Assessing Acceptability, Adherence, and Systems Readiness for the Transition from IFA to MMS in Ghana: A Mixed-Methods Implementation Research Study

INTERVENTION: CONDITION: ; Haematological Disorders PRIMARY OUTCOME: Adherence ‐ • To assess adherence patterns between MMS and IFA and explore contextual factors contributing to observed differences.; • To assess whether adherence to MMS varies across socio‐economic, demographic and geographic (regional) groups and identify the factors associated with these disparities.; • To evaluate the impact of MMS packaging options (90‐count and 180‐count bottles) on adherence rates and ANC attendance over time. SECONDARY OUTCOME: Acceptability. To evaluate the acceptability of MMS among key stakeholders, including pregnant women, healthcare providers, family members, community leaders, and policymakers, and explore the reasons for their perceptions. ; • To investigate whether beliefs about new medicines or supplements influence the uptake of MMS. Sustainability of MMS integration into routine ANC services, assessed qualitatively through perceived policy, financing, supply chain, and monitoring arrangements, and the identified facilitators and barriers to maintaining MMS use over time. INCLUSION CRITERIA: • 18 – 49 years • Gestational Age (GA): MCHRB shows GA = 21 wks (by last menstrual period (LMP), fundal height, ultrasound biometry, or ANC attendant indication of Early Pregnany [EP], universally understood to mean = 21 wks) • No IFA supplements use during this pregnancy before enrollment • MCHRB shows hemoglobin concentration >7.0 g/dL). • Resides in study district/region