Prevalence and factors associated with anaemia among adolescents in Sub-Saharan Africa and India

Anaemia remains a major global health concern among adolescents. While regional and national studies report varying prevalence, cross-continental evidence is limited. This study examines anaemia prevalence and its determinants among adolescents in Sub-Saharan Africa and India. We analyzed cross-sectional data from 9,820 adolescents (10-19 years) in Burkina Faso, Ethiopia, Ghana, India, Nigeria, Tanzania, and Uganda. Hemoglobin levels were measured using a finger-prick capillary blood and a portable HemoCue device, with anaemia defined according to the World Health Organization's age- and sex-specific cutoffs. Multivariable logistic regression was used to identify factors associated with anaemia. The sample comprised 51.5% females; 56.8% had ≥ 7 years of education, and 91.5% were literate. The mean age was 14.2 years (SD ± 2.7), with 52.8% aged 10-14 years. Overall, anaemia prevalence was 42.0% (95% CI: 40.9-43.1), including 3.9% with severe anaemia. Prevalence varied substantially by country; lowest in Ethiopia (4.9%) and highest in Ghana (73.6%). While the prevalence of anaemia across Sub-Saharan African countries was 43.9%, it was 31% in India. Overall, female adolescents had 15% higher odds of anaemia than males (adjusted odds ratio [aOR] 1.15; 95% CI: 1.04-1.28), while older adolescents 15-19 years had lower odds compared with younger adolescents 10-14 years (aOR 0.87; 95% CI: 0.69-0.94). Adolescents with normal (aOR 0.76; 95%CI: 0.64-0.90) and overweight (aOR 0.79; 95%CI: 0.63-0.97) body mass index (BMI) had lower odds of anaemia than their underweight counterparts. Consumption of eggs and legumes was protective, and residing in Ghana was associated with doubled odds of anaemia (aOR 2.21; 95%CI: 1.74-2.80). Anaemia remains highly prevalent among adolescents in Sub-Saharan Africa and India, particularly among females. Protective correlation of consuming eggs and legumes highlights the potential of targeted feeding interventions. The higher prevalence in younger adolescents underscore the need for age-specific strategies to combat adolescent anaemia. Additionally, underweight status is a risk factor for anaemia; thus, nutrition literacy intervention is imperative for improved nutritional status to reduce adolescent anaemia.