Giulia Pastori

Background/Objectives: Emerging evidence suggests that multiple micronutrient supplements (MMS) provide additional benefits for maternal and neonatal health compared with iron and folic acid (IFA) supplements. To achieve effective coverage, acceptability, and adherence—and to inform a nationwide rollout of MMS—it is essential to understand the context-specific factors that shape implementation. This study evaluated the pilot implementation of MMS in Rwanda to identify key enablers, areas for improvement, and challenges related to antenatal care (ANC) attendance and MMS use. Methods: Data were collected through a survey of 3257 women who attended ANC services, seven focus group discussions with 35 ANC attendees, and key informant interviews with 20 ANC nurses and 21 community health workers. Results: Pregnant women reported high ANC attendance (74%) and MMS consumption (79%), largely driven by strong motivation and awareness of MMS benefits. Strategies to remember daily intake and to manage side effects supported adherence, as did reminders, motivation, and information from family members and healthcare providers. Limited patient-centered counselling, financial constraints, barriers to accessing ANC services, and product stock-outs were key areas for strengthening service delivery in Rwanda. Conclusions: Sustaining high ANC attendance and MMS adherence as the program transitions from the pilot phase to national scale-up is essential. Improving counseling quality and strengthening supply chains may reinforce ANC services and support sustained MMS adherence, with benefits for maternal and child health.

Fruit and vegetable consumption is below the WHO recommendations, globally, in Southeast Asia, and in West Africa. Affordability, accessibility, and acceptability are the main drivers of consumption. Nutrition-sensitive food system interventions that address these drivers may be effective in increasing fruit and vegetable consumption. This study evaluates the effect of an integrated nutrition-sensitive program that aimed to increase fruit and vegetable consumption in low-income urban adults in Hanoi, Vietnam (n = 582), and Ibadan, Nigeria (n = 626), through the simultaneous implementation of three interventions at the market and consumer levels. Fruit and vegetable intake data were collected after eight months of exposure to the program with repeated quantitative 24-hour recalls and exposure effect was estimated with inverse probability weighting with regression adjustment, adjusting for potential confounders. The impact size on total fruits and vegetables (144 g/d, 95%CI 93, 196), fruits (137 g/d, 95%CI 93, 183) and vegetables (6 g/d, 95%CI -12, 24) showed that intake was higher in the exposed Nigerian population than the control group. In Vietnam, intakes of fruits and vegetables in the exposed group did not statistically differ from the control group when controlling for differences between groups with propensity scores. Participants exposed to all three interventions reported slightly higher intakes compared to those who were exposed to fewer interventions, but these differences were not statistically significant. Integrated approaches of nutrition-sensitive food system interventions need to be implemented to increase fruit and vegetable consumption. Co-creation of interventions provides the possibility to address the different drivers and barriers of healthy diets specific of the context.

With the recent growing interest in improving fruit and vegetable intake for better health and limited research resources in many settings, simple-to-administer and low-priced indicators are essential tools for monitoring fruit and vegetable intake at the population level. A potential candidate indicator is the fruit and vegetable component of the Global Dietary Recommendation score (FV-GDR) based on data collected using the Diet Quality Questionnaire (DQQ). We investigated the relative validity of FV-GDR collected with the DQQ to measure fruit and vegetable intake by comparison with a 24-h recall (24hR) as a reference collected from 620 Vietnamese and 630 Nigerian adults in 2021. We found proportional differences in the prevalence of intake of vitamin A-rich vegetables, other vegetables and other fruits in Vietnam and all vegetable food groups in Nigeria. In both countries, we found a small difference in the total FV-GDR from DQQ compared with the 24hR, and the percentage of agreement between the two methods was quite high for the majority of the food groups. The FV-GDR calculated from the DQQ correlated with the actual intake, although less strongly than the FV-GDR from 24hR. The DQQ is a promising low-burden, low-cost and simple tool to calculate FV-GDR and to monitor fruit and vegetable consumption at the population level. This provides the possibility of evaluating an important aspect of diet quality in low-resource settings.