School-based iron and folic acid supplementation for adolescent girls: findings from Manica Province, Mozambique
Horjus, P.; Aguayo, V.M.; Roley, J.A.; Pene, Mício.C.; Meershoek, S.P.
Food and Nutrition Bulletin 26(3): 281-286
2005
ISSN/ISBN: 0379-5721 PMID: 16222919 DOI: 10.1177/156482650502600305Document Number: 256032
Background: The 1997 Demographic and Health Survey in Mozambique shows that 47% of girls 15 to 19 years old living in Manica province (west-central Mozambique) are pregnant or have already had a child. A recent survey also shows that 45% of girls 10 to 18 years old attending school are anaemic. Strategies are needed to build iron stores before pregnancy and to control seasonal and chronic iron deficiency and anaemia in school-aged girls. Objective: To assess the programme effectiveness of two school-based weekly iron and folic acid (IFA) supplementation regimes (five-month supplementation vs. eight-month supplementation) in girls 10 to 18 years old attending school in the districts of Macossa and Guro in Manica province. Methods: Twelve schools were included in the study. Schools were ordered by descending mean haemoglobin concentration, and assigned alternately to study group 5 (six schools; five-month supplementation) or study group 8 (six schools; eight-month supplementation). In both study groups, the weekly supplement contained 60 mg of elemental iron and 400 micro g of folic acid. All girls received a single dose of mebendazole (500 mg) twice - once at the beginning of the study (T0) and once six months later (T6). Supplementation was implemented and supervised by the teachers of the schools included in the study. Between T0 and T3, girls in study group 8 received IFA supplements weekly whereas girls in study group 5 did not. Between T3 and T8, all girls in both groups received weekly IFA supplements. The girls started weekly supplementation in February 2002 and concluded in October 2002. Results: At T0, mean haemoglobin concentration and anaemia prevalence were comparable in study groups 8 and 5 (125.3+or-12.6 g/litre vs. 123.8+or-12.8 g/litre; 28% vs. 29%, respectively). At T3, the mean haemoglobin concentration in study group 8 was significantly higher (126.3+or-14.3 g/litre vs. 121.5 g/dL+or-11.9 g/litre, P<0.001) and the prevalence of anaemia was lower (28% vs. 35%, P=0.076) than in study group 5. At T8, after an additional five-month supplementation period in both study groups, mean haemoglobin concentration and anaemia prevalence in study groups 8 and 5 were not significantly different (126.5+or-12.6 g/litre vs. 124.9+or-12.3 g/litre; 23% vs. 27%, respectively). Conclusion: In Manica Province, school-based weekly IFA supplementation is a feasible and effective intervention to prevent seasonal drops in haemoglobin concentration and increases in anaemia prevalence. Short supplementation periods can have an important impact on girls' haematological status. However, the size of girls' haematological response in this study is significantly lower that observed in studies with similar population groups, initial anaemia prevalence, supplement dosing, and/or supplementation regime.