{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T09:46:01Z","timestamp":1792057561298,"version":"4.4.0"},"reference-count":21,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T00:00:00Z","timestamp":1784246400000},"content-version":"vor","delay-in-days":16,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Maternal &amp;amp; Child Nutrition"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:label\/>\n                    <jats:p>Micronutrient deficiencies in pregnancy remain a critical public health issue in Nepal, where iron\u2013folic acid (IFA) supplementation alone has not fully addressed maternal and neonatal risks. Multiple micronutrient supplements (MMS) promise broader nutritional benefits; however, real\u2010world guidance for their effective and equitable integration into routine maternal care is lacking. A qualitative study, guided by the ExpandNet scaling\u2010up framework, was conducted from February to March 2025, including 28 focus group discussions with antenatal care (ANC) providers and female community health volunteers (FCHVs) and 40 key informant interviews with policymakers at different levels of the health system. Data was analyzed thematically to identify perceived facilitators and barriers to MMS adoption, institutionalization, and scale\u2010up, and equitable implementation. Stakeholders viewed MMS as offering clear advantages over IFA, citing broader micronutrient coverage and fewer side effects that could improve adherence. However, they identified several system\u2010level requirements for successful scale\u2010up, including formal policy integration, sustainable financing, strengthened procurement and supply chains, and adequate storage capacity at facilities. FCHVs and ANC providers emphasized the need for clearer role definitions, improved training, and manageable counseling workloads. Persistent community\u2010level barriers\u2014such as concerns about tablet size, misconceptions about fetal growth, and low trust in free medicines\u2014were seen as risks to equitable uptake. Respondents highlighted community engagement, culturally tailored counseling, and consistent support for FCHVs and ANC providers as essential to ensuring effective and equitable MMS adoption. Stakeholders in Nepal view MMS as a promising strategy to improve maternal and newborn nutrition, but its potential depends on strong policy commitment, adequate and sustainable financing, and community\u2010centered implementation. Addressing product\u2010related concerns, strengthening counseling and trust in public services, and ensuring uninterrupted supply chains are essential to MMS scale\u2010up, including translating its introduction into equitable and meaningful gains in maternal and child nutrition.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/mcn.70231","type":"journal-article","created":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T10:03:54Z","timestamp":1784282634000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Feasibility and Readiness for Scaling\u2010Up Multiple Micronutrient Supplements in Nepal: A Qualitative Study Using the Expandnet Scaling\u2010Up Framework"],"prefix":"10.1111","volume":"22","author":[{"given":"Mai\u2010Anh","family":"Hoang","sequence":"first","affiliation":[{"name":"Helen Keller Intl New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nira","family":"Joshi","sequence":"additional","affiliation":[{"name":"New ERA Kathmandu Bagmati Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenda","family":"Cunningham","sequence":"additional","affiliation":[{"name":"Helen Keller Intl New York New York USA"},{"name":"International Food Policy Research Institute London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Usha","family":"Singh","sequence":"additional","affiliation":[{"name":"New ERA Kathmandu Bagmati Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bibek Kumar","family":"Lal","sequence":"additional","affiliation":[{"name":"Family Welfare Division, Ministry of Health and Food Safety Kathmandu Bagmati Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lila Bikram","family":"Thapa","sequence":"additional","affiliation":[{"name":"Family Welfare Division, Ministry of Health and Food Safety Kathmandu Bagmati Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pooja","family":"Pandey","sequence":"additional","affiliation":[{"name":"Helen Keller Intl Kathmandu Bagmati Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rolf","family":"Klemm","sequence":"additional","affiliation":[{"name":"Helen Keller Intl New York New York USA"},{"name":"Johns Hopkins Bloomberg School of Public Health Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yashodhara","family":"Rana","sequence":"additional","affiliation":[{"name":"Eleanor Crook Foundation Washington, D.C. USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sudip","family":"Pokhrel","sequence":"additional","affiliation":[{"name":"Eleanor Crook Foundation Washington, D.C. USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sasmita","family":"Poudel","sequence":"additional","affiliation":[{"name":"Helen Keller Intl Kathmandu Bagmati Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,17]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/mcn.13809"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13063-025-09031-1"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/mcn.13659"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2023-082363"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD004905.pub6"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/mcn.13745"},{"key":"e_1_2_10_8_1","volume-title":"Community Health Workers in Asia: Insights From the 2024 State of the Evidence Analysis","author":"Mark Mwenda","year":"2024"},{"key":"e_1_2_10_9_1","unstructured":"Ministry of Health and Population (MoPH) New ERA & ICF. 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Nepal Demographic and Health Survey 2022."},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/mcn.13170"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1093\/jn\/nxy090"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0179873"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/jocn.15737"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.3390\/nu18030373"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/mcn.13173"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1177\/03795721231179570"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajcnut.2025.04.033"},{"key":"e_1_2_10_18_1","volume-title":"Practical Guidance for Scaling up Health Service Innovations","author":"Simmons R.","year":"2009"},{"key":"e_1_2_10_19_1","volume-title":"Nine Steps for Developing A Scaling\u2010up Strategy","author":"Simmons R.","year":"2010"},{"key":"e_1_2_10_20_1","volume-title":"Beginning With the End in Mind: Planning Pilot Projects and Other Programmatic Research for Successful Scaling Up","author":"Simmons R.","year":"2011"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.advnut.2025.100455"},{"key":"e_1_2_10_22_1","volume-title":"Nutritional Interventions update: Multiple Micronutrient Supplements during Pregnancy","author":"World Health Organization","year":"2020"}],"container-title":["Maternal &amp; Child Nutrition"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/mcn.70231","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/mcn.70231","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/mcn.70231","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T08:57:45Z","timestamp":1792054665000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/mcn.70231"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7]]},"references-count":21,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026,7]]}},"alternative-id":["10.1111\/mcn.70231"],"URL":"https:\/\/doi.org\/10.1111\/mcn.70231","archive":["Portico"],"relation":{},"ISSN":["1740-8695","1740-8709"],"issn-type":[{"value":"1740-8695","type":"print"},{"value":"1740-8709","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7]]},"assertion":[{"value":"2026-03-23","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-06-24","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-17","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70231"}}