Knowledge, attitude, intention, and program implementation of iron supplementation among adolescent girls in Sidoarjo, Indonesia


  • Hanna Tabita Hasianna Silitonga Doctoral Program of Public Health, Faculty of Public Health, Universitas Airlangga, Surabaya
  • Lutfi Agus Salim Faculty of Public Health, Universitas Airlangga, Surabaya
  • Ira Nurmala Faculty of Public Health, Universitas Airlangga, Surabaya
  • Rachmat Hargono Faculty of Public Health, Universitas Airlangga, Surabaya
  • Septiana Purwandini Faculty of Public Health, Universitas Airlangga, Surabaya



attitude, intention, iron supplementation, knowledge, program, SDGs


Background. The government established an iron supplementation program as a solution to overcome anemia in adolescent girls in Indonesia. Research shows that various factors influence the compliance of adolescent girls in consuming iron supplements, including knowledge, attitude, intention, and program implementation. Objective. This study aims to determine adolescent girls’ knowledge, attitudes, and intentions and explore the program implementation of iron supplementation in high school adolescent girls in Sidoarjo, Indonesia. Materials and Methods. This was mixed-method research. Quantitative data was collected on 202 girls students from 3 high schools in Sidoarjo using a questionnaire.Qualitative data was collected by interviewing 13 high school girls from 3 schools in Sidoarjo and Focus Group Discussion with the health office and primary health center representatives in Sidoarjo. Results. Most adolescent girls’ knowledge about anemia was still poor (59.9%), but knowledge about iron supplements was mostly good (59.9%). The attitudes towards anemia and iron supplements and intentions to consume iron supplements in adolescent girls were mostly low (51.0% and 51.5%). The focus group discussion found that the program was already referred to national guidelines, but the pandemic affected the implementation. Findings from the interview with adolescent girls show that the distribution of iron supplements in schools was carried out in 3 ways: distributed with explanations, distributed without explanation, and distributed only to students who request it or feel anemic. Conclusion. There is a need to improve the knowledge, attitudes, and intentions of adolescent girls and improve the implementation of iron supplementation programs in schools in Sidoarjo, Indonesia.

Download data is not yet available.


Ministry of Health. Surat Edaran Nomor HK. 03.03/V/0595/2016 tentang Pemberian Tablet Tambah Darah

pada Remaja Putri dan Wanita Usia Subur (Iron Supplementation on Adolescent Girls and Women on Childbearing Age). Jakarta: Ministry of Health Republic of Indonesia, 2016.

Ministry of Health. Pedoman Pencegahan dan Penanggulangan Anemia pada Remaja Putri dan Wanita Usia Subur (Guidelines for the Anaemia Pre- vention and Control in Adolescent Girls and Women of Childbearing Age). Jakarta: Ministry of Health Republic of Indonesia, 2016.

Jalambo M, Karim N, Naser I, et al. Effects of iron supplementation and nutrition education on haemoglobin, ferritin and

oxidative stress in iron-deficient female adolescents in Palestine: Randomized control trial. East Mediterr Health J 2018;24:560-8. DOI:

Handiso YH, Belachew T, Abuye C, et al. A community-based randomized controlled trial providing weekly iron-folic acid

supplementation increased serum- ferritin, -folate and hemoglobin concentration of adolescent girls in southern Ethiopia.

Sci Rep 2021;11:1-7.

Gupta A, Kant S, Ramakrishnan L, et al. Impact of daily-supervised administration of a package of iron and folic acid and

vitamin B12 on hemoglobin levels among adolescent girls (12–19 years): a cluster randomized control trial. Eur J Clin Nutr 2021;75:1588-97. DOI:

WHO. Prevention of iron deficiency anaemia in adolescents role of weekly iron and folic acid supplementation. India, 2011.

Horjus P, Aguayo VM, Roley JA, et al. School-based iron and folic acid supplementation for adolescent girls: Findings from

Manica Province, Mozambique. Food Nutr Bull 2005;26:281-6. DOI:

Sedlander E, Long MW, Bingenheimer JB, et al. Examining intentions to take iron supplements to inform a behavioral

intervention: The Reduction in Anemia through Normative Innovations (RANI) project. PLoS One 2021;16:1-16. DOI:

Kheirouri S, Alizadeh M. Process evaluation of a national school-based iron supplementation program for adolescent

girls in Iran. BMC Pub Health 2014;14:1-8.

Dubik S, Amegah K, Alhassan A, et al. Compliance with weekly iron and folic acid supplementation and its associated factors among adolescent girls in Tamale Metropolis of Ghana. Hindawi J Nutr Metab 2019;2019:1-12. DOI:

Apriningsih, Madanijah S, Dwiriani CM, et al. Determinant of highschool girl adolescent’adherence to consume iron folic

acid supplementation in Kota Depok. J Nutr Sci Vitaminol (Tokyo) 2020;66:S369-75. DOI:

Mulugeta A, Tessema M, Kiday H, et al. Examining Means of Reaching Adolescent Girls for Iron Supplementation in Tigray, Northern Ethiopia. Nutrients 2015;2015:9033-45. DOI:

Khammarnia M, Amani Z, Hajmohammadi M, et al. A Survey of Iron Supplementation Consumption and its Related Factors in High School Students in Southeast Iran, 2015. Malys J Med Sci 2016;23:57-64. DOI:

Ansari MR, Kandarina BJI, Kusmayanti N, et al. The acceptability of weekly iron-folic acid supplementation and its influencing factors among adolescent school girls in Yogyakarta city : a mix- methods study. Mal J Nutr 2021;27:53-66. DOI:

Priya Sh, Datta S, Bahurupi Y, et al. Factors influencing weekly iron folic acid supplementation programme among school

children: Where to focus our attention? Saudi J Health Sci 2016;5:28. DOI:

Chourasia A, Pandey CM, Awasthi A. Factors influencing the consumption of iron and folic acid supplementations in high

focus states of India. Clin Epidemiol Glob Health 2017;5:180-4. DOI:

William RF, Balaji R, Logaraj M. Anaemia and associated factors among school going adolescent girls in chidambaram,

tamilnadu - A cross-sectional study. J Int Med Sci Acad 2016;29:11-3.

Wiafe MA, Apprey C, Annan RA. Knowledge and practices of dietary iron and anemia among early adolescents in a rural district in Ghana. Food Sci Nutr 2021;2021:2915-24. DOI:

Elsharkawy NB, Abdelaziz EM, Ouda MM, et al. Effectiveness of Health Information Package Program on Knowledge and Compliance among Pregnant Women with Anemia: A Randomized Controlled Trial. Int J Environ Res Public Health 2022;19:2724. DOI:

Antwi J, Ohemeng A, Boateng L, et al. Primary school-based nutrition education intervention on nutrition knowledge, attitude and practices among school-age children in Ghana. Glob Health Promot 2020;27:114-22. DOI:

Abu-Baker NN, Eyadat AM, Khamaiseh AM. The impact of nutrition education on knowledge, attitude, and practice

regarding iron deficiency anemia among female adolescent students in Jordan. Heliyon 7.

Gosdin L, Sharma AJ, Tripp K, et al. Barriers to and facilitators of iron and folic acid supplementation within a school-based integrated nutrition and health promotion program among ghanaian adolescent girls. Curr Dev Nutr 2020;4:1-11. DOI:

Chakma T, Rao PV, Kumar MP. Factors associated with high compliance / feasibility during iron and folic acid supplementation in a tribal area of. Public Health Nutr 2012;16:377-80. DOI:

Mshanga CN, Maseta EJ. Knowledge, Attitudes and Practices towards the Use of Iron and Folic Acid Supplements among

Pregnant and Lactating Women in Dar es Salaam. Tanzania Journal of Science 2022;48:640-8. DOI:

Kimiywe J, Ahoya B, Kavle J, et al. Barriers to maternal Iron_Folic acid supplementation & compliance in Kisumu and Migori, Kenya. 2017.

Lyoba WB, Mwakatoga JD, Festo C, et al. Adherence to Iron- Folic Acid Supplementation and Associated Factors among

Pregnant Women in Kasulu Communities in North-Western Tanzania. Int J Reprod Med 2020;2020:1-11. DOI:

Gosdin L, Amoaful EF, Sharma D, et al. A qualitative analysis of program fidelity and perspectives of educators and parents after two years of the girls’ iron-folate tablet supplementation (gifts) program in ghanaian secondary schools. Curr Dev Nutr 2021;5:1-13. DOI:

Kamau MW, Mirie W, Kimani S. Compliance with Iron and folic acid supplementation (IFAS) and associated factors

among pregnant women: Results from a cross-sectional study in Kiambu County, Kenya. BMC Public Health 2018;18:1-10. DOI:

Mora JO. Iron supplementation: overcoming technical and practical barriers. J Nutr 2002;132:853S-5S. DOI:

Wangaskar SA, Sahu SK, Majella MG, et al. Prevalence of Anaemia and Compliance to Weekly Iron-Folic Acid

Supplementation Programme amongst Adolescents in Selected Schools of Urban Puducherry, India. Niger Postgrad Med J


Dhikale P, Suguna E, Thamizharasi A, et al. Evaluation of Weekly Iron and Folic Acid Supplementation program for adolescents in rural Pondicherry, India. Int J Med Sci Public Health 2015;4:1360. DOI:

Aguayo VM, Paintal K, Singh G. The Adolescent Girls’ Anaemia Control Programme: A decade of programming experience to break the inter-generational cycle of malnutrition in India. Public Health Nutr 2013;16:1667-76. DOI:

Roche ML, Bury L, Yusadiredjai IN, et al. Adolescent girls’ nutrition and prevention of anaemia: A school based multisectoral collaboration in Indonesia. BMJ (Online) 2018;363:1-6. DOI:

WHO. Guideline: Intermittent Iron and Folic Acid Supplementation in Menstruating Women. Geneva: World

Health Organization, 2011.




How to Cite

Hasianna Silitonga, H. T., Salim, L. A., Nurmala, I., Hargono, R., & Purwandini, S. (2023). Knowledge, attitude, intention, and program implementation of iron supplementation among adolescent girls in Sidoarjo, Indonesia. Journal of Public Health in Africa, 14(s2).