Understanding Knowledge, Attitudes, and Practices Around Multiple Micronutrient Supplementation in Rwanda

Background: In Rwanda, micronutrient deficiencies among pregnant women remain a public health concern. To address this, Rwanda introduced Multiple Micronutrient Supplementation (MMS) in antenatal care (ANC) services in an integrated manner. Understanding knowledge, attitudes, and practices (KAP) related to MMS is crucial for effective implementation. Therefore, the current study aimed to assess knowledge, attitudes, and practices related to MMS among pregnant and lactating women, and to identify factors influencing adherence and uptake. Methods: A mixed-methods study was conducted in December 2024 in the Rwandan districts of Gasabo, Rutsiro, and Burera, where the MMS program was implemented. Quantitative data were collected from 484 women (pregnant and lactating) through structured questionnaires, while qualitative data were gathered via 18 focus group discussions (FGDs) with women and husbands, exit interviews with 12 pregnant women, and key informant interviews with healthcare providers and district officials. Data were analyzed using SPSS and Atlas.ti. Results: Despite high reported use (94%) and adherence (92%) to MMS among pregnant women, knowledge levels remained largely moderate, with 58.5% scoring in the moderate range and only 15% achieving high knowledge scores. In terms of attitudes, 56.6% demonstrated a high attitude toward MMS, while only 2% showed low attitudes. Notably, most respondents expressed a willingness to recommend MMS to others (96%), had minimal concerns about its use (83%), and intended to continue supplementation (77.7%). Trust in healthcare providers was high, with 95.5% expressing confidence in the advice received and 93.6% reporting satisfaction with the information provided. However, misconceptions—such as fears of delivery complications due to large babies and confusion between MMS and other medications, fear of side effects—remain key barriers. Conversely, male partner support, awareness of MMS benefits, and encouragement from health providers were identified as significant facilitators. Conclusions: Despite high MMS use and adherence among women, knowledge levels remain largely moderate, whereas attitudes toward MMS are generally positive. Misconceptions about MMS and the fear of side effects are the challenges. Partner support, knowing the benefits of MMS and encouragement from healthcare providers are key facilitators. Strengthening early health education and involving partners could enhance MMS uptake and impact.