(P17-014-23) Addressing Anemia Among School-Going Adolescents With Iron and Folic Acid Versus Multiple Micronutrient Supplements

Objectives: Few policies and programs target adolescent nutrition, despite iron-deficiency anemia being among the leading causes of morbidity and mortality among adolescents ages 10-19 years in low- and middle- income countries. To generate evidence that will inform policy and practice, we investigate whether iron and folic acid tablets or multiple micronutrient supplements are effective in addressing anemia among school-going adolescents in Burkina Faso.

Methods: Between April 2021-April 2022, we enrolled and followed 3,123 secondary school students aged 10-18 years in a cluster-randomized trial in Burkina Faso. Students were supplemented with weekly iron and folic acid (IFA), daily multiple micronutrient supplements (MMS), or received only standard nutrition education as controls. Supplementation happened over two distinct periods, separated by a 20-week school break without supplementation: an initial 10-week period and a second 16-week period. Hemoglobin levels were assessed before and after each supplementation period, a total of four times. Anemia was defined as none, mild, moderate, or severe based on World Health Organization cutoffs. Multilevel mixed effects generalized linear models with schools as random effects were used to evaluate associations between treatment arms and anemia.

Results: Adolescents in the IFA arm had hemoglobin levels 0.32 g/dL higher than those in the control arm (aβ = 0.32; 95% CI: 0.02, 0.62). Among those in the MMS arm, only male students had higher hemoglobin than controls (aβ = 0.36; 95% CI: 0.07, 0.66). We observed no significant relationships between study arm and anemia outcomes.

Conclusions: Though results do not provide strong evidence that weekly IFA or daily MMS supplements are effective on their own in addressing anemia, supplementation remains an important part of packages aimed at anemia prevention. Additional research is required to determine how to best address adolescent anemia.

Funding Sources: Anonymous funder