Factors Of Compliance To Iron Supplementation On Adolescent Girls With Anemia In Asia: A Systematic Review
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Abstract
Introduction: Iron deficiency anemia (IDA) remains a critical global health challenge, particularly among adolescent girls, with a worldwide prevalence of 29.4%. While iron supplementation is a proven intervention, adherence rates remain suboptimal (32.7%-44.3%), undermining anemia control efforts. This systematic review synthesizes evidence on factors affecting adherence to iron supplementation in adolescent girls. Methods: This study followed the PRISMA guidelines, with searches conducted in five databases for studies published between 2020 and 2025. Of the 309 articles identified, 13 met the inclusion criteria and were analyzed thematically. Results: Key findings reveal that individual, social, and systemic factors influence adherence. Personal factors influencing adherence include low knowledge, negative attitudes, and low awareness of the consequences of anemia, which hinder adherence. Meanwhile, social factors include maternal support and peer influence, which significantly influence adherence behavior. Barriers related to supplements, such as unpleasant taste and gastrointestinal side effects, are often reported, along with forgetfulness as a major challenge. The systemic factors include school-based policies and the quality of program implementation, which also shape adherence. Context-specific interventions such as nutrition and monitoring can demonstrate improved adherence, highlighting the importance of locally tailored strategies. Conclusion: Adherence to iron supplementation is multifactorial, requiring integrated approaches. Recommendations include: (1) targeted education campaigns to enhance knowledge and attitudes, (2) optimizing supplement formulations to minimize side effects, (3) strengthening school and community-based distribution systems, and (4) engaging families and peers to foster supportive environments. Future programs should prioritize contextual adjustments to maximize compliance and reduce IDA among vulnerable groups.
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