CHALLENGES AND OPPORTUNITIES IN DESIGNING WEEKLY IRON AND FOLIC ACID SUPPLEMENTATION PROGRAMS FOR ADOLESCENT GIRLS IN AND OUT OF SCHOOL IN 3 AFRICAN COUNTRIES

Background and objectives: The 600 million adolescent girls living in developing countries have to become a focus of anemia reduction efforts to reach the WHA target of a 50-percent reduction in anemia by 2025. Despite the 2011 WHO recommendation for weekly iron folic acid supplementation (WIFAS), n...

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Bibliographic Details
Published in:Annals of nutrition and metabolism 2017-10, Vol.71, p.625
Main Authors: Roche, Marion, Lewetie, Ermias Mekuria, Niang, Cheikh Tidiane, Murage, Lucy, Holte-McKenzie, Merydth, Adish, Abdul Aziz, Velez, Luz Maria De Regil
Format: Article
Language:English
Subjects:
Adolescents
Anemia
Demonstration programmes
Developing countries
Feasibility studies
Folic acid
Girls
Health
Iron
Latrines
LDCs
Medical personnel
Nutrition
Reduction
Supplements
Teachers
Teaching methods
Teenagers
Vitamin B
Vitamin deficiency
Workers
Youth
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Summary:Background and objectives: The 600 million adolescent girls living in developing countries have to become a focus of anemia reduction efforts to reach the WHA target of a 50-percent reduction in anemia by 2025. Despite the 2011 WHO recommendation for weekly iron folic acid supplementation (WIFAS), national policies and operational guidelines are lacking and national programs are not being implemented in most African countries. Our objective was to design demonstration programs informed by context specific formative research, to assess feasibility of delivery platforms that could inform national scale up to reach adolescent girls in and out of school system in Ethiopia, Kenya, and Senegal. Methods: Formative research protocols were adapted for each country and studies were implemented with local partners in 2016 and 2017 to identify contextual opportunities for reaching adolescent girls with WIFAS and factors that could influence coverage and adherence. Purposive sampling guided the selection of adolescents, teachers, health workers, decision makers and influencers. Methods included focus group discussions (FGDs) and in-depth interviews (IDIs): Ethiopia-30 FGDs and 85 IDIs; Kenya- 45 FGDs and 36 IDIs; and Senegal-83 FGDs and 301 IDIs. Results: As adolescent girls have low access of the health system for preventative services, the delivery of WIFAS through the school system was the most efficient platform for greatest reach in all settings. Engagement of teachers and school attendance have the greatest influencers on coverage and adherence. Attendance is often much lower than enrollment due to family and community pressures and a lack of basic amenities, such as female-friendly latrines and safe water. Reaching disperse out-of-school girls with health extension workers will be more resource and time intensive. Awareness of anemia is high, yet misconceptions are common. WIFAS benefits that motivate adolescent girls are related to current school performance, strength and health, rather than future reproductive potential; yet, distinct segments exist within adolescent girls. Conclusions: Reaching adolescent girls with WIFAS requires multi-sector collaboration between health and education. Impact of these anemia reduction efforts requires overcoming gendered barriers to school attendance and youth-specific barriers to the health system, while recognizing the specific motivators of diverse adolescents in each country.
ISSN:0250-6807
1421-9697