Ghana

Project—Girls Iron-Folate Tablet Supplementation (GIFTS)

Objective

To evaluate a program that provides iron and folic acid supplements to girls aged 10 to 19 years and provide technical support for expanding the program’s reach throughout Ghana.

Background

In Ghana, 26% of girls aged 15 to 19 years have anemia, according to the 2017 Ghana Micronutrient Survey. Anemia reduces cognitive development in children, which has long-term effects on educational achievement, and human capital. Providing iron supplements to adolescent girls could have multi-pronged benefits as iron deficiency is a leading cause of anemia. Folic acid deficiency can also cause anemia, and insufficient folic acid is associated with neural tube birth defects, such as spina bifida.

Ghana Health Service (GHS), Ghana Education Service, and the UNICEF country office provide anemia prevention education to all adolescents. They also provide weekly iron and folic acid supplements to girls aged 10 to 19 years through the GIFTS program. CDC’s International Micronutrient Malnutrition Prevention and Control (IMMPaCt) team provides technical support for evaluating and monitoring the program and expanding its reach throughout Ghana.

Activities

During the 2017–2018 academic year, an impact evaluation examined the GIFTS program in schools in four regions—Brong-Ahafo, Northern, Upper East, and Volta. Over the school year, prevalence of anemia among girls in the program dropped from 25% to 19.5%, which is a statistically significant 22% reduction in the proportion of girls who suffered from anemia. A qualitative evaluation of the program’s operational features from parents, schools, and district levels was conducted following the second year of the program. CDC assisted with another pre- and post-impact evaluation in the Upper West and Western regions for the 2019–2020 school year. This evaluation included both girls and boys.

Potential Impact

Findings from the impact evaluations will guide and strengthen the program nationwide. Results and lessons learned from Ghana may assist other countries in the region planning iron and folic acid supplementation programs to reduce anemia prevalence among adolescents.

Next Steps

The CDC will continue to provide technical assistance to national leaders and partners to:

• Collect follow-up data for the second evaluation.
• Interpret results and disseminate findings to key stakeholders.
• Strengthen monitoring systems for adolescents who are both in and out of school program nationwide.
• Facilitate integrating the iron and folic acid supplement program into the national electronic health reporting system.
• Improve the program to reach eligible girls who are not in junior or senior high schools, such as older girls in primary schools.