Bahati Yasinta, Nyanza Elias C, Asori Moses, Mutayoba Rita, Thomas Deborah S K
Department of Environmental, Occupational, and Department of Environmental, Occupational Health, and GIS, School of Public Health, Catholic University of Health and Allied Sciences, Mwanza, Tanzania.
Amref Health Africa and Nutrition International, Regional Health Management Team-Simiyu Region, Simiyu Region, Tanzania.
PLOS Glob Public Health. 2023 Oct 18;3(10):e0002079. doi: 10.1371/journal.pgph.0002079. eCollection 2023.
Iron and folic acid (IFA) supplementation to reduce anemia is key for improving substantial lost disability adjusted life years (DALYs) for adolescent girls. This study assessed the impact of weekly IFA supplementation (WIFAS) on cognitive ability among adolescent girls in the Simiyu Region in northernwestern Tanzania. This cross-sectional comparative evaluation study of 770 adolescent girls (396 -WIFAS supplemented; 374 -not supplemented) evaluated the association between WIFAS and cognitive ability through a face-to-face survey and cognitive ability assessment using standardized tests (Span-forward Test, Span-backward Test and Maze Test). Using a modified Poisson regression, we controlled for the geographic setting (urban vs rural), availability of potable water and feeding programs in schools, age and school level of adolescent girls, parental status, main parental economic activities, and the number of teachers. Participants were between the ages of 11 and 19 years, with more than half (57%) between 12-15 years of age. Those with WIFAS had higher cognitive ability (Span-forward scores, χ2 = 46.34% p <0.001; Span-forward, χ2 = 46.34% p <0.001; and Global Composite Cognitive Performance (GCCP), χ2 = 32.52% p<0.001). Among the IFA supplemented adolescent girls, secondary school level had a significantly higher score with respect to Span-backward (aPR = 1.43, 95% CI = 1.06-1.62); Span-forward ability (aPR = 1.26, 95% CI = 1.04-1.53) and Maze Test ability (aPR = 1.12, 95% CI = 1.01-1.25) as compared to their counterpart in primary school level. Individual adolescent girls with WIFAS and living with both parents performed much better on the Span-backward Test (aPR = 1.22, 95% CI = 1.07-1.68) as compared to those living with relatives and/or orphans. The presence of potable water program among the WIFAS schools resulted in a higher Span-backward ability (aPR = 1.34, 95% CI = 1.03-1.89); and GCCP (aPR = 1.27, 95% CI = 1.03-1.75). Adolescent girls from WIFAS schools with feeding program had higher Span-forward (aPR = 1.38, 95% CI = 1.03-1.63) ability as well as a higher Maze Test (aPR = 1.15, 95% CI = 1.07-1.26) score. The present study provides compelling evidence that WIFAS is positively associated with higher cognitive ability among adolescent girls. Nevertheless, IFA interventions are still rare in communities across Tanzania.
补充铁和叶酸（IFA）以减少贫血，是改善青春期女孩大量损失的伤残调整生命年（DALY）的关键。本研究评估了在坦桑尼亚西北部西米尤地区，每周补充铁和叶酸（WIFAS）对青春期女孩认知能力的影响。这项对770名青春期女孩（396名接受WIFAS补充；374名未补充）进行的横断面比较评估研究，通过面对面调查和使用标准化测试（顺背测试、倒背测试和迷宫测试）进行认知能力评估，来评估WIFAS与认知能力之间的关联。我们使用修正泊松回归，控制了地理环境（城市与农村）、学校饮用水供应情况和供餐计划、青春期女孩的年龄和学校级别、父母状况、父母主要经济活动以及教师数量。参与者年龄在11至19岁之间，超过一半（57%）在12至15岁之间。接受WIFAS补充的女孩具有更高的认知能力（顺背分数，χ2 = 46.34%，p <0.001；顺背，χ2 = 46.34%，p <0.001；以及综合认知表现总分（GCCP），χ2 = 32.52%，p<0.001）。在接受IFA补充的青春期女孩中，中学水平的女孩在倒背（aPR = 1.43，95%置信区间 = 1.06 - 1.62）、顺背能力（aPR = 1.26，95%置信区间 = 1.04 - 1.53）和迷宫测试能力（aPR = 1.12，95%置信区间 = 1.01 - 1.25）方面的得分，显著高于小学水平的同龄人。与与亲属和/或孤儿一起生活的女孩相比，父母双全且接受WIFAS补充的个体青春期女孩在倒背测试中的表现要好得多（aPR = 1.22，95%置信区间 = 1.07 - 1.68）。WIFAS学校中有饮用水供应计划，会带来更高的倒背能力（aPR = 1.34，95%置信区间 = 1.03 - 1.89）和GCCP（aPR = 1.27，95%置信区间 = 1.03 - 1.75）。有供餐计划的WIFAS学校的青春期女孩具有更高的顺背能力（aPR = 1.38，95%置信区间 = 1.03 - 1.63）以及更高的迷宫测试（aPR = 1.15，95%置信区间 = 1.07 - 1.26）分数。本研究提供了令人信服的证据，表明WIFAS与青春期女孩更高的认知能力呈正相关。然而，在坦桑尼亚各地的社区中，IFA干预措施仍然很少见。
