title: Examining Means of Reaching Adolescent Girls for Iron Supplementation in Tigray, Northern Ethiopia.
abstract: BACKGROUND
  Iron deficiency is the most prevalent nutritional deficiency in adolescent girls from the developing world. One of the recommended interventions to improve iron status in adolescent girls is iron supplementation. Yet the provision of iron supplements to adolescent girls proved to be a challenging task for the health systems across the developing world.
  
  
  OBJECTIVE
  The objective of the study was to examine means of reaching adolescent girls for iron supplementation in Northern Ethiopia.
  
  
  METHODS
  Analytical cross-sectional study consisting of both quantitative and qualitative approaches to data collection and analysis was used in this study. Stratified multi-stage systematic random sampling technique was adopted and primary quantitative data were collected from 828 (578 school attending and 250 non school attending) adolescent girls recruited from nine districts of Tigray. The primary quantitative data were analyzed using SPSS version 20 software. The qualitative data collected through key informant interviews and focus group discussions were transcribed verbatim and qualitatively analyzed.
  
  
  RESULTS
  The mean (SD) age of the girls was 16.7 (1.4) years. Four hundred forty seven (54%), 355 (42.9%) and 26 (3.1%) of the adolescent girls had low, medium and high diet diversity scores, respectively. More than half, 467 (56%), of the adolescent girls believed that adolescent girls were overloaded with household jobs everyday compared to boys from their respective communities. Key informants said that, there is no adolescent nutrition message promoted in the study area. Low community awareness, perceiving iron tablet as a contraceptive, religious and cultural influences, and lack of confidence in supplementation value of iron tablets, are some of the potential barriers mentioned by the key informant and focus group discussion participants. Schools (45%), health centers (27%) and health posts (26%) were the preferred public facilities for provision of iron supplements to student adolescent girls whereas schools (11%), health centers (47%) and health posts (41%) were the preferred public facilities for provision of iron supplements to adolescent girls who were not attending schools from the study communities.
  
  
  CONCLUSIONS
  The health posts and health centers were the preferred health facilities for iron supplementation to adolescent girls who were not attending schools while the school was the preferred facility for iron supplementation of student adolescent girls.
authors.affiliation: Mekelle University, P. O. Box: 1871, Mekelle, Ethiopia. afework.mulugeta@gmail.com.
authors.forename: Afework
authors.initials: A
authors.lastname: Mulugeta
authors.affiliation: Ethiopian Public Health Institute, P. O. Box: 1242, Addis Ababa, Ethiopia. masresha88@gmail.com.
authors.forename: Masresha
authors.initials: M
authors.lastname: Tessema
authors.affiliation: Mekelle University, P. O. Box: 1871, Mekelle, Ethiopia. hkiday@gmail.com.
authors.forename: Kiday
authors.initials: K
authors.lastname: H/Sellasie
authors.affiliation: Mekelle University, P. O. Box: 1871, Mekelle, Ethiopia. seoumer@yahoo.com.
authors.forename: Omer
authors.initials: O
authors.lastname: Seid
authors.affiliation: Mekelle University, P. O. Box: 1871, Mekelle, Ethiopia. kidanegere@yahoo.com.
authors.forename: Gebremedhin
authors.initials: G
authors.lastname: Kidane
authors.affiliation: Ethiopian Public Health Institute, P. O. Box: 1242, Addis Ababa, Ethiopia. awekekeb@gmail.com.
authors.forename: Aweke
authors.initials: A
authors.lastname: Kebede
mesh_terms: D000293:Adolescent; D000554:Ambulatory Care Facilities; D018798:Anemia, Iron-Deficiency / Q000517:prevention & control*; D001294:Attitude to Health; D001364:Awareness; D003153:Community Health Services; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care / Q000379:methods*; D003906:Developing Countries; D019587:Dietary Supplements; D005002:Ethiopia; D005260:Female; D006801:Humans; D007501:Iron / Q000008:administration & dosage / Q000627:therapeutic use*; D000090463:Iron Deficiencies; D012572:School Health Services; D012574:Schools
chemical_list: D007501:Iron
keywords: adolescent girls; deworming.; diet diversity score; iron supplementation