Increase in Compliance with Weekly Iron Supplementation of Adolescent Girls by an Accompanying Communication Programme in Secondary Schools in Dar-Es-Salaam, Tanzania

Insufficient compliance has been identified as a major contributing factor to the low effectiveness of iron-supplementation programmes. An experimental community trial was conducted to observe the effect of a communication programme on compliance with weekly iron supplementation in urban Tanzanian adolescent schoolgirls. A sample of 237 girls aged 14 to 17 years was randomly recruited from five schools in Dar-es-Salaam, and randomly assigned to three groups. Group A (schools 1 and 2) received one tablet weekly containing 65 mg of elemental iron with 0.25 mg of folic acid for eight consecutive weeks and participated in weekly communication sessions. Group B (school 3) received the same supplementation without communication sessions. Group C (schools 4 and 5) served as the control group, without supplementation or communication. Reported and observed compliance was checked by pill counting and stool analysis. Haemoglobin levels were determined by the cyanmethaemoglobin method before and after intervention. A knowledge test on iron-deficiency anaemia (causes, effects, and treatment) was carried out before and after intervention. Venn diagrams were drawn to identify the most influential persons. Three focus group discussions with the girls and the teachers were conducted at different stages during the study. In the group receiving supplementation and communication, the prevalence of anaemia decreased significantly (p < .001) from 49% to 5% in school 1 and from 54% to 23% in school 2. The prevalence of anaemia did not change significantly in schools 3 and 4 but increased significantly in school 5. The reported and observed compliance was 90% and 94%, respectively, in school 1, 89% and 75% in school 2, and 48% and 50% in school 3. The participants' knowledge of iron-deficiency anaemia increased significantly in all schools after the intervention (p < .001) but was highest in schools 1 and 2, which received supplementation and communication. It is concluded that comprehensive communication strategies can influence the ingestion of iron supplements and therefore help to reduce anaemia in adolescents.