(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

Objectives: The aim of this implementation research project was to implement and test effectiveness of different delivery modalities to reach adolescent girls (age 10-19 years, in and out of school) with weekly iron folate supplementation (WIFAS) and nutrition counselling package of interventions.

Methods: We employed barriers and facilitators study to identify important bottlenecks and facilitators of WIFAS supplementation at schools. We purposeful sampled and conducted 40 key informant interviews with district health and education office, health care providers, school teachers, religious leader, village leaders and parents of adolescent girls. In addition, four Focus Group Discussions (FGDs) were held with in school as well as out of school adolescent girls.

We evaluate program performance through estimating coverage and adherence of WIFAS program among adolescent girls. We used data obtained from program monitoring data base to estimate monthly and overall WIFAS coverage and adherence. We calculated the contact coverage based on the proportion of adolescent girls who have ever consumed at least one IFA tablet, while adherence level, was calculated based on the proportion of girls who have consumed more than 12 tablets during the supplementation period (6 month).

Results: We identified a total of 16, 323 illegible adolescent girls and enrolled into the program. Among these, 87.9% consumed at least one IFA tablet during the implementation period indicating a high coverage rate.

The adherence levels of adolescent girl’s significantly improved over the supplementation period. The monthly adherence level increased by about 20% over the six month supplementation period. The WIFAS adherence level was estimated at 73.8% at the first month and improved to 93.7% at the sixth month of supplementation period. The primary reasons non-adherence were school absenteeism, stock outs and school dropout.

Conclusions: We demonstrated a high coverage and adherence of WIFA supplementation among adolescent girls. We identified key program barriers and developed mitigation strategies for improved coverage and documented lessons to be used for scale up.

Funding Sources: Micronutrient international