Action - The MOST Project - Iron and folic acid supplementation - Pregnant women (PW)

Programme: The MOST Project

Programme description


Micronutrient deficiency adversely affects the health and economic and social development of individuals, communities, and nations. Given their high prevalence in developing regions, deficiencies in vitamin A, iron, and iodine have great public health significance.

Vitamin A deficiency weakens the immune system and, hence, increases the severity of infections. It is also the most common cause of blindness among children in developing countries. Iron deficiency anemia impairs immunity and reduces physical and mental capacities of populations. Iodine deficiency is the leading cause of mental and physical retardation in infants and children worldwide. As with vitamin A and iron, iodine deficiency increases the risk of death in newborns.

Programs that promote improved micronutrient status can alleviate the disability, morbidity, and mortality—particularly among young children and women—that are the consequences of micronutrient deficiency.

The MOST Mission

The MOST mission is to 1) maintain and enhance USAID's global leadership position in addressing micronutrient malnutrition, particularly vitamin A deficiency; 2) implement and evaluate state-of-the-art interventions to alleviate micronutrient deficiencies; and 3) provide technical guidance and coordination to other USAID projects with micronutrient-related components.

The MOST Strategy

The MOST strategy is built upon a framework of global and country-level results:  

The global agenda focuses on 1) promoting a revised global agenda in collaboration with other organizations worldwide committed to reducing micronutrient malnutrition; 2) translating scientific knowledge into policy and program action; and 3) maximizing lessons learned through USAID’s extensive field program experience. 

Country-level results address deficiencies in vitamin A, iron, and iodine: 1) vitamin A coverage of at least 80 percent of deficient children under 6 years of age; 2) moderate to severe anemia decreased by 30 percent in pregnant women and children 6–24 months of age; and 3) percentage of the population with symptoms of iodine deficiency reduced by 30 percent.

Country Activities

For micronutrient delivery at the country level, MOST’s role is to provide technical support to countries to guide the use of not only USAID funds, but also the full range of financial and human resources needed to eliminate micronutrient deficiencies from the list of public health problems.

In the design of country activities, MOST seeks the appropriate balance between supplementation, food fortification, and other food-based approaches to deliver micronutrients to at-risk populations in an effective, yet affordable way. Country activities are based upon analyses of a variety of relevant information:
—Prevalence and severity of micronutrient deficiencies
—Awareness of effects of micronutrient deficiencies
—Nutrition policies and programs
—Providers’ motivation, knowledge, and practices
—Food consumption data
—Production, distribution, and marketing of staple foods
—Estimates of the costs of alternative interventions

Key Areas of Activity

—Application of behavior change techniques to create demand for micronutrient programs and services
—Enhancement of the effectiveness and sustainability of supplementation programs
—Sound planning, implementation, and quality control of fortification programs
—Inclusion of other food-based approaches in programs
—Application of appropriate economic analysis to guide the evolution of country programs
—Use of monitoring and evaluation to improve program operations
—Development of public and private sector alliances to enhance the effectiveness of interventions

Target Groups

MOST focuses on the improvement of the micronutrient status of children under 6 years of age and women of childbearing age. Several intervention options available to address micronutrient deficiency, such as food fortification, will benefit not only those target groups, but also school-age children and adult males.

The MOST Team

The MOST team consists of five organizations led by the International Science and Technology Institute, Inc. (ISTI) as the primary contractor. ISTI's partners are the Academy for Educational Development, Helen Keller International, the International Food Policy Research Institute, and Johns Hopkins University.

In addition, five resource institutions have joined MOST for in-country implementation and technical tasks: CARE, International Executive Service Corps, Population Services International, Program for Appropriate Technology in Health, and Save the Children.

Programme type



Annual average cost of vitamin A supplementation in Ghana, Zambia:USD 2,851,000Zambia Sugar requested $1 million from USAID to cover the cost of the fortificant in Zambia Sugar Fortification Program.



Start date:


End date:

Four districts of Apac, Kumi, Mukono and Ssembabule (Uganda)
Target group: 
Pregnant women (PW)
Primary health care center
Implementation details : 

Five data collection methods were used:

  1. FGDs were held with the district health teams in the four study districts to  determine gaps in the district health system that constrain the effectiveness of the anemia control program and factors constraining the implementation of recommended actions on anemia control for mothers in ANC.
  2. In-depth interviews were conducted with 32 managers in charge of the health facilities; 32 providers in charge of ANC services at their respective health facilities were interviewed using a structured interview schedule.
  3. Observations of the provider client interaction. The observed behaviors were checked off against a checklist. On completion of the survey, this methodology was assessed and considered to lack sufficient validity. As a result, the team did not use data from these observations.
  4. Exit interviews: Every third womanwho went through the system was interviewed using the exit interview schedule to assess their opinions and satisfaction with the ANC services that the health facility had provided. A total of 256 exit interviews were conducted.
  5. A facility audit was done in all 32 health facilities to assess the availability of basic ANC equipment, logistics/supplies, facilities/equipment, IEC materials
    and activities, and record keeping and reporting.

During the fieldwork, the enumerators worked in pairs. The enumerators were not allowed to use the instruments in the facilities where they worked. Each pair spent a full day at a health facility. Field supervisors supported the enumerators during the data collection and checked the questionnaires for consistency and completeness. This was to ensure that the data collected was accurate as possible.

Coverage level (%): 
total of 32 facilities—8 from each of the 4 study districts (Apac, Kumi, Mukono and Ssembabule)
Outcome indicator(s): 
  • Accessibility to comprehensive ANC services by pregnant women
  • ANC attendance by pregnant women
  • Guarantee to the key services needed for anemia control in pregnancy by women who attended the ANC
  • ANC clients services perceived as being of adequate quality.
  • Women assured of enough supplies of iron folic acid to last up to the next ANC visit.
  • ANC attendees assured of getting the correct dosage of the supplements
  • Consistently intake  iron/folic acid supplements by ANC clients
Outcome reported by social determinants: 
Vulnerable groups


Revision log

Thu, 10/08/2015 - 11:36ginaContribEdited by william_nkoom.published
Sat, 01/26/2013 - 11:42AnnaLarteyEdited by AnnaLartey.draft