{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T09:46:08Z","timestamp":1792057568767,"version":"4.4.0"},"reference-count":74,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T00:00:00Z","timestamp":1789430400000},"content-version":"vor","delay-in-days":76,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100005068","name":"Jimma University","doi-asserted-by":"publisher","award":["JUIH\/IRB\/583\/2023"],"award-info":[{"award-number":["JUIH\/IRB\/583\/2023"]}],"id":[{"id":"10.13039\/501100005068","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Maternal &amp;amp; Child Nutrition"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:label\/>\n                    <jats:p>\n                      Nutritional deficiencies and parasitic infections continue to undermine immune defenses and drive anemia rates among adolescents, creating a significant public health challenge in sub\u2010Saharan Africa. Although multiple factors contribute to this burden, the prevention and treatment of iron deficiency (ID) remain the most critical levers for progress. The longer\u2010term effects of weekly iron\u2013folic acid supplementation (WIFAS) on morbidity symptoms and growth outcomes remain unclear. A cluster randomized controlled trial was implemented within a school setting involving a cohort of 306 adolescent girls, divided equally (153) between an intervention and a control arm. Within each district, six schools (five primary and 1 secondary) were randomly selected as clusters, totaling 12 clusters\/schools out of 37 schools. In this study, the term clusters pertains to schools. Incidences of morbidity symptoms such as diarrhea, cough, and fever were documented via every 14\u2010day recall symptom log\u2010books over the 6\u2010month observation period. To see the effect, we used generalized estimating equations (GEE) employing a Poisson model with a log link function and a linear mixed\u2010effects model. This trial demonstrated that WIFAS at week 18, the intervention group, showed a 44% reduction in the incidence of morbidity symptoms compared to the control group (IRR\u2009=\u20090.56; 95% CI: 0.32\u20130.99;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.045. This reduction effect was sustained at later time points, with significant reductions observed at week 20 (IRR\u2009=\u20090.52, 95% CI: 0.31\u20130.89,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.018) and week 24 (IRR\u2009=\u20090.54, 95% CI: 0.32\u20130.91,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.019). However, there was no association between WIFAS and weight (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u2009=\u20090.008; 95% CI: \u22120.13, 0.14) and BAZ score (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u2009=\u20090.02; 95% CI: \u22120.2, 0.25) change (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&gt;\u20090.05). This trial indicates that the reduction effect of WIFAS on morbidity symptoms is not immediate but emerges after 4 months of consistent intake. While the initial effect at week 18 reached the threshold for statistical significance, the sustained reduction through weeks 20 and 24 suggests that prolonged supplementation is necessary to reduce common illnesses. This delay likely reflects the time required to replenish iron stores and enhance immunity. However, the lack of significant effects on weight and BAZ indicates that 6 months of supplementation may be too short a duration to elicit anthropometric improvements.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial Registration<\/jats:title>\n                    <jats:p>PACTR202309541331083\u00a0Registered\u00a012 Sep 2023.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/mcn.70246","type":"journal-article","created":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T06:15:13Z","timestamp":1789539313000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Evaluating the Role of School\u2010Based Weekly Iron\u2013Folic Acid Supplementation in Shaping Common Morbidity and Growth Outcomes Among Adolescent Girls: Evidence From a Cluster\u2010Randomized Controlled Trial in Central Ethiopia Region"],"prefix":"10.1111","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0565-7610","authenticated-orcid":false,"given":"Shemsu","family":"Kedir","sequence":"first","affiliation":[{"name":"Department of Nutrition and Dietetics, Faculty of Public health, Institute of Health Jimma University Jimma Ethiopia"},{"name":"Department of Public Health, College of Medicine and Health Sciences Werabe University Werabe Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9534-031X","authenticated-orcid":false,"given":"Dessalegn","family":"Tamiru","sequence":"additional","affiliation":[{"name":"Department of Nutrition and Dietetics, Faculty of Public health, Institute of Health Jimma University Jimma Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beyene Wondafrash","family":"Adame","sequence":"additional","affiliation":[{"name":"Department of Nutrition and Dietetics, Faculty of Public health, Institute of Health Jimma University Jimma Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9752-5417","authenticated-orcid":false,"given":"Kalkidan Hassen","family":"Abate","sequence":"additional","affiliation":[{"name":"Department of Nutrition and Dietetics, Faculty of Public health, Institute of Health Jimma University Jimma Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,15]]},"reference":[{"key":"e_1_2_10_2_1","unstructured":"Altitude. Maps Weather and Airports of Silti District Southern Ethiopia."},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1093\/advances\/nmaa037"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.12688\/wellcomeopenres.18829.1"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.5152\/TurkArchPediatr.2023.23049"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pgph.0002079"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-3156.2000.00641.x"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1186\/1475-2891-10-29"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/MCO.0000000000001027"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2018.00149"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1177\/03795721241304475"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/nyas.14092"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.advnut.2024.100215"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.2147\/JMDH.S419714"},{"key":"e_1_2_10_15_1","doi-asserted-by":"crossref","unstructured":"Engidaw M. T. M. M.Wassie andA. S.Teferra. 2018. \u201cAnemia and Associated Factors Among Adolescent Girls Living in Aw\u2010Barre Refugee Camp Somali regional state Southeast Ethiopia.\u201dPLoS One13 no. 10: e0205381.https:\/\/doi.org\/10.1371\/journal.pone.0205381.","DOI":"10.1371\/journal.pone.0205381"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1177\/1178638820953131"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1155\/2020\/5043646"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41577-025-01193-y"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-019-6422-0"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.2147\/AHMT.S94865"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1093\/cdn\/nzz005"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13690-018-0324-y"},{"key":"e_1_2_10_23_1","doi-asserted-by":"crossref","unstructured":"Habtegiorgis S. D. P.Petrucka A. T.Telayneh et al. 2022. \u201cPrevalence and Associated Factors of Anemia Among Adolescent Girls in Ethiopia: A Systematic Review and Meta\u2010analysis.\u201dPLoS One17 no. 3: e0264063.","DOI":"10.1371\/journal.pone.0264063"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.1542\/9781610020237"},{"key":"e_1_2_10_25_1","first-page":"964","article-title":"WIFAS Intervention for Three\u2010Months Was Effective in Reducing Iron and Folate Deficiency in Adolescent Girls","volume":"11","author":"Halala Y.","year":"2021","journal-title":"Scientific Reports"},{"key":"e_1_2_10_26_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1740-8709.2007.00127.x"},{"key":"e_1_2_10_27_1","doi-asserted-by":"publisher","DOI":"10.1093\/ajcn\/84.6.1261"},{"key":"e_1_2_10_28_1","unstructured":"ICF International. Demographic and Health Survey Interviewer's Manual. MEASURE DHS Basic Documentation No. 2.2012."},{"key":"e_1_2_10_29_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0042670"},{"key":"e_1_2_10_30_1","doi-asserted-by":"publisher","DOI":"10.1093\/jn\/130.2.452S"},{"key":"e_1_2_10_31_1","doi-asserted-by":"publisher","DOI":"10.3389\/fped.2024"},{"key":"e_1_2_10_32_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0270628"},{"key":"e_1_2_10_33_1","doi-asserted-by":"publisher","DOI":"10.1017\/jns.2024.76"},{"key":"e_1_2_10_34_1","doi-asserted-by":"publisher","DOI":"10.1017\/jns.2024.76"},{"key":"e_1_2_10_35_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2024-084033"},{"key":"e_1_2_10_36_1","first-page":"60","article-title":"Guidelines for Measuring Household and Individual Dietary Diversity","volume":"1","author":"Kennedy G.","year":"2011","journal-title":"FAO"},{"key":"e_1_2_10_37_1","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000041617"},{"key":"e_1_2_10_38_1","doi-asserted-by":"publisher","DOI":"10.1093\/ajcn\/80.3.729"},{"key":"e_1_2_10_39_1","doi-asserted-by":"crossref","unstructured":"Mrimi E. C. M. S.Palmeirim E. G.Minja K. Z.Long andJ.Keiser. 2022. \u201cMalnutrition Anemia Micronutrient Deficiency and Parasitic Infections Among Schoolchildren in Rural Tanzania.\u201dPLOS Neglected Tropical Diseases16 no. 3: e0010261.","DOI":"10.1371\/journal.pntd.0010261"},{"key":"e_1_2_10_40_1","doi-asserted-by":"publisher","DOI":"10.1002\/hsr2.71247"},{"key":"e_1_2_10_41_1","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2022.816282\/full"},{"key":"e_1_2_10_42_1","doi-asserted-by":"publisher","DOI":"10.1002\/ebch.542"},{"key":"e_1_2_10_43_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2017.03.045"},{"key":"e_1_2_10_44_1","doi-asserted-by":"publisher","DOI":"10.3945\/ajcn.117.156067"},{"key":"e_1_2_10_45_1","doi-asserted-by":"publisher","DOI":"10.3324\/haematol.2024.284967"},{"key":"e_1_2_10_46_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12905-019-0791-5"},{"key":"e_1_2_10_47_1","doi-asserted-by":"publisher","DOI":"10.11622\/smedj.2014156"},{"key":"e_1_2_10_48_1","doi-asserted-by":"publisher","DOI":"10.4269\/ajtmh.2006.75.1.0750126"},{"key":"e_1_2_10_49_1","unstructured":"Rutstein S. O.2015. Steps to Constructing the New DHS Wealth Index.https:\/\/dhsprogram.com\/programming\/wealth%20index\/Steps_to_constructing_the_new_DHS_Wealth_Index.pdf."},{"key":"e_1_2_10_50_1","doi-asserted-by":"publisher","DOI":"10.1017\/PHN2005918"},{"key":"e_1_2_10_51_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(06)67962-2"},{"key":"e_1_2_10_52_1","doi-asserted-by":"publisher","DOI":"10.5402\/2012\/482153"},{"key":"e_1_2_10_53_1","doi-asserted-by":"publisher","DOI":"10.1093\/ajcn\/77.1.234"},{"key":"e_1_2_10_54_1","doi-asserted-by":"publisher","DOI":"10.46799\/jisn.v1i2.9"},{"key":"e_1_2_10_55_1","doi-asserted-by":"publisher","DOI":"10.3390\/life13102007"},{"key":"e_1_2_10_56_1","doi-asserted-by":"publisher","DOI":"10.1093\/jn\/132.3.418"},{"issue":"3","key":"e_1_2_10_57_1","first-page":"509","article-title":"Anemia: Etiology, Pathophysiology, Impact, and Prevention: A Review","volume":"54","author":"Suprapti E.","year":"2025","journal-title":"Iranian Journal of Public Health"},{"key":"e_1_2_10_58_1","doi-asserted-by":"publisher","DOI":"10.1093\/nutrit\/nuag014"},{"key":"e_1_2_10_59_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(06)67963-4"},{"key":"e_1_2_10_60_1","doi-asserted-by":"publisher","DOI":"10.2147\/JBM.S263327"},{"key":"e_1_2_10_61_1","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2023.1279826"},{"key":"e_1_2_10_62_1","article-title":"The State of the World Population 2014","author":"UNFPA","year":"2014","journal-title":"The Power of 1.8 Billion: Adolescents, Youth and the Transformation of the Future"},{"key":"e_1_2_10_63_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(17)32154-2"},{"key":"e_1_2_10_64_1","volume-title":"The Treatment of Diarrhoea: A Manual for Physicians and Other Senior Health Workers. 4th rev","author":"WHO","year":"2005"},{"key":"e_1_2_10_65_1","unstructured":"WHO.Global Nutrition Targets 2025: Anaemia Policy Brief.World Health Organization (WHO).2012.https:\/\/apps.who.int\/iris\/handle\/10665\/148556."},{"key":"e_1_2_10_66_1","unstructured":"WHO. Integrated Management of Childhood Illness.2014."},{"key":"e_1_2_10_67_1","volume-title":"Global Anaemia Reduction Efforts Among Women of Reproductive Age: Impact, Achievement of Targets and the Way Forward for Optimizing Efforts","author":"WHO","year":"2020"},{"key":"e_1_2_10_68_1","author":"WHO","year":"2020","journal-title":"WHO Guideline on Use of Ferritin Concentrations to Assess Iron Status in Individuals and Populations"},{"key":"e_1_2_10_69_1","volume-title":"WHO Guideline on Use of Ferritin Concentrations to Assess Iron Status in Individuals and Populations","author":"WHO","year":"2020"},{"key":"e_1_2_10_70_1","unstructured":"WHO. Accelerating Anemia Reduction: A Comprehensive Framework for Action.2023;."},{"key":"e_1_2_10_71_1","volume-title":"Guideline on Haemoglobin Cutoffs to Define Anaemia in Individuals and Populations","author":"WHO","year":"2024"},{"key":"e_1_2_10_72_1","unstructured":"WHO.2025a. Adolescent Health.https:\/\/www.who.int\/health-topics\/adolescent-health#tab=tab_1."},{"key":"e_1_2_10_73_1","unstructured":"WHO.2025b. WHO Global Anaemia Estimates: Key Findings 2025.https:\/\/www.who.int\/publications\/i\/item\/9789240113930."},{"key":"e_1_2_10_74_1","volume-title":"Adolescent Health in Ethiopia","author":"WHO Regional Office for A","year":"2018"},{"key":"e_1_2_10_75_1","first-page":"1","volume-title":"Anemia","author":"Wiafe M. A.","year":"2023"}],"container-title":["Maternal &amp; Child Nutrition"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/mcn.70246","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/mcn.70246","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/mcn.70246","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T08:58:35Z","timestamp":1792054715000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/mcn.70246"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7]]},"references-count":74,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026,7]]}},"alternative-id":["10.1111\/mcn.70246"],"URL":"https:\/\/doi.org\/10.1111\/mcn.70246","archive":["Portico"],"relation":{},"ISSN":["1740-8695","1740-8709"],"issn-type":[{"value":"1740-8695","type":"print"},{"value":"1740-8709","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7]]},"assertion":[{"value":"2025-10-10","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-07","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-15","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70246"}}