ArticleCurrent developments in nutrition2020
Barriers to and Facilitators of Iron and Folic Acid Supplementation within a School-Based Integrated Nutrition and Health Promotion Program among Ghanaian Adolescent Girls.
Article in Current developments in nutrition, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers.
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Who cites it
16 citing papers in PubMed, 26 citations in OpenAlex.
- Ten2Twenty-Ghana: a randomised controlled trial on the efficacy of multiple micronutrient-fortified biscuits on the micronutrient status of adolescent girls.The British journal of nutrition · 2024Trial
- Implementing school-based nutrition interventions in low- and middle-income countries: a scoping review of implementation strategies, frameworks, and outcomes.Global health action · 2026Article
- Article
- Trends, regional disparities, and projected burden of anemia among women of reproductive age in Ghana, 2000-2030.Reproductive health · 2026Article
- Challenges, motivators and coping strategies of iron-folic acid tablets intake in the girls iron-folic acid tablet supplementation program in Wa municipality of Ghana.BMC nutrition · 2026Article
- Perceived Barriers and Enablers for Taking Iron-Folic Acid Supplementation Regularly Among Adolescent Girls in Indonesia: A Pilot Study.International journal of environmental research and public health · 2025Article
- Demand- and supply-side barriers and facilitators of the weekly iron and folic acid supplementation programme in Sidama Region, Ethiopia.Journal of nutritional science · 2025Article
- Facilitators and barriers to the implementation of the Girls' Iron Folate Tablet Supplementation program among adolescent girls in the Bono Region: a cross-sectional survey.The Pan African medical journal · 2025Article
- Barriers, Facilitators of Iron and Folic Acid Supplementation, and Deworming Program among School-Going Adolescents of Deoghar, Jharkhand, India: A Mixed-Methods Study.Korean journal of family medicine · 2024Article
- Integrating and coordinating programs for the management of anemia across the life course.Annals of the New York Academy of Sciences · 2023Article
- Effective Coverage in Health Systems: Evolution of a Concept.Diseases (Basel, Switzerland) · 2023Review
- Compliance of Iron Supplementation and Determinants among Adolescent Girls: A Systematic Review.Iranian journal of public health · 2023Review
- The Effect of a Turkey Berry (International journal of food science · 2023Article
- A Qualitative Analysis of Program Fidelity and Perspectives of Educators and Parents after Two Years of the Girls' Iron-Folate Tablet Supplementation (GIFTS) Program in Ghanaian Secondary Schools.Current developments in nutrition · 2021Article
- A School-Based Weekly Iron and Folic Acid Supplementation Program Effectively Reduces Anemia in a Prospective Cohort of Ghanaian Adolescent Girls.The Journal of nutrition · 2021Article
- Association of iron supplementation and dietary diversity with nutritional status and learning outcomes among adolescents: Results from a longitudinal study in Uttar Pradesh and Bihar, India.Journal of global health · 2021Article
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Authors and funding
10 authors at 5 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundAnemia is a moderate public health problem among adolescent girls in Ghana.
objectivesWe 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.
methodsAuthors 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.
resultsOf 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).
conclusionsAlthough 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.
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