Anemia is defined as a decrease in the concentration of circulating red blood cells or haemoglobin concentration resulting in insufficient oxygen carrying capacity of red blood cells to meet the physiological needs of the body [
According to the World Health Organization (WHO), adolescence has been defined as the period of life between 10 and 19 years of age [
During childhood and adolescence period, the nutritional needs of boys slightly differ from that of girls. Iron requirements peak during adolescence due to rapid growth and increase in blood volume. Anemia during adolescence causes reduced physical and mental capacity and diminished concentration in work and educational performance, and also poses a major threat to future safe motherhood in girls [
Globally anemia affects the lives of more than 2 billion people, accounting for over 30% of the world’s population which is the most common public health problem particularly in developing countries occurring at all stages of the life cycle [
Adolescents are at an increased risk of developing anemia due to increased iron demand during puberty, menstrual losses, limited dietary iron intake, and faulty dietary habits. This dramatic increase in iron requirement among adolescents peaks between the ages of 14-15 years for girls and one to two years later for boys. The requirement for iron doubles during adolescence as compared to the younger age group. The overall iron requirement increases two to three folds from a preadolescence level of approximately 0.7–0.9 mg Fe/day to as much as 1.37–1.88 mg Fe/day in adolescent boys and 1.40–3.27 mg Fe/day in adolescent girls. This is due to the expansion of total blood volume, increase in lean body mass, and the onset of menstruation in adolescent females [
In spite of increased iron needs, many adolescents, particularly females have iron intakes of only 10-11 mg/day of total iron, resulting in approximately 1 mg of absorbed. About three fourths of adolescent females and 17% of males do not get their dietary iron requirement which makes the adolescents vulnerable to the development of anemia [
Anemia in adolescent has serious implications for a wide range of outcomes, and nearly all of the functional consequences of iron deficiency are strongly related to the severity of anemia. It causes reduced resistance to infection, impaired physical growth and mental development, and reduced physical fitness, work capacity, and school performance [
In Ethiopia, adolescents, who constitute a sizable segment of its population, form a vulnerable group and are at a greater risk of morbidity and mortality. Anemia is widely prevalent in Ethiopia and affects both sexes in all age groups. Among adolescents, girls constitute a vulnerable group, particularly in developing countries such as Ethiopia. In a family with limited resources, the female child is more likely to be neglected due to sociocultural factors [
Even though the study of anemia among both male and female adolescents is very limited in Ethiopia, few studies have been conducted on school female children, reproductive age women, and pregnant women and the results of all these studies put anemia as a moderate-to-severe public concern. The National Nutrition Program (NNP) of Ethiopia gives special attention to address these age groups, but the implementation of this program at the grass root level is very weak as compared with other vulnerable groups [
Therefore, the main aim of this study was to compare the prevalence of anemia and associated factors of anemia among male and female school adolescents in Dilla Town. Results from this research are important to clarify how to approach with adolescent-specific nutrition intervention to reduce anemia-related morbidity and increase productivity. Also, the findings will be used as input for different health sectors at zonal and woreda levels to plan interventions to reduce the problem of anemia.
A school-based comparative cross-sectional study was conducted from 14th May to 1st June 2018 among school adolescents (10 to 19 years) in Dilla Town, Gedeo Zone, Southern Nations, Nationalities, and Peoples’ Region (SNNPR), Southern Ethiopia. Dilla Town is located at 367 km to the south of Addis Ababa, the capital of the country, and 90 km from Hawassa, the center of the region, SNNPR. The study area has a longitude and latitude of 6°24′30″N 38°18′30″E Coordinates: 6°24′30″N 38°18′30″E, with an elevation of 1570 meters above sea level [
The source population for this study was all school adolescents from 10 to 19 years attending both private and government schools in Dilla Town, and the study population was adolescents attending the selected schools during the study period. Adolescents with known chronic diseases were excluded from the study.
The sample size for this study was determined using two population proportion formulas considering prevalence of anemia among male and female taken from a previous cross-sectional study [
In the formula,
The calculated sample based on the above assumption was 688, and by adding ten percent nonresponse rate, the final sample size became 756 (378 males and 378 females).
Adolescent anemia.
Demographic characteristics of the adolescents: age of adolescents, place of residence, grade of adolescents, educational status of mother and father, occupational status of mother and father, livening condition (with family or separate from family), parental condition (existence of mother and father), family size, and marital status.
Water and sanitation: source of drinking water, type of latrine, and wear shoe.
Dietary diversity/practice: food consumption, food frequency, food sources, postmeal consumption of tea and coffee, and school feeding program.
Knowledge of anemia: information on anemia, knowledge of food sources rich in iron, knowledge of causes of anemia, and knowledge of consequences of anemia.
Health and nutrition condition: body mass index for age, height for age, menstrual status, malaria endemicity, malaria and parasitic infection, deworming, and accessibility of adolescent health service.
There are a total of 23 schools in Dilla Town out of which six schools were randomly selected with simple random sampling technique. Then, a total sample was proportionally allocated to each schools based on the number of adolescents in the selected schools. Finally, a simple random sampling (SRS) technique was applied to select study participants using the school roaster as a frame.
For data collection, a pretested questionnaire, anthropometric assessment, haemoglobin measurement, and stool examination checklists were used. The questionnaire was adapted from different literature studies and EDHS [
Haemoglobin determination was done for the selected students in the school compound by laboratory technicians that were working outside of the respective district. The haemoglobin concentration of each student was measured by taking a finger-prick blood sample using a HemoCue haemoglobinometer (HemoCue Hb 301+, Angelholm, Sweden). Standardization of the HemoCue haemoglobinometer was checked by crosschecking CBC machine [
The stool examination was conducted by laboratory technicians using the portable microscope in each school compound. Stool samples were collected from each study participant using clean, wide-mouthed, and leak-proof stool cups and examined at the data collection site within 10–15 minutes of collection by the wet mount for identification of intestinal parasites.
The food and nutrition technical assistance questionnaire was used to collect data for dietary diversity. The types of food adolescents took within the last 24 hours were asked, and the information collected on dietary consumption was used to calculate the dietary diversity score (DDS).
Data were collected by four laboratory professionals and eight nurse diploma professionals. The data collectors were trained for two days on the data collection tools and anthropometric measurement procedures.
Data were entered into EpiData version 3.1 and then exported to SPSS version 20 statistical packages for analysis. Anthropometric data were entered and calculated using the WHO AnthroPlus software. The dietary diversity scores (DDS) for 24-hour recall were calculated per adolescent by summing the number of different consumed food groups. The DDS was categorized into tertiles which include low dietary diversity with ≤2 food groups, medium dietary diversity with 3 food groups, and high dietary diversity with ≥4 food groups [
The questionnaire was originally developed in English and later translated into Amharic and Gedeofa. To keep the consistency of its content, the questionnaire was translated back to English by a language expert. Two-day training was given for data collectors and supervisors. Before data collection, a pretest was conducted among 38 students (5% of the sample size) to centexualize the questionnaires before the actual data collection and revisions were made accordingly. During the study period, the questionnaire was checked every evening for its completeness. Unrecorded data and unlikely responses were manually separated and reinterviewed the next day. All laboratory activities were performed by strictly following manufacturers’ instructions and specific standard operating procedures. All anthropometric measurements were taken twice by two data collectors, and the mean values were used for data analysis. The weighing scale was calibrated with a known weight object regularly, and the scale indicator was checked against zero reading after weighing every adolescent.
From a total of 756 adolescent students expected to participate in this study, 742 (377 males and 365 females) were actually participated making the response rate 98.1%. Among the participants, about 50% (186) of males and about 40% (141) of females were in a late adolescence period with a mean age of 16 years (SD, 2.4) among males and 17 (SD, 2.1) among females. With regard to grade levels, 179 (47.5%) of males and 190 (52.1%) of females were from grade 5 to 8. Protestant religion followers constitute 293 (77.7%) among males and 237 (64.9%) among females in this study.
Regarding family characteristics, 179 (47.5) of male adolescents and 174 (47.7%) of female adolescents were from households with a family size of 5–7 members. With respect to family education, 191 (50.7) of males’ fathers and 198 (54.2) of females’ fathers had attended secondary school or above (Table
Sociodemographic and socioeconomic characteristics of male and female adolescent students in Dilla Town, Gedeo Zone, Southern Ethiopia, May 2018.
Variables | Male number (%) | Female number (%) |
---|---|---|
Age category | 377 | 365 |
Early adolescence (10–13 yrs) | 61 (16.2) | 74 (20.3) |
Middle adolescence (14–16 yrs) | 130 (34.5) | 150 (41.1) |
Late adolescence (17–19 yrs) | 186 (49.3) | 141 (38.6) |
Mean age (±SD) | 16 ± 2.4 | 17 ± 2.1 |
Grade | 377 | 365 |
5–8 | 179 (47.5) | 190 (52.1) |
9-10 | 140 (37.1) | 142 (38.9) |
11-12 | 58 (15.4) | 33 (9.0). |
Ethnicity | 377 | 365 |
Gedeo | 258 (70.9) | 214 (61.7) |
Oromo | 44 (12.1) | 41 (11.8) |
Amhara | 31 (8.5) | 36 (10.4) |
Gurage | 25 (6.9) | 43 (12.4) |
Others | 19 (5.0) | 31 (8.6) |
Religion | 377 | 365 |
Protestant | 293 (77.7) | 237 (64.9) |
Orthodox | 67 (17.8) | 95 (26.0) |
Muslim | 7 (1.9) | 21 (5.8) |
Catholic | 10 (2.7) | 12 (3.3) |
Father’s educational status | 377 | 365 |
Illiterate/cannot read or write | 26 (6.9) | 13 (3.6) |
Can read and write | 91 (24.1) | 82 (22.5) |
Primary school | 69 (18.3) | 72 (19.7) |
Secondary school and above | 191 (50.7) | 198 (54.2) |
Mother’s educational status | 377 | 365 |
Illiterate/cannot read or write | 65 (17.2) | 42 (11.5) |
Can read and write | 92 (24.4) | 98 (26.8) |
Primary school | 112 (29.7) | 101 (27.7) |
Secondary school and above | 108 (28.6) | 124 (34.0) |
Father’s occupational status | 377 | 365 |
Farmer | 73 (19.8) | 54 (15.3) |
Government employee | 155 (42.1) | 147 (41.8) |
Merchant | 140 (38.0) | 151 (42.9) |
Others | 9 (2.4) | 13 (3.6) |
Mother’s occupational status | 377 | 365 |
Housewife | 152 (41.1) | 156 (43.9) |
Farmer | 21 (5.7) | 14 (3.9) |
Government employee | 80 (21.6) | 71 (20.0) |
Merchant | 177 (31.6) | 114 (32.1) |
Others | 7 (1.9) | 10 (2.7) |
Your current marital status | 377 | 365 |
Never married | 341 (90.5) | 337 (92.3) |
On promise | 25 (6.6) | 16 (4.4) |
Married | 11 (2.9) | 12 (3.3) |
Family size | 377 | 365 |
≤4 | 35 (9.3) | 33 (9.0) |
5–7 | 179 (47.5) | 174 (47.7) |
≥8 | 163 (43.2) | 158 (43.3) |
Place of residence | 377 | 365 |
Urban | 329 (87.3) | 337 (92.3) |
Rural | 48 (12.7) | 28 (7.7) |
Parental status | 377 | 365 |
Both parent alive | 343 (91.0) | 333 (91.2) |
Father alive | 7 (1.9) | 6 (1.6) |
Mother alive | 23 (6.1) | 25 (6.8) |
Both parent died | 4 (1.1) | 1 (0.3) |
Current living status | 377 | 365 |
Living with parent | 305 (80.9) | 316 (86.6) |
Living with relatives | 18 (4.8) | 26 (7.1) |
Living separately from family | 54 (14.3) | 23 (6.3) |
Information about the source of food shows that the majority of the family of male (70.8%) and female (76.4%) adolescents achieve food need through buying/purchasing. Most of the study participants in both sexes 272 (72.1%) among male and 262 (71.8%) among female had low DDS in the last 24-hour recall. Concerning daily meal frequency, 335 (88.9%) of male adolescents and 342 (93.7%) female adolescents eat three times or more (Table
Dietary practices and related factors among male and female adolescent students in Dilla Town, Gedeo Zone, Southern Ethiopia, May 2018.
Variables | Male ( | Female ( |
---|---|---|
Daily meal frequency (usual) | 377 | 365 |
Two times or below | 42 (11.1) | 23 (6.3) |
Three times or more | 335 (88.9) | 342 (93.7) |
Daily meal frequency (24 hours) | 377 | 365 |
Two times or below | 113 (30.0) | 83 (22.7) |
Three times or more | 264 (70.0) | 282 (77.3) |
Main sources of family food needs | 377 | 365 |
Grow their own | 99 (26.3) | 74 (20.3) |
Buy/purchase | 267 (70.8) | 279 (76.4) |
Subsidies/food aid | 11 (2.9) | 12 (3.3) |
DDS in last 24 hours | 377 | 365 |
Low | 272 (72.1) | 262 (71.8) |
Medium | 100 (26.5) | 99 (27.1) |
High | 5 (1.3) | 4 (1.1) |
Green leafy vegetable consumption | 377 | 365 |
None | 15 (4.0) | 20 (5.5) |
Once a week | 53 (14.1) | 32 (8.8) |
Twice in a week | 98 (26.0) | 99 (27.1) |
Every other day | 80 (21.2) | 74 (20.3) |
Every day | 87 (23.1) | 86 (23.6) |
Do not remember | 44 (11.7) | 54 (14.8) |
Frequency of fibre foods | 377 | 365 |
None | 24 (6.4) | 29 (7.9) |
Once a week | 83 (22.0) | 61 (16.7) |
Twice in a week | 71 (18.8) | 81 (22.2) |
Every other day | 61 (16.2) | 47 (12.9) |
Every day | 67 (17.8) | 81 (22.2) |
Do not remember | 71(18.8) | 66 (18.1) |
Frequency of foods of animal origin | 377 | 365 |
None | 34 (9.0) | 21 (5.8) |
Once a week | 147 (39.0) | 118 (32.3) |
Twice in a week | 75 (19.9) | 105 (28.8) |
Every other day | 38 (10.1) | 48 (13.2) |
Every day | 42 (11.1) | 41 (11.2) |
Do not remember | 41 (10.9) | 32 (8.8) |
Consumption of tea after a meal | 377 | 365 |
Always | 118 (31.3) | 123 (33.7) |
Sometimes | 207 (54.9) | 194 (53.2) |
Not at all | 40 (10.6) | 33 (9.0) |
Do not remember | 12 (3.2) | 15 (4.1) |
About 50% (140) of males and 43.2% (115) of female respondents have poor knowledge about anemia. About 10.3% (39) of male adolescents and 9.6% (35) of female adolescents have history of malaria infection in the last one month. Regarding stool parasite assessment result, 104 (31.5%) of male study participants and 78 (22.0%) of female adolescents have parasite infestation (Table
Health service, personal practices, and related factors among male and female adolescent students in Dilla Town, Gedeo Zone, Southern Ethiopia, May 2018.
Variables | Male ( | Female ( |
---|---|---|
Knowledge of anemia | 281 | 266 |
Good knowledge | 141 (50.2) | 151 (56.8) |
Poor knowledge | 140 (49.8) | 115 (43.2) |
Malaria endemicity | 377 | 365 |
Yes | 184 (48.8) | 178 (48.8) |
No | 193 (51.2) | 187 (51.2) |
History of malaria last one month | 377 | 365 |
Yes | 39 (10.3) | 35 (9.6) |
No | 338 (89.7) | 330 (90.4) |
Deworming in the last one month | 377 | 365 |
Yes | 48 (12.7) | 62 (17.0) |
No | 329 (87.3) | 303 (83.0) |
Menstruation | 365 | |
Yes | 329 (90.1) | |
No | 36 (9.9) | |
Days of menstruation | 329 | |
<3 days | 183 (55.6) | |
>3 days | 146 (44.4) | |
Frequency of pad change | 329 | |
<3 times | 271 (82.4) | |
>3 times | 58 (17.6) | |
Source of drinking water | 377 | 365 |
Piped water | 295 (78.2) | 318 (87.1) |
Stand pipe | 31 (8.2) | 20 (5.5) |
Protected spring | 51 (13.5) | 27 (7.4) |
Shoe wearing frequency | 377 | 365 |
Some of the time | 90 (23.9) | 35 (9.6) |
Most of the time | 87 (23.1) | 44 (12.1) |
Always | 200 (53.1) | 286 (78.4) |
In this study, the overall prevalence of anemia was 157 (21.1%) and it is 85 (22.5%) among male adolescents and 72 (19.7%) among female adolescents. The mean haemoglobin levels were 14.4 (±2.3) among male and 13.4 (±1.9) among female study participants. Regarding nutritional status of the adolescents, the level of stunting was 48 (12.7%) among males and 37 (10.1%) among females. According to BMI
Prevalence of anemia among male and female adolescents in Dilla Town, Southern Ethiopia, May 2018.
Variables | Male ( | Female ( |
---|---|---|
Number (%) | Number (%) | |
Anemia status | 377 | 365 |
Anemic | 85 (22.5) | 72 (19.7) |
Nonanemic | 292 (77.5) | 293 (80.3) |
Types of anemia | 85 | 72 |
Sever | 1 (0.3) | 4 (1.1) |
Moderate | 46 (12.2) | 43 (11.8) |
Mild | 38 (10.1) | 25 (6.8) |
Mean (SD) | 14.4 ± 2.3 | 13.4 ± 1.9 |
HAZ | 377 | 365 |
Stunted | 48 (12.7) | 37 (10.1) |
Normal | 329 (87.3) | 328 (89.9) |
BAZ | 377 | 365 |
Thin | 39 (10.3) | 19 (5.2) |
Normal | 338 (89.7) | 346 (94.8) |
The multivariable analysis result showed that age category, the frequency of eating fibre foods, and presence of stool parasites were significantly associated with the prevalence of anemia among male adolescent students and malaria endemicity and presence of stool parasites were significantly associated with the prevalence of anemia among female adolescent students.
With regard to factors associated with anemia among males, adolescents in the age range of 10–13 years were 76% less likely to develop anemia (AOR 0.24, 95% CI, 0.07–0.77) compared to those respondents in the age group of 17–19 years. Adolescent males who eat fibre foods every day were 88% less likely to develop anemia compared to those who eat none through the week days (AOR 0.12, 0.02–0.64). Adolescent males who have no stool parasite were 99.5% less likely to develop anemia than adolescent males who have stool parasite (AOR 0.05, 95% CI, 0.02–0.09).
Adolescent females from malaria endemic area were 2.5 times more likely to develop anemia than adolescent females from the less endemic area (AOR 2.52, 95% CI, 1.12–5.62). Adolescent females who have no intestinal parasite were 99.5% less likely to develop anemia than adolescent females who have intestinal parasite (AOR 0.05, 95% CI, 0.01–0.11) (Table
Associated factors of anemia among male and female adolescent students in Dilla Town, Southern Ethiopia, May 2018.
Variables | Male | Female | ||||||
---|---|---|---|---|---|---|---|---|
Anemic | Nonanemic | COR (95% CI) | AOR (95% CI) | Anemic | Nonanemic | COR (95% CI) | AOR (95% CI) | |
Age | 85 | 292 | 72 | 293 | ||||
10–13 | 25 (41.0) | 36 (59.0) | 0.29 (0.15–0.55) | 0.24 (0.07–0.77) | 29 (39.2) | 45 (61.8) | 0.27 (0.14–0.52) | 0.27 (0.05–1.38) |
13–16 | 29 (22.3) | 101 (77.7) | 0.69 (0.39–1.23) | 0.44 (0.17–1.11) | 22 (14.7) | 128 (85.3) | 1.02 (0.53–1.95) | 0.90 (0.30–2.66) |
17–19 | 31 (16.7) | 155 (83.3) | 1 | 1 | 21 (14.9) | 120 (85.1) | 1 | 1 |
Grade | 85 | 292 | 72 | 293 | ||||
5–8 | 51 (28.5) | 128 (71.5) | 1 | 1 | 46 (24.2) | 144 (75.8) | 1 | 1 |
9-10 | 24 (17.1) | 116 (82.9) | 1.93 (1.12–3.33) | 0.62 (0.24–1.58) | 21 (14.8) | 121 (85.2) | 1.84 (1.04–3.25) | 1.63 (0.57–4.63) |
11-12 | 10 (17.2) | 48 (82.8) | 1.91 (0.89–4.07) | 0.56 (0.14–2.10) | 5 (15.2) | 28 (84.8) | 1.79 (0.65–4.90) | 0.84 (0.14–4.79) |
Father’s education | 85 | 292 | 72 | 293 | ||||
No formal education | 8 (30.8) | 18 (69.2) | 0.73 (0.30–1.79) | 3 (23.1) | 10 (76.9) | 0.64 (0.17–2.46) | 0.39 (0.06–2.47) | |
Read and write | 14 (15.4) | 77 (84.6) | 1.79 (0.93–3.47) | 22 (26.8) | 60 (73.2) | 0.53 (0.28–0.97) | 0.57 (0.18–1.73) | |
Primary school | 16 (23.2) | 53 (76.8) | 1.08 (0.56–2.07) | 15 (20.8) | 57 (79.2) | 0.73 (0.37–1.45) | 0.89 (0.27–2.91) | |
Secondary and above | 47 (24.6) | 144 (75.4) | 1 | 32 (16.2) | 166 (83.8) | 1 | 1 | |
Father’s occupation | 85 | 292 | 72 | 293 | ||||
Farmer | 13 (17.8) | 60 (82.2) | 1 | 7 (13.0) | 47 (87.0) | 1 | 1 | |
Government employee | 35 (22.6) | 120 (76.4) | 0.74 (0.36–1.50) | 21 (14.3) | 126 (85.7) | 0.89 (0.35–2.23) | 2.00 (0.42–9.53) | |
Merchant | 36 (25.7) | 104 (74.3) | 0.63 (0.31–1.27) | 43 (28.5) | 108 (71.5) | 0.37 (0.15–0.89) | 1.38 (0.36–5.20) | |
Others | 1 (11.1) | 8 (88.9) | 0.80 (0.57–1.12) | 1 (7.7) | 12 (92.3) | 0.53 (0.35–0.80) | 0.26 (0.01–4.16) | |
Mother’s occupation | 85 | 292 | 72 | 292 | ||||
Housewife | 37 (24.3) | 115 (75.7) | 1 | 26(16.7) | 130 (83.3) | 1 | 1 | |
Farmer | 4 (19.1) | 17 (80.9) | 1.37 (0.43–4.32) | 1 (7.1) | 13 (92.9) | 2.60(0.32–20.75) | 1.31 (0.11–15.72) | |
Government employee | 17 (21.3) | 63 (78.7) | 1.19 (0.62–2.29) | 11 (15.5) | 60 (84.5) | 1.09 (0.51–2.35) | 0.79 (0.25–2.47) | |
Merchant | 24 (20.5) | 93 (79.5) | 1.25 (0.69–2.23) | 33 (29.8) | 80 (70.2) | 0.47 (0.26–0.84) | 0.68 (0.27–1.69) | |
Others | 3 (42.9) | 4 (57.1) | 1.08 (0.89–1.29) | 1 (10.0) | 9 (90.0) | 0.73 (0.59–0.87) | 1.29 (0.14–11.19) | |
Shoe wearing | 85 | 292 | 72 | 293 | ||||
Some of the time | 17 (18.9) | 73 (81.1) | 1.47 (0.79–2.72) | 6 (17.1) | 29 (82.9) | 0.95 (0.37–2.42) | 1.19 (0.30–4.79) | |
Most of the time | 17 (19.5) | 70 (80.5) | 1.41 (0.76–2.61) | 19 (43.2) | 25 (56.8) | 0.26 (0.13–0.50) | 0.39 (0.12–1.27) | |
Always | 51 (25.5) | 149 (84.5) | 1 | 47 (16.4) | 239 (83.6) | 1 | 1 | |
Sources of family food | 85 | 292 | 72 | 293 | ||||
Grow their own | 18 (18.2) | 81 (81.8) | 1 | 8 (10.8) | 66 (89.2) | 1 | 1 | |
Buy/purchase | 65 (24.3) | 202 (75.7) | 0.69 (0.38–1.23) | 62 (22.2) | 217 (77.8) | 0.42 (0.19–0.93) | 0.55 (0.17–1.67) | |
Subsidies/food aid | 2 (18.2) | 9 (81.8) | 1.00 (0.19–5.02) | 2 (16.7) | 10 (83.3) | 0.61 (0.11–3.27) | 5.85 (0.33–101.37) | |
Fibre foods per week | 85 | 292 | 72 | 293 | ||||
None | 4 (16.7) | 20 (83.3) | 1 | 1 | 4 (13.8) | 25 (86.2) | 1 | 1 |
Once a week | 11 (13.3) | 72 (86.7) | 1.31 (0.37–4.55) | 0.68 (0.12–3.67) | 11 (18.0) | 50 (82.0) | 0.73 (0.21–2.52) | 0.53 (0.09–2.94) |
Twice in a week | 18 (25.4) | 53 (74.6) | 0.59 (0.17–1.95) | 0.24(0.04–1.27) | 8 (9.9) | 73 (90.1) | 1.460 (0.40–5.26) | 3.36 (0.50–22.24) |
Every other day | 11 (18.0) | 50 (82.0) | 0.91 (0.26–3.19) | 0.61(0.11–3.36) | 12 (25.5) | 35 (74.5) | 0.47 (0.13–1.61) | 0.73 (0.13–4.12) |
Every day | 27 (40.3) | 40 (59.7) | 0.29 (0.09–0.96) | 0.12 (0.02–0.64) | 28 (34.6) | 53 (65.4) | 0.30 (0.09–0.95) | 0.63 (0.12–3.11) |
Do not remember | 14 (19.7) | 57 (80.3) | 0.81 (0.24–2.76) | 0.55 (0.10–2.95) | 9 (13.6) | 57 (86.4) | 1.01 (0.28–3.60) | 1.55 (0.26–9.06) |
Animal food per week | 85 | 292 | 72 | 293 | ||||
None | 3 (9.1) | 31 (90.9) | 1 | 1 | 6 (28.6) | 15 (71.4) | 1 | |
Once a week | 38 (25.9) | 109 (84.1) | 0.28 (0.08–0.96) | 0.36 (0.08–1.58) | 20 (16.9) | 98 (73.1) | 1.96 (0.67–5.66) | |
Twice in a week | 16 (21.3) | 59 (78.7) | 0.36 (0.09–1.32) | 0.43 (0.09–2.09) | 20 (19.0) | 85 (81.0) | 1.70 (0.58–4.93) | |
Every other day | 8 (21.1) | 30 (78.9) | 0.36 (0.08–1.49) | 0.64 (0.11–3.61) | 9 (18.8) | 39 (81.2) | 1.73 (0.52–5.71) | |
Every day | 11 (26.2) | 31 (73.8) | 0.27 (0.06–1.07) | 0.74 (0.13–4.01) | 11 (26.8) | 30 (73.2) | 1.09 (0.33–3.52) | |
Do not remember | 9 (22.0) | 32 (78.0) | 0.34 (0.08–1.39) | 0.40 (0.07–2.23) | 6 (18.8) | 26 (81.2) | 1.73 (0.47–6.34) | |
Stool parasite | 82 | 272 | 63 | 267 | ||||
No | 30 (10.9) | 246 (89.1) | 0.06 (0.03–0.11) | 0.05 (0.02–0.09) | 13 (5.8) | 213 (94.2) | 0.07 (0.03–0.13) | 0.05 (0.01–0.11) |
Yes | 52 (66.7) | 26 (33.3) | 1 | 1 | 50 (48.1) | 54 (51.9) | 1 | 1 |
Malaria endemicity | 85 | 292 | 67 | 293 | ||||
Yes | 37 (20.1) | 147 (79.9) | 1.31 (0.80–2.13) | 27 (15.2) | 151 (84.8) | 1.77 (1.04–3.00) | 2.52 (1.12–5.62) | |
No | 48 (24.9) | 145 (75.1) | 1 | 45 (24.1) | 142 (75.9) | 1 | 1 | |
Start menstruating | 72 | 293 | ||||||
Yes | 57 (17.3) | 272 (82.7) | 1 | 1 | ||||
No | 15 (41.7) | 21 (58.3) | 0.29 (0.14–0.60) | 2.56 (0.53–12.28) |
The result of this study indicated that the overall prevalence of anemia among adolescents in the study areas was 21.1%. According to the WHO established criterion, this prevalence is of a moderate public health concern. The comparative assessment revealed that male adolescents (22.5%) were slightly more anemic than female (19.3%) adolescents. However, the difference was found to be not statistically significant. Another finding of a study conducted among adolescents in Wonago District, Gedeo Zone, Southern Ethiopia, found significantly higher prevalence of anemia among male adolescents (24.3%) than among female adolescents (18.1%) [
Regarding the overall prevalence, the result of this study revealed that the prevalence of anemia was comparable to the other studies in Ethiopia including those conducted in Wonago Town [
In the present study, the prevalence of anemia among adolescent males whose age 10–13 years is lower than the prevalence among adolescent males with an age group of 17–19 years. This study is not in agreement with another comparable study conducted in Wonago District, Gedeo Zone, which indicated anemia to be higher among early adolescent periods (10–13 years) compared to the late adolescent period (17–19 years) [
This study also revealed that adolescent males who eat fibre foods every day were less likely to develop anemia than adolescent males who eat none throughout the weeks. This finding is in line with the study done in Alexandria, Egypt, which reported high consumption of whole wheat bread and bread, low dietary intake of iron-rich foods, and low consumption of vitamin C rich foods to have a significant association with anemia [
Regarding the factors associated with anemia among adolescent females, those coming from where malaria was common in their area were more likely to develop anemia than adolescent females for whom malaria is not common in their area of residence. This is because malaria is a main cause of anemia in adolescents in Sub-Saharan Africa, and it behaves such as an endemic disease in some areas, such as Ethiopia. Malaria infection is associated with a reduction in haemoglobin levels by the destruction of red blood cells, frequently leading to anemia. This study also identified that the prevalence of anemia among female adolescents who had been infected with intestinal parasites was significantly higher compared to those not infected with intestinal parasites. A similar finding was reported from a study conducted in Siaya District, Kenya; female adolescents who were infected by worms were to develop anemia as opposed to those who did not have worm infestation [
The current study attemted to reveal the level of anemia among male and female adolescents employing a comparative cross-sectional study to have enough sample among the comparison groups. It also addressed a wide range of factors that are associated with anemia in both sexes. The measurement used to assess anemia using HemoCue Hb 301+machine is precise and accurate proxy indicator for anemia study. The limitation of this study was the exclusion of adolescents who are out of school. In addition, there could also be a social-desirability bias in dietary questions asked for food habit.
The prevalence of anemia was higher in male adolescent students than females. Age, the frequency of eating fibre foods, and intestinal parasites were significantly associated factors for anemia among male adolescents, and malaria endemicity and stool parasites were factors significantly associated with anemia among female adolescent students. Hence, nutrition programs focusing on anemia among adolescents should give due consideration for both sexes and male adolescents need to have more emphasis. Furthermore, stronger studies with better designs need to be conducted to confirm this finding and to come up with concrete evidence for policy making.
The data underlying this study are readily available and can be accessed as needed from the corresponding author.
The ethical clearance letter to conduct this study was obtained from the Institutional Review Board (IRB) of Dilla University, College of Health Sciences and Medicine. Permission to conduct the study was obtained from each school director’s office. The data collectors explained the objectives and benefits of the study for study participants to obtain informed written consent prior to data collection. The authors obtained written informed consent from 18- to 19-year-old study participants and assent from guardians of less than 18-year-old study participants. Participants confirmed as severe anemic and having an intestinal parasitic infection were linked to the nearby health facility.
There was no role of the funding body in designing, execution of the study, and writeup of the manuscript.
There are no conflicts of interest among the authors.
MB, MF, and SH conceived the idea, designed the methodology, analyzed data, interpreted the finding, and drafted the manuscript. AT participated in data analysis, interpretation, and manuscript writeup. All authors have read and approved the manuscript.
The authors are grateful to the Dilla University NORHED/SENUPH project for financial coverage and Gedeo Zone Education Office for their cooperation. Also, our heartfelt gratitude goes to supervisors, data collectors, and study participants. The funding for undertaking this study was obtained from the Dilla University NORHED/SENUPH project.