Elsevier

Public Health

Volume 142, January 2017, Pages 159-166
Public Health

Original Research
Prevalence of iron-deficiency anaemia and risk factors in 1010 adolescent girls from rural Maharashtra, India: a cross-sectional survey

https://doi.org/10.1016/j.puhe.2016.07.010Get rights and content

Highlights

  • This cross-sectional survey from rural areas of Maharashtra state of India reported a very high prevalence of anaemia (87%) in adolescent girls.

  • Increase in age, low mid-upper arm circumference and low fruit intake showed highest risk of being diagnosed with anaemia.

  • There is an urgent need to evaluate current anaemia control strategies in rural areas of the state.

Abstract

Objective

Iron-deficiency anaemia (IDA) is the most common nutritional disorder observed in adolescent girls in India. Our aim was to investigate the prevalence and risk factors associated with IDA in rural Maharashtra, India, to address current evidence gaps.

Study design

Cross-sectional survey.

Methods

The study recruited 13- to 17-year-old adolescent girls living in 34 villages of Osmanabad district. Data were collected on individual health, dietary, sociodemographic factors, and anthropometric measurements were taken. Haemoglobin (Hb) levels were measured using Sahli's haemometer. Logistic and linear regressions were used to identify risk factors associated with IDA and Hb levels, respectively.

Results

Among 1010 adolescent girls (response rate 97.5%), the mean Hb was 10.1 g/dl (standard deviation = 1.3), and 87% had anaemia (Hb < 12 g/dl). The prevalence of mild (11.0–11.9 g/dl), moderate (8.0–10.9 g/dl) and severe (Hb ≤ 7.9 g/dl) anaemia was 17%, 65% and 5%, respectively. Anaemia likelihood increased significantly with age (odds ratio (OR): 1.41 per year, 95% confidence interval (CI): 1.17–1.70). Factors associated with decreased anaemia risk were mid-upper arm circumference (MUAC) ≥22 cm (OR: 0.51, 95% CI: 0.31–0.82), ≥3 days/week consumption of fruit (OR: 0.35, 95% CI: 0.23–0.54) or rice (OR: 0.39, 95% CI: 0.17–0.91), and incomplete schooling (OR: 0.47, 95% CI: 0.24–0.91). In the final model lower age, MUAC and fruit consumption were significantly associated with Hb level.

Conclusion

Anaemia prevalence was extremely high among adolescent girls in rural areas of Maharashtra. Whilst we identified risk factors that could be used for targeting interventions, there is urgent need of comprehensive preventative interventions for the whole adolescent girl population.

Introduction

Iron-deficiency anaemia (IDA) is the most common nutritional disorder observed in India particularly in under-five year old children, adolescent girls and pregnant women.1 About 56% of adolescent girls in India are affected by IDA.1, 2 During adolescence, IDA may lead to growth retardation, impaired physical and mental development and poorer reproductive outcomes continuing through childbearing years; thus, it is a serious public health issue in the country.3, 4 The government has emphasized the need for education programmes and national iron supplementation initiatives for adolescent girls. However, practical implementation has revealed important health services and infrastructural issues as well as inadequate iron tablet supplies for young girls; as a result, IDA prevalence remains much higher than predicted targets.3, 4

One of the largest surveys of adolescent girls reported an overall anaemia prevalence of 89% with substantial regional variation.5 This survey was described to be nationally representative and reported higher prevalence in older girls (15–19 years). Studies published in the past 10 years from Maharashtra state of India reported 40%–65% anaemia prevalence in western Maharashtra6, 7 and 35%–40% in eastern Maharashtra8 with a higher prevalence in deprived areas (up to 90%).9 However, evidence from central Maharashtra (the Marathwada region) is limited to a 2012 study of 385 adolescent girls, which reported 68% anaemia and assessed dietary preference, parents' education and menarche in addition to factors studied in the national survey.2

There are no published studies from rural areas particularly in the Marathwada region on anaemia prevalence in adolescent girls, and there is limited evidence on their sociodemographic, dietary and medical risk factors. Therefore, we conducted a cross-sectional study of 1010 adolescent girls; the first conducted in the Osmanabad district and largest from rural areas of Maharashtra state, India.

Section snippets

Study context

The Maharashtra Anaemia Study (MAS) was a joint collaboration between the Halo Medical Foundation (HMF), India, and the University of Nottingham, UK. The cross-sectional study was conducted to investigate anaemia prevalence in adolescent girls and associated risk factors in villages of Marathwada region of Maharashtra state. The target population was all unmarried girls aged 13–17 years from 34 villages (total population: 60,921) in the Tuljapur and Lohara blocks of Osmanabad district. We

Results

We approached 1035 adolescent girls from 34 villages, of which only 25 (2%) did not participate in full data collection (Fig. 2). Villages from the project had similar social and health infrastructure; all villages had government nurses [however, most of them were visiting only once a month (N = 29)], few had government health centres (N = 9), and only one had an established primary health centre (PHC). None had a centralized water purification facility, and all had limited private transport

Discussion

To our knowledge, this is the largest study from Marathwada region of the state where findings from a large representative rural adolescent population are presented. The prevalence of anaemia in adolescent girls in our study area of rural Maharashtra was extremely high (87%) with the majority of participants having moderate anaemia (65%).

Acknowledgements

The authors acknowledge the support of Ms Sandhya Rankhamb in data collection, data entry, verification, and recognize her contribution in the project. The authors thank HMF village health workers for providing field level support for this study. The authors dedicate our research to Dr Sulbha Hardikar and Professor (Mr) and Mrs Chawathe who supported the project and the PhD studies, respectively.

Ethical approval

The study was approved by the Institutional Ethics Committee of the Government Medical College

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