{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T17:33:12Z","timestamp":1789579992864,"version":"build-2803163510"},"reference-count":43,"publisher":"BMJ","issue":"6","license":[{"start":{"date-parts":[[2024,6,11]],"date-time":"2024-06-11T00:00:00Z","timestamp":1718064000000},"content-version":"unspecified","delay-in-days":10,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100024416","name":"Institute of Health, Jimma University","doi-asserted-by":"publisher","award":["JUIH\/IRB\/583\/2023"],"award-info":[{"award-number":["JUIH\/IRB\/583\/2023"]}],"id":[{"id":"10.13039\/501100024416","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Werabe University","award":["WRU\/RP&CS-VP\/2023"],"award-info":[{"award-number":["WRU\/RP&CS-VP\/2023"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2024,5,30]]},"published-print":{"date-parts":[[2024,6]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This systematic review and meta-analysis aimed to comprehensively assess the impact of weekly iron-folic acid supplementation (WIFAS) on the nutrition, health and educational outcomes of children and adolescents in sub-Saharan Africa.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>A systematic review and meta-analysis was used.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data sources<\/jats:title>\n                    <jats:p>Five databases, namely, MEDLINE, Scopus, Web of Science, Cochrane Library and Google Scholar, were systematically searched for relevant articles up to 23 August 2023.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Eligibility criteria<\/jats:title>\n                    <jats:p>It was focused on randomised controlled trials involving children and adolescents in sub-Saharan Africa, exploring the effects of iron supplementation on various outcomes, such as serum ferritin and haemoglobin levels, anaemia, mental health and school performance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data extraction and synthesis<\/jats:title>\n                    <jats:p>The Joanna Briggs Institute Critical Appraisal tools were used for quality assessment, with two independent reviewers thoroughly evaluating each paper. Using the Cochrane risk of bias tool, we evaluated the certainty of evidence such as the risk of bias, inconsistency, indirectness, imprecision and publication bias.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A systematic review of 10 articles revealed that WIFAS significantly increased serum ferritin levels in adolescent girls (Hedge\u2019s g=0.53, 95%\u2009CI 0.28 to 0.78; heterogeneity I\n                      <jats:sup>2<\/jats:sup>\n                      =41.21%, p&lt;0.001) and haemoglobin levels in school-aged children (Hedge\u2019s g=0.37, 95%\u2009CI 0.01 to 0.73; heterogeneity I\n                      <jats:sup>2<\/jats:sup>\n                      =91.62%, p&lt;0.001). The analysis further demonstrated a substantial reduction in the risk of anaemia by 20% (risk ratio=0.8, 95%\u2009CI 0.69 to 0.93; heterogeneity I\n                      <jats:sup>2<\/jats:sup>\n                      =28.12%, p&lt;0.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>WIFAS proved effective in enhancing serum ferritin and haemoglobin concentrations and lowering the risk of anaemia in school-aged children and adolescents compared with a placebo. Similarly, there are not enough studies to examine the effects of WIFAS on school performance. However, information regarding mental health problems, mortality and potential side effects remains insufficient.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>PROSPERO registration number<\/jats:title>\n                    <jats:p>CRD42023397898.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2024-084033","type":"journal-article","created":{"date-parts":[[2024,6,11]],"date-time":"2024-06-11T14:03:04Z","timestamp":1718114584000},"page":"e084033","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":14,"title":["Weekly iron-folic acid supplementation and its impact on children and adolescents iron status, mental health and school performance: a systematic review and meta-analysis in sub-Saharan Africa"],"prefix":"10.1136","volume":"14","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, Institute of Health, Jimma University, Jimma, Ethiopia"},{"name":"Department of Public Health, College of Medicine and Health Science, Werabe University, Werabe\nEthiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kalkidan","family":"Hassen Abate","sequence":"additional","affiliation":[{"name":"Department of Nutrition and Dietetics, Institute of Health, Jimma University, Jimma, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bekri","family":"Mohammed","sequence":"additional","affiliation":[{"name":"Department of Nutrition and Dietetics, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beyene Wondafrash","family":"Ademe","sequence":"additional","affiliation":[{"name":"Department of Nutrition and Dietetics, Institute of Health, Jimma University, Jimma, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2024,6,11]]},"reference":[{"key":"2025120618530067000_14.6.e084033.1","unstructured":"WHO . Adolescent health."},{"key":"2025120618530067000_14.6.e084033.2","unstructured":"UNFPA . The state of the world population 2014. The power of 1.8 billion; adolescents, youth and the transformation of the future."},{"key":"2025120618530067000_14.6.e084033.3","unstructured":"UNICEF, WHO, and C . Iron & folic acid (IFA) supplementation for adolescent girls and women. Participants Manual for Health Workers 2017."},{"key":"2025120618530067000_14.6.e084033.4","doi-asserted-by":"publisher","DOI":"10.3945\/jn.114.191981"},{"key":"2025120618530067000_14.6.e084033.5","doi-asserted-by":"crossref","DOI":"10.1186\/s13045-021-01202-2","article-title":"Burden of anemia and its underlying causes in 204 countries and territories, 1990\u20132019: results from the global burden of disease study 2019","volume":"14","author":"Safiri","year":"2021","journal-title":"J Hematol Oncol"},{"key":"2025120618530067000_14.6.e084033.6","unstructured":"World Bank . Prevalence of anemia among reproductive age (% of women ages 15\u201349). 2021."},{"key":"2025120618530067000_14.6.e084033.7","doi-asserted-by":"publisher","DOI":"10.1177\/156482650602700405"},{"key":"2025120618530067000_14.6.e084033.8","doi-asserted-by":"publisher","DOI":"10.2147\/NDT.S72491"},{"key":"2025120618530067000_14.6.e084033.9","article-title":"Intermittent iron supplementation for improving nutrition and developmental outcomes in children","volume":"2011","author":"De-Regil","year":"2011","journal-title":"Cochrane Database Syst Rev"},{"key":"2025120618530067000_14.6.e084033.10","unstructured":"WHO . Anaemia Policy Brief. Geneva, Switzerland: WHO, 2019."},{"key":"2025120618530067000_14.6.e084033.11","doi-asserted-by":"crossref","DOI":"10.1186\/s13063-015-1116-0","article-title":"Evaluation of alternative school feeding models on nutrition, education, agriculture and other social outcomes in Ghana: rationale, randomised design and baseline data","volume":"17","author":"Gelli","year":"2016","journal-title":"Trials"},{"key":"2025120618530067000_14.6.e084033.12","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1401038"},{"key":"2025120618530067000_14.6.e084033.13","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.130628"},{"key":"2025120618530067000_14.6.e084033.14","doi-asserted-by":"crossref","DOI":"10.3390\/nu14010224","article-title":"Iron status, anemia, and iron interventions and their associations with cognitive and academic performance in adolescents: a systematic review","volume":"14","author":"Samson","year":"2022","journal-title":"Nutrients"},{"key":"2025120618530067000_14.6.e084033.15","unstructured":"Kaufman AS , Lichtenberger EO , Fletscher-Janzen E . K. L. Essentials of KABC-II Assessment. 2005."},{"key":"2025120618530067000_14.6.e084033.16","doi-asserted-by":"publisher","DOI":"10.1080\/13854049108403297"},{"key":"2025120618530067000_14.6.e084033.17","doi-asserted-by":"publisher","DOI":"10.3109\/09637486.2010.495710"},{"key":"2025120618530067000_14.6.e084033.18","doi-asserted-by":"publisher","DOI":"10.3945\/ajcn.2008.26993"},{"key":"2025120618530067000_14.6.e084033.19","doi-asserted-by":"publisher","DOI":"10.1016\/j.plefa.2008.12.006"},{"key":"2025120618530067000_14.6.e084033.20","unstructured":"JBI . Joanna Briggs Institute (JBI) critical appraisal tools for use in JBI systematic reviews checklist for randomized controlled trials. 2017."},{"key":"2025120618530067000_14.6.e084033.21","doi-asserted-by":"crossref","DOI":"10.1186\/1471-2288-8-79","article-title":"Undue reliance on I2 in assessing heterogeneity may mislead","volume":"8","author":"R\u00fccker","year":"2008","journal-title":"BMC Med Res Methodol"},{"key":"2025120618530067000_14.6.e084033.22","doi-asserted-by":"publisher","DOI":"10.2307\/2533446"},{"key":"2025120618530067000_14.6.e084033.23","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.315.7109.629"},{"key":"2025120618530067000_14.6.e084033.24","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-151-4-200908180-00135"},{"key":"2025120618530067000_14.6.e084033.25","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1038\/sj.ejcn.1602919","article-title":"The effect of weekly iron and vitamin A supplementation on hemoglobin levels and iron status in adolescent schoolgirls in Western Kenya","volume":"63","author":"Leenstra","year":"2009","journal-title":"Eur J Clin Nutr"},{"key":"2025120618530067000_14.6.e084033.26","doi-asserted-by":"crossref","DOI":"10.1038\/s41598-021-89115-5","article-title":"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","volume":"11","author":"Handiso","year":"2021","journal-title":"Sci Rep"},{"key":"2025120618530067000_14.6.e084033.27","doi-asserted-by":"crossref","first-page":"794","DOI":"10.1046\/j.1365-3156.2000.00641.x","article-title":"The impact of weekly iron supplementation on the iron status and growth of adolescent girls in Tanzania","volume":"5","author":"Beasley","year":"2000","journal-title":"Tropical Med Int Health"},{"key":"2025120618530067000_14.6.e084033.28","doi-asserted-by":"publisher","DOI":"10.1177\/156482650502600305"},{"key":"2025120618530067000_14.6.e084033.29","doi-asserted-by":"crossref","first-page":"1099","DOI":"10.1093\/infdis\/jiy257","article-title":"Effects of weekly iron and folic acid supplements on malaria risk in nulliparous women in Burkina Faso: a periconceptional, double-blind, randomized controlled noninferiority trial","volume":"218","author":"Gies","year":"2018","journal-title":"J Infect Dis"},{"key":"2025120618530067000_14.6.e084033.30","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1079\/PHN2001327","article-title":"A randomised trial in Mali of the effectiveness of weekly iron supplements given by teachers on the Haemoglobin concentrations of schoolchildren","volume":"5","author":"Hall","year":"2002","journal-title":"Public Health Nutr"},{"key":"2025120618530067000_14.6.e084033.31","doi-asserted-by":"crossref","first-page":"1646","DOI":"10.1093\/jn\/nxab024","article-title":"A school-based weekly iron and folic acid supplementation program effectively reduces anemia in a prospective cohort of Ghanaian adolescent girls","volume":"151","author":"Gosdin","year":"2021","journal-title":"J Nutr"},{"key":"2025120618530067000_14.6.e084033.32","doi-asserted-by":"publisher","DOI":"10.1016\/S0035-9203(01)90171-3"},{"key":"2025120618530067000_14.6.e084033.33","doi-asserted-by":"crossref","first-page":"12","DOI":"10.4314\/mmj.v21i1.10982","article-title":"Impact of iron supplementation on Schistosomiasis control in Zambian school children in a highly Endemic area","volume":"21","author":"Mwanakasale","year":"2009","journal-title":"Malawi Med J"},{"key":"2025120618530067000_14.6.e084033.34","doi-asserted-by":"crossref","unstructured":"Nagmeldin Abbas Fageer M , Hussein MD , N Abbas Fagiri M , et al . 1239\u2005randomized controlled trial on the effect of weekly iron\/folic acid supplementation on anemia and school performance among school children in rural Sudan. BMJ; October 2021 doi:10.1136\/archdischild-2021-rcpch.501","DOI":"10.1136\/archdischild-2021-rcpch.501"},{"key":"2025120618530067000_14.6.e084033.35","unstructured":"Cochrane . Rob 2: a revised Cochrane risk-of-bias tool for randomized trials. 2019."},{"key":"2025120618530067000_14.6.e084033.36","unstructured":"WHO . Guideline: intermittent iron and folic acid supplementation in Menstruating women. In: Guideline: intermittent iron and folic acid supplementation in menstruating women. 2011."},{"key":"2025120618530067000_14.6.e084033.37","doi-asserted-by":"publisher","DOI":"10.1079\/BJN19900144"},{"key":"2025120618530067000_14.6.e084033.38","unstructured":"FE, V . Global Consultation on Weekly Iron-Folic Acid Supplementation for Preventing Anaemia in Women of Reproductive Age Group. 2007."},{"key":"2025120618530067000_14.6.e084033.39","unstructured":"U. N. C. F. nutrition, for every child. UNICEF Nutrition Strategy 2020-2030; 2020."},{"key":"2025120618530067000_14.6.e084033.40","unstructured":"UNICEF . United Nations children\u2019s Fund, U. programming guidance: nutrition in middle childhood and adolescence. 2021."},{"key":"2025120618530067000_14.6.e084033.41","unstructured":"WHO . Making every school a health promoting school: adolescent and young adult health. 2023."},{"key":"2025120618530067000_14.6.e084033.42","unstructured":"WHO . Preventing iron deficiency anemia in adolescents: role of WIFAS: world health organization, regional office for South-East Asia. Indraprastha Estate; Mahatma Gandhi Marg, New Delhi-110 002, 2011."},{"key":"2025120618530067000_14.6.e084033.43","doi-asserted-by":"crossref","unstructured":"Hoddinott J , Rosegrant M , Torero M . Hunger and malnutrition: copenhagen consensus challenge. 2012.","DOI":"10.1017\/CBO9781139600484.008"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2024-084033","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,7]],"date-time":"2025-12-07T02:53:14Z","timestamp":1765075994000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2024-084033"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,6]]},"references-count":43,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2024,6,11]]},"published-print":{"date-parts":[[2024,6]]}},"alternative-id":["10.1136\/bmjopen-2024-084033"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2024-084033","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,6]]}}}