Factors associated with anemia among adolescent girls in Western India: insights from a multi-centric cross-sectional...

Anemia remains a persistent public health challenge among adolescent girls in India, with states like Gujarat continuing to report a high burden despite ongoing national nutrition and anemia control programs. Regional disparities, particularly across rural and tribal populations, further exacerbate the problem. This study aimed to estimate the prevalence of anemia among adolescent girls in Gujarat, India, and examine its sociodemographic, nutritional, behavioral, hematological, and biochemical associated factors.

A community-based, multi-centric cross-sectional study was conducted among 2,815 adolescent girls in ten purposively selected districts of Gujarat, representing rural, urban, and tribal settings. A multistage Probability Proportionate to Size sampling strategy was used. Data collection included structured interviews, anthropometric assessments, and venous blood sampling. Hematological parameters were analyzed using an automated six-part hematology analyzer, while biochemical markers-including iron profile, ferritin, vitamin B12, folate, albumin, prealbumin, and C-reactive protein (CRP)-were measured using standardized laboratory platforms. Anemia was defined according to World Health Organization criteria. Statistical analyses were performed using descriptive statistics and inferential tests with a significance level of p < 0.05.

The overall prevalence of anemia was 60.85%, with marked inter-district variation ranging from 42.37% to 75.00%. Mild anemia was most prevalent (33.46%), followed by moderate (25.04%) and severe anemia (2.34%). Anemia prevalence was significantly higher among tribal (73.57%) and rural (56.39%) adolescents compared to urban counterparts (48.19%) (p < 0.001). Socioeconomic disadvantage, lack of digital access, poor knowledge regarding anemia, and non-consumption of iron-folic acid (IFA) supplements were significantly associated with anemia. A strong inverse association was observed between anemia prevalence and knowledge scores (p < 0.001). Multivariate regression analysis demonstrated significant association between health insurance coverage and anemia prevalence (aOR = 1.15, p = 0.004). Biochemical analysis revealed significantly lower serum iron, ferritin, transferrin saturation, albumin, and prealbumin levels among anemic girls, alongside elevated total iron-binding capacity and CRP, indicating a predominance of iron deficiency anemia with an inflammatory component. Hemoglobinopathy screening identified beta-thalassemia trait (5.44%) and sickle cell trait (4.80%), highlighting regional genetic contributors.

Anemia was highly prevalent among adolescent girls in Gujarat, affecting 60.85% of participants, with higher burden observed in tribal and rural populations. Significant associations were identified with socioeconomic status, health insurance coverage, knowledge levels, and iron-folic acid supplementation. Biochemical findings indicated iron deficiency with an inflammatory component, and hemoglobinopathy traits were also present among a subset of participants. These findings highlight the multifactorial nature of anemia in the study population.