(P44-16-26) Sustainability of Antenatal Multiple Micronutrient Supplement Delivery in the UNRWA Health Care System in Jordan

Monday, July 27, 2026

9:30 AM - 10:30 AM ET

Location: Poster Board A-16

Presenting Author(s)

Masako Horino, DrPH, MPH, RD

Nutrition Epidemiologist / Affiliate Faculty
UNRWA / Johns Hopkins Bloomberg School of Public Health
Amman, 'Amman, Jordan

Co-Author(s)

AA

Aya Abuhammad

United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA), Jordan
JC

Jiaxin Chen

Vitamin Angels Alliance, Inc., China (People's Republic)
LA

Luai Al-Khatib

United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA), Jordan
RJ

Reham Jaffal

United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA), Jordan
KK

Klaus Kraemer

Sight and Life Foundation, Switzerland
KH

Kristen M. Hurley, PhD MPH

Associate Professor
Johns Hopkins Bloomberg School of Public Health
Baltimore, Maryland, United States
AS

Akihiro Seita, MD

Director of Health
United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA)
Amman, 'Amman, Jordan
Keith P. West, Jr., DrPH, MPH (he/him/his)

George G. Graham Professor of Infant and Child Nutrition
Johns Hopkins Bloomberg School of Public Health
Baltimore, Maryland, United States

Disclosure(s):

Masako Horino, DrPH, MPH, RD: No relevant financial relationship(s) with ineligible companies to disclose.

Objectives: Prenatal micronutrient deficiencies are common among Palestine refugees in the Middle East. Multiple micronutrient supplementation (MMS) improves birth outcomes. In 2020, WHO recommended use of prenatal MMS with research to assess “sustainability”, although criteria and methods of assessing this outcome remain undefined. UNRWA (UN Relief and Works Agency for Palestine Refugees in the Near East) is monitoring indicators of sustainable antenatal delivery of UNIMMAP-formulated, 15-nutrient MMS in 180-ct bottles.

Methods: Following a trial revealing superiority in MMS over iron-folic acid (IFA) use, UNRWA scaled up MMS as standard of care in Jordan in Sept 2024. Agency policy calls for midwives to issue 1^st bottles of MMS to >95% of gravidae at registration, 2^nd bottles later while still pregnant, and clinicians to add MMS to IFA to treat anemia (Hb < 10 g/dL). Conventional operations data have been monitored such as MMS inventories & issuance, registrant coverage, and management responses to stockouts. As sustainability requires time to falter, results refer to an initial 17-month program period. UNRWA Research Review Board approved the study.

Results: From Sept 2024 to Jan 2026, 26,546 pregnant women registered: 74%, 23% and 3% in 1^st, 2^nd, and 3rd trimesters (TM), 14% with anemia. When central MMS stores were adequate, clinics maintained adequate inventories: 24 of 25 clinics issued 1^st MMS bottles to 95-100% of registrants. One clinic issued MMS at a 2^nd visit to incentivize women to return for lab tests at that time, subsequently corrected. Central stores stocked out in May, lowering coverage in June 2025 to <65% in 8 (32%) clinics, while 6 (24%) retained >90% coverage, revealing importance of ≥1 month routine reserves. Clinics shared surpluses to minimize disruptions. Some returned to providing IFA. Following central resupply, clinics resumed >95%coverage in July, although later coverage in 1 clinic fell to < 4% for 2 mo, having failed timely reordering. Half of 1^st TM but 6% of 2^nd TM registrants received a 2^nd bottle due to delivery. Monthly, 32-46% of anemic patients received IFA+MMS, prompting additional training.

Conclusions: Routine health care systems data can be tracked to assess, correct and forecast timely, sustainable antenatal MMS delivery in 180-ct bottles to prevent micronutrient deficiencies.

Funding Sources: Vitamin Angels, UNRWA, Govt of Japan