Donor: Eleanor Crook Foundation
Budget: $1,236,895
Timeline: October 2023 – September 2025 (24 months total)
Project Background
Nepal has a significant burden of micronutrient deficiencies. These deficiencies, especially during pregnancy, lead to multiple complications including higher risks of maternal mortality, poor birth outcomes, and impaired cognitive as well as physical development. Most recently, the United Nations International Multiple Micronutrient Antenatal Preparation - Multiple Micronutrient Supplementation (UNIMMAP-MMS) formulation has been added to the World Health Organization’s (WHO) list of essential medicine. With the global evidence highlighting benefits of Multiple Micronutrient Supplementation (MMS) during pregnancy compared to IFA, its transition seems more effective in terms of improved maternal and neonatal health and productivity. However, Nepal's challenge lies in the persistent burden of deficiencies and the potential for improved health outcomes with MMS adoption.
Nepal's Ministry of Health and Population (MoHP) is planning a shift from IFA to MMS. To support this, Helen Keller Intl, with the financial and technical support from Vitamin Angles, conducted a landscape analysis in 2023 to assess the enabling environment for MMS, explore the local evidence on maternal nutritional status, generate an understanding of key perceived issues that may hinder a national transition from IFA to MMS, and build consensus on the way forward for MMS. This landscape analysis recommended the need for implementation research on the feasibility of transitioning from IFA to MMS. After the landscape finding, under the leadership of Family Welfare Division, Department of Health Services, MoHP, Helen Keller Intl. with support from Elenor Crook Foundation, is implementing this project aimed to explore and generate evidence on the acceptability and adherence of MMS among pregnant women and lactating mothers in Nepal, as well as the operational feasibility, cost effectiveness and supply readiness of the transition to MMS.
This ongoing 24- month project, aims to create an evidence-based framework for transitioning from IFA to MMS in Nepal. Key activity of this project includes:
1. Evidence Generation through Implementation Research: Assessing MMS product acceptability, adherence, and barriers/opportunities for integration into antenatal care through a three-armed non-inferiority randomized controlled trial. Evidence generation through implementation research comprises of four sub-studies as listed below:
a) Randomized controlled trial (RCT): In Lumbini province, MMS adherence and accessibility will be assessed through a three-arm study in which pregnant women will receive IFA in blister packaging or MMS in blister packaging or MMS in bottle packaging.
b) Demonstration study: MMS adherence and acceptability will be quantitatively assessed in selected health facilities of Nepal's other six provinces.
c) Household qualitative study: Factors affecting adherence and acceptability will be qualitatively assessed through focused group discussion and interviews with high and low adherers to supplements during pregnancy as well as their key family members in all seven provinces.
d) Operation feasibility qualitative study: Enablers and barriers to the potential transition to MMS will be explored with ANC healthcare providers and female community health volunteers and national, provincial, and local policymakers in all seven provinces.
2. Improved Knowledge of MMS Benefits: Creating awareness and understanding of MMS advantages in selected provinces to foster a supportive environment for transition through research briefs, awareness-raising sessions, and IEC materials after the research findings.
3. Policy Engagement for MMS Program: Forming a technical committee, engage with stakeholders for MMS inclusion in the national essential medicines list, and obtaining ministerial approval through evidence review and stakeholder consultations.