Socio demographic characteristics
Of 407 adolescent girls recruited for the study, 400 (98.2%) of them participated voluntarily and as described in the method section the respondents were selected from 6 kebels. Most of the respondents, 393 (98.0%), were rural residents. About 129 (31.6%), 167 (41.0%), and 111(27.3%) were selected from high, middle and lowlands, respectively. The altitude of the Kebeles included in the study ranged from 1518 to 2450 meters above sea level.
The mean (+SD) age of the adolescent girls was 15.1 (±2.8 SD) years. About 167 (41.8%) were in the early adolescent age group of 10-14years, while 233(58.3%) were in the late adolescent age group of 15-19 years. As the educational background of the adolescent girls is concerned, 372(93.0%) had attended formal education, of which were 327(81.8%), and 45(11.3%) had attained primary and secondary education respectively, while the rest 28 (7.0%) were illiterates (see Table 2).
Majority, 384 (96.0%) of the study subject were single (unmarried). Regarding father educational status, illiterate fathers took the highest proportion, 213(53.3%) and, while the rest 129(32.3%) and 58(14.5%) were attended primary and secondary or above school, respectively. The majority of 333(83.3%) of father`s occupation were farming and followed by merchant 48(12%), the rest 11(2.8%) were civil servants. More than half, 264(66.0%) of the respondents mothers had not attained formal education who were illiterate. The rest 112(28.0%), and 24(6.0%) had attained formal education in primary and secondary or above, respectively. Higher proportion 310 (77.5%) of mothers were not involved in income generating activity (IGA), while the remaining 90 (22.5%) had income generating activity.
The median family size of the respondents was 7.0 ranged from 3 to 13. Majority of the respondent, 162(40.5%) had 6-7 family size, about 97(24.3%) of the respondent had <5 family size, while the rest 141(35.3%) of the study participant had 8 or above family size respectively. Higher proportion of respondents 386(96.5%) were Protestant by religion and the rest 11(2.8%) of the study subjects were Orthodox by religion.
Knowledge about anemia
As described in the methods section, knowledge towards anemia was assessed using composite index. Only 29 (7.3%) adolescent girls had good knowledge regarding anemia and 79 (19.9%) of the study participant had average knowledge, while the rest 289 (72.8%) of study subject had poor knowledge regarding anemia.
Dietary intake of adolescents
Based on FANTA score household DDS were calculated out of 12 food groups. The mean (±SD) household DDS was 4.09 (±1.05) and ranged from 2 to 7. Based on the cutoff points recommended by FAO, the majority 242 (60.5%) had medium DD, 115 (28.75%) Of the study subjects had low and the remaining 43 (10.75%) had high DD. Most of the adolescent girls, 347(86.8%) ate food made from root and followed by 295(73.8%) of cereals, 235(58.8%) of milk and milk product, 180 (45.0%) of legumes, 114(28.5%) of oil or butter, 58(14. 5%) of eggs, 34(8.5%) of meat and no one ate fresh or dried fish.
The dietary intake pattern was also assessed using food frequency method. The mean (+SD) frequency of flesh food consumption per week was 1.36 (+0.54). Among the adolescent girls, 266(66.5%) of they had not eaten meat in the preceding week, while the rest 123(30.8%) and 12(3.0%) had eaten 1-2times and >3 times per week, respectively. More than half, 214 (53.5%) respondent ate greens leafy vegetables >3times per week, about 141(35.3%) of the study participant had eaten green leafy vegetable 1-2 times per week, while the rest 45(11.3%) of the respondents had not eaten green leafy vegetables per week. The mean (+SD) frequency of consumption of green leaf vegetable per week was 2.42(+ 0.68). More than half, 225(56.3%) of the respondent had eaten legumes > 3times per week, 134 (33.6%) the study subjects reported that as they ate legumes 1-2 times per week ,while the rest 40 (10.0%) adolescent girls had not eaten legumes per week.
The respondents were asked to describe their staple diet; most respondents mentioned maize based (180(45%)) and root based (133(33.3%)) foods; while Enset and teff based foods were mentioned by 65(16.3%) and 21(5.3%) of the respondents, respectively (see table 4).
Regarding adolescent dietary frequency, meal frequency was 3-4 times per day for the majority of adolescent girls 390 (97.5%), but 10 (2.5%) of the adolescent girls reported that they eat only 1-2 times a day. Furthermore, the study participant asked to describe the yesterday feeding frequency, only 26 (6.5%) of the adolescent girls mentioned, as they ate 1-2 times per day, while the rest 374 (93.5%) of study participant ate 3-4 times per day.
Of 400 study subjects, 284 (71.0%) of the respondents had coffee drinking habit after meals, of which 196 (70.0%) consumed 2-4 cup, 52 (18.6%) and 32 (11.4%) of the respondents had consumed less than 2 cup and greater than 4 cup of coffee, respectively.
Prevalence of stunting and thinness among adolescents
Nutritional status of adolescent girls was evaluated by using BMI-for-age and height-for-age, the mean (±SD) z-scores for the two indices were -0.70±1.30, and -0.51±1.37, respectively. Out of the study participant, 66(16.5%) had BMI-for-age less than -2SD, they were thinness, and 85 (21.3%) of the respondent had height-for-age less than -2SD, indicating stunted.
Prevalence of Anemia
The mean (+SD) of hemoglobin concentration adjusted for altitude was 13.7+1.2 and ranged from 8.0 to 16.6 g/dl. The overall prevalence of anemia was 15.2% [95% CI: 11.7%, 18.7%]. Out of the total 400 adolescent girls 13.7% [95% CI: 10.3%, 17.1%] and 1.5% [95%CI: 0.3%, 2.7%] had mild and moderate anemia, respectively. But there was no severe anemia case in this study.
Factors association with anemia
The prevalence of anemia was higher in the lower altitude group than in the higher altitude groups. As altitude increases, the odds of anemia tend to decline The odds of being anemic were 3.2(1.23,8.3) times higher among adolescent girls living low altitude.
The prevalence of anemia was higher among those who had low dietary diversity, as compare to their counterparts. Taking medium DD group as a reference, the odds were (AOR=3.6, 95 % CI: 1.7, 7.7), 3.6times increased in the low DD category. Similarly, the proportion of anemia was higher among those who had history of malaria infection in the last 3 months, and the odd was 3.2 times higher in the group (AOR=3.2, 95%CI: 1.4, 7.2).
In the bivariate analysis, adolescent girls who had heavy menstrual bleeding compared to light menses had increased odds of anemia. However, in multivariate logistic model the association failed to be significant. On the other hand, the relationship between menstrual duration and anemia risk was assessed. Less than 5 days considering as reference, the odds of being anemic were 6.4 times (AOR=6.4, 95%CI: 1.55, 27.0) higher among adolescent girls whose menstrual duration stay 5-7 days than in those whose menstrual duration was less than 5 days.