Action - Weekly Iron Folic Acid Supplementation - Nutrition International - Ethiopia - Iron and folic acid supplementation - Adolescents

Programme: Weekly Iron Folic Acid Supplementation - Nutrition International - Ethiopia

Programme description

Iron deficiency anaemia is now recognized as the number one cause of lost disability adjusted life years (DALYs) in adolescent girls globally[1]. Anaemia has three major consequences for adolescent girls: (i) decreased school performance (and challenges in concentration); (ii) loss of productivity; and (iii) decreased current and future reproductive health, for those that become pregnant. Related to this, young maternal age increases the risk of maternal anaemia during pregnancy. 

After infancy, adolescence (10-19 years of age) is the most rapid period of development. Adolescents have the highest nutritional needs and provide a second window of opportunity for catch-up growth[2]. While WHO and others formally acknowledge adolescents as a group with specific nutrition needs, until recently, Adolescent Nutrition has been neglected in global and national investment, policy and programming in developing countries. The 2014 WHO report “Health for the World’s Adolescents” notes that progress for adolescents lags behind gains made in maternal and child health programs. 

Improving adolescent anaemia is critical to general anaemia gains. The World Health Assembly has called for a 50% reduction in anaemia in women of reproductive age (15-49 years of age) by 2025[3]. Although adolescent specific data are lacking globally, it is estimated that approximately 30% of adolescents are anaemic[4]. Therefore, to reach this goal, the approximately 600 million adolescent girls living in developing countries must become a prime focus of anaemia reduction efforts. 

The WHO recommends intermittent iron and folic acid supplementation (at least once weekly for three months, twice yearly) as an effective strategy to prevent anaemia in populations where anaemia in women of reproductive age is of public health concern (>20% anaemia)[5]. Despite this WHO recommendation, the policy environment for WIFAS remains a challenge. In coordination with government and other partners, NI aims to improve the health and well-being of girls by reducing anaemia in adolescent girls through Weekly Iron and Folic Acid Supplementation (WIFAS), and contribute to empowering girls through Adolescent Nutrition education. Adolescent boys also benefit from the nutrition education. These Adolescent Nutrition programs are informed by gender-analysis and consider the inequalities in anemia, as well as gendered barriers to attending school and accessing health systems.

Nutrition International contributes to the WIFAS program in Ethiopia by:
  • Providing technical leadership and support to the government
  • Revising implementation guidelines, training manuals, job-aids and monitoring and reporting tools.
  • Providing training to key intermediaries on the quality and timely provision and tracking of WIFAS and nutrition counselling. 
  • Developing and implementing an  evidence-based gender sensitive Behaviour Change Intervention (BCI)  strategy, based on formative research including gender analysis
  • Supporting supply management and procurement plans, and working with government to ensure supply for projects 
  • Supporting capacity building of key intermediaries on delivery of package of interventions, including training of trainers and on the job training for school staff, teachers, and health post staff. 
  • Disseminating learnings with key stakeholders and partners.

These activities are being implemented in partnership with the Federal Ministry of Health, the Federal Ministry of Education, Addis Ababa University School of Public Health, and regional and woreda health and education bureaus and offices. This program is being implemented nationally through technical guidance, policy support and advocacy, and sub-nationally in 96 woredas across six regions (Amhara, Oromia, Southern Nations, Nationalities, and Peoples’ Region (SNNPR), Tigray, Afar and Benishangul Gumaz). NI started providing support to the government for WIFAS in 2016, and this support is on-going.

Programme type



  1. WHO, AA-HA! Global Accelerated Action for the Health of Adolescents (AA-HA!) – Guidance to Support Country Implementation – Summary.
  2. Prentice AM, Ward KA, Goldberg GR, Jarjou LM, Moore SE, Fulford AJ, Prentice A. Critical windows for nutritional interventions against stunting. The American journal of clinical nutrition. 2013 May 1;97(5):911-8.
  3. WHO, WHA Global Nutrition Targets 2025: Anaemia Policy Brief. 2014
  4. UNICEF, Progress for Children: A report card on adolescents, 2012.
  5. WHO. Guideline: Intermittent iron and folic acid supplementation in menstruating women. Geneva, World Health Organization, 2011.

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Revision log

Thu, 10/18/2018 - 21:14zillmerkpublishedpublished
Thu, 10/18/2018 - 19:22GINAadminNIAction edited by GINAadminNI.needs_review
Thu, 10/18/2018 - 19:20GINAadminNIAction edited by GINAadminNI.draft
Tue, 10/02/2018 - 16:21engesveenkEdited by GINAadminNI.published
Tue, 09/11/2018 - 15:42GINAadminNIEdited by GINAadminNI.delegated
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