainable funds, minimizing bureaucratic and procedural delays, and eliminating political pressure. Affordability of Iron Folic Acid and conservative social norms influenced the demand and awareness of Iron Folic Acid and nutritional knowledge among the target population. The stakeholder recommendations emphasize the need for intersectoral collaboration, mass media campaigns, frequent capacity building and incentivizing of healthcare workers, engagement of key community stakeholders, digitizing the health system, improvement in supply chain mechanism, and investment in small\u2010scale innovative solutions.<\/jats:p>","DOI":"10.1111\/mcn.13797","type":"journal-article","created":{"date-parts":[[2025,2,12]],"date-time":"2025-02-12T02:32:42Z","timestamp":1739327562000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["A Bottleneck Analysis of Iron and Folic Acid Supplementation Program in Pakistan"],"prefix":"10.1111","volume":"21","author":[{"given":"Anamta","family":"Ghur","sequence":"first","affiliation":[{"name":"Global Health deaprtment PHC Global Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Soha","family":"Randhawa","sequence":"additional","affiliation":[{"name":"Global Health deaprtment PHC Global Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Namira","family":"Shahid","sequence":"additional","affiliation":[{"name":"Global Health deaprtment PHC Global Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Waffa","family":"Ali","sequence":"additional","affiliation":[{"name":"Global Health deaprtment PHC Global Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Banafsha","family":"Ali","sequence":"additional","affiliation":[{"name":"Global Health deaprtment PHC Global Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saroosh","family":"Rashid","sequence":"additional","affiliation":[{"name":"Global Health deaprtment PHC Global Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ambreen","family":"Khan","sequence":"additional","affiliation":[{"name":"Global Health deaprtment PHC Global Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aman Akbar","family":"Babri","sequence":"additional","affiliation":[{"name":"Global Health deaprtment PHC Global Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khawaja","family":"Masood","sequence":"additional","affiliation":[{"name":"Health department Nutrition Wing\u2014Ministry of National Health, Services, Regulations, and Coordination (MoNHSRC) Islamabad Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saba","family":"Shuja","sequence":"additional","affiliation":[{"name":"Health sector UNICEF Islamabad Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-9177-9176","authenticated-orcid":false,"given":"Maliha","family":"Fatima","sequence":"additional","affiliation":[{"name":"Global Health deaprtment PHC Global Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noshad","family":"Ali","sequence":"additional","affiliation":[{"name":"Global Health deaprtment PHC Global Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. Imran","family":"Khan","sequence":"additional","affiliation":[{"name":"Global Health deaprtment PHC Global Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5432-5474","authenticated-orcid":false,"given":"Ali","family":"Turab","sequence":"additional","affiliation":[{"name":"Global Health deaprtment PHC Global Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,2,11]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.15537\/smj.2015.2.10289"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1177\/156482650802900207"},{"key":"e_1_2_11_4_1","volume-title":"Qualitative Research Methods for the Social Sciences","author":"Berg B. 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Pakistan National Nutrition Survey Government of Pakistan Islamabad."},{"key":"e_1_2_11_10_1","volume-title":"Reaching Universal Health Coverage Through District Health System Strengthening: Using a Modified Tanahashi Model Sub\u2010Nationally to Attain Equitable and Effective Coverage","author":"O'Connell T.","year":"2013"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph16173152"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jmwh.2007.02.014"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1177\/15648265100312S202"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/mcn.12532"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0210634"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijgo.2013.03.030"},{"key":"e_1_2_11_17_1","volume-title":"Background Paper for the Technical Consultation on Effective Coverage of Health Systems, 27\u201329 August 2001","author":"Wing N.","year":"2018"},{"key":"e_1_2_11_18_1","volume-title":"Anaemia in Women and Children","author":"World Health Organization","year":"2021"},{"key":"e_1_2_11_19_1","unstructured":"World Health Organization.2023.Anaemia. World Health Organization.https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/anaemia."}],"container-title":["Maternal &amp; Child Nutrition"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/mcn.13797","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,30]],"date-time":"2025-08-30T05:06:36Z","timestamp":1756530396000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/mcn.13797"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2,11]]},"references-count":18,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2025,7]]}},"alternative-id":["10.1111\/mcn.13797"],"URL":"https:\/\/doi.org\/10.1111\/mcn.13797","archive":["Portico"],"relation":{},"ISSN":["1740-8695","1740-8709"],"issn-type":[{"value":"1740-8695","type":"print"},{"value":"1740-8709","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,2,11]]},"assertion":[{"value":"2024-01-06","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-12-16","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-02-11","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e13797"}}