{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,30]],"date-time":"2026-08-30T12:43:52Z","timestamp":1788093832226,"version":"build-2803163510"},"reference-count":26,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T00:00:00Z","timestamp":1769126400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Eleanor Crook Foundation and CRI Foundation","award":["6023"],"award-info":[{"award-number":["6023"]}]},{"name":"Gates Foundation","award":["SC240565"],"award-info":[{"award-number":["SC240565"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Background\/Objectives: Emerging evidence suggests that multiple micronutrient supplements (MMS) provide additional benefits for maternal and neonatal health compared with iron and folic acid (IFA) supplements. To achieve effective coverage, acceptability, and adherence\u2014and to inform a nationwide rollout of MMS\u2014it is essential to understand the context-specific factors that shape implementation. This study evaluated the pilot implementation of MMS in Rwanda to identify key enablers, areas for improvement, and challenges related to antenatal care (ANC) attendance and MMS use. Methods: Data were collected through a survey of 3257 women who attended ANC services, seven focus group discussions with 35 ANC attendees, and key informant interviews with 20 ANC nurses and 21 community health workers. Results: Pregnant women reported high ANC attendance (74%) and MMS consumption (79%), largely driven by strong motivation and awareness of MMS benefits. Strategies to remember daily intake and to manage side effects supported adherence, as did reminders, motivation, and information from family members and healthcare providers. Limited patient-centered counselling, financial constraints, barriers to accessing ANC services, and product stock-outs were key areas for strengthening service delivery in Rwanda. Conclusions: Sustaining high ANC attendance and MMS adherence as the program transitions from the pilot phase to national scale-up is essential. Improving counseling quality and strengthening supply chains may reinforce ANC services and support sustained MMS adherence, with benefits for maternal and child health.<\/jats:p>","DOI":"10.3390\/nu18030373","type":"journal-article","created":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T17:52:38Z","timestamp":1769190758000},"page":"373","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Antenatal Care Attendance and Multiple Micronutrient Supplementation Intake: Perspectives from Women and Antenatal Care Service Providers in Rwanda"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1291-673X","authenticated-orcid":false,"given":"Giulia","family":"Pastori","sequence":"first","affiliation":[{"name":"Sight and Life, 4303 Kaiseraugst, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kesso Gabrielle","family":"van Zutphen-K\u00fcffer","sequence":"additional","affiliation":[{"name":"Sight and Life, 4303 Kaiseraugst, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shashank","family":"Sarvan","sequence":"additional","affiliation":[{"name":"Sight and Life, 4303 Kaiseraugst, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yana","family":"Manyuk","sequence":"additional","affiliation":[{"name":"Sight and Life, 4303 Kaiseraugst, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elvis","family":"Gakuba","sequence":"additional","affiliation":[{"name":"Sight and Life, 4303 Kaiseraugst, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1551-8278","authenticated-orcid":false,"given":"Yashodhara","family":"Rana","sequence":"additional","affiliation":[{"name":"Eleanor Crook Foundation, San Marcos, TX 78666, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jack","family":"Clift","sequence":"additional","affiliation":[{"name":"Eleanor Crook Foundation, San Marcos, TX 78666, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kara","family":"Weiss","sequence":"additional","affiliation":[{"name":"CRI Foundation, Boston, MA 02116, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bonnie","family":"Weiss","sequence":"additional","affiliation":[{"name":"CRI Foundation, Boston, MA 02116, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiao-Yu","family":"Wang","sequence":"additional","affiliation":[{"name":"CRI Foundation, Boston, MA 02116, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aline","family":"Uwimana","sequence":"additional","affiliation":[{"name":"Rwanda Biomedical Centre, Kimihurura, Kigali P.O. Box 7162, Rwanda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4180-442X","authenticated-orcid":false,"given":"Claude M.","family":"Muvunyi","sequence":"additional","affiliation":[{"name":"Rwanda Biomedical Centre, Kimihurura, Kigali P.O. Box 7162, Rwanda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eliphaz","family":"Tuyisenge","sequence":"additional","affiliation":[{"name":"Rwanda Biomedical Centre, Kimihurura, Kigali P.O. Box 7162, Rwanda"},{"name":"UNICEF Rwanda, Kacyiru, Kigali P.O. Box 381, Rwanda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-0210-3584","authenticated-orcid":false,"given":"Samson","family":"Desie","sequence":"additional","affiliation":[{"name":"UNICEF Rwanda, Kacyiru, Kigali P.O. Box 381, Rwanda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melinda K.","family":"Munos","sequence":"additional","affiliation":[{"name":"Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21218, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sufia","family":"Askari","sequence":"additional","affiliation":[{"name":"Sight and Life, 4303 Kaiseraugst, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1177\/0379572120975298","article-title":"Review of the Micronutrient Situation in Rwanda","volume":"42","author":"Arsenault","year":"2021","journal-title":"Food Nutr. Bull."},{"key":"ref_2","unstructured":"(2025, July 22). 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