Determinants of non-compliance to iron and folic acid supplementation among adolescent girls in schools of Salima district
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Date
2022-09-09
Authors
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Publisher
Kamuzu University of Health Sciences
Abstract
Executive Summary
Type of the study
This will be a school-based quantitative cross-sectional study aiming at assessing the
determinants of non-compliance to iron and folic acid supplementation among adolescent girls in
selected schools in Salima district.
Problem
In Malawi, the prevalence of anaemia among adolescent girls is unacceptably high. The
Malawi demographic health survey (MDHS) 2015-2016 indicated the anaemia prevalence of
35.3% among adolescent girls. World health organization (WHO) recommends iron and folic
acid supplementation to adolescent girls in a country with prevalence of more than 20%. The
recommendation is based on evidence that Iron and Folic Acid Supplementation (IFAS) has been
proved cost effective way of improving iron status especially in developing countries.
Considering this, the ministry of health, in collaboration with the ministry of education and other
partners in 2019 launched the weekly IFAS program for adolescent girls aged 10 to 19 years to
mitigate the 35.3% prevalence of anemia among adolescent girls in the country. The program
was piloted in six districts of Mangochi, Dedza, Salima Lilongwe, Dowa, and Machinga, and
later rolled out to other districts. However, since the implementation started in Salima district,
compliance rates have been disappointingly low below the national requirement of 100% for the
past 3 years of implementation. According to Salima Health Information and Management
System (HMIS) data for school platform, from July to December 2019, the program had a
coverage of 79% with a compliance rate of 61%. In 2020, the same duration, 69% IFAS
coverage was achieved with a compliance rate of 14%, and from July to December 2021, 82%
IFAS coverage was achieved with a 21% compliance rate. Yet, the reasons behind the low
compliance remain unknown due to limited literature and being a new intervention among
adolescent girls in Malawi. Hence the need for this study.
Broad Objective
The aim of the study is to assess determinants of non-compliance to Iron and Folic Acid
supplementation among adolescent girls enrolled in selected schools in Salima district. Specific Objectives
(1) To determine the adolescent girlsā level of knowledge of Iron deficiency anaemia and
IFAS program in selected schools in Salima district.
(2) To identify individual factors affecting compliance with IFAS among adolescent girls
enrolled in selected schools in Salima district.
(3) To examine modifying factors affecting compliance to IFAS among adolescent girls
enrolled in selected schools in Salima district.
Methodology
The study will be conducted in randomly selected primary schools and is targeting
adolescent girls (10 to 19 years) with a sample size of 106 calculated using Cochran's formula.
Sampling will be done in stages (multi stage sampling) to select the health facilities, schools, and
adolescent girls (responded). The data will be collected through face to face interviews using a
structured questionnaire and analyzed using SPSS version 22. Descriptive statistics will be used
to present the data in figures and tables. And then, logistic regression analysis will be carried out
to identify determinants of IFAS non-compliance. The ethical approval to conduct this study will
be sort from college of medicine research and ethics committee (COMREC) and institution
clearance was obtained from Salima district council, education department.
Expected findings
The study findings will document determinants of non-compliance to IFAS among
adolescent girls. This will give evidence that will serve as a basis for recommendation to
policymakers, program managers, advocators and service providers to formulate policies and
improve IFAS program strategies by including interventions that will promote compliance
among the girls hence reducing the prevalence of iron deficiency anemia.
Dissemination of the results
The findings will be presented to schools and district nutrition coordinating committee
(DNCC) in Salima, COMREC, and ministry of health, department of nutrition and HIV Aids
(DNHA). The study findings will be published in a reputable peer review journals and presentedat a conference. A copy of thesis will be in Kamuzu University of health sciences (KUHES)
library.