Pathways | Nutrition Supplements
Optimising adherence to antenatal supplements in Northern Nigeria
Nigeria has an anaemia prevalence amongst women of reproductive age at approximately 58% and as high as 72% in some states. The Nigerian Federal Ministry of Health has expressed the importance of identifying and addressing critical barriers to the uptake and adherence to maternal supplements. As Nigeria transitions from iron-folic acid to multiple micronutrient supplements (MMS) for pregnant women, Nutrition International, in collaboration with Sonder Collective, are applying interdisciplinary research methods, human centred design and the Pathways segmentation to develop solutions to increase supplement adherence among pregnant women.
In northern Nigeria, approximately 58% of women of reproductive age (WRA) – and as high as 72% in some states – have anaemia, and only 56% of WRA are classified as having an adequately diverse diet. Iron deficiency anaemia has been linked with an increased risk of preterm delivery, postpartum haemorrhage, low birth weight, and delayed psychomotor development and impairment of cognitive development in the child’s infancy, which has an impact on the child’s development later in life. This makes anaemia a serious maternal and child health issue for pregnant women in northern Nigeria that needs to be addressed. In response, the Nigerian Federal Ministry of Health (FmoH) has expressed the importance of identifying and addressing critical barriers to the uptake and adherence to maternal supplements by pregnant women as Nigeria transitions from the use of iron-folic acid supplements to multiple micronutrient supplements (MMS) for the prevention of anaemia during pregnancy. To address this challenge, Nutrition International, in collaboration with Sonder Collective, is applying interdisciplinary research methods, human-centred design and the Pathways segmentation to develop solutions to increase antenatal supplement adherence among pregnant women in Northern Nigeria, with a focus on Bauchi state.
An initial phase of formative research has applied social research methods to surface the barriers and needs related to women's antenatal supplement adherence in the context of their everyday lived experience, sociocultural context, and interactions with the healthcare system. Formative research investigated women's entire pregnancy care and supplement adherence journey, including their pregnancy health knowledge and education, experiences with ANC visits, beliefs and attitudes towards supplements, and supplement uptake and adherence behaviours. From the research analysis, we created a strategic framework to guide design thinking and the development of adherence solutions. Design solutions will beare currently being further validated and refined through a second round of behavioural and cultural research in 2023 as part of a sequenced, multidisciplinary approach to learning and development
Throughout the development process, concept refinement and rapid field testing will engage national, state and local stakeholders, including healthcare workers, women and men in the community, to validate, refine and finalise innovative and effective strategies for MMS adherence.
This project applies and builds on the emerging Pathways framework to identify the needs and barriers of women who are most vulnerable to poor maternal health outcomes and use that understanding to design more effective, human-centred, and innovative solutions to MMS adherence. The Pathways segmentation for Northern Nigeria provided insights into women's and families' vulnerability to RMNCH+N outcomes and was used to guide recruitment and analysis of the formative research.
This project will result in the development of an enhanced MMS adherence strategy. The strategy, informed by interdisciplinary research and design, will include approaches for individual, household, community and clinics. The enhanced strategy will be implemented and evaluated by Nutrition International for their effectiveness in increasing pregnant women’s adherence to MMS.
As of early 2023, the design research (i.e., Phase I of the interdisciplinary research) and an initial dissemination and design workshop with national, state and local stakeholders, including health workers, have been completed.
Honestly taking [supplements daily is [pregnant people’s] challenge. You find out that they forget to take them...that’s how days are skipped. Another will travel and not carry [her supplements], saying that she forgot and left [her supplements] at home.
Health worker in Ganjua, Bauchi State.