Our Work

We aim to prevent maternal and child undernutrition globally. While several evidence-based maternal, infant, and young child (MIYCN) interventions exist, many are poorly implemented or not implemented at all, and thus do not produce expected health benefits. Implementation science is the systematic approach to understanding and addressing barriers and enablers to effective and quality implementation of health interventions, strategies, and policies. Stakeholders (e.g., governments and NGOs) interested in implementing evidence-based maternal, infant, and young children’s interventions can introduce and/or strengthen the intervention delivery in conjunction with implementation science strategies to ensure its effective implementation and scaling.

Through The Initiative to Advance Implementation Science in Nutrition, we:

Address barriers to effective and quality implementation of evidence-based nutrition interventions
Share access to technical expertise and a vast network of government, NGO, and academic partners;
Generate and analyze data, disseminate knowledge, and facilitate global advocacy of evidence that can accelerate effective introduction and scaling of nutrition interventions.

Health worker showing MMS tablet in Karamoja region, Uganda. Photo by Rebecca Birungi

In Uganda, implementation research is underway to explore how antenatal multiple micronutrient supplementation can be effectively introduced and scaled within the context of the country’s antenatal care system. The Initiative, in collaboration with the Ministry of Health/Uganda, UNICEF/Uganda, and the Child and Family Foundation Uganda, conducted formative research with pregnant women, their influential family members, health care workers, district and national level government, and other national stakeholders across eight districts to identify a set of key challenges with delivery, uptake, and adherence to prenatal supplements. This work led to a set of design questions that will be the subject of a series of human-centered design workshops being held in June and July 2024. The workshops will bring together pregnant women, ANC providers, and district-level stakeholders to co-design a set of implementation strategies that could be integrated within the existing ANC context. Prototypes of the implementation strategies that result from the workshops will be pre-tested, prioritized, refined and then tested in a larger implementation research that will be launched in early 2025 across these same eight districts. The findings from the study will help to inform the Ugandan government’s decision to transition from iron folic acid for pregnant women to MMS and provide potential strategies to support effective and efficient implementation of that intervention that facilitate ANC attendance and ensure high uptake and adherence.

United States

Breastfeeding Implementation Research

Despite the well-documented benefits of optimal breastfeeding practices for infants and mothers, current breastfeeding practices lag behind national public health goals, and disparities in breastfeeding initiation, exclusivity, and duration persist in the United States. To develop impactful breastfeeding programs with existing service delivery platforms, formative research is needed to understand the factors affecting breastfeeding practices as well as the reach and utilization of breastfeeding support services. Audrey Buckland is completing her dissertation through a collaboration between the Johns Hopkins Bloomberg School of Public Health, the Vitamin Angel Alliance, and Chiricahua Community Health Centers, Inc. (a Federally Qualified Health Center in Arizona). This research aims to characterize breastfeeding intent and describe the facilitators and barriers to breastfeeding experienced by Latine families in a rural border county in Arizona through interviews with pregnant and postpartum women and health and nutrition service providers. The long-term goal of this research is to develop actionable recommendations to health and nutrition service providers in the U.S.-Mexico border region to support evidence-based, culturally responsive breastfeeding interventions for Latine families.

A mother holding her baby closely and kissing his head in the U.S. — ©Vitamin Angels

Indonesia

Introducing Antenatal MMS Effectively

To address the Indonesian government’s request for implementation research to inform their transition from IFA to MMS, The Initiative to Advance Implementation Science in Nutrition is working in Indonesia in partnership with several local universities. The implementation research aims to explore how antenatal MMS can be effectively introduced and scaled within the country’s ANC system to support improved maternal nutrition, with the goals of creating an enabling environment for MMS introduction; understanding contextual factors, enablers, barriers and potential solutions to MMS introduction through formative research; designing and testing implementation strategies; and ultimately raising awareness through and among stakeholders for the investment of domestic resources to support MMS scale-up. At the same time, within the context of IR, efforts are underway to ensure a local supply of UNIMMAP MMS. For example, a supply context assessment has been conducted and efforts to build capacity for local manufacturing have been initiated, with local manufacturing available to the government by early 2025.

Haiti

Introduction of MMS

In 2020, the World Health Organization recommended the introduction of MMS informed by rigorous research, including implementation research to support the transition from IFA to MMS. In line with this guidance, the Haitian Ministry of Public Health and Population, in partnership with Haitian Health Foundation, Vitamin Angel Alliance, and the Johns Hopkins Bloomberg School of Public Health, began to conduct implementation research in 2019 to inform the introduction of MMS in Haiti. The initial formative research aimed to assess the current perceptions, knowledge and experiences with ANC care and prenatal micronutrient supplementation in Haiti. Specifically, it aimed to i) understand the current knowledge and experiences of ANC and supplements among pregnant women, their families, and the broader community in Haiti, and ii) identify the barriers and enablers to uptake and adherence to ANC and prenatal supplements during pregnancy.

Woman holding a young child in Haiti. Both are smiling at the camera, while other children walk in the other direction down a dirt road. — ©Vitamin Angels

Mexico

Breastfeeding support in Yucatán, Mexico

Early initiation of breastfeeding (within one hour of birth) is a key predictor of exclusive breastfeeding. Healthcare providers play an important role in promoting optimal breastfeeding practices before delivery, immediately after delivery, and postnatally. In Mexico, where the large majority of births occur in health facilities, post-delivery care provides an excellent opportunity to support early initiation of breastfeeding and provide information to mothers in support of optimal breastfeeding practices. Consistency in provision of breastfeeding counseling services to mothers within hospitals after delivery and within communities (in the context of work, families, infant formula marketing, and antenatal and postnatal care), is needed to reduce disparities in optimal breastfeeding practices. The objective of this study is to contribute to a better understanding of the quality and coverage of breastfeeding support in public hospitals in Mérida, Mexico, to determine whether mothers are being supported effectively and equitably in their decision-making around breastfeeding.

UNRWA

Achieving a Critical Standard of Nutrition Care among Palestine Refugees in Jordan

Multiple micronutrient deficiencies comprise a major public health burden among Palestine refugee pregnant women in the Middle East, due to chronic dietary inadequacy, food insecurity, recurrent conflicts, joblessness, and political and socioeconomic instability. Mandated by the UN General Assembly, the United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) provides free of charge primary health care to 5.9 million Palestine refugees including antenatal care to 90,000 pregnant women annually in Jordan, Lebanon, Syria, the West Bank and the Gaza Strip. UNRWA Health Department is addressing the prevention of gestational MNDs by introducing the UN International Multiple Micronutrient Antenatal Preparation (UNIMMAP)-formulated MMS (Kirk Humanitarian) to replace IFA. To align with the WHO 2020 antenatal guidelines, the UNRWA Health Department is conducting implementation research, starting in Jordan, to assess acceptability, feasibility, coverage, fidelity, equity, effectiveness and sustainability of MMS vs IFA. A 10-month systems trial comparing MMS to IFA delivery is underway, to be completed in 2024, followed by planned scale up in Jordan. Applying lessons learned, UNRWA expects to expand MMS thereafter throughout its five fields of operation.

2023

BSPH Public Health Practice Awards

Members of the Initiative to Advance Implementation Science in Nutrition were awarded one of the 2023 Johns Hopkins Bloomberg School of Public Health Faculty Team Awards for Excellence in International Public Health Practices. The awards were announced in May 2023, and there was a ceremony to commemorate the recognition on Friday, October 28.

The Office of Public Health Practice and Training at the Bloomberg School annually recognizes faculty, staff, and students who demonstrate outstanding public health contributions. The awards honor a practice effort that has made or has great potential to make a sustained impact on a health-related outcome. The Initiative to Advance Implementation Science in Nutrition team was honored for their work on the project entitled, “Advocating and Scaling the Use of Prenatal Micronutrient Supplements to Reduce Adverse Birth Outcomes in LMICs.”

Award recipients included the following members of the Initiative:

Kristen M. Hurley, PhD '07, MPH, Director of the Center for Implementation Science in Nutrition; Associate Professor, Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health; Chief Nutrition Officer for Vitamin Angels
Parul Christian, DrPH '96, Professor and Director, Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health
Robert Black, MD, MPH, Professor, Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health
Keith West, DrPH '86, MPH, Professor, Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health
Monica Fox, MHS '99, Senior Research Associate, Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health