Knowledge, Attitude, and Practices Regarding Iron Folic Acid Tablets and Coverage of the Weekly Iron Folic Acid Supplementation Programme Among Rural Adolescent Girls in Nagpur District: A Cross-Sectional Study

Authors

  • Varsha S. Dhurde Fogarty Global Health Fellow (2019-2020), Lata Medical Research Foundation, Kinkini Kutir, Vasantnagar,  Nagpur, Maharashtra, India
  • Archana B. Patel Program Director, Lata medical research foundation, KinkiniKutir,  Vasantnagar, Nagpur, Maharashtra, India,
  • Lindsey M. Locks Assistant Professor, Department of Health Sciences, Boston University: Sargent College, 635 Commonwealth Ave., Boston MA
  • Patricia L. Hibberd 4Chair and Professor, Department of global health, Boston university school of public health, Professor of medicine and pediatrics, Boston university school of medicine, Corsstown,373,801 Massachusetts Avenue, Boston MA.

DOI:

https://doi.org/10.37506/9e19gr89

Keywords:

Adolescent, anaemia, Folic acid, Knowledge, India, Iron

Abstract

Despite years of programmatic efforts, anemia among adolescent girls in India remains a significant public health 
challenge. This study aimed to assess awareness, practices related to iron and folic acid (IFA) tablet consumption, 
and coverage of the Weekly Iron and Folic Acid Supplementation (WIFS) program among adolescent girls in rural 
areas of Nagpur district, Maharashtra.
A cross-sectional design was employed to gather socio-demographic data and assess knowledge (five questions), 
attitude (three questions), and practices (nine questions) related to government-recommended IFA tablet consumption.
Among 221 randomly selected adolescent girls, 90.5% were aware of IFA tablets, primarily informed by school 
teachers. Over half knew the purpose of IFA supplementation. Although 94% reported having received IFA tablets 
in the past, only 88% consumed them. While most did not report adverse effects, one-third did not believe IFA 
consumption was beneficial. Common barriers to adherence included the bitter taste of the tablets, forgetfulness, 
and symptoms like nausea or vomiting.  The recent coverage of WIFS was observed to be low. In 2017 and 2018 the 
program coverage was above 75% but dropped below 60% in other years. Only 9% of participants had received an 
IFA tablet in the past 14 days; of these, 60% consumed two tablets. The primary reason for non-consumption was 
non-receipt from schools (89%).
The study highlights inadequate knowledge of IFA benefits despite high awareness and suboptimal coverage of 
the WIFS program. Strengthening program delivery and addressing barriers to IFA consumption are essential to 
improve adherence and reduce anemia among adolescent girls in rural India.

Author Biographies

  • Varsha S. Dhurde, Fogarty Global Health Fellow (2019-2020), Lata Medical Research Foundation, Kinkini Kutir, Vasantnagar,  Nagpur, Maharashtra, India

    Fogarty Global Health Fellow (2019-2020), Lata Medical Research Foundation, Kinkini Kutir, Vasantnagar, 
    Nagpur, Maharashtra, India

  • Archana B. Patel, Program Director, Lata medical research foundation, KinkiniKutir,  Vasantnagar, Nagpur, Maharashtra, India,

    Program Director, Lata medical research foundation, KinkiniKutir,  Vasantnagar, Nagpur, Maharashtra, India,

  • Lindsey M. Locks, Assistant Professor, Department of Health Sciences, Boston University: Sargent College, 635 Commonwealth Ave., Boston MA

    Assistant Professor, Department of Health Sciences, Boston 
    University: Sargent College, 635 Commonwealth Ave., Boston MA

  • Patricia L. Hibberd, 4Chair and Professor, Department of global health, Boston university school of public health, Professor of medicine and pediatrics, Boston university school of medicine, Corsstown,373,801 Massachusetts Avenue, Boston MA.

     Chair and Professor, Department of  global health, Boston university school of  public health, Professor of medicine and pediatrics, Boston  university school of  medicine, Corsstown,373,801 Massachusetts Avenue, Boston MA.

References

International Institute for Population Sciences. National Family Health Survey (NFHS-4), 2015-16. https://dhsprogram.com/pubs/pdf/FR339/FR339.pdf

Raykar N, Majumder M, Laxminarayan R., Menon P. India Health Report: Nutrition 2015. New Delhi, India: Public Health Foundation of India. https://api.semanticscholar.org/CorpusID:79347870

Gillespie S. Major issues in controlling iron deficiency.1998; Ottawa: Micronutrient Initiative. https://idl-bnc-idrc.dspacedirect.org/server/api/core/bitstreams/bcb6295d-2315-435d-8801-8e29e8c329fc/content

International Institute for Population Sciences, India Fact Sheet. National Family Health Survey‐5 2019‐21;2022. Ministry of Health and Family Welfare, Government of India. India_National_Fact_Sheet.pdf

Global Nutrition Monitoring Framework: operational guidance for tracking progress in meeting targets for 2025; December 2017. https://iris.who.int/bitstream/handle/10665/259904/9789241513609-eng.pdf?sequence=1%25

Varghese JS, Swaminathan S, Kurpad AV, Thomas T. Demand and supply factors of iron-folic acid supplementation and its association with anaemia in North Indian pregnant women. PLOS ONE. 2019;14(1):e0210634. doi:10.1371/journal.pone.0210634. https://pubmed.ncbi.nlm.nih.gov/30699167/

Singh M, Honnakamble RA, Rajoura OP. Knowledge, Attitude and Practice Change about Anemia after Intensive Health Education among Adolescent School Girls of Delhi: An Intervention Study. Int J Med Public Health. 2019;9(3):71-3. IntJMedPubHealth-9-3-71.pdf

Salam SS, Ramadurg U, Charantimath U, Katageri G, Gillespie B, Mhetri J, et al. Impact of a school-based nutrition educational intervention on knowledge related to iron deficiency anaemia in rural Karnataka, India: A mixed methods pre–post interventional study. BJOG.2023;00:1–11. https://doi.org/10.1111/1471-0528.17619.

Sudfeld CR, Rai RK, Barik A et al. Population-level effective coverage of adolescent weekly iron folic acid supplementation is low in rural West Bengal, India. Public Health Nutrition.2020; 23:2819–2823. https://pubmed.ncbi.nlm.nih.gov/32524931/

Khapre M, Shewade HD, Kishore S, Ramaswamy G, Dongre AR. Understanding barriers in implementation and scaling up WIFS from providers perspective: A mixed-method study, Rishikesh, India. J Family Med Prim Care. 2020;9:1497-509. https://pubmed.ncbi.nlm.nih.gov/32509640/

Dhurde VS, Patel AB, Locks LM, and Hibberd PL. Anaemia prevalence, its determinants and profile of micronutrient status among rural school adolescent girls aged 14–19 years: a cross-sectional study in Nagpur district, Maharashtra, India. Public Health Nutrition.2024; 27: e248, 1–10. doi: 10.1017/ S1368980024002234. https://pubmed.ncbi.nlm.nih.gov/39526451/

International institute for Population Sciences. National Family Health Survey (NFHS-2), 1998-99, International Institute for Population Sceinces;2000. https://www.dhsprogram.com/publications/publication-frind2-dhs-final-reports.cfm

Verma SK, Khanum RS, Kumar SD, Narayanmurthy MR. Knowledge, attitude and practices towards anemia among late adolescent girls of JSS schools and colleges of Mysuru, India: a cross-sectional survey. Int J Community Med Public Health.2021; 8:4919-22. https://www.researchgate.net/publication/354895918_Knowledge_attitude_and_practices_towards_anemia_among_late_adolescent_girls_of_JSS_schools_and_colleges_of_Mysuru_India_a_cross-sectional_survey

Singh M, Rajoura OP, Honnakamble RA. Anemia related knowledge, attitude, and practices in adolescent schoolgirls of Delhi: A cross-sectional study. Int J Health Allied Sci. 2019;8:144-8. https://www.researchgate.net/publication/354860146_Anemia-related_knowledge_attitude_and_practices_in_adolescent_schoolgirls_of_Delhi_A_cross-sectional_study

Bhatt RJ, Mehta HK, Khatri V, Chhaya J, Rahul K, et al. A study of access and compliance of iron and folic acid tablets for prevention and cure of anaemia among adolescent age group females in Ahmedabad district of India surveyed under multi-indicator cluster survey 2011. Global J Med Public Health. 2013;2(4):1-6. https://www.researchgate.net/publication/326905443_A_study_of_access_and_compliance_of_iron_and_folic_acid_tablets_for_prevention_and_cure_of_anemia_among_adolescent_age_group_of_females_in_Ahmedabad_district_of_India_surveyed_under_multi_indicator_cl

Diamond-Smith N, Holton AE, Francis S, Bernard D. Addressing anemia among women in India—an informed intervention using Facebook Ad manager. mHealth. 2020;6:39. Anemia in women in India- Facbook study, doi: 10.21037/mhealth-19-237a. https://pubmed.ncbi.nlm.nih.gov/33437835/

Gillespie, B., Katageri, G., Salam, S., Ramadurg, U., Patil, S., et al . Attention for and awareness of anemia in adolescents in Karnataka, India: A qualitative study. PLoS ONE. 2023; 18(4 April), [e0283631]. https://doi.org/10.1371/journal.pone.0283631

Sajna MV, Jacob SA. Adherence to weekly iron and folic acid supplementation among the school students of Thrissur corporation – a cross sectional study. Int J Community Med Public Health.2017; 4:1689-94. https://www.researchgate.net/publication/316484063_Adherence_to_weekly_iron_and_folic_acid_supplementation_among_the_school_students_of_Thrissur_corporation_-_a_cross_sectional_study

Dhikale PT, Suguna E, Thamizharasi A, Dongre AR. Evaluation of Weekly Iron and Folic Acid Supplementation program for adolescents in rural Pondicherry, India. Int J Med Sci Public Health.2015; 4 (Online First). DOI: 10.5455/ijmsph.2015.14042015280. https://www.researchgate.net/publication/281391065_Evaluation_of_Weekly_Iron_and_Folic_Acid_Supplementation_program_for_adolescents_in_rural_Pondicherry_India

Vir SC, Singh N, Nigam AK, Jain R. Weekly iron and folic acid supplementation with counseling reduces anemia in adolescent girls: a large-scale effectiveness study in Uttar Pradesh, India. Food Nutr Bull. 2008;29(3):186-94. doi: 10.1177/156482650802900304. https://pubmed.ncbi.nlm.nih.gov/18947031/

Rai Rajesh Kumar Iron-and-folic-acid supplementation among adolescents (aged 10–19 years) in two North Indian States, 2015–2016: a sex-stratified analysis Public Health Nutrition. 2020; 25(3), 617–622 doi:10.1017/S136898002000508X. https://pubmed.ncbi.nlm.nih.gov/33315007/

Wadhwa R, Chaudhary N, Bisht N, Gupta A, Behera N, Verma AK, et al. Improving adolescent health services across high priority districts in 6 states of India: Learnings from an integrated reproductive maternal newborn child and adolescent health project. Indian J Community Med. 2018;43:S6-11. https://www.researchgate.net/publication/329768012_Improving_Adolescent_Health_Services_across_High_Priority_Districts_in_6_States_of_India_Learnings_from_an_Integrated_Reproductive_Maternal_Newborn_Child_and_Adolescent_Health_Project

Joe W, Rinju, Patel N, Alambusha R, Kulkarni B, Yadav K, Sethi V. Coverage of iron and folic acid supplementation in India: progress under the Anemia Mukt Bharat strategy 2017-20. Health Policy Plan. 2022;37(5):597-606. doi: 10.1093/heapol/czac015. https://pubmed.ncbi.nlm.nih.gov/35257147/

Ahmad K, Singh J, Singh RA, Saxena A, Varghese M, Ghosh S, et al. Public health supply chain for iron and folic acid supplementation in India: Status, bottlenecks and an agenda for corrective action under Anemia Mukt Bharat strategy. PLoS ONE. 2023;18(2): e0279827. https://doi.org/10.1371/journal.pone.0279827).

Nair M, Choudhury MK., Choudhury SS., Kakoty SD, Sarma UC, et al. Association between maternal anemia and pregnancy outcomes: a cohort study in Assam, India. BMJ Global Health. 2016;1:e000026. doi:10.1136/bmjgh-2015- 000026 https://pubmed.ncbi.nlm.nih.gov/28588921/

Shrivastava P & Maliye C. Status and Effectiveness of Implementation of Weekly Iron and Folic Acid Supplementation Scheme in Schools in Central India. Indian Journal of Public Health Research & Development.2019; 10(12). https://scholar.google.com/scholar?hl=en&as_sdt=0%2C5&q=+Status+and+Effectiveness+of+Implementation+of+Weekly+Iron+and+Folic+Acid+Supplementation+Scheme+in+Schools+in+Central+India.+Indian+Journal+of+Public+Health+Research+%26+Development.2019%3B+10%2812%29&btnG=

Downloads

Published

2026-01-06

How to Cite

Knowledge, Attitude, and Practices Regarding Iron Folic Acid Tablets and Coverage of the Weekly Iron Folic Acid Supplementation Programme Among Rural Adolescent Girls in Nagpur District: A Cross-Sectional Study. (2026). Indian Journal of Public Health Research & Development, 17(1), 268-276. https://doi.org/10.37506/9e19gr89