Multiple micronutrient supplements in pregnancy: Implementation considerations for integration as part of quality services in routine antenatal care. Objectives, results, and conclusions of the meeting.

Maria Nieves Garcia‐Casal,Diana Estevez,Luz Maria De‐Regil

doi:10.1111/mcn.12704

Abstract

Health promotion, screening, diagnosis, and disease prevention are essential services of quality routine antenatal care for pregnant adult and adolescent women. Supplementation programmes in pregnancy, generally implemented in the context of antenatal care services, have had less than optimal results in many countries, generally attributed to limited access, low coverage, and reduced adherence to the recommended regimens and counselling. The World Health Organization Department of Nutrition for Health and Development, in collaboration with the United Nations Children's Fund and Nutrition International, convened the technical consultation “Multiple micronutrient supplements in pregnancy: Implementation considerations for successful incorporation into existing programmes.” The objectives of the technical consultation were to (a) examine implementation experiences of micronutrient supplementation interventions in pregnant women, lessons learnt, and best practices; (b) discuss programmatic and technical considerations of interventions on multiple micronutrient supplementation in pregnant women in low‐, middle‐, and high‐income countries; and (c) identify implementation considerations that can be useful to scaling up efforts by national policymaker and their advisors considering multiple micronutrient supplementation in pregnant women as part of existing antenatal care programmes as well as other delivery platforms. The consultation was based on presentations of background papers, case studies, and plenary discussions. Country representatives were asked to discuss the context of micronutrient supplementation for their countries and share implementation challenges they faced. This paper provides the background and rationale of the technical consultation, synopsises the presentations, and provides a summary of the main considerations and conclusions reached during plenary discussions.

Highlights

Micronutrient malnutrition in pregnant women is widespread across regions and countries
The Evidence and Programme Guidance Unit, Department of Nutrition for Health and Development, World Health Organization (WHO), in collaboration with the United Nations Children's Fund (UNICEF) and Nutrition International, convened the technical consultation “Multiple micronutrient supplements in pregnancy: Implementation considerations for successful incorporation into existing programmes,” to examine the programmatic evidence, including successful implementation experiences, best practices, and lessons learnt, in order to inform the scale up of multiple micronutrient (MMN) supplementation during pregnancy as part of quality existing services in routine antenatal care (ANC) programmes in these settings
The results showed that ANC was the main delivery platform, and community‐based approaches existed, they were poorly implemented

Summary

| INTRODUCTION

Micronutrient malnutrition in pregnant women is widespread across regions and countries. The objective of this review was to describe monitoring, evaluation, and surveillance indicators for MMN in pregnancy programmes by developing indicator titles based on the WHO/CDC logic model to cover the areas of inputs, activities, outputs, and outcomes (World Health Organization/Centers for Disease Control and Prevention, 2016) For this purpose, practice‐based evidence was assessed including monitoring manuals, implementation manuals, country reports, published literature, and expert opinion. Basic nutrition interventions should become part of the concept of universal health coverage and quality of care Another important topic raised during plenary sessions was about the composition of the product itself and the careful consideration of evidence, or the lack of it, to inform a possible change in the national policies and distribution of the product through the public sector to control the anaemia problem. Other key factors are capacity building, supply management, right formulation, clear regulation of the countries, quality health services, and behaviour change: the demand for nutrition actions

| CONCLUSIONS

Findings

CONFLICTS OF INTEREST