The adverse side effects and other factors inhibiting compliance in India’s Weekly Iron Folic Acid Supplementation programme

Abstract Number Theme Presentation Type Cover Approved
0257 Formative and/or implementation research to improve program design and/or implementation; process and impact evaluation Poster Approved


Abstract Content


India’s Weekly Iron Folic Acid Supplementation (WIFS) programme is successfully reaching 108 million youths, to control anemia among adolescents. But compliance still remains low. Incidence of side effects, negative media reports, public anxiety and peer pressure surrounding the program, were found to inhibit WIFS compliance, requiring corrective actions.


A school based cross-sectional study was carried out in two states of Delhi and Haryana, to track WIFS compliance among 4,183 adolescents over three weeks. The association between the predictors of side effects and its incidence was assessed using multinomial regression analysis.


Incidence of side effects declined from 25% in week 1, to 7% in week 2 and to 5% in week 3. WIFS compliance also decreased from 85%, to 63%, and 52%, over the same period. Out of all adolescents reporting side effects in week 1, 45% discontinued taking the tablets. Among those reporting no side effects, however, 26% discontinued consumption. Reported side effects, including abdominal pain (80%), nausea (10%), dizziness (8%) and fever (2%), were higher among urban girls, those coming to school hungry, and those neglecting to follow WIFS protocol, sometimes chewing instead of swallowing the tablets with water. Nutritional and socio-economic status was not associated with reporting of side effects. Feedback from parents, teachers, and peers did influence compliance.


Incidence of side effects decreased over the study period, but compliance also decreased. Reinforcing WIFS protocols through media should be accelerated to help offset negative effects of public impression and peer pressure associated with WIFS intake.

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