Mahdi Garba (Lead writer)
Hajara Abdullahi, a mother of five in Bauchi State, noted that her health had improved since she started taking Multiple Micronutrient Supplementation (MMS), a supplementary drug that provides pregnant women with a mix of essential vitamins and minerals. “It makes me eat well,” she explained, “and I now feel energetic unlike before,” she narrated.
Nutrient deficiency continues to affect mothers and children under five across Nigeria, especially in the northern region. Meat, liver, and other foods that contain high amounts of bioavailable nutrients are often unaffordable for the poor, further worsening the problem. According to data from the 2018 Nigeria Demographic and Health Survey (NDHS), more than 68% women in Bauchi including those that are pregnant are anaemic.
After extensive research, the World Health Organisation (WHO) recommended in 2020 that Iron and Folic Acid (IFA) tablets should be replaced with MMS in low-and middle-income countries where nutritional gaps exist. IFA contains only iron and folic acid, while MMS includes 15 additional micronutrients, including 30mg of iron and 0.4mg of folic acid, making it more effective. In addition, MMS is intended as a preventive supplement, not a curative treatment that has been shown to reduce moderate anaemia, improve birth outcomes, and provide broader protection for both mother and child, as demonstrated in countries such as Botswana and Indonesia.
The global health organisation explained that the recommendation is based on evidence from trials using MMS, especially the widely available United Nations International Multiple Micronutrient Antenatal Preparation (UNIMMAP).
In collaboration with the Federal Government and Bauchi State Government, Nutrition International is supporting a three-year implementation research project on the transition from IFA supplementation to MMS as part of antenatal care (ANC) among pregnant women by distributing MMS in 84 primary healthcare centres (PHCs) and three general hospitals across Dass Ganjuwa and Giade Local Government Areas (LGAs) of the state.
“After taking the supplement daily, I have not experienced any negative effects. This makes me recommend it for other pregnant women in our village,” Hajara revealed.
Taking advantage of existing structures
Abubakar Bara, Nutrition Officer at the Bauchi State Primary Healthcare Development Board, said that accessibility, demand and security were reasons for selecting Dass, Giade and Darazo as the implementing LGAs in Bauchi State. Since November 2023, when the initiative began, MMS had been distributed across the three implementing LGAs. Between then and January 2025, over 25,000 pregnant women received MMS, and about 31,449 bottles of MMS were distributed through the state’s Primary Healthcare Development Board through the state’s Logistic Management Unit (LMU). The organisations also store MMS for Giade, a zonal warehouse in Azare, which supplies Dass and Ganjuwa.
Image credit: Nigeria Health Watch
Bara explained that women are advised on how to use the supplement. Each bottle contains 100 tablets and is expected to last for three months if taken daily. Patients are given a factsheet, and and are expected to tick it each they take a tablet. The factsheet providing information about the nutritional value of MMS is written in Hausa for better understanding. However, Bara emphasised that “MMS only complements what they eat. If she continues taking MMS without adequate diet, the aims will not be achieved,”.
Micronutrients for better results
According to Asabe Lekwot, Coordinator of Nutrition International in Bauchi State, MMS offers numerous benefits and helps prevent iron deficiency, which is common during pregnancy and can lead to complications such as maternal morbidity caused by micronutrient deficiencies.
She explained that MMS also support foetal growth and development. Micronutrients like folic acid prevent neural defects, while zinc and iodine contribute to brain and overall foetal development. It also reduces the risk of low birthweight and preterm birth. “MMS ensures the baby gets adequate nutrients for healthy growth, reducing the risk of underweight birth,” she said.
MMS also boosts maternal immunity through key nutrients such as Vitamin C, Vitamin D, and Vitamin A. Lekwot noted that MMS helps protect mothers from infections. “It improves pregnancy outcomes, reduces complications like preeclampsia and other pregnancy-related risks,” she added.
Safe deliveries
Lekwot noted that they have heard testimonies from women who have used the supplement, most of them expressed satisfaction. Some started taking MMS while pregnant, according to her and have now safely given birth to healthy babies.
Some mothers who testified to her, complained about feeling nauseous when they took the IFA, but were happy the MMS did not have any negative side effects. “Some women even told us that during their previous pregnancies they had blood transfusion but after taking the MMS, they delivered safely, without any transfusion. The husbands [usually] tell us how their wives look good,” Lekwot explained.
Image credit: Nigeria Health Watch
Trials and research conducted in India, Bangladesh, Kenya and other parts of the world have demonstrate the greater efficacy of MMS compared to IFA, with women who take MMS recording fewer low-birth weight babies.. Currently, Nutrition International is conducting a study in Bauchi to test both its uptake and effectiveness, Bara added that at the end of the study, there will conduct an endline survey to gather more comprehensive information on the use of MMS.
He also noted that when the women who use MMS attend ANC at the PHCs, healthcare workers often report an increase in their haemoglobin levels as the pregnancy advances.
Some challenges
Pregnant women with moderate anaemia often require therapeutic doses of iron, which are higher than what MMS provide. “MMS contains iron, but in a lower, safer dose intended for prevention of micronutrient deficiencies in generally healthy pregnant women, not for treating [severe] anaemia,” Lekwot said.
Image credit: Nigeria Health Watch
Another challenge, according to Bara is adherence. He frowned at how women, especially in rural areas care less about their health and the supplement. “Especially [for young mothers] in their first pregnancy, their age is not up to which they can think of what is good for them,” he continued.
Bara added that in-house transfers, study leaves and retirement of healthcare workers, also create a gap in the MMS distribution.
However, while Nutrition International is still gathering insights on the supplement, Bara noted that the survey results will be used to scale up distribution of the supplement across other local governments in Bauchi and other parts of Nigeria. “We want to expand it to cover all the health facilities that offer antenatal services,” he said.
He pointed out that UNICEF and Gates Foundation supplied over 1,000,000 bottles of MMS for the scale up as a seed stock. “They gave it to the government and before we exhaust it, the government can procure its own. We are now advocating for the government to procure the MMS for its citizens,” he noted.
It is essential that the Bauchi State Government includes the procurement of additional MMS in health planning to improve maternal outcomes, as development partners will not fund this initiative forever. This should be reflected in the state’s’ next budget, ensuring equitable distribution is maintained.