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 Sep;29(3):186-94. doi: 10.1177/156482650802900304.


Background: Weekly iron-folic acid supplementation in small-scale research trials and as administered in institutions has been demonstrated to be effective in reducing anemia in adolescent girls.

Objective: To assess the effectiveness of weekly iron-folic acid supplementation in a large-scale project in reducing the prevalence of anemia in adolescent girls.

Methods: The project provided weekly iron-folic acid tablets, family life education, and deworming tablets every 6 months to 150,700 adolescent school girls and non-schoolgirls of a total district population of 3,647,834. Consumption of the iron-folic acid tablets was supervised for schoolgirls but not for non-schoolgirls. Hemoglobin levels were assessed in a random sample of non-schoolgirls at 6 and 12 months and schoolgirls at 6 months. The effect of supplementation on the prevalence of anemia and the compliance rate were assessed over a 4-year period.

Results: In 4 years, the overall prevalence of anemia was reduced from 73.3% to 25.4%. Hemoglobin levels and anemia prevalence were influenced significantly at 6 months. No difference in the impact on hemoglobin or anemia prevalence was observed between supervised and unsupervised girls. Counseling on the positive effects of regular weekly iron-folic acid intake contributed to a high compliance rate of over 85%. The cost of implementation was US$0.36 per beneficiary per year.

Conclusions: Weekly iron-folic acid supplementation combined with monthly education sessions and deworming every 6 months is cost-effective in reducing the prevalence of anemia in adolescent girls. Appropriate counseling, irrespective of supervision, is critical for achieving positive outcomes.

MeSH terms

  • Adolescent
  • Anemia, Iron-Deficiency / drug therapy*
  • Anemia, Iron-Deficiency / therapy
  • Counseling* / methods
  • Dietary Supplements*
  • Female
  • Folic Acid / administration & dosage
  • Folic Acid / therapeutic use*
  • Folic Acid Deficiency / blood
  • Folic Acid Deficiency / drug therapy*
  • Health Surveys
  • Hemoglobins / metabolism
  • Humans
  • India
  • Iron / administration & dosage
  • Iron / therapeutic use*
  • Motivation
  • Nutritional Status
  • Patient Compliance
  • Prevalence


  • Hemoglobins
  • Folic Acid
  • Iron