Preprint Article | https://doi.org/10.12688/verixiv.2006.1
Date of Publication | December 2025
Abstract
Background
As countries transition from iron folic acid (IFA) to multiple micronutrient supplements (MMS) for pregnant women, they need accurate data on who is being reached with these interventions. The aim of our formative research in Ethiopia and Bangladesh was to design updated household survey questions, response options, and visual aids to measure coverage of prenatal micronutrient supplements.
Methods
In Phase I, we landscaped health providers and retailers to identify prenatal micronutrient products available in each country and interviewed currently pregnant women (CPW) and recently delivered women (RDW) about how they differentiated among micronutrient products. In Phase II, we used these findings to draft survey questions and visual aids. In Phase III, we iteratively tested and refined the draft tools through cognitive interviews with women.
Results
The total number of study participants, including CPW, RDW, healthcare workers, and retailers, was 73 in Ethiopia and 132 in Bangladesh. Women in both contexts distinguished among micronutrient products based on color, shape, packaging, and perceived purpose. In cognitive tests, women generally understood the English term “iron” as a catch-all term for any iron-containing supplement. No specific term for multivitamin or MMS was consistently recognized by women. Shorter recalls of 7 days or 1 month for adherence were feasible for respondents.
Conclusions
It is challenging to identify terms and images that help women distinguish between supplement types. The final set of questions are feasible for adaptation and use in multi-topic surveys, in contexts with MMS but require validation.
