TY - JOUR T1 - Improving Iron and Folic Acid Supplementation Among Pregnant Women: An Implementation Science Approach in East-Central Uganda JF - Global Health: Science and Practice JO - GLOB HEALTH SCI PRACT DO - 10.9745/GHSP-D-21-00426 VL - 10 IS - 6 SP - e2100426 AU - Ahmed K. Luwangula AU - Laura McGough AU - Moses Tetui AU - Henry Wamani AU - Mark Ssennono AU - Caroline N. Agabiirwe AU - Isabelle Michaud-Létourneau AU - Nathan Tumwesigye AU - Keith Baleeta AU - Twaha Rwegyema AU - Augustin Muhwezi Y1 - 2022/12/21 UR - http://www.ghspjournal.org/content/10/6/e2100426.abstract N2 - Key FindingsAlthough iron and folic acid supplementation (IFAS) is a well-known and effective intervention for anemia in pregnant women, its access and uptake were affected by stock-outs and inadequate health education of both health care workers and pregnant women.An intervention combined enhanced quality improvement (QI) activities with an implementation science approach that resulted in a significant increase in the probability of pregnant women receiving IFAS and health education on IFAS during antenatal care (ANC).The approach improved stakeholder engagement at all levels and helped health workers understand the importance of IFAS, which motivated them to deliver related health education messages and adhere to national IFAS protocols.Key ImplicationsEnhancing QI for IFAS improved and sustained its availability to pregnant women during ANC and transformed health providers into advocates for IFAS.Key stakeholder engagement at all levels is critical for objectively identifying the service delivery bottlenecks, gaining consensus, ensuring acceptability, and mobilizing champions for change.Introduction:To address maternal iron-deficiency anemia and low uptake of iron and folic acid supplementation (IFAS) among antenatal care (ANC) clinic attendees in East-Central Uganda, the Anemia Implementation Science Initiative embedded enhanced quality improvement (QI) activities into an integrated health project utilizing QI methodologies.Methods:To address 2 bottlenecks of stock-outs and inadequate health education for pregnant women during ANC, an enhanced QI intervention was implemented from July 2019 to September 2020 in 2 districts. We conducted a mixed-methods effectiveness quasi-experimental study to assess whether the intervention increased the availability of IFAS in the intervention districts. We used longitudinal facility-level data from 2 treatment districts and 1 comparison district for the quantitative results. Difference-in-difference estimation was used to measure the impact of the intervention on IFAS health education and IFA availability at the health facility. We used logistic regression modeling to control for factors associated with IFAS uptake and potential differences in baseline values. Researchers conducted exit interviews with ANC clients and in-depth interviews with providers and district managers for greater insights into the implementation process.Results:The intervention increased the probability, at a statistically significant level, of pregnant women both receiving IFAS and receiving health education on IFAS during ANC. According to inter-viewees, the intervention approach improved stakeholder engagement and buy-in, which brought about change at all levels of the health system.Discussion:The intervention successfully addressed the 2 main bottlenecks to availability of IFAS for pregnant women attending ANC—inadequate provision of IFAS education and a weak drug quantification process. Even without additional funds to purchase commodities, this approach improved district capacity to advocate for and manage IFAS commodities. It could also be used to strengthen overall ANC quality. ER -