Empowering girls and building community trust for anemia prevention
A comprehensive nutrition programme for adolescents in 10 districts
Improving adolescent girls’ health and wellbeing is an issue that is getting significant attention from local authorities in Salima district in Malawi to fast-track the district’s development.
Like other districts in the country, Salima faces many challenges to educate and empower girls, and this is compounded by recurring food insecurity is one of the most prominent problems adolescents face .For instance, in 2018, only 24% of adolescent girls aged 15-19 years in Salima had the required minimum dietary diversity. Although this number increased to about 47% in 2024, it is still low and fell below the year’s target of 48%. In Salima district, the primary school attendance for girls has improved from 71 % in 2022 to 87.6% in 2024 and above the district target of 73.3% for girls.
According to the World Bank’s poverty assessment for Malawi in 2020, 72 per cent of households were reported to be food insecure. The prevalence of anemia among adolescent girls was at 35 per cent based on the 2015-2016 Malawi Demographic and Health Survey (MDHS).
As part of a strategy to improve the health and wellbeing of adolescents who are in and out of school, the government of Malawi, with support from UNICEF and funding from the Norwegian Agency for Development Cooperation (NORAD), implemented a comprehensive nutrition programme for adolescents in 10 districts, including Salima.
The programme includes iron folate supplementation, provision of deworming tablets, and promotion of nutritious and diversified diets among adolescents in the 10 districts. The programme has seen at least 74,297 adolescent girls (60,440 in school and 13,858 out of school) benefiting from weekly supplements in 2024.
In Salima, myths and misconceptions about iron folic acid supplementation led to hesitancy, as peers, parents and guardians discouraged uptake, believing it was intended for family planning rather than its true purpose – supporting adolescent health, education outcomes, and overall well-being.
To address these concerns, UNICEF has strengthened social behavioural change efforts to build community trust and encourage acceptance of IFA supplements, increasing the uptake from about 200 to more 300 girls at Mchoka Primary School alone in 2024.
Twenty-three-year-old Angela Bwanali, like many other community-based youth champions across the country, takes pride in the work she does, working with adolescents and communities to address these misconceptions. She is a member and secretary of the Mchoka Youth Friendly Club.
These misconceptions are common and often fueled by parents with limited knowledge about the supplements. We hold dialogue sessions with such parents to explain the importance of IFA supplements, and most parents now understand, and are supportive of their girls taking the supplements.
Iron folic acid supplementation happens mostly in schools where teachers share information on the programme and its benefits. Girls who receive the supplements, mothers who have received information through community platforms, and other community members do play a critical role in sharing information in their social circles. As a result, the community has proved to be the cornerstone to demystifying myths associated with the programme.
The contribution of community leaders towards improving the programme’s acceptability has complemented efforts of the government and UNICEF to train frontline workers and youth champions in peer support.
Speaking to UNICEF during a community site support visit at Ndindi Village, Senior Group Village Headman Ndindi expressed his pride in the role he plays in educating his community to support actions that improve nutrition for adolescents, and iron-folic acid supplementation.
“In the past, many girls were not taking the supplements. I called for meetings to encourage parents to allow the girls to receive the supplements so that the girls have good health to continue to go to school to reach Standard 8 and proceed to secondary school. There is now a big improvement. With this programme, girls are not being left behind. They are doing well in school,” said the chief.
These social and behaviour change efforts have made remarkable differences in improving compliance in the micronutrient supplementation programme and its coverage, as data shows that 100% of the targeted 54 schools in Salima district are providing the IFA supplements, with 74% compliance in 2024 compared to 61% compliance in 2023.
Adolescent girls who were refusing to take IFA supplements including those who were not coming to school on the IFA administration day, are now opening up and happily taking the IFA supplements following the dialogue sessions and awareness meetings targeting adolescents, parents, communities and local governance structures which addressed the issues of myths and misconceptions around the IFA supplementation intervention in Salima.
“My wish is that this programme should continue and be scaled up across the entire district of Salima so that more adolescent girls can benefit. We need to ensure girls have a good foundation for their future so that our communities can develop,” said chief Ndindi.
To reduce anemia and improve school attendance for girls in Salima, the district’s principal nutrition, HIV and AIDS officer, Yamikani Makondi, said the IFA supplementation programme should cover all 166 schools in the district and not just the 54 schools.
He said Salima District Council is lobbying government to scale up the programme in the remaining schools, adding it would also be good for the programme to be nationwide and target all schools in Malawi.
