Anemia remains a formidable public health challenge worldwide, disproportionately affecting low- and middle-income countries. Among vulnerable groups, adolescent girls constitute a particularly high-risk population due to rapid physical growth, menstrual blood loss, and increased iron requirements during puberty. The World Health Organization (WHO) estimates that over 30% of adolescent girls globally are anemic, with the burden significantly higher in rural and resource-constrained settings [1]. In India, despite the implementation of national programs the prevalence of anemia among adolescent girls remains alarmingly high, ranging from 40% to 80% across various regions [2].

Adolescence, defined by WHO as the age between 10 to 19 years, is a critical phase marked by substantial physiological and psychosocial development [3]. During this period, nutritional demands increase sharply to support growth spurts, onset of menarche, and cognitive maturation. However, rural adolescent girls often experience inadequate dietary intake, gender-based disparities in food distribution, early marriage, limited access to health services, and poor menstrual hygiene practices, all of which contribute to the high prevalence of anemia [4]. Moreover, infectious diseases such as hookworm infestations and malaria, coupled with poor sanitation and limited health literacy, further exacerbate iron deficiency in these populations [5].

From a public health standpoint, anemia during adolescence has profound implications. It adversely affects school attendance, concentration, physical stamina, and future maternal health outcomes, including increased risks of low birth weight, preterm birth, and maternal morbidity when these girls enter reproductive age [6]. Addressing anemia during adolescence offers a window of opportunity to break the intergenerational cycle of malnutrition and to lay the foundation for a healthier reproductive life.

Current literature has identified several determinants of anemia in adolescent girls, including socio-demographic factors (age, education, family income), dietary habits (vegetarianism, intake of green leafy vegetables, meal frequency), menstrual patterns, body mass index (BMI), and hygiene practices [7]. However, most studies are either hospital-based or urban-centric, with limited data from rural community settings where healthcare access and health-seeking behaviors differ significantly.

Given this background, it becomes imperative to generate robust, community-based epidemiological data specific to rural adolescent girls. Identifying not only the prevalence but also the contextual determinants of anemia can inform targeted, culturally sensitive interventions. The current study aims to bridge this evidence gap by estimating the prevalence of anemia and exploring its associated factors in young girls.

This community-based cross-sectional study was conducted in the rural field practice area of the Department of Community Medicine, Kamineni Academy of Medical Sciences and Research Centre, between June 2024 and May 2025. The region predominantly comprises agrarian households, with limited access to advanced healthcare facilities, and represents a typical rural Indian demographic setting.

Study Population and Sample Size

Young girls aged between 10 and 18 years residing in the selected rural areas were selected for the study. Those with known hematological disorders (such as thalassemia, sickle cell anemia), on iron therapy for more than three months, or who declined consent were excluded.

Assuming a prevalence of anemia among rural adolescent girls to be 50% (as per NFHS-5 data), with a 95% confidence level and 8% absolute precision, the sample size was estimated of around 165 (considering a 10% non-response rate). Participants were selected using systematic random sampling from household registers maintained by Accredited Social Health Activists (ASHAs).

Data Collection Tools and Techniques

Data were collected using a pre-tested, semi-structured questionnaire covering:

• Socio-demographic data (age, education, socioeconomic status, family type)
• Dietary practices (meal frequency, iron-rich food intake, tea consumption, vegetarian/non-vegetarian diet)
• Menstrual history (age at menarche, cycle regularity, duration, flow)
• Personal hygiene and deworming status
• Awareness and compliance with Iron-Folic Acid (IFA) supplementation

Anthropometric measurements (height and weight) were recorded using standardized methods. Body Mass Index (BMI) was calculated and categorized based on WHO growth standards.

Hemoglobin estimation was performed using a portable HemoCue analyzer (Hb 301 System), with capillary blood obtained by finger prick under aseptic conditions. Anemia was classified according to WHO guidelines for adolescent girls:

• Mild: 11.0–11.9 g/dL
• Moderate: 8.0–10.9 g/dL
• Severe: <8.0 g/dL

Ethical Considerations

Ethical clearance was obtained from the Institutional Ethics Committee. Written informed assent and parental consent were obtained for participants below 18 years. Anemic individuals were referred to nearby health centers for appropriate management.

Statistical Analysis

Data were entered in Microsoft Excel 2019 and analyzed using SPSS version 26. Descriptive statistics (mean, standard deviation, frequency, percentage) were used to summarize data. Chi-square test was applied to identify associations between categorical variables. Multivariate logistic regression analysis was performed to determine significant predictors of anemia. A p-value of <0.05 was considered statistically significant. Adjusted Odds Ratios (AOR) and 95% Confidence Intervals (CI) were reported for independent determinants.

Table 1 – Demographic Characteristics of Participants

Table 2 – Prevalence and Severity of Anemia

Table 3 – Dietary and Menstrual Characteristics

Table 4 – Bivariate Analysis of Anemia with Key Variables

Table 5 – Logistic Regression Analysis for Determinants of Anemia

Out of 165 adolescent girls surveyed, 99 (60.0%) were found to be anemic, indicating a high community prevalence. The most common category was moderate anemia, affecting 45 girls (27.3%), followed by mild anemia in 41 (24.8%) and severe anemia in 13 (7.9%). Only 66 participants (40.0%) had normal hemoglobin levels (Table 2, Figure 1).

Dietary habits emerged as significant determinants. Girls consuming green leafy vegetables daily had a markedly lower anemia prevalence (48.5%) compared to those who did not (71.1%), with a statistically significant association (χ² = 6.82, p = 0.009) (Table 4). Similarly, those consuming ≥3 meals daily showed lower anemia rates (50.0%) than those eating less frequently (69.3%) (χ² = 4.35, p = 0.037). Menstrual irregularity was also associated with higher anemia prevalence (75.0% vs. 54.1%; χ² = 5.91, p = 0.015).

Multivariate logistic regression revealed three independent predictors. Inadequate intake of leafy vegetables increased the risk of anemia nearly threefold (AOR = 2.9, 95% CI: 1.4–6.1, p = 0.004). Meal frequency less than three times per day had an adjusted odds ratio of 2.1 (95% CI: 1.1–4.3, p = 0.026), while irregular menstruation was also a strong determinant (AOR = 2.7, 95% CI: 1.3–5.6, p = 0.007) (Table 5).

These findings indicate that modifiable factors such as dietary diversity and menstrual health play a significant role in anemia prevalence. The high rates of moderate and severe anemia underscore the need for targeted interventions in rural adolescent populations.

Anemia among adolescent girls is on the rise at an alarming rate, especially in rural India, where nutritional deficiencies and menstrual morbidities are common. The present study, conducted in a rural setting, identified a high prevalence of anemia (60.0%) among adolescent girls, with moderate anemia being the most frequent category (27.3%). These findings align with those reported by Toteja et al. [9], who observed a prevalence of 59.8% among rural adolescent girls in India.

The primary rationale for this study was to generate context-specific data to address gaps in anemia control efforts. Despite national programs like Anemia Mukt Bharat, local implementation remains challenged by dietary insufficiencies, sociocultural taboos, and poor menstrual hygiene—issues that are often magnified in rural populations.

Comparison with other studies supports our findings. In a community-based study in Maharashtra, Kotecha et al. [10] reported an anemia prevalence of 65.1%, highlighting similar determinants such as irregular menstruation and poor iron intake. Our study also identified daily non-consumption of green leafy vegetables as a significant risk factor. Among those not consuming these vegetables daily, 71.1% were anemic, compared to 48.5% among regular consumers (p = 0.009). This echoes the observations of Pasricha et al. [11], who emphasized the role of iron-rich dietary components in preventing adolescent anemia.

Meal frequency was another critical factor. Girls consuming fewer than three meals per day had significantly higher anemia prevalence (69.3%) compared to those consuming more frequent meals (50.0%). This supports findings by Choudhary et al. [12], who reported that low meal frequency doubled the risk of anemia (OR = 2.1), similar to our adjusted OR of 2.1 (95% CI: 1.1–4.3, p = 0.026).

Menstrual health also played a key role. Our study found that girls with irregular menstruation had a significantly higher anemia prevalence (75.0%) compared to those with regular cycles (54.1%), a trend supported by Kaur et al. [13], who observed irregular cycles as an independent risk factor with OR = 2.8.

Clinically, these findings are relevant because adolescent anemia not only compromises immediate cognitive and physical development but also leads to long-term reproductive risks. Bharti et al. [14] demonstrated that adolescent anemia was associated with a 2.5-fold increased risk of low birth weight in future pregnancies, emphasizing the need for early interventions.

This study highlights a substantial prevalence (60%) of anemia among adolescent girls in rural areas, with a significant proportion affected by moderate to severe forms. Inadequate consumption of green leafy vegetables, low meal frequency, and irregular menstrual cycles emerged as key determinants. The findings underscore the urgent need for targeted, community-level interventions focusing on nutrition education, dietary diversification, and menstrual health awareness. Strengthening school-based screening and ensuring regular Iron-Folic Acid (IFA) supplementation could serve as practical measures in reducing anemia burden in this vulnerable group. Addressing these modifiable risk factors during adolescence offers a crucial opportunity to improve long-term reproductive health and break the intergenerational cycle of malnutrition. Future research should incorporate biochemical markers and longitudinal designs to further validate causal pathways. A coordinated approach involving families, schools, health workers, and policymakers is essential to achieve the anemia reduction targets outlined in national and global health agendas.

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