A Health Systems Strengthening Approach to Improve Nutrition of Pregnant Women and Newborns in Ethiopia, Kenya and Senegal.

Objectives: Coverage of nutrition interventions for pregnant women is poor, but potential for improvement is limited where health systems are weak. The Community-based Maternal and Newborn Health and Nutrition (CBMNH) program aims to increase utilization and quality of health and nutrition services for pregnant women and newborns by strengthening health systems. With the program's focus on increasing demand for prenatal and birth services, we implemented Knowledge, Attitudes and Practices (KAP) surveys to identify key individuals/factors influencing demand and use. Methods: As part of the baseline surveys, we randomly selected women with children 0-11 months. Using mixed methods, we assessed current KAP surrounding nutrition in antenatal care. Results: We identified gaps in the provision and utilization of services, particularly antenatal care (ANC), iron-folic acid supplements (IFA), among others. The proportion of women who had attended 4 ANC visits during pregnancy was 4.8% in Ethiopia, 43% in Kenya, and 50% in Senegal; about a fifth in Ethiopia and Kenya and 60.7% in Senegal attended ANC in the first trimester. Only 3.4% of women in Ethiopia, 36.7% in Kenya and 93.6% in Senegal had taken ≥90 IFA tablets during pregnancy. Qualitative data found that knowledge and attitudes of women regarding care seeking for ANC and benefits of IFA during pregnancy period was low. Conclusions: In all 3 countries, but particularly Ethiopia, health and nutrition services for pregnant women and newborns are under-provided and under-utilized. This evaluation revealed both demand and supply side barriers that are now being addressed as part of the on-going program.