How macronutrient supplements and improved diet are changing maternal nutrition in Zanzibar

The soft laughs of a five-month-old baby girl-Hulaitham Adhiru resonated through the moving coconut trees of Ukunjwi village, carried by the gentle morning breeze of Pemba Island, Zanzibar. In her mother’s arms, she radiated joy, a moment that, just months ago, seemed like a distant dream. 

Mchanga Omari Kombo, a 25-year-old mother, had struggled through a difficult pregnancy. She had been prescribed iron and folic acid (IFA) supplements to prevent anaemia. Yet the unpleasant taste, smell, and side effects such as nausea, vomiting, and constipation made them unbearable for Mchenga. "I did not feel well when I took the red tablets (IFA) prescribed at the hospital. Shortly after taking them, I began to feel nauseous and started vomiting, so I decided to stop taking them," says Mchanga. Skipping doses became a habit, and soon, severe anaemia took hold of her fragile body. The fatigue, dizziness, and weakness were constant, turning what should have been a beautiful journey into a daily battle for strength.  

“I was vomiting and felt tired most of the time. When I went to the clinic, they ran tests and told me the iron count in my blood were very low. Along with the prescribed medicine, they gave me multiple micronutrient supplements, and over time, the symptoms stopped,”  recalls Mchanga, now a mother of two. 

Determined to restore her health, Mchanga persistently followed the anaemia treatment guidelines provided by healthcare professionals, sustaining the discomfort and challenges for the sake of overcoming her condition. Finally, her condition resolved, and therefore she resumed using IFA to prevent a recurrence. “It was a difficult time, and we became increasingly worried,” says Mchanga’s husband. 

After resuming anaemia preventive services, a breakthrough came along her journey: a new maternal health initiative aimed at improving the quality of Ante Natal Care (ANC) services introduced Multiple Micronutrient Supplements (MMS) as a superior alternative to IFA. Unlike IFA, which only provided iron and folic acid, MMS contained fifteen essential micronutrients, offering a much broader spectrum of benefits. Not only MMS prevents anaemia, but it also reduces the risks of low birth weight, premature delivery, and babies being born too small. 

For the first time, Mchanga found hope. MMS was different; it had a better taste, smell, and color, making it easier to consume. Alongside the supplements, she received comprehensive maternal care including nutrition assessments, anaemia screenings, guidance on healthy eating (eating a variety of nutritious food), physical activity, and advice on limiting caffeine intake. She no longer felt alone on her journey. Her husband stood beside her, actively engaging in maternal nutritional counselling and ensuring they could afford various nutritious foods. With the solid support of dedicated healthcare providers and community health workers in her community, Mchanga attended every Pre Natal Care clinic without fail, never missing a single dose of MMS. She knew that these nutrients were not just for her but for the healthy development of her unborn baby. 

“I bring these mothers together to educate them on proper nutrition, which is essential for improving their health and their children. We teach them how to prepare meals that provide essential nutrients to combat anaemia and other diseases,” explains Sada Seif, the community health worker at Kipangani. 

When the time came, Mchanga gave birth to a healthy and thriving baby girl, a testament to the power of proper maternal nutritional care and the life-changing benefits of MMS. 

Today, as her daughter’s laughter folds in with the whisper of leaves in the morning breeze, Mchanga smiles, knowing that her journey was about embracing a healthier future for herself and her child.   

Now, Mchanga has transformed her experience into a mission. She has become a passionate advocate for maternal nutrition, using her journey to inspire and educate other pregnant women in her community. With solid determination, she encourages them to attend antenatal clinics early and embrace MMS as a key to a healthier pregnancy and stronger babies. 

In Zanzibar, anaemia has long been a silent challenge for women, affecting their health and the well-being of their babies. According to the 2022 Tanzania Demographic and Health Survey (TDHS), 60 percent of pregnant women and women of reproductive age in Zanzibar are anaemic, putting both mothers and newborns at risk of severe health complications. 

To tackle this crisis, the Government of Zanzibar, in collaboration with UNICEF and with funding from the Gates Foundation, launched a groundbreaking maternal nutrition initiative in 2022. It encompassed a comprehensive package of essential maternal nutrition services including the introduction of MMS. 

The impact of this intervention has been truly transformative, reaching far beyond Ukunjwi village (Mchanga’s village) and extending into the Micheweni and Wete districts of Pemba. Nearly 16,000 pregnant women have benefited from MMS and comprehensive nutrition guidance, empowering them with the knowledge and resources needed for healthier pregnancies. Women like Mchanga, who once battled severe anaemia, are now thriving, living proof of the life-changing power of proper maternal nutrition and care. 

Recognizing the undeniable benefits of MMS, the Government of Zanzibar has officially approved the transition from the use of IFA to MMS for pregnant women across public and private healthcare facilities. This marks a new era in maternal nutrition and health care during pregnancy, ensuring that more mothers and their babies have the best possible start in life.