# School‐Based Weekly Iron–Folic Acid Supplementation and Its Effect on Mental Health Outcomes Among Adolescent Girls in Central Ethiopia: A Cluster‐Randomized Controlled Trial

## TL;DR

Weekly iron-folic acid supplements in Ethiopian schools reduced mental health issues in adolescent girls.

## Contribution

First study to show that weekly iron-folic acid supplementation improves mental health in adolescent girls.

## Key findings

- Girls receiving WIFAS had significantly lower CMD scores than the control group.
- The mental health benefit remained significant after adjusting for sociodemographic factors.
- WIFAS may offer mental health benefits beyond preventing anemia and iron deficiency.

## Abstract

Common mental disorders (CMDs) are increasingly recognized as a major public health challenge worldwide, with adolescent girls bearing a disproportionate burden. Moreover, iron deficiency (ID) and iron deficiency anemia (IDA) remain prevalent nutritional problems among adolescents. Observational studies have highlighted that the prevalence of CMD is higher among anemic individuals compared to their non‐anemic counterparts. This study hypothesizes that preventing anemia through weekly iron and folic acid supplementation (WIFAS) among adolescent girls may have a positive effect on CMDs. However, the potential effect of WIFAS on CMDs remains unexplored. This critical evidence gap highlights the need for targeted research. Therefore, this study aimed to assess the effect of WIFAS on CMD among adolescent girls in the Central Ethiopia Region.

This study employed a school‐based, parallel‐cluster randomized controlled trial (RCT) design, involving 306 adolescent girls across 12 clusters in the Silti and Kibet Districts of the Central Ethiopia Region. Participants were proportionally allocated, with 153 girls assigned to the intervention group (six clusters in Silti District) and 153 to the control group (six clusters in Kibet District). The outcome variable, CMD score, was treated as a continuous measure and assessed using the World Health Organization’s (WHO) Self‐Reporting Questionnaire (SRQ‐20). Data were collected at baseline and endline, with the latter conducted 6 months after the completion of the WIFAS. Linear mixed‐effects models (LMEMs) were used to examine the association between WIFAS and CMD.

The findings of this study indicated that adolescents who received WIFAS had significantly lower CMD scores compared to those who did not (β = −1.12; 95% CI: −1.68, −0.55). The unadjusted mean difference was −0.88 (Model 1: β = −0.88; 95% CI: −1.47, −0.29). This association remained significant after adjusting for baseline CMD score (Model 2: β = −1.01; 95% CI: −1.58, −0.45), parental sociodemographic characteristics (Model 3: β = −1.12; 95% CI: −1.68, −0.55), and in the fully adjusted model (Model 4: β = −1.12; 95% CI: −1.68, −0.55).

The findings of this study revealed that WIFAS significantly reduced CMD scores among adolescent girls. This suggests that WIFAS may offer mental health benefits in addition to its known role in preventing anemia and ID. Hence, integrating WIFAS into school‐based health programs should be prioritized as a potential strategy to improve mental health outcomes among adolescent girls.

Trial Registration: ClinicalTrials.gov identifier: PACTR202309541331083