Evaluation of Implementation of the Girls’ Iron Folate Tablet Programme in the Accra Metropolis

Abstract

Introduction: Anaemia prevalence among adolescent girls is a problem of public health importance for many Lower Middle-Income Countries, including Ghana. Iron-folate supplementation has been found to be a highly effective intervention in reducing the burden of anaemia among adolescent girls. However, implementation bottlenecks are hindering the success of this intervention. Objective: The study evaluated implementation of the Girls Iron Folate Tables (GIFT) programme in the Accra Metropolitan Area. Methods: This study employed a descriptive cross-sectional study design. A mixed data collection approach was used involving a survey of teenage girls, and interview of teachers and health workers involved in the GIFT programme implementation. Sample size was 380 adolescent girls and 12 coordinators. Stata 17 was used for analysis and results presented in table and graphs. Descriptive, Bivariate, and logistic analyses was done to establish the relationship between adherence to GIFT protocol and predictor factors at 95% confidence level and 0.05 p-value. Thematic analysis was used for the qualitative data, and findings presented in a narrative. Findings: Out of 380 adolescent girls surveyed, 304 were in school and 76 out of school. In addition, 12 facilitators were interviewed for this evaluation. The results showed that GIFT implementation was 57% effective in school and 42% for out school. Being in JHS (AOR=2.1, 95% CI=1.20, 3.83, p<.01), adequate knowledge on anaemia (AOR=3.2, 95% CI=1.65, 6.05, p<.01) and adequate knowledge on GIFT programme (AOR=5.7, 95% CI=2.50, 12.77, p<.01) were significantly associated with implementation effectiveness, while IFA shortage, inadequate awareness in the community, side effects and misconceptions were barriers against programme implementation. Conclusion: The study found that GIFT implementation effectiveness was slightly better in the in-school, compared to out-school. Programme protocol adherence was severely affected by IFA shortages and other programme bottlenecks. To improve programme implementation effectiveness, IFA availability should be improved, while interventions to increase adherence to the GIFT programme should focus on increasing knowledge about anaemia and the features of the GIFT programme. Efforts should also be made to improve community awareness of GIFT and education on side effects of IFA to allay the fears of the community