European Journal of Cardiovascular Medicine

Iron deficiency anemia (IDA) is the most widespread nutritional deficiency globally, particularly affecting women and children in developing nations (1). Adolescents, especially girls, are at high risk due to rapid growth spurts, increased iron demands during puberty, poor dietary intake, and menstrual blood loss (2). In India, the burden of anemia among adolescent girls is alarmingly high, contributing significantly to morbidity and impaired cognitive and physical development (3).

According to the National Family Health Survey (NFHS-5), over 59.1% of Indian adolescent girls aged 15–19 years were anemic, with even higher prevalence observed in rural areas (4). The etiology of anemia in this age group is often multifactorial, involving nutritional inadequacies, parasitic infections, and socioeconomic disparities (5). Poverty, limited access to healthcare, poor dietary diversity, and low maternal education are known determinants that exacerbate the problem in rural populations (6,7).

Despite national programs such as the Weekly Iron and Folic Acid Supplementation (WIFS) and the Anemia Mukt Bharat initiative, the progress in combating anemia has been suboptimal, particularly in underserved rural regions (8). There is a critical need to assess not only the prevalence but also the underlying social and economic contributors to anemia in these vulnerable groups.

This study aims to estimate the prevalence of iron deficiency anemia among adolescent girls in rural India and examine the influence of socioeconomic factors contributing to the condition

Study Design and Setting:
The study included adolescent girls aged between 10 to 19 years who were residents of the selected villages for at least six months. Girls with known chronic illnesses, current iron supplementation, or unwilling to provide informed consent were excluded from the study.

Data Collection Tools and Procedure:
A pre-tested and semi-structured questionnaire was used to collect data on sociodemographic factors, dietary habits, menstrual history, and access to healthcare. The questionnaire was developed in English and translated into the local language for field use. Trained female health workers conducted face-to-face interviews after obtaining written informed assent and parental consent for minors.

Hemoglobin Estimation:
Capillary blood samples were collected under aseptic conditions, and hemoglobin levels were estimated using Sahli’s hemoglobinometer at local primary health centers. Based on WHO guidelines, anemia was classified as mild (11.0–11.9 g/dL), moderate (8.0–10.9 g/dL), or severe (<8.0 g/dL).

Socioeconomic Assessment:
Socioeconomic status was assessed using a modified B.G. Prasad classification, which considers per capita monthly income. Additional factors such as parental education, occupation, and household size were also evaluated.

Data Analysis:
Data were entered and analyzed using SPSS version 25. Descriptive statistics were used to summarize baseline characteristics. Chi-square tests were applied to assess associations between anemia and categorical variables. Logistic regression was performed to identify independent predictors of anemia, with p-values less than 0.05 considered statistically significant.

A total of 400 adolescent girls participated in the study, with a mean age of 15.2 ± 2.1 years. The overall prevalence of iron deficiency anemia among the participants was 62.5% (n=250). Of these, 40% (n=100) had mild anemia, 18% (n=72) had moderate anemia, and 4.5% (n=18) had severe anemia as per WHO classification.

Sociodemographic Characteristics
Table 1 presents the baseline demographic and socioeconomic characteristics of the study participants. A majority of the girls (67%) belonged to families with a monthly income below INR 5,000. Approximately 42% of the mothers were illiterate, and 38% of the fathers were involved in unskilled labor. Most girls (76%) reported consuming a cereal-dominated diet, with limited intake of green leafy vegetables and iron-rich foods.

Table 1: Sociodemographic Profile of Study Participants (n=400)

Association between Anemia and Socioeconomic Variables
Table 2 illustrates the association between anemia prevalence and selected socioeconomic variables. A significant association was found between anemia and low monthly family income (p<0.01), maternal illiteracy (p=0.02), and poor dietary diversity (p<0.001). Logistic regression showed that girls from low-income families were 2.8 times more likely to be anemic (OR=2.8, 95% CI: 1.9–4.1).

Table 2: Association of Anemia with Socioeconomic Variables

As observed in Table 2, anemia was more prevalent among participants from economically disadvantaged backgrounds and households with lower educational status of mothers. Poor dietary diversity emerged as the strongest determinant, with the highest percentage of anemic girls (85.6%) in this category.

The present study reveals a high prevalence of iron deficiency anemia (IDA) among adolescent girls in rural India, with 62.5% of participants found to be anemic. This finding is consistent with previous national surveys and local studies, which have consistently reported anemia prevalence rates between 50–70% among this age group in similar settings (1,2). The high proportion of mild to moderate anemia observed mirrors the results of NFHS-5 and underscores the need for early screening and intervention (3).

Socioeconomic factors were found to significantly influence anemia prevalence. Girls from families with lower income had markedly higher odds of anemia, a trend also observed in previous research (4,5). Financial constraints often limit access to iron-rich foods and healthcare, contributing to poor nutritional status and delayed diagnosis or treatment of anemia (6). Maternal education emerged as another critical determinant. In our study, girls whose mothers were illiterate had significantly higher anemia rates, echoing studies that demonstrate how maternal literacy positively influences dietary practices and healthcare utilization (7,8).

Poor dietary diversity was strongly associated with increased anemia risk, with over 85% of anemic girls consuming ≤3 food groups regularly. Similar associations have been reported in studies from rural Maharashtra and Uttar Pradesh, where monotonous cereal-based diets lacking in heme iron and micronutrients were found to contribute to iron deficiency (9,10). This finding emphasizes the urgent need to incorporate nutrition education and community-based dietary interventions into anemia control programs.

Menstrual blood loss, although not directly measured in our study, has been widely reported as a contributing factor to anemia in adolescent girls due to cumulative iron depletion over time (11). Furthermore, parasitic infections, which are prevalent in rural areas, may exacerbate anemia by causing chronic blood loss and impairing nutrient absorption (12,13). These factors highlight the multifactorial nature of anemia and the importance of a holistic approach to prevention and management.

Despite national programs such as Anemia Mukt Bharat and the Weekly Iron and Folic Acid Supplementation (WIFS) initiative, anemia continues to be a major public health problem (14). Limited program coverage, irregular supplementation, poor compliance, and lack of community awareness may be responsible for the suboptimal impact of these efforts (15).

This study adds to the growing body of evidence that suggests a multidimensional strategy—combining nutrition supplementation, health education, maternal empowerment, and poverty alleviation—is essential to reduce the burden of anemia in adolescent girls. Community-based screening and school-based interventions could also be effective in identifying and managing at-risk individuals early.

However, this study has a few limitations. Being cross-sectional in nature, it cannot establish causality. Additionally, serum ferritin and other biochemical markers of iron status were not assessed, which may have led to underestimation or misclassification of anemia types. Future research should explore longitudinal outcomes and assess the effectiveness of integrated intervention models.

Iron deficiency anemia remains highly prevalent among adolescent girls in rural India, driven primarily by socioeconomic disparities, poor dietary diversity, and maternal illiteracy. Targeted interventions focusing on nutrition education, economic support, and maternal empowerment are essential to reduce the burden and improve adolescent health outcomes.

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