PREVALENCE AND SEVERITY OF ANEMIA AND ASSOCIATED FACTORS

PREVALENCE AND SEVERITY OF ANEMIA AND ASSOCIATED FACTORS AMONG SCHOOL ADOLESCENTS IN GEDEO ZONE WONAGO WOREDA, SNNPR, SOUTH ETHIOPIA MOHAMMED FEYISSO *, 13 -12 -2016 YOHANNES ADDISU 1

OUTLINE OF THE PRESENTATION • Background • Methods and Materials • Result and Discussion • Conclusion and recommendation • Acknowledgement • References 13 -12 -2016 2

Background • Adolescence is population of 10 -19 years of age (WHO, 1986) • a formative period of life characterized by rapid growth and development next to the period of infancy (Giuseppina D. , 2000) • an important physiological stage which offers the second and last chance for the catch up growth in life cycle (J. Beard, 2000) • Adolescents gain 30% of their adult weight and more than 20% of their adult height between 10 -19 years, which we call as growth spurt (Lal S. , 2007). • Such remarkable physical growth and development significantly increases needs for both macro and micronutrients (Soekarjo D. et al, 2005; ) • They constitute about 25% of the world population (Raju et. al, 2013) 13 -12 -2016

Background… § There is a dramatic increases in iron requirement among adolescents , both adolescent boys and girls, from preadolescence level of 0. 7 -0. 9 mg Fe/day to as much as 2. 2 mg Fe/day. This is due to ü expansion of total blood volume, ü increase in lean body mass ü the onset of menstruation in adolescent females, (J. Beard, 2000; Lal S, 2007). • In spite of increased iron needs, many adolescents, particularly females have iron intakes of only 10 -11 mg/day of total iron, resulting in approximately 1 mg of absorbed iron (T. Karine and F. F. Jennifer, 2007) 13 -12 -2016

Background… • About three fourths of adolescent females and 17% of males do not meet their dietary iron requirements which makes the adolescents vulnerable to development of anemia (Soekarjo D. , 2005; Lal S. , 2007 ) • There are limited studies done in different countries of the world on anemia among adolescents -showing high prevalence of anemia • In Ethiopia information regarding adolescents’ nutritional status in general and status of anemia in particular is substantially limited. • Hence this study was planned to delineate the burden of anemia among adolescents to put forward the need to develop pragmatic intervention programmes by providing data for policy makers, program planners, researchers and relevant stakeholders on adolescents 13 -12 -2016 5

Methodology • A school based descriptive cross-sectional study design was conducted among 443 adolescents from March 22 – April 28, 2016 • Sample size was determined usingle population proportion formula: n= z 2 p (1 -p)/d 2 • Blood test was measured by Portable hemoglobinometer (Hemo. Cue AB, Angelhom, Sweden) and anemia status was determined according to WHO standard for different age and each sex. • Weight and height was measured on a battery powered digital scale with height measurement board and the anthropometric indicator used in this study was BMI • For stool examination sample of feces were examined for the presence of geo-helminths • Written consent was obtained from the parent of each study subjects 6

Result and Discussion • From total 443 students expected to participate in the study about 424 (96%) responded for the enquiry. • More than half 247 (58. 3%) are male students and about 180 (42. 4%) of the participants are in middle adolescence period (14 - 16 years). • About 90% of the adolescents are from households with family size of five and above • In the school of about 245 (57. 8%) adolescent students, there is a regular feeding program for the last six month. • 248 (58. 5%) of the adolescents have at least one stool parasite • 22% of the adolescents were found to be anemic and about 85 (20%) of the adolescents are with severe chronic energy deficiency. 13 -12 -2016 7

Result and Discussion… Table 1: characteristics of respondents Gedeo Zone, Wonago Woreda, South Ethiopia, April 2016 S. No Characteristics Category Frequency Percentage 1 Age N=424 Early adolescence (10 -13) 173 40. 8 Middle adolescence (14 -16) 180 42. 4 Late adolescence (17 -19) 71 16. 7 Mean age 1. 13. 9± 2. 3 No 179 42. 2 Family size N=424 Four and below 43 10. 1 219 51. 7 162 38. 2 None 149 35. 1 Once 143 33. 7 93 21. 9 Three times or more 39 9. 2 Yes 163 38. 4 No 6. 57. 8 Twice 5. 245 Eight and above 4. Yes Five to seven 4 Regular food program in school (N=424) 261 61. 6 214 50. 5 Buy/purchase 189 44. 6 Subsidies/food aid 21 5. 0 Diet of animal origin per week (N=424) Tea consumption after meal (N=424) Sources of Family food need (N=424) Grow their own

Result and Discussion… Fig 1: Prevalence of Stool parasites among School adolescents in Gedeo Zone, Wonago Woreda, South Ethiopia, April 2016 13 -12 -2016 9

Result and Discussion… üAccording to WHO classification this is of moderate public health significance. The finding nearly comply with the study done among primary school (10 -14) adolescents in Eastern Ethiopia (23. 6%). üHigher than the study done in Southwest Ethiopia, Bonga town (15. 2%) (Tesfaye M. et al, 2015) and South East Ethiopia Filtu town (13. 6%) (Gutema B et al, 2014) üAlmost twice the national prevalence among youths (13. 7%) üMuch higher than study in Turkey, Denzil (5. 2%) (Balcı in Gedeo Fig 3: Anemia status of school adolescents YI et al, 2012) Zone, üBut much lower than South Ethiopia, April 2016 et Wonago Woreda, prevalence in India which range from 30%-90% (T Jain 10 al, 2012; Gupta D. et al, 2013 ; Kaur, 2011

Result and Discussion… • With this result adolescents in early period of adolescence were found to be about five times more likely to be anemic compared to older adolescents (AOR: 5. 557 (CI: 1. 435, 21. 523)) which relatively in agreement with many studies reported from other area ESWG, 2010; Shatha S et. al , 2002; Milman N, 2006. • Female adolescents were found to be less anemic when compared to male adolescents AOR: 0. 242, CI: (0. 080, 0. 738) and this result comply with finding from study conducted in Palestine, West bank (Mikki N, et. al, 2011). • However it is on contrary to many studies done elsewhere female adolescents are always more anemic (Sinha A, 2012; EDHS, 2011; Balci YI, 2012; Gupta D, 2013) 13 -12 -2016 11

Result and Discussion… • Probability of being anemic decrease by 85. 9% for adolescents from households with family size of < 4 when compared to those from >8 [AOR: 0. 141, CI (0. 025, 0. 787)] inline with studies done in different parts of the world including those in our country (Al-sharbatti SS, 2002; Tesfaye M, 2015). • Adolescents in lowest category according to wealth index classification were about 8 times more likely to be anemic [AOR: 7. 809 (1. 554, 39. 249)] and similar findings were obtained from Turkey (Balci YI, 2012), South West Ethiopia (Assefa S, 2014). • For adolescents whom their families meet their food need through purchasing the likelihood of anemia is about five times higher when compared to those whom their families meet food need by producing themselves (AOR: 4. 434 (1. 609, 12. 218). • Adolescents with severe chronic energy deficiency were also found to be 4 times more likely anemic as compared to normal adolescents (AOR: 4. 394 (CI: 1. 483, 13. 018)) 12

Result and Discussion… Zone, South Ethiopia Table 2: Predictors of anemia among school adolescents in Wonago Woreda, Gedeo S. No Characteristics Category Anemia Yes No COR (95% CI) AOR (95% CI) 1 Age (N= 424) Early adolescence (10 -13) 69 104 5. 225 (2. 357, 11. 583) 5. 557 (1. 435, 21. 523) Middle adolescence (14 -16) 15 165 0. 716 (0. 289, 1. 771 0. 441 (0. 106, 1. 838) Late adolescence (17 -19) 8 63 1 1 Male Female 60 32 187 145 1 0. 688(0. 425, 1. 112) 1 3 40 0. 640 (0. 179, 2. 292) 0. 242, (0. 080, . 738) 0. 141 (0. 025, 0. 787) Five to seven 72 147 4. 178 (2. 348, 7. 433) 1. 895 (0. 640, 5. 617) Eight and above Grow their own Purchase 17 24 64 145 190 125 1 1 0. 537 (0. 167, 1. 728) 1 1 Aid 4 17 2. 176 (0. 703, 6. 737) 0. 960 (0. 084, 10. 991) status Severe CED 40 45 8. 533 (4. 557, 15. 979) 4. 394 (1. 483, 13. 018) Moderate CED 15 33 4. 364 (2. 031, 9. 374) 1. 545 (0. 441, 5. 412) Mild CED 17 62 2. 632 (1. 298, 5. 339) 1. 161 (0. 341, 3. 953) 20 19 192 64 1 0. 946 (0. 443, 2. 023) 1 21 59 1. 135 (0. 536, 2. 403) 3. 571 (0. 799, 15. 965) Middle 8 68 0. 375 (0. 149, 0. 944) 0. 261 (0. 058, 1. 174) Fourth 18 78 0. 736 (0. 344, 1. 573) 4. 166 (0. 912, 19. 035) Highest 16 51 1 2 3 4 5 6 Sex (N= 424) Family size 424) (N= Four and below Family food source (N= 424) Nutritional (N= 424) Normal Wealth index (N= Lowest 424) Second 4. 434 (1. 609, 12. 218) 7. 809 (1. 554, 39. 249)

Conclusion and Recommendation • The prevalence of anemia is of moderate public health significance • About 50% of the adolescents are with mild to moderate chronic energy deficiency • Nutrition programs focusing on adolescents needs to be designed and work more to alleviate the problem of malnutrition including anemia among adolescents. • Special focus should be given for adolescents in early adolescence period and adolescents from low socioeconomic status. • Male adolescents should also get due emphasis. • Food production in Cash crop areas 14

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