School Availability of Iron Supplements and Peer Support as Key Determinants of Iron Supplementation Adherence among Adolescent Girls in Urban Indonesia

Abstract

Iron and folic acid supplementation for adolescent girls is essential for preventing anemia in countries such as Indonesia, where the prevalence of anemia ranges from 20% to 40%. The iron supplementation coverage rate in Bekasi City is 13.29%. However, only 8.3% of adolescent girls adhere to iron supplementation. This study aimed to analyze relationships between predisposing, enabling, reinforcing factors and adherence to iron supplementation among adolescent girls in Bekasi, Indonesia. A descriptive cross-sectional study was conducted between June and August 2023 using validated questionnaires to assess predisposing, enabling, and reinforcing factors. A total of 400 participants were selected using the multistage sampling method consisting of cluster random sampling followed by consecutive sampling. Chi-square tests and multiple logistic regression analyses were used to establish the relationship between the variables. The availability of iron supplementation at schools, peer support, family support, attitude, and teacher support were found to be significantly associated with adjusted odds ratios(AOR) consecutively of 4.738 (2.654–8.460), 4.218 (2.150–8.275),2.463 (1.379–4.398), 2.291 (1.273–4.112), and 2.089 (1.058–4.124). The availability of supplements in schools emerged as the strongest factor associated with adherence to iron supplementation. Anemia prevention strategies for adolescent girls should prioritize interventions targeting the most influential determinants of adherence.