Anaemia is a major public health concern for adolescent girls in developing countries, with negative implications for growth, birth outcomes, and long-term health. This study was designed to estimate the prevalence of anemia among adolescent girls in the Somalia region (a region known for food insecurity thus high rate of anemia). Also, the study attempted to identify factors associated with low haemoglobin concentration. The haemoglobin concentration was in the range of 7.3 g/dl to 18.1 g/dl, with a mean value of 12.3 ± 1.3 g/dl. Anemia was prevalent in 31.5% of the study participants.
Anemia prevalence in this study found was 31.5%, which this higher than the national average of about (18%) (Ethiopian notational micronutrient survey (2016), and (24%) (EDHS, (2016). but lower than the ENMNS (2016) finding in the Somali region which showed (34.8%). however, approximately similar to the report of the study in Babile District, Eastern Ethiopia where the prevalence of anemia among adolescent girls was 32% .
Increased family size may adversely affect the nutritional status of every member of the household, including adolescent girls, because it may be associated with decreased per capita human inputs. In other words, the allocation of food per household is likely to decrease with the increase in the family size, which, in turn, may adversely affect the nutritional status of adolescent girls. In line with this, the current study revealed that adolescent girls from family size ≥5 were approximately two times more likely to be anaemic [(AOR = 1.80), CI:(1.14, 2.85)] compared to those who from ≤5 people.
A survey study in Misamis oriental province has shown that reducing family size can be more effective in preventing nutritional problems among the high-risk group (pregnant women, children, and adolescent girls). The results indicate that decreases in family size will effectively improve the household’s level of living and the expected sequence of influence may be that: first, a decrease in the number of family size makes it more possible to buy adequate food; second, these foods have enough nutrient content that they meet the daily recommended dietary requirements; and third, when adequate nutritious foods are available, the good health of a family is improved .in line with this, the current study revealed s that adolescent girls from family size ≥5 people were approximately two times more likely to be anaemic [(AOR = 1.80), CI: (1.14, 2.85)] when we compared those who from l family that are < 5 people.
Somali region approximately 100% is exposed to Malaria (World Bank, (2006). Malaria has a range of manifestations but malaria-related anemia is one of the leading causes of death, with reproductive women and children being the most affected . Malaria infection causes anemia either in the early stage of infection, rupture of parasitized red blood or hypersplenism that result in clearance of both mature and not matured red blood cell , however, the current study doesn’t show a significant association b/n malaria and haemoglobin concentration of adolescent girls. The First reason, malaria infection was based on verbal history from participants rather than any test of blood and this might have masked the actual status of the respondents. The second reason, Somali region is a stable endemic malaria area (transmission of infection throughout the year) adolescent girls might develop high immunity.
Anemia was significantly associated level of knowledge of anemia among adolescent girls in this study. Adolescent girls who never heard anemia were 1.6 more likely to be anemic [AOR = 1.62), CI (1.01, 2.59)] compared to those who heard anemia. The possible reason for the high prevalence of anemia among students who never heard/know anemia could be poor knowledge regarding iron-rich foods compared to girls with knowledge about anemia that consider the prevention and control mechanism of anemia.
This is similar to observation done in Tatah Makmur South Kalimantan Public Health Center by Tumanggor, & Tumanggor (2017), who reported that the incidence of anemia was significantly associated level of knowledge of anemia among adolescent girls.
Menstruation is a monthly endometrial shedding leading to the discharge of blood from the uterus occurring every 8 ± 7 days and a part of the normal reproductive cycle of the female. The average menstrual bleeding lasts about 5 days . It is known that heavy as well as menstrual bleeding for a prolonged period can lead to anaemia . The current study revealed that 62.6% of adolescent girls had menstrual duration ≥5 days and 84.9% of adolescent girls had irregular menstruation patterns. However, this study indicated that both irregular menstruation patterns and duration menstruation ≥5 days were not significant to the haemoglobin concentration of adolescent girls. The possible reason behind more girls with an irregular cycle in our study could be due to the higher percentage of young girls aged, as the study suggested that normal cycle length is obtained around the chronological age of 19–20 . Research results in line with our result is conducted in Depok City Region reported there is no significant relationship between the pattern of menstruation and the incidence of anaemia in adolescent girls .
Hemoglobin (Hb) measurement used the recommended laboratory equipment (Hem cue HB 301 Analyzer) and procedures by trained laboratory technicians. The quality control issues were strictly followed as per the manual (guidelines). One-day intensive training was given for data collectors and supervisors. But this study might have some limitations; such only haemoglobin estimation was done other hematological parameters ware not estimated and malaria infection was based on recall history in the last 14 days and not laboratory-based which might compromise the accuracy of the data.