{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T22:09:20Z","timestamp":1784326160927,"version":"3.55.0"},"reference-count":24,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2025,1,31]],"date-time":"2025-01-31T00:00:00Z","timestamp":1738281600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Maternal &amp; Child Nutrition"],"published-print":{"date-parts":[[2025,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:label\/><jats:p>In low and middle\u2010income 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\u2010folate 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\u2010up. 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\u2010building 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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Trial Registration<\/jats:title><jats:p><jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"http:\/\/ClinicalTrials.gov\">ClinicalTrials.gov<\/jats:ext-link> Identifier: NCT05708183 Registered 01 February 2023\u2014Retrospectively registered, <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"https:\/\/classic.clinicaltrials.gov\/ct2\/show\/NCT05708183\">https:\/\/classic.clinicaltrials.gov\/ct2\/show\/NCT05708183<\/jats:ext-link>.<\/jats:p><\/jats:sec>","DOI":"10.1111\/mcn.13809","type":"journal-article","created":{"date-parts":[[2025,1,31]],"date-time":"2025-01-31T11:13:42Z","timestamp":1738322022000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Piloting Multiple Micronutrient Supplementation Within the Routine Antenatal Care System in Ethiopia: Insights From Stakeholders"],"prefix":"10.1111","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3513-1097","authenticated-orcid":false,"given":"Anene Tesfa","family":"Berhanu","sequence":"first","affiliation":[{"name":"Health Systems and Reproductive Health Department Ethiopian Public Health Institute Addis Ababa Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Atkure","family":"Defar","sequence":"additional","affiliation":[{"name":"Department of Disease Control London School of Hygiene &amp; Tropical Medicine London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Girum","family":"Taye","sequence":"additional","affiliation":[{"name":"Health Systems and Reproductive Health Department Ethiopian Public Health Institute Addis Ababa Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5043-5526","authenticated-orcid":false,"given":"Alemneh Kabeta","family":"Daba","sequence":"additional","affiliation":[{"name":"Food Science and Nutrition Research Department Ethiopian Public Health Institute Addis Ababa Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Senait","family":"Alemayehu","sequence":"additional","affiliation":[{"name":"Health Systems and Reproductive Health Department Ethiopian Public Health Institute Addis Ababa Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bedasa","family":"Tessema","sequence":"additional","affiliation":[{"name":"Food Science and Nutrition Research Department Ethiopian Public Health Institute Addis Ababa Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kalkidan","family":"Zenebe","sequence":"additional","affiliation":[{"name":"Food Science and Nutrition Research Department Ethiopian Public Health Institute Addis Ababa Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles","family":"Opondo","sequence":"additional","affiliation":[{"name":"Department of Medical Statistics London School of Hygiene &amp; Tropical Medicine London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Getachew","family":"Tollera","sequence":"additional","affiliation":[{"name":"Deputy Director Office Ethiopian Public Health Institute Addis Ababa Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mesay","family":"Hailu","sequence":"additional","affiliation":[{"name":"Director General Ethiopian Public Health Institute Addis Ababa Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joanna","family":"Schellenberg","sequence":"additional","affiliation":[{"name":"Department of Disease Control London School of Hygiene &amp; Tropical Medicine London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lars Ake","family":"Persson","sequence":"additional","affiliation":[{"name":"Department of Disease Control London School of Hygiene &amp; Tropical Medicine London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tanya","family":"Marchant","sequence":"additional","affiliation":[{"name":"Department of Disease Control London School of Hygiene &amp; Tropical Medicine London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masresha","family":"Tessema","sequence":"additional","affiliation":[{"name":"Food Science and Nutrition Research Department Ethiopian Public Health Institute Addis Ababa Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,1,31]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.f7716"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1093\/ajcn\/82.4.829"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(22)00126-7"},{"key":"e_1_2_10_5_1","volume-title":"Ethiopia Demographic and Health Survey 2022: Key Indicators Report","author":"Central Statistical Agency (CSA) [Ethiopia] and ICF","year":"2022"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2020.01504"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/nyas.14756"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0216112"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/00019514-199806020-00006"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.g1687"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD004905.pub6"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/XEB.0000000000000110"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/mcn.13124"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2013.1632"},{"key":"e_1_2_10_15_1","unstructured":"Macrotrends.2024. \u201cEthiopia Population 1950\u20102024.\u201d Accessed November 25 2024.https:\/\/www.macrotrends.net\/global-metrics\/countries\/ETH\/ethiopia\/population."},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.h1258"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1093\/heapol\/czaa122"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(18)30398-X"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-020-08574-z"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n2061"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12884-017-1448-8"},{"key":"e_1_2_10_22_1","unstructured":"UNICEF.2020.Interim Country\u2010Level Decision\u2010Making Guidance for Introducing Multiple Micronutrient Supplementation for Pregnant Women.https:\/\/www.unicef.org\/documents\/interim-country-level-decision-making-guidance-introducing-multiple-micronutrient."},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.1186\/1748-5908-4-67"},{"key":"e_1_2_10_24_1","volume-title":"WHO Antenatal Care Recommendations for a Positive Pregnancy Experience Nutritional Interventions Update: Multiple Micronutrient Supplements During Pregnancy","author":"WHO","year":"2020"},{"key":"e_1_2_10_25_1","unstructured":"World Health Organization.2019.Prevalence of Anaemia in Women Aged 15\u201349. 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