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Formative research in Ethiopia and Bangladesh

Strengthening household survey measures of maternal micronutrient supplementation in low- and middle-income countries

Bibliographic Data

ID21874739
AuthorsShelley Walton (0000-0003-3635-4567, Johns Hopkins University), Ellina Wood (Johns Hopkins University), Hanna Y Berhane (0000-0002-5654-3552, Addis Continental Institute of Public Health), Firehiwot Workeneh (Addis Continental Institute of Public Health), Fiker Ferdaweke (Addis Continental Institute of Public Health), Sk Masum Billah (0000-0002-8690-6932, The University of Sydney), Sharif Uddin Lotus (0000-0002-9013-7216, International Centre for Diarrhoeal Disease Research), Melinda Munos (0000-0002-1349-8026, Johns Hopkins University), Sunny Kim (0000-0002-2926-2712, International Food Policy Research Institute), Swetha Manohar (0000-0003-4042-8952, International Food Policy Research Institute), Phuong Nguyen (0000-0001-9341-0719, Health Strategy and Policy Institute), Syed Shehryar Azeem (International Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA), Sara Azeem (Johns Hopkins University), Rebecca Heidkamp (0000-0003-3146-1320, Johns Hopkins University)
Year2026
Volume16
Pages04159-04159
Publication date2026-07-03
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueJournal of Global Health (JOURNAL)
Journal identifiersISSN: 2047-2978 • E-ISSN: 2047-2986
PublisherInternational Society of Global Health (PUBLISHER • GB)
DOI10.7189/jogh.16.04159
PMID42396896
OpenAlexW7167234957
LanguageEN
References cited20

Background: As countries transition from implementing 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: We had 73 participants in Ethiopia and 132 in Bangladesh, encompassing CPW, RDW, healthcare workers, and retailers. Women in both contexts distinguished among micronutrient products based on colour, 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. Women did not recognise any specific term for multivitamins or MMS. Shorter recalls of seven days or one month for adherence were feasible for respondents. Conclusions: It is challenging for the measurement community to identify terms and images that help women distinguish between supplement types. The final set of survey questions developed as part of this research is comprehensible and can be feasibly adapted and used in multi-topic surveys in MMS contexts, but requires validation

Behavior change communication · Developing country · Formative assessment · Micronutrient · Micronutrient deficiency · Pregnancy · Prenatal care · Public health · Child Nutrition and Water Access · Folate and B Vitamins Research · Iron Metabolism and Disorders

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Citation velocityhistorical
Highly citedNo
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