The Effect of Iron Supplementation Combined with Oranges on the Preference Level, Consumption Adherence, and Haemoglobin Levels among Adolescent Girls

Abstract

Anaemia remains a severe public health problem affecting adolescent girls. Despite government-provided Iron and Folic Acid (IFA) supplementation, adherence remains low due to unpleasant taste and odour. To analyse the impact of blood-boosting tablet (IFA) intervention accompanied by orange fruit on liking levels, consumption adherence, and haemoglobin levels among adolescent girls. This quasi-experimental non-equivalent control group pre-test-post-test design involved 56 adolescent girls from four schools in Maros Regency, Indonesia. Participants were allocated by cluster into an intervention group (n=27) and a control group (n=29), without individual randomization. The intervention group received IFA tablets with 100–150 g of orange fruit once weekly for four weeks, while the control group received IFA tablets alone. Taste and aroma liking were assessed using a 5-point hedonic scale, and adherence was monitored using Directly Observed Supplementation (DOS). Haemoglobin levels were measured at pre-test and post-test. Liking and adherence were analysed using the Mann–Whitney U test, while post-test haemoglobin was analysed using ANCOVA adjusted for covariates. He intervention group had higher mean ranks for taste liking (35.15 vs. 22.31; p=0.001), aroma liking (32.78 vs. 24.52; p=0.044), and adherence (35.06 vs. 22.40; p=0.002) than the control group. After covariate adjustment, study group was associated with post-test Hb (p=0.005; partial η²=0.159). IFA supplementation with orange fruit showed better outcomes in terms of liking, adherence, and haemoglobin levels compared with IFA supplementation alone. However, these findings cannot yet establish a causal relationship due to the non-randomized study design, short intervention duration, and limitations related to cluster-level allocation.