Severity and Determinants of Anemia Among Adolescent Girls in Africa: A Multicountry and Multilevel Analysis of 25 Countries.

BACKGROUND

Anemia remains a major public health concern in Africa, with substantial health and developmental consequences. Adolescents, particularly girls, are at increased risk due to rapid growth, menstruation, and inadequate dietary intake. Identifying the severity and determinants of anemia among adolescent girls in Africa is crucial for developing appropriate interventions, yet evidence remains scarce.

OBJECTIVE

To assess the severity and determinants of anemia among adolescent girls in Africa using nationally representative data.

METHODS

Data were obtained from the most recent Demographic and Health Surveys (DHS) of 25 African countries, including 41,662 adolescent girls aged 15-19 years. The severity of anemia was determined using descriptive statistics based on proportions. Anemia severity was modeled as a four-level ordinal outcome (none, mild, moderate, and severe) using survey-weighted multilevel ordinal (proportional-odds) logistic regression with a random intercept at the cluster level. Chi-square tests assessed initial associations, and adjusted odds ratios (AOR) with 95% confidence intervals (CI) were reported from the final model.

RESULTS

The overall magnitude of anemia among adolescent girls was 42.3% (95% CI: 41.96-44.20). In the multivariable analysis, factors significantly associated with lower odds of anemia included primary education (AOR = 0.84; 95% CI: 0.75-0.94), secondary and above education (AOR = 0.86; 95% CI: 0.75-0.98), rich and richer wealth status (AOR = 0.77; 95% CI: 0.65-0.91), employment (0.86; 95% CI: 0.78-0.94), hormonal contraceptive use (AOR = 0.44; 95% CI: 0.38-0.51), parity (0.85; 95% CI: 0.76-0.95), and normal and overweight/obese nutritional status (AOR = 0.84; 95% CI:0.73-0.97 and AOR = 0.75; 95% CI: 0.62-0.91), respectively.

CONCLUSION

Anemia affects a substantial proportion of adolescent girls in Africa and is influenced by educational, economic, reproductive, and nutritional factors. Interventions should focus on keeping girls in school, encouraging employment opportunities, and maintaining healthy bodyweight. Addressing these determinants is vital for improving adolescent girls' health and achieving sustainable development goals.