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Abstract

Background:

Anemia negatively affects physical and mental development in adolescent girls, especially in resource-limited settings. This study aims to determine the prevalence of anemia and its related factors among adolescent girls in a northern mountainous province of Vietnam.

Design and methods:

An analytical cross-sectional study was conducted on 805 adolescent girls in 11 high schools in a mountainous province in Northern Vietnam from September to October 2024. Data were collected via Google Forms, and participants underwent direct anthropometric measurements and hemoglobin (Hb) testing. Anemia is classified based on Hb into four groups: no anemia (>12 g/L), mild (100–119.9 g/L), moderate (70–99.9 g/L), and severe (<70 g/L). Multivariate logistic regression was used to identify anemia-related factors.

Results:

The mean age of the participants was 15.88 ± 0.92 years. The prevalence of anemia was 47.1% (95% confidence interval [CI]: 43.7%–50.6%), with mild, moderate, and severe levels accounting for 29.5%, 17.1%, and 0.5%, respectively. Factors associated with increased risk of anemia included poor household (adjusted odds ratio [AOR] = 1.89, 95% CI: 1.34–2.70), use of unsanitary toilets (AOR = 1.58, 95% CI: 1.06–2.37), and consumption of milk or milk products less than or equal to 3 times per week (AOR = 1.62, 95% CI: 1.14–2.29). Factors associated with reduced anemia rates were Kinh ethnicity (AOR = 0.55, 95% CI: 0.37–0.83); knowledge of iron-rich foods (AOR = 0.60, 95% CI: 0.44–0.83).

Conclusion:

The high prevalence of anemia among adolescent girls and its associated factors highlights the need for targeted interventions focusing on education, sanitation, and iron-rich diets.

Keywords

anemia adolescent girls iron-rich foods Vietnam

Introduction

Anemia remains a significant public health problem, particularly among women in remote areas of poor and developing countries. Anemia in adolescent girls causes fatigue, impaired concentration and learning, irregular menstruation, and various health problems.^1,2

Globally, an estimated 1.8 billion people are anemic, with a prevalence of approximately 23,176 cases per 100,000 people.³ Despite global efforts to reduce the prevalence of anemia among adolescents, the condition continues to pose a growing threat to their health. Alarmingly, anemia has increased from the second-ranked factor in 2009 to the top position in 2019 among the 10 factors affecting disability-adjusted life years of adolescents.⁴ In Vietnam, anemia remains a significant public health concern. Although anemia rates have declined over time, the decline has been uneven across ethnic groups and regions, with high anemia rates still occurring in mountainous ethnic minority communities.^5,6

Additionally, several previous studies have shown that anemia in adolescent girls is associated with various factors, such as menstrual cycle,^7,8 parasitic infections,^9,10 low socioeconomic status,^11–13 the type of sanitation facilities currently in use,¹⁴ knowledge of iron-rich foods,^15,16 and the frequency of milk and dairy product consumption.¹⁷ However, in Vietnam, most previous studies and interventions have primarily focused on pregnant women and children^18–20 while adolescents, who are in a critical stage of physical and mental development, have not received adequate attention. This is particularly concerning in mountainous provinces like Lai Chau, located in northern Vietnam, where economic and social conditions remain challenging, with the highest poverty rate in the country in 2021 (27.9%) and the risk factors for anemia among adolescent girls have not been comprehensively studied.²¹ Lai Chau, where most of the population belongs to ethnic minorities with low educational attainment faces a high prevalence of anemia due to poor nutrition,²² challenging living conditions, and limited access to healthcare services. Understanding the current situation and related factors of anemia among adolescent girls in Lai Chau is not only scientifically significant but also provides a foundation for developing interventions to reduce anemia rates, improve school health, and enhance the quality of life for adolescent girls. Therefore, the objective of this study was to determine the prevalence of anemia and identify associated factors among adolescent girls in a northern mountainous province of Vietnam.

Materials and methods

Study design and participants

An analytical cross-sectional study was conducted from September to October 2024 on 805 adolescent girls aged 14–18 from 11 out of 23 high schools in Lai Chau province.

Inclusion criteria Participants were all adolescent girls studying at 11/23 high schools in Than Uyen, Tan Uyen, Tam Duong districts and Lai Chau City, Lai Chau province, Vietnam. They agreed to participate and had their parents’ permission for their children to participate in this study. The study excluded participants with physical disabilities, blood diseases such as red blood cell disease, congenital hemolytic disease, bone marrow failure, myelodysplasia, malignant blood disease, G6P deficiency or acute infections at the time of data collection. This study was reported in accordance with the STROBE guidelines.²³ The checklist outlining the STROBE items is provided in the Supplemental Materials.

Sample size and sampling

The study used the formula to calculate the sample size to estimate one ratio with 95% confidence level, error margin of 5% and an estimated proportion of 0.4. This proportion was based on the reported prevalence of anemia among Tay ethnic adolescent girls in a 2018 study conducted in Yen Bai province, Vietnam with p = 40.0%.⁶ We calculated the sample size as n = 369. However, because cluster sampling was used, we multiplied the sample size by a design effect of k = 2. Therefore, the minimum required sample size for the study is n = 738.

During the data collection period, we recruited a total of 805 participants who met the inclusion criteria for the study. The sample was selected by cluster sampling method of all adolescent girls in 11 schools randomly selected from 23 high schools in Lai Chau province (Figure 1).

Figure 1.

Study area map showing the locations of the 11 selected schools in Lai Châu province, Vietnam.

Data collection, tool, and measurement

We sent invitations to all 1500 adolescent girls and their parents from 11 out of 23 high schools in Than Uyen, Tan Uyen, and Tam Duong districts, as well as Lai Chau City of Lai Chau Province. Adolescent girls who met the sampling criteria and agreed to participate in the study completed a questionnaire via Google Forms. Additionally, they were weighed and measured directly, and their blood samples were collected for testing.

The study questionnaire was referenced from the research of Innocent Yusufu and the guidelines of FAO (Food and Agriculture Organization of the United Nations—2014).^24,25 It was designed using Google Forms to collect data on demographic characteristics, knowledge of anemia prevention, frequency of iron-rich food consumption during the month, and information related to the occupation and education level of parents of female students.

The original English version of the questionnaire was translated into Vietnamese using the forward–backward translation method recommended by the World Health Organization. Some questions were modified by the research team to ensure cultural appropriateness for the Vietnamese context. To assess the clarity, feasibility, and preliminary reliability of the questionnaire, a pilot test was conducted with 20 first year students at Phenikaa University. This group was selected because they shared similar characteristics with the target high school students in terms of age, education level, and digital literacy. The questionnaire, designed using the Google Forms platform, was distributed to the participants. During the response process, the research team directly observed and recorded any questions or difficulties raised by the students.

After the pilot test, internal consistency was assessed using Cronbach’s alpha. The overall reliability coefficient was 0.67. Although this value is slightly below the commonly accepted threshold of 0.70, it is considered acceptable for an instrument in its early development stage. Based on participant feedback, several questions were revised to improve clarity and ease of understanding before the official data collection.

Participants were weighed using a Japanese Seca electronic scale with an accuracy of 0.1 kg. The results were read in “kg” with one decimal place.²⁶ In addition, we measured the participants’ height using a standing height measuring stick with 0.1 cm accuracy.

School health workers at each participating school were responsible for collecting anthropometric measurements, including height and weight, of the female students involved in the study. All school health workers received training on standardized measurement techniques and the proper use of scales and measuring equipment. To ensure the accuracy and reliability of the measurements, the research team consistently used the same UNICEF measuring board and Seca scale throughout the data collection process. The equipment was checked and calibrated prior to each data collection session.

Blood samples were collected from each participant with 2 mL and stored in an Ethylenediaminetetraacetic Acid (EDTA) tube. Hemoglobin concentration and blood formula were analyzed using the Beckman Coulter AU machine. Anemia is defined by the World Health Organization classification criteria as blood hemoglobin <120 g/L, categorized as no anemia (>120 g/L), mild (100–119.9 g/L), moderate (70–99.9 g/L), and severe (<70 g/L).²⁷

Blood samples were collected at the schools by health workers from district health centers in the study area. These professionals included experienced physicians and clinical nurses. The blood sampling process was consistently supervised by the research team to ensure strict adherence to aseptic techniques and compliance with the approved sampling protocol.

After sample collection at each school, the blood samples were organized according to student ID codes, packed in specialized cold-storage containers, and immediately transported to the Than Uyen District Health Center for laboratory testing. The maximum time from sample collection to testing was approximately 3 h, even for the most remote schools.

Statistical analysis

Data were entered in Microsoft Excel software and analyzed using IBM SPSS Statistics (Version 26.0). Qualitative variables, including binary and nominal variables, were described using frequencies and percentages while quantitative variables were reported as means and standard deviations. The Chi-square test was used to test the association in univariate analysis between anemia and independent variables. We applied a multivariate logistic regression model to remove confounding factors and performed stepwise analysis to remove irrelevant variables gradually from the model keeping relevant variables in the model. The Hosmer-Lemeshow test evaluated the model’s appropriateness (p > 0.05). The study used a significance level of α < 0.05.

Ethical approval: The study was approved by the Ethics Committee of the National Institute of Hygiene and Epidemiology, Vietnam (IRB-VN1057/IORG 00008555/No: HĐĐĐ-12/2024) on June 27, 2024, and was conducted in accordance with the Declaration of Helsinki. Before data collection, all female students and their parents or legal guardians received an information sheet explaining the study’s purpose, procedures, benefits, potential risks, and the right to withdraw at any time. A consent form was also provided. Only students who returned signed consent forms from both their parent or guardian and themselves were allowed to participate. All collected data were kept confidential and used solely for research purposes.

Results

We sent 1500 study invitations, receiving 935 responses after excluding 130 individuals with conditions such as red blood cell disease, thalassemia, G6PD deficiency, or acute infections. Thus, 805 participants who met the sampling criteria were included in the study.

Characteristics of study participants

Table 1 shows that the mean age of the study participants was 15.88 ± 0.92 years. The majority were of Thai ethnicity (44.4%), and most lived in rural areas (71.4%) with families with fewer than five children (83.6%). Over half (53.8%) had menstrual cycles lasting ≥5 days. Nearly one-fifth (17.8%) had a height-for-age index (Z-score) at the stunting level. The proportion of participants who did not deworm every 6 months was 79.1%, while 97.3% had not taken iron tablets in the last 3 months. Regarding economic conditions, 24.0% of the participants were from poor and near-poor households. Additionally, 28.9% relied on unsafe household water sources, and 82.5% used unsanitary toilets. Furthermore, 66.8% were unaware of iron-rich foods.

Table 1.

Characteristics of study participants (n = 805).

Characteristics		Frequency (n)	Percentage (%)
Age (mean ± standard deviation)		15.88 ± 0.92	Min-Max: 14–18
Ethnicity	Thai	357	44.4
	Kinh	150	18.6
	Hmong	137	17.0
	Other ethnicities	161	20.0
Place of residence	Rural	575	71.4
Place of residence	Urban	230	28.6
Number of children in the family	≥5 children	132	16.4
Number of children in the family	<5 children	673	83.6
Menstrual duration	≥5 days	433	53.8
Menstrual duration	<5 days	372	46.2
Height-for-age index (Z-score)	Stunted	143	17.8
Height-for-age index (Z-score)	Normal	661	82.1
Deworming every 6 months	No	637	79.1
Deworming every 6 months	Yes	168	20.9
Took iron pills in the last 3 months	No	783	97.3
Took iron pills in the last 3 months	Yes	22	2.7
Household economic status	Poor/near poor	193	24.0
Household economic status	well-off/better	612	76.0
Household water source	Unsafe	233	28.9
Household water source	Safe	572	71.1
Toilet type	Unsanitary	664	82.5
Toilet type	Sanitary	141	17.5
Awareness of iron-rich foods	No	538	66.8
Awareness of iron-rich foods	Yes	267	33.2

Consumption of common iron-rich foods

The results of Table 2 show the frequency of iron-rich food consumption among the study participants. The majority of participants ate the following foods less than three times per week: pork (69.8%), liver from pork, beef, chicken, or duck (96.4%), vegetable oils or animal fats (73.2%), freshwater fish (87.0%), chicken or duck eggs (85.7%), milk or milk products (74.8%), and fruits rich in vitamin C, such as oranges, grapefruits, tangerines, or lemons (66.6%). In contrast, participants consumed certain foods three or more times per week, with rice (69.2%) and dark green leafy vegetables (55.4%) being the most frequently consumed.

Table 2.

Frequency of consumption of common iron-rich foods (n = 805).

Food type		Frequency (n)	Percentage (%)
Pork meat	≤3 times/week	562	69.8
Pork meat	>3 times/week	243	30.2
Liver of pork/beef/chicken/duck	≤3 times/week	776	96.4
Liver of pork/beef/chicken/duck	>3 times/week	29	3.6
Cooking oil/animal fat	≤3 times/week	589	73.2
Cooking oil/animal fat	>3 times/week	216	26.8
Freshwater fish	≤3 times/week	700	87.0
Freshwater fish	>3 times/week	105	13.0
Chicken/duck eggs	≤3 times/week	680	85.7
Chicken/duck eggs	>3 times/week	115	14.3
Milk/milk products	≤3 times/week	602	74.8
Milk/milk products	>3 times/week	203	25.2
Rice	≤3 times/week	238	29.6
Rice	>3 times/week	557	69.2
Dark green leafy vegetable	≤3 times/week	359	44.6
Dark green leafy vegetable	>3 times/week	446	55.4
Orange/grapefruit/tangerine/lemon	≤3 times/week	536	66.6
Orange/grapefruit/tangerine/lemon	>3 times/week	269	33.4

Anemia status in adolescent girls

Figure 2 shows that the rate of anemia in adolescent girls in this study was 47.1% (95% confidence interval: 43.7%–50.6%). Anemia was categorized into mild, moderate, and severe levels, accounting for 29.5%, 17.1%, and 0.5%, respectively. In addition, there was a statistically significant difference in anemia among ethnic groups (p < 0.001), with the Thai ethnic group having the highest rate at 58.3%, whereas the Kinh ethnic group had the lowest rate at 34.0%.

Figure 2.

Prevalence of anemia in adolescent girls and stratification by ethnicity (n = 805).

Factors associated with anemia in adolescent girls

The results of multivariate analysis (Table 3) show that factors associated with anemia in adolescent girls included ethnicity, household economic conditions, type of toilet, knowledge of iron-rich foods, and consumption of milk or dairy products (p < 0.05). Among them, participants of Kinh ethnicity had a lower risk of anemia than Thai ethnicity (AOR = 0.55, 95% CI: 0.37–0.83). Participants from poor or near-poor households had a 1.89 times higher risk of anemia than those from well-off or better households econoic status (AOR = 1.89, 95% CI: 1.34–2.70). Similarly, those using unsanitary toilets had a 1.58 times higher risk of anemia than those using sanitary toilets (AOR = 1.58, 95% CI: 1.06–2.37). In addition, adolescent girls who were knowledgeable about iron-rich foods were less likely to be anemic than those who did not (AOR = 0.60, 95% CI: 0.44–0.83). Those who consumed milk or milk products less than or equal to 3 times per week had a higher risk of anemia than those who consumed them more than 3 times per week (AOR = 1.62, 95% CI: 1.14–2.29).

Table 3.

Factors associated with anemia in adolescent girls (n = 805).

		Anemia
Factors		Yes n (%)	No n (%)	p ₁	COR (95% CI)	p ₂	AOR (95% CI)
Age, mean ± standard deviation		15.83 ± 0.91	15.92 ± 0.92	0.185**	1.11(0.95–1.29)
Ethnicity	Thai	208 (58.3)	149 (41.7)	1	1	1	1
	Kinh	51 (34.0)	99 (66.0)	0.003	0.56 (0.39–0.82)	0.04	0.55 (0.37–083)
	Hmong	49 (35.8)	88 (64.2)	0.069	1.53 (0.97–2.42)	0.34	1.27 (0.78–2.07)
	Other ethnicities	71 (44.1)	90 (55.9)	0.144	1.42 (0.89–2.42)	0.07	157 (0.96–2.55)
Place of residence	Rural	288 (50.1)	287 (49.9)	0.007*	1.53 (1.12–2.09)
Place of residence	Urban	91 (39.6)	139 (60.4)		1
Number of children in the family (children)	≥5	56 (42.4)	76 (57.6)	0.241*	0.79 (0.55–1.16)
Number of children in the family (children)	<5	325 (48.0)	350 (52.0)	0.241*	1
Menstrual duration (days)	≥5	208 (48.0)	225 (52.0)	0.558*	1.09 (0.82–1.43)
Menstrual duration (days)	<5	171 (46.0)	201 (54.0)	0.558*	1
Height-for-age index (Z-score)	Stunted	59 (41.3)	84 (58.7)	0.128*	0.75 (0.22–1.09)
Height-for-age index (Z-score)	Normal	319 (48.3)	342 (51.7)	0.128*	1
Deworming every 6 months	No	310 (48.7)	327 (51.3)	0.078*	1.36 (0.96–1.92)
Deworming every 6 months	Yes	69 (41.1)	99 (58.9)	0.078*	1
Took iron pills in the last 3 months	No	371 (47.4)	412 (52.6)	0.307*	1.58 (0.65–3.79)
Took iron pills in the last 3 months	Yes	8 (36.4)	14 (63.6)	0.307*	1
Household economic status	Poor/near poor	115 (59.6)	78 (40.4)	<0.0001*	1.94 (1.40–2.70)	<0.001	1.89 (1.34–2.70)
Household economic status	Well-off/better	208 (58.3)	348 (56.9)	<0.0001*	1		1
Household water source	Unsafe	116 (49.8)	117 (50.2)	0.326*	1.16 (0.86–1.58)
Household water source	Safe	263 (46.0)	309 (54.0)	0.326*	1
Toilet type	Unsanitary	319 (48.0)	345 (52.0)	0.236*	1.25 (0.87–1.80)	0.025	1.58 (1.06–2.37)
Toilet type	Sanitary	60 (42.6)	81 (57.4)	0.236*	1		1
Awareness of iron-rich foods	No	240 (44.6)	298 (55.4)	0.046*	0.74 (0.55–0.99)	0.002	0.60 (0.44–0.83)
Awareness of iron-rich foods	Yes	139 (52.1)	128 (47.9)	0.046*	1		1
Pork consumption (times/week)	≤3	277 (49.3)	285 (50.7)	0.056*	1.34 (0.99–1.82)
Pork consumption (times/week)	>3	102 (42.0)	141 (58.0)	0.056*	1
Liver of pork/beef/chicken/duck consumption (times/week)	≤3	368 (47.4)	408 (52.6)	0.315*	1.48 (0.68–3.18)
Liver of pork/beef/chicken/duck consumption (times/week)	>3	11 (46.0)	18 (54.0)	0.315*	1
Cooking oil/animal fat consumption (times/week)	≤3	282 (47.9)	307 (52.1)	0.454*	1.12 (0.83–1.54)
Cooking oil/animal fat consumption (times/week)	>3	97 (44.9)	119 (55.1)	0.454*	1
Freshwater fish consumption (times/week)	≤3	331 (47.3)	369 (52.7)	0.764*	1.07 (0.71-–1.61)
Freshwater fish consumption (times/week)	>3	48 (45.7)	57 (54.3)	0.764*	1
Chicken/duck eggs consumption (times/week)	≤3	330 (47.8)	360 (52.2)	0.299*	1.24 (0.83–1.84)
Chicken/duck eggs consumption (times/week)	>3	49 (42.6)	66 (57.4)	0.299*	1
Milk/milk products consumption (times/week)	≤3	305 (50.7)	297 (49.3)	<0.001*	1.79 (1.3–2.48)	0.007	1.62 (1.14–2.29)
Milk/milk products consumption (times/week)	>3	74 (36.5)	129 (63.5)	<0.001*	1		1
Rice consumption (times/week)	≤3	118 (49.6)	120 (50.4)	0.326*	1.17 (0.86–1.58)
Rice consumption (times/week)	>3	255 (45.8)	302 (54.2)	0.326*	1
Dark green leafy vegetable consumption(times/week)	≤3	175 (48.7)	184 (51.3)	0.396*	1.13 (0.85–1.49)
Dark green leafy vegetable consumption(times/week)	>3	204 (45.7)	242 (54.3)	0.396*	1
Orange/grapefruit/tangerine/lemon consumption (times/week)	≤3	261 (48.7)	275 (51.3)	0.196*	1.22 (0.91–1.63)
Orange/grapefruit/tangerine/lemon consumption (times/week)	>3	118 (43.9)	151 (56.1)	0.196*	1

p₁: p-value univariate analysis; p₂: p-value logistic multivariate analysis; COR: crude odds ratio; AOR: adjusted odds ratio; CI: confidence interval.

Chi-square test **T-test; .

Discussion

The study was conducted in Lai Chau province, a mountainous region in the north of Vietnam, which has the most challenging socio-economic conditions in the country %).²¹ The main results of our study showed that the prevalence of anemia in adolescent girls was 47.1%, with a 95% confidence interval of 43.7%–50.6%. The rates of mild, moderate, and severe anemia were 29.5%, 17.1%, and 0.5%, respectively. Anemia was more common among the Thai ethnic group than among other ethnic groups. Risk factors for anemia included poor or near-poor household economic status, consuming milk or milk products less than thrice weekly, and unsanitary toilet use. In contrast, protective factors of anemia included the Kinh ethnic group and knowing iron-rich foods.

The rate of anemia in adolescent girls in our study was found to be higher than in previous studies in some other northwestern mountainous provinces in Vietnam, such as Yen Bai (26.9%) and Son La (30,8%).^6,28 This may be because our study site had the most challenging economic conditions and a higher ethnic minority population,^21,22 and possibly lower levels of knowledge; we also found that only 33.2% of participants knew iron-rich foods. In addition, compared to other countries, our results are higher than those of a study in Malaysia, which reported an anemia rate of 31.4%,¹² but lower than those in some West African countries, such as Mali, Burkina Faso, and India, where rates range from 50% to 63.5%.^29–31 These differences may be attributed to the economic conditions of the study areas. The study in Malaysia was conducted in Sabah province, where socio-economic conditions and living standards were higher than in Lai Chau province, Vietnam. In contrast, studies in Mali, Burkina Faso, and India took place in regions with more significant economic challenges. The World Health Organization classified these three countries as having high anemia rates and significantly impacting public health.³²

The risk factors associated with anemia that our study found included poor household economic conditions, consuming milk or dairy products less than or equal to 3 times per week, and using unsanitary toilets. This is consistent with reality because economic conditions directly affect the ability to provide daily food, especially iron-rich foods, which are the body’s main components for blood production.¹¹ In addition, milk and dairy products are rich in nutrients, easy to absorb, and suitable for all ages. Studies have also shown that milk and dairy products help prevent anemia.¹⁷ Our study also showed that adolescents who consumed milk less than or equal to 3 times per week had a 1.62 times higher risk of anemia than those who drank more than 3 times per week. On the other hand, using unsanitary toilets can be a source of worm infections in adolescents, a common cause of anemia identified in previous studies.^14,33 Our study further supports these findings.

In addition, our results also showed that Kinh people were less anemic than Thai people. Participants who knew iron-rich foods were less anemic. This may be because Kinh people often have better economic conditions and better access to medical services and health care than Thai people. Similar to previous studies in Laos, Nepal.^6,34–36 One of the solutions to prevent anemia that is being applied worldwide is to diversify daily meals.¹¹ Therefore, when adolescents know about iron-rich foods and understand the role of these foods in preventing anemia, they will proactively choose suitable foods to protect their health. In our study, participants who knew iron-rich foods had a risk of anemia only 0.60 times higher than those who did not have this knowledge. Similar to previous studies, there was an association between a lack of knowledge about iron-rich foods and anemia in adolescent girls.^15,16

The strength of our study is that it was conducted with a large sample size, providing a picture of anemia in a mountainous province in northern Vietnam. It offers valuable evidence on the prevalence of anemia among adolescent girls, a group with increased iron requirements during a period of rapid physical and physiological development. Previous studies have recognized anemia in adolescents as a major cause of reduced quality of life and academic performance, particularly in low and middle income countries.^4,11 Micronutrient supplementation interventions, including iron, folic acid, nutrition education, and behavior change, have been recommended by the World Health Organization (WHO) for implementation through school based periodic supplementation programs. These interventions have been shown to reduce anemia prevalence by up to 31% (RR 0.69; 95% CI: 0.62–0.76), improve serum hemoglobin levels (1.94 g/dL; 95% CI: 1.48–2.41), and alter ferritin concentrations (3.80 µg/L; 95% CI: 2.00–5.59).³⁷

Another strength of our study is that it was conducted among high school female students in the ethnic minority mountainous region of Lai Chau, where scientific evidence remains scarce. The study not only identified the prevalence of anemia but also clarified its associated factors. These findings contribute to the scientific evidence base for school-based interventions that combine iron/folic acid supplementation with nutrition education and communication, aiming to improve both physical health and academic performance among adolescents.

However, this study also has some limitations. Firstly, although the study was conducted in three districts and a city in Lai Chau Province, it did not cover the entire province. Some remote areas could not be surveyed due to transportation difficulties and limited access. Additionally, students who did not attend school regularly because of economic challenges were not included in this survey.

Secondly, the data were collected via Google Forms, which may have led to dishonest responses. Thirdly, recall bias may occur when participants reported their food consumption over the past week.

In conclusion, this study reported a high prevalence of anemia among adolescent girls in a mountainous province in northern Vietnam. Factors associated with anemia included ethnicity, poor or near-poor household economy, unsanitary toilet use, low consumption of milk and dairy products, and lack of knowledge about iron-rich foods. Therefore, managers should establish intervention programs, disseminate knowledge about iron-rich foods to adolescent girls, and improve sanitation conditions to reduce the prevalence of anemia in this population.

Supplemental Material

sj-docx-1-phj-10.1177_22799036251380893 – Supplemental material for Anemia in adolescent girls in a northern mountainous province of Vietnam: A analytical cross-sectional study among 805 participants

Supplemental material, sj-docx-1-phj-10.1177_22799036251380893 for Anemia in adolescent girls in a northern mountainous province of Vietnam: A analytical cross-sectional study among 805 participants by Nguyen Van Liep, Nguyen Thi Thanh Huong, Tran Dai Quang, Nguyen Thi Lam, Ta Hong Long, Le Thi Ngoc Anh and Dao Van Dung in Journal of Public Health Research

Footnotes

Acknowledgements

We sincerely thank the Board of Directors of the Department of Education and Training and the Department of Health of Lai Chau province. We would like to thank the principals and teachers of the high schools in Than Uyen, Tan Uyen, and Tam Duong districts, as well as Lai Chau City. We thank the Board of Directors, doctors, and medical staff at Lai Chau General Hospital and the Medical Centers of Than Uyen, Tan Uyen, and Tam Duong districts for supporting this study. In particular, we would like to thank the parents and adolescent girls for their cooperation and participation in this study.

ORCID iD

Le Thi Ngoc Anh

Author contributions

Conceptualization: Nguyen Van Liep, Tran Dai Quang, Nguyen Thi Thanh Huong; Methodology: Nguyen Van Liep, Nguyen Thi Thanh Huong, Dao Van Dung; Formal analysis: Nguyen Van Liep, Nguyen Thi Thanh Huong, Tran Dai Quang, Le Thi Ngoc Anh; Investigation: Ta Hong Long; Writing-original draft: Nguyen Van Liep; Writing—review & editing: Le Thi Ngoc Anh, Tran Dai Quang, Nguyen Thi Lam; Supervision: Nguyen Thi Thanh Huong, Tran Dai Quang, Nguyen Thi Lam.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Declaration of conflicting interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Data availability statement

Data will be available upon request.

Supplemental material

Supplemental material for this article is available online.

References

Bahrami

Khorasanchi

Tayefi

, et al. Anemia is associated with cognitive impairment in adolescent girls: a cross-sectional survey. Appl Neuropsychol Child 2020; 9(2): 165–171.

Ocak

Kilicaslan

Yildirmak

, et al. Adolescents and anemia. Med Bull Sisli Etfal Hosp 2017; 51(4): 309–317.

Safri

Kolahi

Noori

Burden of anemia and its underlying causes in 204 countries and territories, 1990–2019: results from the Global Burden of Disease Study 2019. J Hematol Oncol 2021; 14(1): 185.

Murray

Aravkin

Zheng

, et al. Global burden of 87 risk factors in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet 2020; 396(10258): 1223–1249.

Government of the Socialist Republic of Vietnam. No. 02 QD/TTg Decision approving the national nutrition strategy for 2021 - 2030 and vision to 2045, https://vanban.chinhphu.vn/?pageid=27160&docid=204983 (2022, accessed 20 June 2024).

Nguyen

Hoang

NPL

Nguyen

TA.

Iron deficiency anemia, iron store status among girl aged 11-13 in ethnic areas, in Yen Bai province, 2018. Vietnam Med J 2018; 518(1): 204–208. DOI: 10.51298/vmj.v518i1.3353

Jalambo

Karim

Naser

, et al. Prevalence and risk factor analysis of iron deficiency and iron-deficiency anaemia among female adolescents in the Gaza Strip, Palestine. Public Health Nutr 2018; 21(15): 2793–2802.

Sari

Judistiani

RTD

Herawati

DMD

, et al. Iron deficiency anemia and associated factors among adolescent girls and women in a rural area of Jatinangor, Indonesia. Int J Womens Health 2022; 14: 1137–1147.

WHO. Research priorities for helminth infections. Technical Report of the TDR Disease Reference Group on Helminth Infections, 2012.

10.

Gemechu

Asmerom

Gedefaw

, et al. Anemia prevalence and associated factors among school-children of Kersa Woreda in eastern Ethiopia: a cross-sectional study. PLoS One 2023; 18(3): e0283421.

11.

WHO. Nutritional anaemias: tools for effective prevention and control, https://www.who.int/publications/i/item/9789241513067 (2017, accessed 20 June 2024).

12.

Roslie

Yusuff

ASM

Parash

MTH

. The prevalence and risk factors of iron deficiency anemia among rural school children in Kudat, Sabah. Malays J Med Health Sci 2019; 15(3): 54–60.

13.

Nguyen

Hoang

NPL

, et al. The status of iron storage, iron deficiency anemia and some related factors among women 15-35 years old in poor communes in Son La province, 2018. Vietnam J Nutr Food 2021; 17(3): 59–68.

14.

Tirore

Areba

Habte

, et al. Prevalence and associated factors of severity levels of anemia among women of reproductive age in sub-Saharan Africa: a multilevel ordinal logistic regression analysis. Front Public Health 2023; 11: 1349174.

15.

Novelia

Rukmaini Sari

IP.

The analysis of factors associated with anemia among adolescent girls. Nurs Heal Sci J 2022; 2(3): 266–273.

16.

Gosdin

Tripp

Mahama

, et al. Predictors of anaemia among adolescent schoolchildren of Ghana. J Nutr Sci 2020; 9: e43.

17.

Soni

Halder

Soni

Prevalence of anemia among adult male camel milk consumers and nonconsumers in rural Rajasthan: a community-based cross-sectional study. Indian J Med Spec 2024; 15(1): 31–34.

18.

Tran

MT.

The prevalence of iron-deficiency anemia in the first three months of pregnant women at Binh Thuan general hospital. Ho Chi Minh City J Med 2019; 23(2): 56–62.

19.

Nguyen

DPT

TTH

. Study on anemia and ferritin deficiency in pregnant women visiting Danang Obstetrics and Pediatrics Hospital. Vietnam Obstet Gynecol J 2021; 20(2): 22–29.

20.

Nguyen

TXH

Lam

, et al. Risk factors of anemia in children from 2 months to 5 years old at the pediatric center, Thai Nguyen National Hospital. Vietnam Med J 2024; 543(1): 274–278.

21.

Social and Environmental Statistics Department, General Statistics Office of the Socialist Republic of Vietnam. Result of the Viet Nam household living standards survey 2022. Statistical Publishing House 2023, https://www.nso.gov.vn/wp-content/uploads/2022/06/Bieu-tong-hop-ket-qua-KSMS-2021.pdf

22.

Prime Minister of Vietnam. Decision 1585/QD-TTg on the Decision approving the planning of Lai Chau province for the period 2021 - 2030, with a vision to 2050, https://vanban.chinhphu.vn/?pageid=27160&docid=209137 (2023, accessed 23 July 2024).

23.

Vandenbroucke

von Elm

Altman

, et al. Strengthening the reporting of observational studies in epidemiology (STROBE): explanation and elaboration. PLoS Med 2007; 4(10): e297–1655.

24.

Yusufu

Cliffer

Yussuf

, et al. Factors associated with anemia among school-going adolescents aged 10-17 years in Zanzibar, Tanzania: a cross sectional study. BMC Public Health 2023; 23: 1814.

25.

Macías

Glasauer

Guidelines for assessing nutrition-related knowledge, attitudes and practices. FAO, 2014.

26.

Nguyen

DH.

Nutritional care for mothers and children. Institute of Nutrition, 2015. pp.108–118.

27.

WHO. Technical Handbook on Anaemia in Adolescents. Nelson Textbook of Pediatrics, 2017.

28.

Nguyen

Hoang

NPL

, et al. Anemia and iron store status in women aged 15-35 years old in Muong La district, Son La province in 2018. Vietnam Med J 2021; 505(1): 246–250.

29.

Armah-Ansah

EK.

Determinants of anemia among women of childbearing age: analysis of the 2018 Mali demographic and health survey. Arch Public Health 2023; 81(1): 10.

30.

Mank

De Neve

Mauti

, et al. Prevalence of obesity and anemia among early adolescents in junior secondary schools: a cross-sectional study in Ouagadougou, Burkina Faso. J Sch Health 2022; 92(11): 1081–1095.

31.

Chauhan

Kumar

Marbaniang

, et al. Prevalence and predictors of anaemia among adolescents in Bihar and Uttar Pradesh, India. Sci Rep 2022; 12(1): 8197.

32.

WHO. Anaemia: cut-off values for public health significance, https://www.who.int/data/nutrition/nlis/info/anaemia (2008, accessed 7 May 2025).

33.

Kothari

Coile

Huestis

, et al. Exploring associations between water, sanitation, and anemia through 47 nationally representative demographic and health surveys. Ann N Y Acad Sci 2019; 1450(1): 249–267.

34.

Keokenchanh

Kounnavong

Tokinobu

, et al. Prevalence of anemia and its associate factors among women of reproductive age in Lao PDR: evidence from a nationally representative survey. Anemia 2021; 2021(1): 8823030.

35.

Ford

Bichha

Parajuli

, et al. Factors associated with anaemia among adolescent boys and girls 10–19 years old in Nepal. Matern Child Nutr 2022; 18: e13013.

36.

Juffrie

Helmyati

Hakimi

Nutritional anemia in Indonesia children and adolescents: Diagnostic reliability for appropriate management. Asia Pac J Clin Nutr 2020; 29(1): S18–S31.

37.

Salam

Hooda

Das

, et al. Interventions to improve adolescent nutrition: a systematic review and meta-analysis. J Adolesc Health 2016; 59(4): S29–S39.

Supplementary Material

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Anemia in adolescent girls in a northern mountainous province of Vietnam: An analytical cross-sectional study among 805 participants

Abstract

Background:

Design and methods:

Results:

Conclusion:

Keywords

Introduction

Materials and methods

Study design and participants

Sample size and sampling

Data collection, tool, and measurement

Statistical analysis

Results

Characteristics of study participants

Consumption of common iron-rich foods

Anemia status in adolescent girls

Factors associated with anemia in adolescent girls

Discussion

Supplemental Material

sj-docx-1-phj-10.1177_22799036251380893 – Supplemental material for Anemia in adolescent girls in a northern mountainous province of Vietnam: A analytical cross-sectional study among 805 participants

Footnotes

Acknowledgements

ORCID iD

Author contributions

Funding

Declaration of conflicting interests

Data availability statement

Supplemental material

References

Supplementary Material