Folic Acid Supplementation Program Research Articles

IJCM_27A: To assess consumption of IFA in adolescent girls and pregnant women in selected health blocks of Himachal Pradesh.

Background: In India, anaemia is the most widespread nutritional deficiency disorder occurring primarily due to iron deficiency. Despite implementation of the Weekly Iron & Folic Acid Supplementation (WIFS) Programme under NRHM since 2013, the prevalence of anaemia is high among adolescents and pregnant women (PW) Objectives: To assess consumption of IFA in adolescent school going girls and pregnant women in selected health blocks of Himachal Pradesh. Methodology: It was a community-based study which was a part of project under WCD department of H.P. PW and school going adolescent girls of age 10-19 years from 9 Community development blocks were selected randomly using PPS. IFA consumption in last one year among adolescent girls and last 1 month among pregnant women was assessed by interviewing them. Results: Total participants among PW were 180 with mean age of 26.3±4.13, whereas 720 adolescents with mean age of 15.82±1.19 were enrolled in the study. Out of 180 PWs, 160(88.8%) received IFA where majority (156;97%) of them consumed IFA distributed by ASHA worker. On the other hand, majority of adolescent girls (484/720;67%) did not receive IFA, 196/236 (83%) who received IFA was distributed by ASHAs. Mean Hb level of PW was 11.7±1.47 whereas for adolescents was 12.73±4.85. Conclusion: It was observed that most of the pregnant women are utilizing government services, however the services are not being utilized by the school going adolescent girls as WIFS are not provided regularly.

Barriers, Facilitators of Iron and Folic Acid Supplementation, and Deworming Program among School-Going Adolescents of Deoghar, Jharkhand, India: A Mixed-Methods Study.

This study aimed to identify barriers and facilitators of iron and folic acid supplementation and deworming programs among school-going adolescents. A mixed-method observational study was conducted among adolescents in the 8th to 10th standards and their teachers across four schools in Deoghar, Jharkhand, India, using simple random sampling. The study included a questionnaire on socio-demographics, knowledge (34 items) (α=0.894), attitudes (2 items) (α=0.711) toward iron deficiency anemia, awareness of the Weekly Iron and Folic Acid Supplementation (WIFS) program and deworming (20 items) (α=0.783), and practices related to iron folic acid supplementation (IFS) and deworming, along with qualitative components. Data were analyzed using jamovi. Compliance rates for IFS and deworming were 27.5% and 67.9%, respectively. The multivariable logistic regression analysis showed that sex, religion, caste, father's educational status, per capita monthly family income (PCMI), diet type, adequate knowledge, and positive attitude toward anemia influenced IFS compliance. Religion, PCMI, and prior information on the importance of deworming facilitate compliance. Implementation barriers included irregular medication supply and a lack of student awareness. Periodic evaluation, regular sensitization, and a consistent drug supply are necessary to effectively implement WIFS and deworming programs in the study area.

Prevalence of Anemia, Knowledge, Attitude and Compliance Related to Weekly Iron Folic Acid Supplementation Programme among the Adolescents in Selected School of South East Delhi

Prevalence of Anemia, Knowledge, Attitude and Compliance Related to Weekly Iron Folic Acid Supplementation Programme among the Adolescents in Selected School of South East Delhi

P17-020-23 Coverage, Adherence Level and Lessons From Weekly Iron and Folic Acid Supplementation Program for Adolescent Girls in Ethiopia: Results From an Implementation Research

P17-020-23 Coverage, Adherence Level and Lessons From Weekly Iron and Folic Acid Supplementation Program for Adolescent Girls in Ethiopia: Results From an Implementation Research

The role of social support and interpersonal trust to improve compliance of iron supplementation amongst adolescent girls: A qualitative approach.

Adolescence is a crucial phase in preventing and controlling anaemia. One of the efforts made by the Indonesian government to overcome adolescent girl's anaemia is the iron and folic acid (IFA) supplementation programme. This programme is one of the most effective interventions that various countries have used to overcome anaemia. The key to the success of the supplementation of IFA is the compliance of adolescent girls. This study investigates the compliance and its contributing factors of IFA supplementation and the role of social support and interpersonal trust as a source of information and reminder amongst adolescent girls in Sidoarjo, Indonesia. This research was a qualitative study using the in-depth interview to collect data. Thirteen adolescent girls from three high schools in Sidoarjo, Indonesia, were recruited using a snowball sampling technique. Most of the girls did not comply with IFA supplementation. Contributing factors were the influence of peers, influence of teachers, parental influence, risk and benefit of taking IFA tablet and also failure to remember to take IFA tablet. The social environment that provided information and reminder came from teacher, parent, peer and also health worker. Interpersonal trust was needed to have positive perceived social support. Compliance with the consumption of IFA supplements requires the cooperation of various parties (teachers, parents, peers and health workers) and also interpersonal trust between adolescent girls to their social environment so the programme could be run optimally.

Prevalence and Trends of Birth Defects - Five Counties, Shanxi Province, China, 2003-2022.

The Shanxi Province, located in northern China, holds the highest prevalence of birth defects (BDs) across the country. Following the implementation of a nationwide folic acid supplementation program in 2009, a significant reduction of 53.89% in the prevalence of neural tube defects (NTDs) was observed in Shanxi from 2012 to 2017. However, despite this decrease, the prevalence rate for congenital heart defects (CHDs) in 2017 was over four times that of the 2012 rate. Since 2014, CHDs have emerged as the most predominant BD in Shanxi. The present study has identified a marked reduction in the prevalence of both total BDs and NTDs in five counties within Shanxi over the past two decades. As of 2017-2022, NTDs continue to be the most prevalent BDs recorded in this region. Contrarily, there has been a noteworthy increase in the prevalence of CHDs, ranking them among the top five most common BDs in the region between 2017 and 2022, though their rate remains below the national average. Additionally, the proportion of external anomalies remains high. Nevertheless, due to constrained access to primary healthcare services and diagnostic facilities, the early detection rate for internal anomalies, particularly CHDs, may be underestimated in the region. The results of this study underscore the necessity for augmented efforts in promoting folic acid supplementation as a preventive measure for NTDs. Moreover, improvements in the distribution of medical resources within this region are recommended, particularly the introduction and enforcement of local training programs aimed at enhancing CHD screening and diagnostic processes in these respective counties.

Study Characteristics of School Adolescent Girls on Iron Folic Acid Supplementation Program as the Prevention of Anemia in Adolescent

Background: Efforts to accelerate stunting reduction involve specific and sensitive nutrition interventions. School adolescent girls are the target group in reducing stunting through anemia prevention. Iron folic acid (IFA) supplementation program is the specific nutrition intervention to prevent anemia in adolescent girls. Objectives: This research aims to study the characteristics of students who received the IFA supplementation program. Methods: Research design was a cross sectional that involved 123 students from 12 public high schools in Cianjur District, West Java Province. Student’s characteristics consist of knowledge on anemia and their adherence on IFA supplementation program. Data collection is carried out by self-administering questionnaires monitored by enumerator. Data is performed by using mean ± SD and n (%). Results: Student’s knowledge on anemia mostly (61.8%) were categorized as low, as 30.9% were moderate, and only 7.3% were high. Students (44.7%) knew how to detect anemia is by measuring blood hemoglobin levels. As of 59.3% and 51.2% students knew the main causes of anemia are inadequate iron intake and blood loss during menstruation. Approximately 60-80% students recognized the common symptoms and sign of anemia. Most students (76.8%) have received IFA on a weekly basis and 41.2% students acknowledge their adherence in the IFA consumption with aim to prevent anemia (85.1%), the rest 23.4% and 14.9% due to the advice by the teachers and health officers. Students who have no adherence were due to their fear on the side effects, the tablet taste, forgetfulness, and feeling healthy. Conclusions: Iron folic acid supplementation program have been conducted and well targeted, however, student’s understanding on the objectives, benefit, and their adherence is needed to be gained.

Prevalence of Anaemia among Adolescent Girls on Weekly Iron and Folic Acid Supplementation (WIFS) and Non WIFS Group in Rural Schools of Mangalore, Karnataka; a Comparative Study

Background: Weekly Iron and Folic Acid Supplementation (WIFS) Programme is an initiative to decrease the burden of anaemia among adolescents studying in Government schools.
 Objective: To assess the difference in prevalence of anaemia among Government school-going adolescents girls on WIFS as compared to private school girls not on WIFS.
 Methods: Cross-sectional study was conducted among adolescent girls, 7th to 10th standard in Government schools (on WIFS) and private schools (not on WIFS). The sample size in each group was 104, selected by multi-stage sampling. Data was collected using semi-structured questionnaire, clinical examination and haemoglobin estimation. Chi-square test and Unpaired t test used to compare the categorical and continuous variables respectively.
 Results: The prevalence of anaemia among the school children in government schools was 51% and in the private schools it was 64.4%. The mean haemoglobin was 11.77 ± 1.41 and 11.34 ± 1.49 in government and private school girls, respectively, which was statistically significant (p=0.013).
 Conclusions: The prevalence of anaemia among the government school girls was lesser as compared to the private schools girls, suggesting the role of WIFS in the reduction of prevalence of anemia. WIFS programme may be extended to private schools as well.

Utilization and compliance of weekly iron and folic acid supplementation programme among school dropout adolescent girls in rural areas of Odisha, India

Utilization and compliance of weekly iron and folic acid supplementation programme among school dropout adolescent girls in rural areas of Odisha, India

Crowd-out in school-based health interventions: Evidence from India’s midday meals program

Governments often rely on schools to implement multiple programs targeting child outcomes. How to improve the implementation of these programs is an important, open question. As part of a randomized controlled trial in Odisha, India, we measured the impacts of a nutrition program and a monitoring intervention on the implementation of a pre-existing school-based nutrition program, specifically the Indian government’s iron and folic acid supplementation (IFA) program. The new nutrition intervention distributed a micronutrient mix (MNM) to be added to school meals while the monitoring intervention varied the intensity of monitoring activities. We find that high intensity monitoring improved implementation of the government’s IFA program, while the MNM intervention crowded it out. The net effect is that high intensity monitoring improved child health, while the MNM intervention did not. Both crowd-out of the IFA program and sensitivity to monitoring were predominantly found among schools that were resource or capacity constrained.

Impact of daily-supervised administration of a package of iron and folic acid and vitamin B12 on hemoglobin levels among adolescent girls (12-19 years): a cluster randomized control trial.

The prevalence of anemia has remained high among Indian adolescent girls over the past decade, despite the ongoing iron and folic acid (IFA) supplementation program. This study was conducted to assess the impact of daily supplementation of a package of IFA with vitamin B12 on hemoglobin levels among adolescent girls. A community-based cluster-randomized trial was conducted in the rural block of Faridabad District, Haryana, India in the year 2017. A total of 760 adolescent girls in the age group of 12-19 years with mild and moderate anemia were selected from government schools. Daily-supervised administration of iron and folic acid was conducted for 90 days: experimental group-IFA (iron (60 mg), folic acid (500) mcg), and cyanocobalamin (1000 mcg), control group-IFA and placebo. Hemoglobin, serum ferritin, and vitamin B12 levels were assessed at baseline and endline. Two-hundred adolescent girls completed 90 doses of daily supplementation. The mean hemoglobin (experimental group: 1.3 ± 1.0 g/dL, control group: 1.6 ± 1.2 g/dL, P = 0.004) and ferritin levels (experimental group: 18.6 ± 31.5 ng/mL, control group: 18.8 ± 35.0 ng/mL, P = 0.188) increased in both the control and experiment groups. Serum vitamin B12 deficiency significantly reduced to 2.5% in the experimental group and ferritin deficiency alleviated in more than 96% of the girls post intervention. Daily supplementation of IFA with/without vitamin B12 for 90 days eliminated iron, vitamin B12 deficiency and reduced the overall proportion of anemia by 53.5%. However, addition of vitamin B12 to IFA supplementation had no impact on improving the hemoglobin levels among adolescent girls. The present study does not recommend provision of vitamin B12 for prevention and treatment of anemia in this population group.

A review of the maternal iron and folic acid supplementation programme in Nepal: Achievements and challenges.

In the late 1990s, an estimated 75% of pregnant women in Nepal were anaemic. Although iron and folic acid (IFA) supplements were available free of charge, coverage among pregnant women was very low. In response, the Government of Nepal launched the Iron Intensification Programme (IIP) in 2003 to improve the coverage of IFA supplementation and anthelminthic treatment during pregnancy, as well as promote the utilization of antenatal care. This review examined how the IIP programme contributed to Nepal's success in increasing the consumption of IFA supplements during pregnancy. Nepal's cadre of Female Community Health Volunteers were engaged in the IIP to support the community‐based distribution of IFA supplements to pregnant women and complement IFA distribution through health facilities and outreach services. As a result, the country achieved a fourfold increase in the proportion of women who took IFA supplements during pregnancy between 2001 and 2016 (from 23% to 91%) and a 12‐fold increase in the proportion who took IFA supplements for at least 90 days during pregnancy (from 6% to 71%). The increase in coverage of IFA supplements accompanied an increase in the coverage of antenatal care during the same period. By 2016, the prevalence of anaemia in pregnant women decreased to 46%, highlighting the need to tackle other causes of anaemia and improve haemoglobin concentration before pregnancy, while maintaining the successful efforts to reach pregnant women with IFA supplements at the community level.

A School-Based Weekly Iron and Folic Acid Supplementation Program Effectively Reduces Anemia in a Prospective Cohort of Ghanaian Adolescent Girls.

Background:School-based iron and folic acid (IFA) supplementation is recommended for adolescent girls in countries with high burdens of anemia.Objectives:We aimed to evaluate the context-specific effectiveness of a school-based, integrated anemia control program with IFA supplementation in Ghana.Methods:Using data from a pre-post, longitudinal program evaluation, we evaluated the effectiveness of school-based weekly IFA supplementation in reducing the burden of anemia and increasing hemoglobin concentrations (Hb; primary outcomes) in 2 regions of Ghana. Generalized linear mixed effects models with schools (clusters) as random effects were used to quantify the change in the anemia prevalence and the mean Hb associated with cumulative IFA tablet consumption over 1 school year (30–36 weeks), controlling for participant-level potential confounders. A cut point for minimum effective cumulative IFA consumption that is reflective of adequate Hb was derived following logistic regression. This cut point was verified by a restricted cubic spline model of IFA consumption and Hb.Results:The analytical sample included 60 schools and 1387 girls ages 10–19 years. The prevalence of anemia declined during 1 school year of the intervention, from 25.1% to 19.6% (P = 0.001). Students consumed a mean of 16.4 IFA tablets (range, 0–36). IFA consumption was positively associated with Hb and negatively associated with anemia. Each additional IFA tablet consumed over the school year was associated with a 5% (95% CI, 1–10%) reduction in the adjusted odds of anemia at follow-up, though the relationship is nonlinear. The cut point for minimum effective consumption was 26.7 tablets over a 30–36-week school year, with tablets provided weekly.Conclusions:School-based weekly IFA supplementation is effective in improving Hb and reducing the anemia prevalence among schoolgirls in Ghana, though most participants consumed fewer than the minimum effective number of IFA tablets. Increasing intake adherence may further improve anemia outcomes in this population. J Nutr 2021;00:1–10.

The Prevalence of Iron Deficiency Anemia and its Associated Risk Factors among a Samples of Primary Schools Students in Burao City,Somaliland

Background: Anemia is a global public health problem affecting the majority of the population of the world in both developed and developing countries with major consequences on human health as well as social and economic development. It is the world's second leading cause of disability of the whole global disease burden. It affects 1.62 billion (24.8%) of the population among them it is affecting 305 million (25.4%) school age children (SAC). Objectives: The main objective of this study was assess prevalence and factors associated with anemia among schoolage children in primary schools in Burao city, Somaliland, 2020. Materials & Methods: A school based cross sectional study design was done in four primary schools in Burao, Somaliland. About 285 school age children with in the age group between 6-14 years were selected with respondent rate of 93.4%. Random sampling was used to select schools and systemic random sampling used to identify children from the selected schools. Sociaodemographic data was collected by using questionnaire & interview of respondents in addition to anthropometric measurement, hemoglobin measurement and stool examination. Complete Blood Counting (CBC) was used to determine the mean corpuscular (kor-PUS-kyu-lar) volume (MCV) and hematocrit (HMC) levels to detect of hemoglobin status of the children. Data was entered and analyzed using SPSS statistical software for Windows version 21. Anthropometric data was analyzed using WHO Anthro Plus. Bivariate logistic regression and multivariable logistic regression were used to identify independent predictors of anemia in-school adolescent girls. Statistical significance was set at p<0.05. Results: A total of 285 school age children were included in this study. The overall prevalence of anemia was ( 23.1%) (CI: 18.1%, 28.1%) with the mean and standard deviation of (12.7±1.59). Out of the anemic children, 20.4% were mild and 2.3% and 0.4% of them were moderate and severe respectively. Children's from illiterate mothers was (AOR = 2.37; 95%CI: 1.14, 4.94), consuming organ meat less than once a week (AOR = 2.19; 95%CI: 1.05, 4.43) and having parasites on stool were identified as statistically independent associated factors of anemia in school age children's from Burao, Somaliland. Conclusion: Prevalence of anemia in Burao city, Somaliland primary schools was moderate public health problem in the current study area. Nutrition education, iron folic acid supplementation program, deworming, good hygiene and sanitation are play important role in the prevalence of anemia and we recommend to give them more attention from ministry education and ministry of health in Somaliland.

Prevalence and Factors Associated with Iron Deficiency Anemia among School-Age Children in Primary Schools in Burao City, Somaliland, 2020

Background: Anemia is a global public health problem affecting the majority of the population of the world in both developed and developing countries with major consequences on human health as well as social and economic development. It is the world’s second leading cause of disability of the whole global disease burden. It affects 1.62 billion (24.8%) of the population, among them, it is affecting 305 million (25.4%) school-age children (SAC). Objectives: The main objective of this study was to assess the prevalence and factors associated with anemia among school-age children in primary schools in Burao city, Somaliland, 2020. Materials & Methods: A school-based cross-sectional study design was done in four primary schools in Burao, Somaliland. About 285 school-age children in the age group between 6 - 14 years were selected with a respondent rate of 93.4%. Random sampling was used to select schools and systemic random sampling was used to identify children from the selected schools. Socio-demographic data was collected by using a questionnaire & interviews of respondents in addition to anthropometric measurements, hemoglobin measurement, and stool examination. Complete Blood Counting (CBC) was used to determine the mean corpuscular (kor-PUS-kyu-lar) volume (MCV) and hematocrit (HMC) levels to detect hemoglobin status of the children. Data was entered and analyzed using SPSS statistical software for Windows version 21. Anthropometric data was analyzed using ANTHRO Plus. Bivariate logistic regression and multivariable logistic regression were used to identify independent predictors of anemia in school adolescent girls. Statistical significance was set at p Results: A total of 285 school-age children were included in this study. The overall prevalence of anemia was (23.1%) (CI: 18.1%, 28.1%) with the mean and standard deviation of (12.7 ± 1.59). Out of the anemic children, 20.4% were mild and 2.3% and 0.4% of them were moderate and severe, respectively. Children’s from illiterate mothers (AOR = 2.37; 95% CI: 1.14, 4.94. P-value = 0.020), consuming organ meat less than once a week (AOR = 2.19; 95% CI: 1.05, 4.43. P-value = 0.036) and having parasites in stool (AOR = 5.21; 95% CI: 1.10, 24.6. P-value = 0.037) were identified as statistically independent associated factors with prevalence of anemia in school-age children’s from Burao, Somaliland. Conclusion: Prevalence of anemia in Burao city, Somaliland primary schools was a moderate public health problem in the current study area. Nutrition education, iron folic acid supplementation program, deworming, good hygiene, and sanitation are playing an important role in the prevalence of anemia and we recommend to give them more attention from ministry of education and ministry of health in Somaliland.

School Readiness in Weekly Iron Folic Acid Supplementation Program in Urban Area, West Java, Indonesia

Background:School based weekly iron and folic acid supplementation (WIFAS) program was aimed to decrease anemia prevalence and improve the adherence to consume iron tablet.Limited information on the school perspective and their readiness to implement the program.Objectives:To analyze program guidelines, stakeholders’ perspective and school readiness to implement the program which will help evaluate and improve adherence to WIFAS.Methods:Using cross sectional design with mixed method approach to utilize social ecological model and community readiness model.Results: Most of schools received awareness campaign regarding the program,only 38,9% have conducted a drinking together session once a week,only 27,8% recorded their students’ adherence.The average score for the school readiness was 3.36 (SD ±0.82), the school was in the vague awareness stage.There is a correlation between the score of school’s knowledge, attitude toward WIFAS program,City Health Authority and Education Regional Office ‘s support score, the total score of the school readiness, ever got socialization with implementation of WIFAS (r= 0.35, r=0.2, r=0.49, r=0.21, r= 0.66, r= 0.43, p value &lt;0.005).The strongest correlation with implementation of WIFAS at school was the school readiness total score, ever received socialization and score school’s knowledge on WIFAS (p value &lt;0.005) and City health Authority and Education regional office’s support score for WIFAS program as covariant (p &gt;0.05).Conclusions: School readiness is important factor of community and environment which contribute to behavior change.School realize that anemia and schoolgirl adherence to consume WIFAS had to solved but did not know how and assume outside parties can help solve the problem.The City Health Authority and Education Regional Office is expected to help improve the school readiness to implement the program.

Epidemiological characteristics of serum vitamin B(12) and folate levels in women awaiting delivery

Objectives: To analyze the epidemiological characteristics and levels of vitamin B(12) and folate as well as their relationship in women awaiting delivery, in Shaanxi province. Methods: Data were collected from healthy pregnant women who gave birth at six top hospitals in Shaanxi, from January 2014 to December 2016. Blood samples were taken prenatally to determine the levels of vitamin B(12) and folate. Quantile regression model was used to analyze the relationship between the levels of vitamin B(12) and folates in women awaiting delivery. Results: A total of 1 277 women awaiting delivery were included in this study. Among them, the median level of serum vitamin B(12) was 164.7 pg/ml, in women at late pregnancy, with the deficiency rate as 69.6%, while the median level of serum folate was 7.6 ng/ml, with the deficiency rate as 12.1%. 58.4% of these women presented simple vitamin B(12) deficiency and 0.9% with simple folate deficiency. Women living in rural areas showed lower levels of both vitamin B(12) and folate than the women from the urban areas. Both the levels of vitamin B(12) and folate increased with age but were significantly lower in women under the age of 25. Among those with or without folate deficiency, the average difference in the levels of vitamin B(12) was 37.62 pg/ml. Quantile regression models showed that the vitamin B(12) levels in women with folate deficiency were significantly lower than those without, despite the different levels of vitamin B(12). This difference appeared increasing along with the increase of the vitamin B(12) levels. Conclusions: Our data showed that both vitamin B(12) and folate were deficient in women awaiting delivery, in Shaanxi. We suggest that vitamin B(12) should also be added into the folic acid supplementation program, together with the reinforcement on health education program to improve the awareness of nutrient supplementation in rural and young women. Hopefully, these strategies could increase the levels of both vitamin B(12) and folate, in the province.

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

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.

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

To assess the coverage of the adolescent weekly iron and folic acid supplementation (WIFS) programme in rural West Bengal, India. 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). Birbhum Health and Demographic Surveillance System. A total of 4448 adolescents 10-19 years of age participated in the study. 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. 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.

Understanding barriers in implementation and scaling up WIFS from providers perspective: A mixed-method study, Rishikesh, India.

Context:Since the implementation of Weekly Iron and Folic acid Supplementation (WIFS) program in India in 2013, little effort has been made to comprehensively evaluate the program.Aims:This study was carried out to assess the coverage of WIFS among adolescent girls, explore implementation barriers, and suggest solutions to improve WIFS through public schools in Rishikesh, India (2018–19).Methods and Materials:This was a sequential explanatory mixed-methods study. Quantitative component was a community-based cross-sectional survey to determine the prevalence of anemia and coverage of WIFS. Qualitative component added an explanation to understand WIFS implementation through document review and nonparticipant observation of WIFS session. We invited stakeholders for nominal group discussion on barriers and solutions.Statistical Analysis Used:Variables were described as proportion and mean. Group discussion transcript was analyzed using content analysis.Results:Of 400 adolescent girls, 16% (95% CI: 12.4, 19.6) received weekly and 45% ever received iron tablets over the last 3 months and 79% were anemic. From ten schools, one school never implemented WIFS. There was iron-folic acid (IFA) stock out for 10 months last year. Major barriers identified were nonavailability of IFA, and irregularity in submitting IFA consumption report. Suggested solutions were ensuring IFA stock, strengthening supervision, ownership, training, and regular meetings of stakeholders.Conclusions:To conclude, in a setting with high anemia prevalence, WIFS was poorly implemented. Ownership and strengthening supervision is essential for the success of the program.