Adherence of Weekly Iron Folic-acid Supplementation and Determinant Factors Among Adolescent School Girls in Hadiya Zone, Ethiopia, 2023: Institutional Based Mixed Method

Globally, 1.62 billion individuals are affected by anemia, and iron deficiency is thought to be half of all cases. From this, 15% are adolescents. According to a WHO report, 50% of anemia cases are attributed to iron deficiency. The prevalence of anemia in sub-Saharan Africa surpasses 39%. Hence, iron and folic acid supplementation is a World Health Organization-recommended adolescent nutrition intervention to prevent the high burden of anemia. This study investigated adherence to weekly iron and folic acid supplementation and determinant factors among adolescent schoolgirls aged 10-19 years in the Hadiya Zone, Central Ethiopia region, Ethiopia, in 2023. An institution-based mixed method was deployed. Data were collected through a self-administered questionnaire for the cross-sectional one and an open-ended questionnaire for key informants in the study period of March to April 2023. Logistic regression used for quantitative analysis, and thematic analysis was used for qualitative part. From a sample size of 569, the adherence was 74%, and of that, 60.8% always consumed at school on-spot provision and 13.2% consumed by the home take approach. The odds of adolescent school girls who were accessed social and behavioral change communication tools were 14.22 times more likely to adhere to the supplementation; AoR 14.22 (4.56-13.02). Those who were exposed to in-school nutrition education were 16 times more likely to adhere; AoR 16 (15.43-240). Those who had discussed weekly iron folic acid supplementation with their family were 7.47 times more likely to adhere to WIFAS than those who had not discussed about it; AoR 7.47 (1.38-40.14). Those who heard about anemia and knew about anemia were 9.25 times more likely to adhere to WIFAS AoR 9.25 (1.43-59.72). One of the key informants, an adolescent girl, said, “<i>The great positive experience was that we adolescent girls were aware that the program was a targeted, nutrition-specific supplementary program to prevent anemia, and that was why we accepted and adhered to the weekly provision</i>." However, significant numbers (26%) of adolescent schoolgirls were interrupting weekly iron and folic acid supplementation consumption. Hence, it should be primarily led and owned by the government, engage all stakeholders, and provide enough locally adapted and adolescent-friendly social and behavioral change communication tools.