scholarly journals Barriers to and Facilitators of Iron and Folic Acid Supplementation within a School-Based Integrated Nutrition and Health Promotion Program among Ghanaian Adolescent Girls

2020 ◽  
Vol 4 (9) ◽  
Author(s):  
Lucas Gosdin ◽  
Andrea J Sharma ◽  
Katie Tripp ◽  
Esi F Amoaful ◽  
Abraham B Mahama ◽  
...  
Keyword(s):  
Folic Acid ◽  
Adolescent Girls ◽  
Public Health Problem ◽  
Folic Acid Supplementation ◽  
School Level ◽  
Health Promotion Program ◽  
Cross Sectional ◽  
School Year ◽  
School Based ◽  
Iron And Folic Acid

ABSTRACT Background Anemia is a moderate public health problem among adolescent girls in Ghana. Objectives We aimed to evaluate the barriers to and facilitators of program fidelity to a school-based anemia reduction program with weekly iron and folic acid (IFA) supplementation. Methods Authors analyzed directly observed weekly IFA consumption data collected longitudinally and cross-sectional data from a representative survey of 60 secondary schools and 1387 adolescent girls in the Northern and Volta regions of Ghana after 1 school year (2017–2018) of the intervention (30–36 wk). A bottleneck analysis was used to characterize the levels of IFA coverage and used adjusted generalized linear mixed-effects models to quantify the school and student drivers of IFA intake adherence. Results Of girls, 90% had ever consumed the tablet, whereas 56% had consumed ≥15 weekly tablets (mean: 16.4, range: 0–36), indicating average intake adherence was about half of the available tablets. Among ever consumers, 88% of girls liked the tablet, and 27% reported undesirable changes (primarily heavy menstrual flow). School-level factors represented 75% of the variance in IFA consumption over the school year. Total IFA tablets consumed was associated with the ability to make up missed IFA distributions (+1.4 tablets; 95% CI: +0.8, +2.0 tablets), junior compared with senior secondary school (+5.8; 95% CI: +0.1, +11.5), educators’ participating in a program-related training (+7.6; 95% CI: +2.9, 12.2), and educator perceptions that implementation was difficult (−6.9; 95% CI: −12.1, −1.7) and was an excessive time burden (−4.4; 95% CI: −8.4, −0.4). Conclusions Although the program reached Ghanaian schoolgirls, school-level factors were barriers to adherence. Modifications such as expanded training, formalized make-up IFA distributions, sensitization (awareness promotion), and additional support to senior high schools may improve adherence. Spreading the responsibility for IFA distribution to other teachers and streamlining monitoring may reduce the burden at the school level. Strengthening the health education component and improving knowledge of IFA among students may also be beneficial.

scholarly journals Pattern of anaemia, determinants and weekly iron and folic acid supplementation programme among tribal adolescent girls attending a primary health centre in Wayanad, Kerala

2020 ◽  
Vol 7 (7) ◽  
pp. 2803
Author(s):  
Aman Bhardwaj ◽  
Aswathy Sreedevi ◽  
Sanjeev Vasudevan ◽  
Geetha Vidyadharan
Keyword(s):  
Folic Acid ◽  
Adolescent Girls ◽  
Health Centre ◽  
Folic Acid Supplementation ◽  
Health Care Centre ◽  
Cross Sectional ◽  
Acid Supplementation ◽  
Primary Health ◽  
Tribal Area ◽  
Iron And Folic Acid

Anaemia is a major cause of concern during adolescence particularly among the persons of tribal origin. The objective of the study was to determine the pattern of anaemia, determinants and coverage of the weekly iron and folic acid supplementation (WIFS) programme among adolescent girls in a tribal area. A cross sectional study was conducted among 196 adolescent girls at a primary health care centre in tribal area of Kerala. Every alternate adolescent girl attending the centre was chosen over a period of three months. Assent and informed consent from accompanying parents was obtained. Haemoglobin was estimated by Sahli’s method and peripheral smear prepared. Three fourths of the adolescent girls had iron deficiency anaemia; of which 48.64% had moderate anaemia 5.40% had severe anaemia and 1.6% had sickle cell anaemia. Adolescents belonging to Paniya tribe and those not consuming Iron and folic acid tablets under WIFS programme were three times (OR 2.95 95% CI 1.38,6.28) and two times (OR 2.5 95% CI 1.24, 5.11) respectively were more likely to be anaemic. Most (80%) of the anaemic girls were unaware about WIFS scheme and the intake of the iron supplementation was significantly higher in school going girls. Strengthening the WIFS scheme by targeting the vulnerable adolescent girls of Paniya tribe and out of school girls are of extreme importance in tackling the problem of anaemia among tribal adolescent girls.

scholarly journals Adherence to iron and folic acid supplementation and associated factors among antenatal care attendants in Northwest Ethiopia

2020 ◽  
Vol 9 (1) ◽  
pp. 20
Author(s):  
Berhanu Abebaw Mekonnen ◽  
Yadeta Dessie ◽  
Negga Baraki ◽  
Abdu Oumer ◽  
Mehari Gebru
Keyword(s):  
Folic Acid ◽  
Antenatal Care ◽  
Folic Acid Supplementation ◽  
Northwest Ethiopia ◽  
Adherence Rate ◽  
P Value ◽  
Cross Sectional ◽  
Acid Supplementation ◽  
Iron And Folic Acid ◽  
Pregnant Mothers

<p>Iron and folic acid supplementation is the key approach for anemia prevention and control during pregnancy. In Ethiopia only &lt;1% of pregnant mothers ingest the ideal number of tablets. Although, adherence is the most important challenge, literature is dearth and the predictors are undoubtedly recognized. Institution based quantitative cross sectional study design triangulated with qualitative methods was employed among 395 systematically selected pregnant mothers attending antenatal care in Debre Markos town, Ethiopia. Data were collected using interviewer administered structured questionnaire. Data were entered into Epi data and exported to SPSS software. Bivariate and multivariable Logistic regression with the 95% confidence interval was computed. P-value &lt; 0.05 was declared as statistically significant. Eight in-depth interviews were conducted. The data were entered and analyzed using open code software. Adherence rate was 55.5% (95%CI, 50.5%-60.4%). Pregnant mothers who had; history of anemia during current pregnancy [AOR:7.9, 95%CI (4.44-14.01)], primary education (AOR:4.0, 95%CI (1.88-8.54)], secondary education and above (AOR:3.6, 95%CI (1.20-6.94)], good knowledge of iron and folic acid supplementation [AOR:2.1, 95%CI (1.24-3.56)], and early registration for antenatal care (AOR:1.8, 95%CI (1.06-3.11)] were predictors of iron and folic acid supplementation adherence. The rate of adherence was low. Getting medical advice and fear of illness if missed were the primary reasons that enforce mothers to take the tablets. Hence, improving mothers’ knowledge regarding overall aspects of the tablet through better advice, community teaching and the mass media at large, would improve adherence.</p>

scholarly journals Effect of long-term intermittent supplementation with multiple micronutrients compared with iron-and-folic acid supplementation on Hb and micronutrient status of non-anaemic adolescent schoolgirls in rural Bangladesh

2012 ◽  
Vol 108 (8) ◽  
pp. 1484-1493 ◽  
Author(s):  
Faruk Ahmed ◽  
Moududur R. Khan ◽  
Mohammad Akhtaruzzaman ◽  
Rezaul Karim ◽  
Gail Williams ◽  
...  
Keyword(s):  
Folic Acid ◽  
Adolescent Girls ◽  
Folic Acid Supplementation ◽  
Double Blind ◽  
Rural Bangladesh ◽  
Micronutrient Status ◽  
Acid Status ◽  
Iron And Folic Acid ◽  
Hb Concentration

The present study examined whether long-term supplementation with once- and twice-weekly multiple micronutrients (MMN-1 and MMN-2) can improve Hb and micronutrient status more than twice-weekly Fe–folic acid (IFA-2) supplementation in non-anaemic adolescent girls in Bangladesh. An equal number of 324 rural schoolgirls aged 11–17 years were given MMN-1 or MMN-2 or IFA-2 supplements for 52 weeks in a randomised, double-blind trial. Blood samples were collected at baseline, and at 26 and 52 weeks of supplementation. The girls receiving IFA-2 supplements were more likely to be anaemic than the girls receiving MMN-2 supplements for 26 weeks (OR 5·1, 95 % CI 1·3, 19·5; P = 0·018). All three supplements reduced Fe deficiency effectively. Both the MMN-1 and MMN-2 groups showed significantly greater improvements in vitamins A, B2 and C status than the girls in the IFA-2 group, as might be expected. Receiving a MMN-1 supplement was found to be less effective than MMN-2 supplement in improving Fe, vitamins A, B2 and folic acid status. Receiving micronutrient supplements beyond 26 weeks showed little additional benefit in improving micronutrient status. In conclusion, given twice-weekly for 26 weeks, MMN supplements can improve micronutrient status effectively with no significant increase in Hb concentration compared with IFA supplements in non-anaemic Bangladeshi adolescent girls. However, it significantly reduces the risk of anaemia. Before any recommendations can be made, further research, including into cost-effectiveness, is needed to see whether MMN supplementation has any additional longer-term health benefits over that of IFA supplementation in this population.

scholarly journals Population-level effective coverage of adolescent weekly iron and folic acid supplementation is low in rural West Bengal, India

2020 ◽  
Vol 23 (15) ◽  
pp. 2819-2823
Author(s):  
Christopher R Sudfeld ◽  
Rajesh Kumar Rai ◽  
Anamitra Barik ◽  
Joseph J Valadez ◽  
Wafaie W Fawzi
Keyword(s):  
Folic Acid ◽  
Adolescent Girls ◽  
West Bengal ◽  
Folic Acid Supplementation ◽  
Cross Sectional Survey ◽  
Effective Coverage ◽  
Acid Supplementation ◽  
School Girls ◽  
Iron And Folic Acid ◽  
Out Of School

AbstractObjective:To assess the coverage of the adolescent weekly iron and folic acid supplementation (WIFS) programme in rural West Bengal, India.Design:We conducted a population-based cross-sectional survey of intended WIFS programme beneficiaries (in-school adolescent girls and boys and out-of-school adolescent girls).Setting:Birbhum Health and Demographic Surveillance System.Participants:A total of 4448 adolescents 10–19 years of age participated in the study.Results:The percentage of adolescents who reported taking four WIFS tablets during the last month as intended by the national programme was 9·4 % among in-school girls, 7·1 % for in-school boys and 2·3 % for out-of-school girls. The low effective coverage was due to the combination of large deficits in WIFS provision and poor adherence. A large proportion of adolescents reported they were not provided any WIFS tablets in the last month: 61·7 % of in-school girls, 73·3 % of in-school boys and 97·1 % of out-of-school girls. In terms of adherence, only 41·6 % of in-school girls, 38·1 % of in-school boys and 47·4 % of out-of-school girls reported that they consumed all WIFS tablets they received. Counselling from teachers, administrators and school staff was the primary reason adolescents reported taking WIFS tablets, whereas the major reasons for non-adherence were lack of perceived benefit, peer suggestion not to take WIFS and a reported history of side effects.Conclusions:The effective coverage of the WIFS programme for in-school adolescents and out-of-school adolescent girls is low in rural Birbhum. Integrated supply- and demand-side strategies appear to be necessary to increase the effective coverage and potential benefits of the WIFS programme.

scholarly journals Adherence to weekly iron and folic acid supplementation among the school students of Thrissur corporation – a cross sectional study

2017 ◽  
Vol 4 (5) ◽  
pp. 1689 ◽  
Author(s):  
Sajna M. V. ◽  
Shefaly Ann Jacob
Keyword(s):  
Growth Rate ◽  
Folic Acid ◽  
Pilot Study ◽  
Folic Acid Supplementation ◽  
Cross Sectional Study ◽  
Cluster Sampling ◽  
Sectional Study ◽  
School Students ◽  
Cross Sectional ◽  
Iron And Folic Acid

Background: Anemia is one of the major problems among adolescents in India. As daily and once weekly supplementation of iron and folic acid show same effects in terms of growth rate, it has been decided that weekly supply is an effective method to tackle anaemia. The adherence to these tablets is an important factor to monitor the programme. Methods: A cross sectional study was conducted among the school students of 6-10th classes in Thrissur corporation area for a period of 6 months regarding the adherence to weekly iron and folic acid tablets. Sample size was calculated based on a pilot study and for a cluster sampling technology. After getting consent, data were collected, coded and analysed using SPSS17. Results: 380 students participated in the study. Mean age of the population was 13.01+ 1.3 years (with a range of 10 – 16 years). Only 139 (36.6%) students took tablets initially for a period of 1-2 months. Among the total girls, 124 (34.6%) took tablets initially. Of the students who took initially, 57 were continuing intake of iron tablets. The adherence to weekly iron and folic acid tablets for at in this study was 15% (n=57). Among the students who initially consumed tablets 36.6% reported stomach ache. Nausea (13.6%), vomiting (10.7%), black stool (9.3%), diarrhoea (5%) were other reported side effects of the drugs. Conclusions: The adherence to weekly iron and folic to this study was less. This can be effectively improved with continued health education sessions using different methods including the parents.

scholarly journals Counselling and knowledge on iron and folic acid supplementation (IFAS) among pregnant women in Kiambu County, Kenya: a cross-sectional study

2019 ◽  
Vol 1 ◽  
pp. 21
Author(s):  
Mary Kamau ◽  
Samuel Kimani ◽  
Waithira Mirie
Keyword(s):  
Folic Acid ◽  
Pregnant Women ◽  
Community Education ◽  
Folic Acid Supplementation ◽  
Cross Sectional Study ◽  
Health Facilities ◽  
Sectional Study ◽  
Cross Sectional ◽  
Acid Supplementation ◽  
Iron And Folic Acid

Background: The increased demand for iron and folic acid during pregnancy is not met through diet due to insufficiency or reduced bioavailability of nutrients among women from low income countries. Thus, iron and folic acid supplementation (IFAS) is a promising interventional strategy for control of anaemia during pregnancy. Kenya adopted the global IFAS intervention with a target of 80% coverage by 2017, however, the compliance remains low. Increasing awareness, counselling, communication and community education on IFAS have improved compliance among pregnant women. Thus, we aimed to determine: IFAS knowledge, availability, practices, and content of IFAS counselling among pregnant women attending health facilities in Kiambu County, Kenya. Methods: A cross-sectional study involving 364 pregnant women aged 15-49 years. A two stage cluster sampling, including one sub-county and five public health facilities were used. A pre-tested structured questionnaire consisting of socio-demographic data, maternal knowledge and counselling on IFAS was used. An observation checklist was used to observe practices and content of antenatal counselling session in each facility. Data was analysed using STATA in which descriptive and inferential statistics were computed. Results: Of 364 respondents, less than half (40.9%) scored high on knowledge on IFAS. Women who were counselled on duration of IFAS intake, side effects, and their mitigation were more likely (p <0.005) to have high IFAS knowledge. Although all the health facilities had varied IFAS posters displayed, none had key IFAS counselling documents. Conclusion: Less than half of the pregnant women had high IFAS knowledge, IFAS documents were scarce in health facilities, IFAS counselling information in different health facilities was limited and varied and content of counselling was associated with levels of knowledge on IFAS. This underscores the need to strengthen focused and targeted IFAS counselling for pregnant women and standardization of counselling messages to improve compliance and pregnancy outcomes.

scholarly journals Factors associated with high compliance/feasibility during iron and folic acid supplementation in a tribal area of Madhya Pradesh, India

2012 ◽  
Vol 16 (2) ◽  
pp. 377-380 ◽  
Author(s):  
Tapas Chakma ◽  
Pinnamneni Vinay Rao ◽  
Pradeep Kumar Meshram
Keyword(s):  
Folic Acid ◽  
Adolescent Girls ◽  
Compliance Rate ◽  
Folic Acid Supplementation ◽  
Madhya Pradesh ◽  
High Compliance ◽  
Factors Associated ◽  
Blister Pack ◽  
Iron And Folic Acid

AbstractObjectiveTo study the feasibility of iron and folic acid (IFA) supplementation among tribal adolescent girls and identify factors associated with high compliance.DesignIntervention study with IFA supplementation among tribal adolescent girls of Bijadandi block, Mandla district, Madhya Pradesh, India. Girls (n 274) from twelve villages randomly selected out of 100 potential villages received daily tablets containing iron (iii) hydroxide polymaltose complex equivalent to 100 mg of elemental Fe and 350 μg of folic acid (commercially available as Feritas tablets, marketed by Intas Pharmaceutical Ltd, India). IFA was given for 100 d and supervised by school teachers and anganwadi workers. Compliance was measured using cards and interviews.SettingCommunity-based iron supplementation programme.SubjectsTribal adolescent girls aged 12–19 years.ResultsIn total 233 girls completed the study. Prevalence of anaemia was reduced from 94 % at baseline to 69 % after the intervention. Compliance rate (>80 tablets) was 89 %. Minor side-effects were reported by three girls, yet they consumed >80 tablets. Factors associated with compliance included fasting during the local festival (χ2 = 72·74, df 3; P < 0·0001) and counselling (χ2 = 72·74, df 3; P < 0·0001). Other qualitative factors like social mobilization, timely supply of tablets, quality of tablets (blister pack) and availability of teachers and anganwadi workers were also associated with the compliance and feasibility.ConclusionsHigh compliance indicates that IFA supplementation with tablets is feasible among the tribal adolescent girls of Bijadandi block, Mandla district.

scholarly journals The Adolescent Girls’ Anaemia Control Programme: a decade of programming experience to break the inter-generational cycle of malnutrition in India

2013 ◽  
Vol 16 (9) ◽  
pp. 1667-1676 ◽  
Author(s):  
Víctor M Aguayo ◽  
Kajali Paintal ◽  
Gayatri Singh
Keyword(s):  
Folic Acid ◽  
Adolescent Girls ◽  
Scale Up ◽  
Scaling Up ◽  
Folic Acid Supplementation ◽  
Control Programme ◽  
Lessons Learned ◽  
Nutrition Interventions ◽  
Critical Elements ◽  
Iron And Folic Acid

AbstractObjectiveTo document the scale-up of India's Adolescent Girls’ Anaemia Control Programme following a knowledge-centred framework for scaling up nutrition interventions and to identify the critical elements of and lessons learned from a decade of programme experience for the control of anaemia in adolescent girls.DesignWe reviewed all articles, programme and project reports, and baseline and endline assessments published between 1995 and 2012 regarding the control of anaemia through intermittent iron and folic acid supplementation; key programme specialists and managers were interviewed to complete or verify information wherever needed.SettingIndia.SubjectsAdolescent girls.ResultsThe scale-up of India's Adolescent Girls’ Anaemia Control Programme followed a knowledge-centred programme cycle comprising five phases: Evidence, Innovation, Evaluation, Replication and Universalization. By the end of 2011, the programme was being rolled out in thirteen states and was reaching 27·6 million adolescent girls of whom 16·3 million were school-going girls and 11·3 million were out-of-school girls. Building on the critical elements of and lessons learned from the programme, the Government of India launched in 2012 the national Weekly Iron and Folic Acid Supplementation (WIFS) programme to universalize the benefits of anaemia control to the overall population of Indian adolescents.ConclusionsThe Adolescent Girls’ Anaemia Control Programme in India provides a good example of how a knowledge-centred approach can successfully guide the scaling up of public health nutrition interventions and facilitate intersectoral convergence among different government departments and development partners to break the inter-generational cycle of undernutrition and deprivation.

School-Based Iron and Folic Acid Supplementation for Adolescent Girls: Findings from Manica Province, Mozambique

2005 ◽  
Vol 26 (3) ◽  
pp. 281-286 ◽  
Author(s):  
Peter Horjus ◽  
Victor M. Aguayo ◽  
Julie A. Roley ◽  
Maurício C. Pene ◽  
Stephan P. Meershoek
Keyword(s):  
Folic Acid ◽  
Program Effectiveness ◽  
Hemoglobin Concentration ◽  
Study Groups ◽  
Folic Acid Supplementation ◽  
Study Group ◽  
School Based ◽  
Supplementation Period ◽  
Iron And Folic Acid ◽  
Group 5

Background The 1997 Demographic and Health Survey in Mozambique shows that 47% of girls 15 to 19 years old living in Manica province (west-central Mozambique) are pregnant or have already had a child. A recent survey also shows that 45% of girls 10 to 18 years old attending school are anemic. Strategies are needed to build iron stores before pregnancy and to control seasonal and chronic iron deficiency and anemia in school-aged girls. Objective To assess the program effectiveness of two school-based weekly iron and folic acid (IFA) supplementation regimes (5-month supplementation vs. 8-month supplementation) in girls 10 to 18 years old attending school in Manica province. Methods Twelve schools were included in the study. Schools were ordered by descending mean hemoglobin concentration, and assigned alternately to study group 5 (six schools; 5-month supplementation) or study group 8 (six schools; 8-month supplementation). In both study groups, the weekly supplement contained 60 mg of elemental iron and 400 μg of folic acid. All girls received a single dose of mebendazol (500 mg) twice—once at the beginning of the study (T0) and once six months later (T6). Supplementation was implemented and supervised by the teachers of the schools included in the study. Between T0 and T3, girls in study group 8 received IFA supplements weekly whereas girls in study group 5 did not. Between T3 and T8, all girls in both groups received weekly IFA supplements. Results At T0, mean hemoglobin concentration and anemia prevalence were comparable in study groups 8 and 5 (125.3 ± 12.6 g/L vs. 123.8 ± 12.8 g/L; 28% vs. 29%, respectively). At T3, the mean hemoglobin concentration in study group 8 was significantly higher (126.3 ± 14.3 g/L vs. 121.5 g/dL ± 11.9 g/L p < .001) and the prevalence of anemia was lower (28% vs. 35%, p = .076) than in study group 5. At T8, after an additional 5-month supplementation period in both study groups, mean hemoglobin concentration and anemia prevalence in study groups 8 and 5 were not significantly different (126.5 ± 12.6 g/L vs. 124.9 ± 12.3 g/L; 23% vs. 27%, respectively). Conclusion In Manica Province, school-based weekly IFA supplementation is a feasible and effective intervention to prevent seasonal drops in hemoglobin concentration and increases in anemia prevalence. Short supplementation periods can have an important impact on girls' hematological status. However, the size of girls' hematological response in this study was significantly lower that that observed in studies with similar population groups, initial anemia prevalence, supplement dosing, and/or supplementation regime.

scholarly journals Knowledge and Compliance of Iron and Folic Acid Supplementation among Pregnant & Postnatal Women in a Hospital of Kathmandu

2020 ◽  
Vol 7 (1) ◽  
pp. 63-69
Author(s):  
Rupesh Kumar Mishra ◽  
Kalpana Tiwari
Keyword(s):  
Folic Acid ◽  
Pregnant Women ◽  
Compliance Rate ◽  
Folic Acid Supplementation ◽  
Deficiency Anemia ◽  
Cross Sectional ◽  
Acid Supplementation ◽  
Postnatal Women ◽  
Level Of Knowledge ◽  
Iron And Folic Acid

The high prevalence of iron deficiency anemia and low compliance of iron and folic acid supplementation was reported among pregnant women in Nepal. This study aimed to determine the knowledge and compliance of iron and folic acid supplementation among pregnant and postnatal women in Kathmandu. A descriptive cross-sectional study design was adopted for the study. Sample size was 103 and purposive sampling technique was used to collect the data. All Pregnant women of having above 7 month pregnancy and postnatal’s up to 6 months women were included. Data was collected by using self-administered questionnaire .All the obtained data were analyzed with the help of SPSS version 20. Assessment of knowledge revealed that 85.6 % (88) of the participants have adequate knowledge regarding iron and folic acid supplementation .The findings showed 78.6% (81) of the respondents had  iron and folic acid compliance as standard of Nepal government that is to be taken minimum 180 tablet before delivery. It concludes that the level of knowledge and compliance rate of iron and folic acid supplementation in Kathmandu is satisfactory in comparisons to national status i.e. 42% according to Nepal Demographic health survey 2016. Pearson chi-square test shows that level of knowledge on iron and folic acid tablet is not associated with the compliance of iron and folic acid tablet (χ²= 0.019, p< 0.889). The main reason of respondents having compliance is due to having proper counseling from health worker and non compliance is due to forgetting to have tablet. Therefore improving knowledge level only can’t improve compliance level, various factors like counseling, accessibility and availability of iron and folic acid tablet, side effect of tablet and family support also affects the compliance of iron and folic acid supplementation.

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