Qualitative Evaluation of the Pilot Introduction of Multiple Micronutrient Supplementation in Burkina Faso

Effective transition from iron-folic acid (IFA) to multiple micronutrient supplementation (MMS) requires context-specific evidence. Using the MMS pilot program in Burkina Faso, this study aimed to evaluate the feasibility and acceptability of MMS and identify factors that can influence a successful scale-up. We conducted a qualitative study. In-depth interviews (n = 57) with policymakers, clinicians and community actors as well as focus group discussions (n = 12) were conducted with pregnant/lactating women, husbands, and community leaders. Attitudes, barriers, and enablers to MMS access/utilization were assessed after two-years of piloting. A total of 153 participants were interviewed either through focus groups (n = 96) or In-depth interviews (n = 57). The MMS intervention was perceived to be highly acceptable to most participants. Strong stakeholder engagement, supported by coordination meetings and targeted training increased fidelity to the program. MMS's integration through the use of existing IFA distribution channels, and the high level of participant awareness about micronutrient deficiencies-particularly during pregnancy-were key enablers for effective transition. Stakeholders across all levels perceived MMS as more effective than IFA in preventing anemia and supporting maternal-fetal health even if their perceptions collected through interviews and have not been verified through clinical measurements. However, barriers include women forgetting to take pills, supply chain disruptions, fragmented interdepartmental coordination, mild side effects (i.e. nausea) and cultural practices like food taboos. The barriers raised emphasized the need for increasing the reach of culturally-adapted nutrition education targeting women and influencers in the family. Facilitators found associated to program sustainability were mainly community engagement, health partners' support and awareness campaigns on the MMS. The piloting of the MMS helped identify numerous context-specific enablers and barriers that if addressed could lead to a smoother and more effective transition.