Prevalence And Determinants of Anemia Among Adolescents in Coimbatore District, Tamil Nadu – A School Based Analytical Cross-Sectional Study
Keywords:Adolescence, Anemia, predictors, India
Context: The objective of the study was to estimate the prevalence of anemia among adolescents 10 to 19 years of age disaggregated by age group and gender. We also assessed the determinants of anemia among adolescents.
Methods: An analytical cross-sectional study was carried out between July and November 2019 in a senior secondary public school, located in Coimbatore district, Tamil Nadu, India using a predesigned, semi-structured, pretested proforma that included haemoglobin estimation using oxyhemoglobin method.
Results: The overall prevalence of anemia was 88.6% (95% CI 87.2 to 89.8); it was ten percent points higher in females (93.8%, 95% CI 92.1 to 95.1) compared to males (83.9%, 95% CI 81.7 to 85.8). Multivariate regression analysis showed that early adolescents (AOR 3.05, 95% CI 2.19 to 4.24), females (AOR 6.94, 95% CI 4.90 to 9.83), those with A or B or AB blood groups (AOR 2.58, 95% CI 1.92 to 3.49), physical inactivity (AOR 2.18, 95% CI 1.43 to 3.33) and attainment of menarche (AOR 2.69, 95% CI 1.73 to 4.21) were independent predictors of anemia in adolescents.
Conclusion: It is the need of the hour to identify vulnerable groups; factors that predict occurrence, prioritize them to design and implement an effective public health action. Also, the effectiveness of existing strategies in the form of periodic deworming, Iron and Folic acid tablets (IFA) should be reassessed.
World Health Organization. Adolescent health and development. Accessed 11 August, 2022. https://www.who.int/news-room/questions-and-answers/item/adolescent-health-and-development
World Health Organization. Adolescent health. Accessed 11 August, 2022. https://www.who.int/westernpacific/health-topics/adolescent-health
UNICEF. Adolescents. Accessed 11 August, 2022. https://data.unicef.org/topic/adolescents/overview/
United Nations. World Population Prospects 2019. Accessed 11 August, 2022. https://population.un.org/wpp/Publications/Files/WPP2019_Highlights.pdf
Kumar MM, Karpaga PP, Panigrahi SK, Raj U, Pathak VK. Impact of COVID-19 pandemic on adolescent health in India. J Family Med Prim Care. Nov 2020;9(11):5484-5489. Doi: https://doi.org/10.4103/jfmpc.jfmpc_1266_20 PMid:33532383 PMCid:PMC7842466
Ministry of Health and Family Welfare. National Family Health Survey (NFHS - 5), 2019-21. Accessed 11 August, 2022. https://dhsprogram.com/pubs/pdf/FR375/FR375.pdf
Miller JL. Iron deficiency anemia: a common and curable disease. Cold Spring Harb Perspect Med. Jul 1 2013;3(7) Doi: https://doi.org/10.1101/cshperspect.a011866 PMid:23613366 PMCid:PMC3685880
Haas JD, Brownlie TIV. Iron Deficiency and Reduced Work Capacity: A Critical Review of the Research to Determine a Causal Relationship. The Journal of Nutrition. 2001;131(2):676S-690S. Doi: https://doi.org/10.1093/jn/131.2.676S PMid:11160598
Figueiredo A, Gomes-Filho IS, Silva RB, et al. Maternal Anemia and Low Birth Weight: A Systematic Review and Meta-Analysis. Nutrients. May 12 2018;10(5) Doi: https://doi.org/10.3390/nu10050601 PMid:29757207 PMCid:PMC5986481
Kidanto HL, Mogren I, Lindmark G, Massawe S, Nystrom L. Risks for preterm delivery and low birth weight are independently increased by severity of maternal anaemia. S Afr Med J. Feb 2009;99(2):98-102.
Habtegiorgis SD, Petrucka P, Telayneh AT, et al. Prevalence and associated factors of anemia among adolescent girls in Ethiopia: A systematic review and meta-analysis. Plos One. 2022;17(3):e0264063. Doi: https://doi.org/10.1371/journal.pone.0264063 PMid:35324901 PMCid:PMC8947116
Meier PR, Nickerson HJ, Olson KA, Berg RL, Meyer JA. Prevention of iron deficiency anemia in adolescent and adult pregnancies. Clinical medicine & research. 2003;1(1):29-36. Doi: https://doi.org/10.3121/cmr.1.1.29 PMid:15931282 PMCid:PMC1069018
NITI Aayog. Anemia Alert: Is the Government Aiming for Cost-Effective interventions? Accessed 11 August, 2022. https://www.niti.gov.in/anemia-alert-government-aiming-cost-effective-interventions
Plessow R, Arora NK, Brunner B, et al. Social Costs of Iron Deficiency Anemia in 6-59-Month-Old Children in India. PLoS One. 2015;10(8):e0136581. Doi: https://doi.org/10.1371/journal.pone.0136581 PMid:26313356 PMCid:PMC4552473
Ministry of Health and Family Welfare. Comprehensive National Nutrition Survey, 2016-2018. Accessed 11 August, 2022. https://nhm.gov.in/WriteReadData/l892s/1405796031571201348.pdf
Ministry of Health and Family Welfare. National Family Health Survey (NFHS-4), 2015-16. Accessed 11 August, 2022. http://rchiips.org/nfhs/NFHS-4Reports/India.pdf
De Onis M, Onyango AW. WHO child growth standards. The Lancet. 2008;371(9608):204. Doi: https://doi.org/10.1016/S0140-6736(08)60131-2 PMid:18207015
Whitehead RD, Jr., Mei Z, Mapango C, Jefferds MED. Methods and analyzers for hemoglobin measurement in clinical laboratories and field settings. Ann N Y Acad Sci. Aug 2019;1450(1):147-171. Doi: https://doi.org/10.1111/nyas.14124 PMid:31162693 PMCid:PMC6709845
Reproductive and Child Health Division, Ministry of Health and Family Welfare. Anemia Mukt Bharat - Training toolkit. Accessed 22 December, 2022. https://anemiamuktbharat.info/wp-content/uploads/2019/11/English_Anemia-Mukt-Bharat-Training-Modules-Folder_Lowress.pdf
Tennant PWG, Murray EJ, Arnold KF, et al. Use of directed acyclic graphs (DAGs) to identify confounders in applied health research: review and recommendations. Int J Epidemiol. May 17 2021;50(2):620-632. Doi: https://doi.org/10.1093/ije/dyaa213 PMid:33330936 PMCid:PMC8128477
Chandrakumari AS, Sinha P, Singaravelu S, Jaikumar S. Prevalence of Anemia Among Adolescent Girls in a Rural Area of Tamil Nadu, India. J Family Med Prim Care. Apr 2019;8(4):1414-1417. Doi: https://doi.org/10.4103/jfmpc.jfmpc_140_19 PMid:31143731 PMCid:PMC6510068
Premalatha T, Valarmathi S, Srijayanth P, Sundar JS, Kalpana S. Prevalence of anemia and its associated factors among adolescent school girls in Chennai, Tamil Nadu, India. Epidemiology: Open Access. 2012;2(2):1-4.
Thyagarajan I, Kanvinde H, Shroff S, Sahi M. Organ donation and the medicolegal aspects: A process analysis study of the Indian States - Observational study. Original Article. International Journal of Nutrition, Pharmacology, Neurological Diseases. April 1, 2011 2011;1(2):184-188. Doi: https://doi.org/10.4103/ijot.ijot_59_21
Addo OY, Yu EX, Williams AM, et al. Evaluation of Hemoglobin Cutoff Levels to Define Anemia Among Healthy Individuals. JAMA Netw Open. Aug 2 2021;4(8):e2119123. Doi: https://doi.org/10.1001/jamanetworkopen.2021.19123 PMid:34357395 PMCid:PMC8346941
Sachdev HS, Porwal A, Acharya R, et al. Haemoglobin thresholds to define anaemia in a national sample of healthy children and adolescents aged 1–19 years in India: a population-based study. The Lancet Global Health. 2021;9(6):e822-e831. Doi: https://doi.org/10.1016/S2214-109X(21)00077-2 PMid:33872581
Siva PM, Sobha A, Manjula VD. Prevalence of Anaemia and Its Associated Risk Factors Among Adolescent Girls of Central Kerala. J Clin Diagn Res. Nov 2016;10(11):Lc19-lc23. Doi: https://doi.org/10.7860/JCDR/2016/20939.8938 PMid:28050409 PMCid:PMC5198362
Christu Rajan VX, Sivamani M, Appalaraju B. Prevalence and the factors influencing soil-transmitted helminths among school age children (5-14 years age) in a rural area of Coimbatore district. Trop Parasitol. Jul-Dec 2020;10(2):74-78. Doi: https://doi.org/10.4103/tp.TP_33_19 PMid:33747872 PMCid:PMC7951075
Chelkeba L, Mekonnen Z, Emana D, Jimma W, Melaku T. Prevalence of soil-transmitted helminths infections among preschool and school-age children in Ethiopia: a systematic review and meta-analysis. Global Health Research and Policy. 2022/03/21 2022;7(1):9. Doi: https://doi.org/10.1186/s41256-022-00239-1 PMid:35307028 PMCid:PMC8935818
Ministry of Health and Family Welfare. National Deworming Day, Operational guidelines. Accessed 11 August, 2022. https://nhm.gov.in/images/pdf/NDD/Guidelines/NDD_Operational_Guidelines.pdf
Deivita Y, Syafruddin S, Andi Nilawati U, Aminuddin A, Burhanuddin B, Zahir Z. Overview of Anemia; risk factors and solution offering. Gaceta Sanitaria. 2021/01/01/ 2021;35:S235-S241. Doi: https://doi.org/10.1016/j.gaceta.2021.07.034 PMid:34929820
Moschonis G, Papandreou D, Mavrogianni C, et al. Association of iron depletion with menstruation and dietary intake indices in pubertal girls: the healthy growth study. Biomed Res Int. 2013;2013:423263. Doi: https://doi.org/10.1155/2013/423263 PMid:24455693 PMCid:PMC3885188
Basak AK, Maji K. Blood group and anemia: Exploring a new relationship. Journal of Public Health and Epidemiology. 2013;5(1):43-45.
Kwenti TE, Kwenti TD. Anaemia and its association with month and blood phenotype in blood donors in Fako division, Cameroon. BMC Hematol. 2016;16:29. Doi: https://doi.org/10.1186/s12878-016-0070-8 PMid:27933177 PMCid:PMC5126878
Haryono I, Zaskia R, Lembar S. Association between Physical Activity Level and Hemoglobin Concentration in Male College Students. Journal of Anthropology of Sport and Physical Education. 04/14 2020;4:47-50. Doi: https://doi.org/10.26773/jaspe.200409
Jannah K. The effect of jogging exercise to improve hemoglobin levels. IOP Publishing; 2020:012028. Doi: https://doi.org/10.1088/1742-6596/1481/1/012028
Bhusal P, Timilsina S, Sharma D. Effect of 30 minutes brisk walking on hemoglobin concentration and leukocyte count. Int J Health Sci Res. 2017;7:70-73.
Education Mo. Dropout Rates in Government and Private Schools, 2019-20. Accessed 12 August, 2022. http://22.214.171.124/loksabhaquestions/annex/176/AU2108.pdf
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