Maternal undernutrition during pregnancy is currently estimated at 23.5% in Africa, which is worrying given the negative impacts of malnutrition on maternal and fetal birth outcomes. The current study aimed at characterizing the associations of maternal dietary intake and nutritional status with fetal growth at 14–26 weeks gestation. It was hypothesized that maternal dietary intake was positively associated with maternal nutritional status and fetal growth both in early and late pregnancy.

Countries are developing roadmaps for the introduction and scale-up of national Multiple Micronutrient Supplementation (MMS), including background, strategy, implementation plan, and financing plan. As part of this roadmap, the implementation plan for MMS introduction and scale-up is to be costed, which then informs the funding requirements and an appropriate financing strategy and plan. The purpose of this tool is to support country stakeholders in costing their MMS implementation plan, to identify the funding requirements, inform the development of a financing/resource mobilization plan, and to serve as an aide to continue to update the country’s costing and financing plans.

In early 2024, Evidence Action conducted formative research (20 facility visits, and 4 focus group discussions) in Oyo and FCT, Nigeria. Key findings are summarized in this report.

More than half of neonatal deaths are attributable to being born too soon or small; these infants are known as small vulnerable newborns. Global estimates for 2020 suggest that 23.4 million neonates were born small for gestational age, 13.4 million were preterm, and 19.8 million had low birthweight. There are several reasons for babies being born small or early; high rates of protein and micronutrient deficiencies in pregnant people are some of the key factors. Small vulnerable newborns are at elevated risk of mortality, growth and cognitive faltering, and non-communicable diseases in later life. In The Lancet Global Health, Dongqing Wang and colleagues used an individual patient data meta-analysis to assess the effect of multiple micronutrient supplements (MMSs) and small-quantity lipid nutrient supplements (SQ-LNSs) on the ten different categories within the small vulnerable newborn group. This is a very timely publication as it reinvigorates the debate for revisiting the guidelines for antenatal supplementation, especially considering the long overdue debate to replace routine iron and folic acid with MMSs.

Small vulnerable newborn types, defined by combinations of being born too soon or too small, have distinct determinants and health consequences. We aimed to assess the effects of prenatal multiple micronutrient supplementation (MMS) and small-quantity lipid-based nutrient supplementation (SQ-LNS) on small vulnerable newborn types, which are currently unknown.

This programme effectiveness study responds to the need for evidence of the effect on birth weight of switching from iron-folic acid supplementation to multiple micronutrient supplementation as part of routine antenatal care in Ethiopia. A 2019 meta-analysis reported a mean increase of 35 g in birth weight among newborns of women who took multiple micronutrient supplements in pregnancy compared with those who took iron-folic acid. Responding to that evidence, the government of Ethiopia decided to implement a 21-district pilot of the use of multiple micronutrient supplementation in routine antenatal care and requested an evaluation of implementation outcomes, including on birth weight.

Inadequately diversified food consumption during pregnancy can lead to micronutrient deficiencies, which can affect maternal and newborn health outcomes. Previous studies on maternal dietary diversity have either been limited to a specific geographical region or consist entirely of systematic reviews, without meta-analyses. Thus, this study aimed to determine the pooled estimate of the association between inadequate dietary diversity during pregnancy, maternal anemia, and low birth weight in Africa.

Anemia in pregnancy has been associated with a number of adverse birth outcomes, such as low birth weight or preterm birth. However, the evidence from primary studies on anemia in pregnancy with low birth weight and preterm birth is contentious. Moreover, a systematic review and meta-analysis to summarize these findings have not been conducted for Ethiopia. This study aimed to synthesize the best available evidence and quantify the strength and direction of the association of anemia in Ethiopia

The objective of this study was to estimate the associations between gestational weight gain during pregnancy and neonatal outcomes in low- and middle-income countries, with a conclusion that inadequate and excessive gestational weigh gain are associated with a higher risk of adverse neonatal outcomes across settings. Interventions to promote optimal GWG during pregnancy are likely to reduce the burden of adverse neonatal outcomes, however further research is needed to assess optimal ranges of GWG based on data from low- and middle-income countries.

A package of care for all pregnant women within eight scheduled antenatal care contacts is recommended by WHO. Some interventions for reducing and managing the outcomes for small vulnerable newborns (SVNs) exist within the WHO package and need to be more fully implemented, but additional effective measures are needed. We summarise evidence-based antenatal and intrapartum interventions (up to and including clamping the umbilical cord) to prevent vulnerable births or improve outcomes, informed by systematic reviews. We estimate, using the Lives Saved Tool, that eight proven preventive interventions (multiple micronutrient supplementation, balanced protein and energy supplementation, low-dose aspirin, progesterone provided vaginally, education for smoking cessation, malaria prevention, treatment of asymptomatic bacteriuria, and treatment of syphilis), if fully implemented in 81 low-income and middle-income countries, could prevent 5·202 million SVN births (sensitivity bounds 2·398–7·903) and 0·566 million stillbirths (0·208–0·754) per year. These interventions, along with two that can reduce the complications of preterm (<37 weeks’ gestation) births (antenatal corticosteroids and delayed cord clamping), could avert 0·476 million neonatal deaths (0.181 – 0.676) per year. If further research substantiates the preventive effect of three additional interventions (supplementation with omega-3 fatty acids, calcium, and zinc) on SVN births, about 8·369 million SVN births (2·398–13·857) and 0·652 million neonatal deaths (0·181–0·917) could be avoided per year. Scaling up the eight proven interventions and two intrapartum interventions would cost about US$1·1 billion in 2030 and the potential interventions would cost an additional $3·0 billion. Implementation of antenatal care recommendations is urgent and should include all interventions that have proven effects on SVN babies, within the context of access to family planning services and addressing social determinants of health. Attaining high effective coverage with these interventions will be necessary to achieve global targets for the reduction of low birthweight births and neonatal mortality, and long-term benefits on growth and human capital.