Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Communication
  • Published:

Prevalence and severity of anemia and iron deficiency: cross-sectional studies in adolescent schoolgirls in western Kenya

Abstract

Objective: Anemia is a major public health concern in preschool children and pregnant women in the developing world. While many studies have examined these two at-risk groups, there is a paucity of data on anemia in adolescents living in developing countries in the complex ecologic context of poverty, parasitism, and malnutrition. We evaluated the prevalence, severity, and risk factors of anemia in adolescent schoolgirls in an area with intense malaria transmission in western Kenya.

Design: Two cross-sectional surveys were conducted, using a multistage random sample design.

Setting: Public primary schools in an area with intense malaria transmission in western Kenya.

Subjects: A total of 648 randomly selected adolescent schoolgirls aged 12–18 y.

Results: The prevalence of anemia (Hb <120 g/l) was 21.1%; only one girl had an Hb less than 70 g/l. Ferritin levels were available from a subsample of 206 girls. The prevalence of iron deficiency (ferritin <12 μg/l) was 19.8, and 30.4% of anemic girls were iron deficient. Malaria and schistosomiasis were the main risk factors for anemia in younger girls (12–13 y), while menstruation was the principal risk factor in older girls (14–18 y).

Conclusions: Iron deficiency and anemia in school-attending girls in western Kenya were more prevalent than in developed countries, but considerably less prevalent than in preschool children and pregnant women from the same study area. Our findings are consistent with other recent school-based surveys from western Kenya, but not with recent community- and school-based cross-sectional surveys from other parts of sub-Saharan Africa. It deserves further study to determine if adolescent girls not attending school are at higher risk of anemia.

Sponsorship: This study was supported by a grant from The Netherlands Foundation for the Advancement of Tropical Research (WOTRO), the Netherlands.

This is a preview of subscription content, access via your institution

Access options

Rent or buy this article

Prices vary by article type

from$1.95

to$39.95

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  • ACC/SCN (1997). Third Report on the World Nutrition Situation Geneva.

  • Aidoo M, Terlouw DJ, Kolczak MS, McElroy PD, ter Kuile FO, Kariuki S, Nahlen BL, Lal AA & Udhayakumar V (2002): Protective effects of the sickle cell gene against malaria morbidity and mortality. Lancet 359, 1311–1312.

    Article  CAS  Google Scholar 

  • Barr F, Brabin L, Agbaje S, Buseri F, Ikimalo J & Briggs N (1998): Reducing iron deficiency anaemia due to heavy menstrual blood loss in Nigerian rural adolescents. Public Health Nutr. 1, 249–257.

    Article  CAS  Google Scholar 

  • Beasley NM, Hall A, Tomkins AM, Donnelly C, Ntimbwa P, Kivuga J, Kihamia CM, Lorri W & Bundy DA (2000): The health of enrolled and non enrolled children of school age in Tanga, Tanzania. Acta Trop. 76, 223–229.

    Article  CAS  Google Scholar 

  • Beier JC, Oster CN, Onyango FK, Bales JD, Sherwood JA, Perkins PV, Chumo DK, Koech DV, Whitmire RE & Roberts CR et al. (1994): Plasmodium falciparum incidence relative to entomologic inoculation rates at a site proposed for testing malaria vaccines in western Kenya. Am. J. Trop. Med. Hyg. 50, 529–536.

    Article  CAS  Google Scholar 

  • Bennett S, Woods T, Linyanage WM & Smith DL (1991): A simplified general model for cluster-sample surveys of health in developing countries. World Health Stat. Q. 44, 98–106.

    CAS  Google Scholar 

  • Bloland PB, Boriga DA, Ruebush TK, McCormick JB, Roberts JM, Oloo AJ, Hawley W, Lal A, Nahlen B & Campbell CC (1999): Longitudinal cohort study of the epidemiology of malaria infections in an area of intense malaria transmission II. Descriptive epidemiology of malaria infection and disease among children. Am. J. Trop. Med. Hyg. 60, 641–648.

    Article  CAS  Google Scholar 

  • Bloland PB, Lackritz EM, Kazembe PN, Were JB, Steketee R & Campbell CC (1993): Beyond chloroquine: implications of drug resistance for evaluating malaria therapy efficacy and treatment policy in Africa. J. Infect. Dis. 167, 932–937.

    Article  CAS  Google Scholar 

  • Brabin L & Brabin BJ (1992): The cost of successful adolescent growth and development in girls in relation to iron and vitamin A status. Am. J. Clin. Nutr. 55, 955–958.

    Article  CAS  Google Scholar 

  • Brabin L, Ikimalo J, Dollimore N, Kemp J, Ikokwu-Wonodi C, Babatunde S, Obunge O & Briggs N (1997): How do they grow? A study of south-eastern Nigerian adolescent girls. Acta Paediatr. 86, 1114–1120.

    Article  CAS  Google Scholar 

  • Brabin L, Verhoeff FH, Kazembe P, Brabin BJ, Chimsuku L & Broadhead R (1998): Improving antenatal care for pregnant adolescents in southern Malawi. Acta Obstet. Gynecol. Scand. 77, 402–409.

    Article  CAS  Google Scholar 

  • Cook JD (1994): Iron-deficiency anaemia. Baillieres Clin. Haematol. 7, 787–804.

    Article  CAS  Google Scholar 

  • DeMaeyer E & Adiels-Tegman M (1985): The prevalence of anaemia in the world. World Health Stat. Q. 38, 302–316.

    CAS  PubMed  Google Scholar 

  • Edson DC & Smith JW (1982): Comparison of concentration procedures for detection of Schistosoma mansoni eggs in a CAP Parasitology Survey specimen. Am. J. Clin. Pathol. 78, 671–672.

    CAS  PubMed  Google Scholar 

  • Fentiman A, Hall A & Bundy D (2001): Health and cultural factors associated with enrolment in basic education: a study in rural Ghana. Soc. Sci. Med. 52, 429–439.

    Article  CAS  Google Scholar 

  • Friedman JF, Phillips-Howard PA, Hawley WA, Terlouw DJ, Kolczak MS, Barber M, Okello N, Vulule JM, Duggan C, Nahlen BL & ter Kuile FO (2003): Impact of permethrin-treated bed nets on growth, nutritional status, and body composition of primary school children in western Kenya. Am. J. Trop. Med. Hyg. 68, 78–85.

    Article  Google Scholar 

  • Fulford AJC, Webster M, Ouma JH, Kimani G & Dunne DW (1998): Puberty and age-related changes in susceptibility to schistosome infection. Parasitol. Today 14, 23–26.

    Article  CAS  Google Scholar 

  • Geissler PW, Mwaniki DL, Thiong'o F, Michaelsen KF & Friis H (1998): Geophagy, iron status and anaemia among primary school children in Western Kenya. Trop. Med. Int. Health 3, 529–534.

    Article  CAS  Google Scholar 

  • Glynn JR, Carael M, Auvert B, Kahindo M, Chege J, Musonda R, Kaona F & Buve A (2001): Why do young women have a much higher prevalence of HIV than young men? A study in Kisumu, Kenya and Ndola, Zambia. AIDS 15, S51–S60.

    Article  Google Scholar 

  • Haas JD & Brownlie Tt (2001): Iron deficiency and reduced work capacity: a critical review of the research to determine a causal relationship. J. Nutr. 131, 676S–688S; discussion 688S–690S.

    Article  CAS  Google Scholar 

  • Hall A, Bobrow E, Brooker S, Jukes M, Nokes K, Lambo J, Guyatt H, Bundy D, Adjei S, Wen ST, Satoto, Subagio H, Rafiluddin MZ, Miguel T, Moulin S, de Graft Johnson J, Mukaka M, Roschnik N, Sacko M, Zacher A, Mahumane B, Kihamia C, Mwanri L, Tatala S, Lwambo N, Siza J, Khanh LN, Khoi HH & Toan ND (2001): Anaemia in schoolchildren in eight countries in Africa and Asia. Public Health Nutr. 4, 749–756.

    Article  CAS  Google Scholar 

  • Harrison KA (1985): Child-bearing, health and social priorities: a survey of 22 774 consecutive hospital births in Zaria, Northern Nigeria. Br. J. Obstet. Gynaecol. 92, 1–119.

    Google Scholar 

  • Hightower AW, Ombok M, Otieno R, Odhiambo R, Oloo AJ, Lal AA, Nahlen BL & Hawley WA (1998): A geographic information system applied to a malaria field study in western Kenya. Am. J. Trop. Med. Hyg. 58, 266–272.

    Article  CAS  Google Scholar 

  • Hill AV (1992): Molecular epidemiology of the thalassaemias (including haemoglobin E). Baillieres Clin. Haematol. 5, 209–238.

    Article  CAS  Google Scholar 

  • Horton S & Levin C (2001): Commentary on “evidence that iron deficiency anemia causes reduced work capacity”. J. Nutr. 131, 691S–696S.

    Article  CAS  Google Scholar 

  • Johnson-Spear MA & Yip R (1994): Hemoglobin difference between black and white women with comparable iron status: justification for race-specific anemia criteria. Am. J. Clin. Nutr. 60, 117–121.

    Article  CAS  Google Scholar 

  • Katz N, Chaves A & Pellegrino J (1972): A simple device for quantitative stool thick-smear technique in Schistosomiasis mansoni. Rev. Inst. Med. Trop. Sao Paulo 14, 397–400.

    CAS  PubMed  Google Scholar 

  • Kirkwood B (1998): Essentials of Medical Statistics. Cambridge, MA: Blackwell Science.

    Google Scholar 

  • Knight WB, Hiatt RA, Cline BL & Ritchie LS (1976): A modification of the formol-ether concentration technique for increased sensitivity in detecting Schistosoma mansoni eggs. Am. J. Trop. Med. Hyg. 25, 818–823.

    Article  CAS  Google Scholar 

  • Konijn AM (1994): Iron metabolism in inflammation. Baillieres Clin. Haematol. 7, 829–849.

    Article  CAS  Google Scholar 

  • Kwena AM, Terlouw DJ, de Vlas SJ, Phillips-Howard PA, Hawley WA, Friedman JF, Vulule JM, Nahlen BL, Sauerwein RW & ter Kuile FO (2003): Prevalence and severity of malnutrition in pre-school children in a rural area of western Kenya. Am. J. Trop. Med. Hyg. 68, 94–99.

    Article  Google Scholar 

  • Lackritz EM, Campbell CC, Ruebush II TK, Hightower AW, Wakube W, Steketee RW & Were JB (1992): Effect of blood transfusion on survival among children in a Kenyan hospital. Lancet 340, 524–528.

    Article  CAS  Google Scholar 

  • Leenstra T, Phillips-Howard PA, Kariuki SK, Hawley WA, Alaii JA, Rosen DH, Oloo AJ, Nahlen BL, Kager PA & ter Kuile FO (2003): Permethrin-treated bed nets in the prevention of malaria and anemia in adolescent schoolgirls in western Kenya. Am. J. Trop. Med. Hyg. 68, 86–93.

    Article  Google Scholar 

  • Levine AM, Berhane K, Masri-Lavine L, Sanchez M, Young M, Augenbraun M, Cohen M, Anastos K, Newman M, Gange SJ & Watts H (2001): Prevalence and correlates of anemia in a large cohort of HIV-infected women: Women's Interagency HIV Study. J. Acq. Immun. Def. Synd. 26, 28–35.

    Article  CAS  Google Scholar 

  • Looker AC, Dallman PR, Carroll MD, Gunter EW & Johnson CL (1997): Prevalence of iron deficiency in the United States. JAMA 277, 973–976.

    Article  CAS  Google Scholar 

  • Lwambo NJ, Brooker S, Siza JE, Bundy DA & Guyatt H (2000): Age patterns in stunting and anaemia in African schoolchildren: a cross-sectional study in Tanzania. Eur. J. Clin. Nutr. 54, 36–40.

    Article  CAS  Google Scholar 

  • Massawe SN, Ronquist G, Nystrom L & Lindmark G (2002): Iron status and iron deficiency anaemia in adolescents in a Tanzanian suburban area. Gynecol. Obstet. Invest. 54, 137–144.

    Article  CAS  Google Scholar 

  • McElroy PD, Lal AA, Hawley WA, Bloland PB, Kuile FO, Oloo AJ, Harlow SD, Lin X & Nahlen BL (1999): Analysis of repeated hemoglobin measures in full-term, normal birth weight Kenyan children between birth and four years of age. III. The Asemobo Bay Cohort Project. Am. J. Trop. Med. Hyg. 61, 932–940.

    Article  CAS  Google Scholar 

  • McElroy PD, ter Kuile FO, Hightower AW, Hawley WA, Phillips-Howard PA, Oloo AJ, Lal AA & Nahlen BL (2001): All-cause mortality among young children in western Kenya. VI: the Asembo Bay Cohort Project. Am. J. Trop. Med. Hyg. 64, 18–27.

    Article  CAS  Google Scholar 

  • Meltzer MI, Terlouw DJ, Kolczak MS, Odhacha A, ter Kuile FO, Vulule JM, Alaii JA, Nahlen BL, Hawley WA & Phillips-Howard PA (2003): The household-level economics of using permethrin-treated bed nets to prevent malaria in children less than five years of age. Am. J. Trop. Med. Hyg. 68, 149–160.

    Article  Google Scholar 

  • Mockenhaupt FP, Falusi AG, May J, Ademowo OG, Olumese PE, Meyer CG & Bienzle U (1999): The contribution of alpha+-thalassaemia to anaemia in a Nigerian population exposed to intense malaria transmission. Trop. Med. Int. Health 4, 302–307.

    Article  CAS  Google Scholar 

  • Murray DM (1998): Design and Analysis of Group-randomized Trials. New York: Oxford University Press.

    Google Scholar 

  • Naeye RL (1981): Teenaged and pre-teenaged pregnancies: consequences of the fetal–maternal competition for nutrients. Pediatrics 67, 146–150.

    CAS  Google Scholar 

  • Ojwang PJ, Ogada T, Gonzalez-Redondo JM, Kutlar A, Kutlar F & Huisman TH (1989): beta S-haplotypes and alpha-thalassemia along the coastal belt of Kenya. East Afr. Med. J. 66, 377–380.

    CAS  PubMed  Google Scholar 

  • Phillips-Howard PA, Nahlen BL, Alaii JA, ter Kuile FO, Gimnig JE, Terlouw DJ, Kachur SP, Hightower AW, Lal AA, Schoute E, Oloo AJ & Hawley WA (2003a): The efficacy of permethrin-treated bed nets on child mortality and morbidity in western Kenya I. Development of infrastructure and description of study site. Am. J. Trop. Med. Hyg. 68, 3–9.

    Article  Google Scholar 

  • Phillips-Howard PA, ter Kuile FO, Nahlen BL, Alaii JA, Gimnig JE, Kolczak MS, Terlouw DJ, Kariuki SK, Shi YP, Kachur SP, Hightower AW, Vulule JM & Hawley WA (2003b): The efficacy of permethrin-treated bed nets on child mortality and morbidity in western Kenya II. Study design and methods. Am. J. Trop. Med. Hyg. 68, 10–15.

    Article  Google Scholar 

  • Prinsen Geerligs P & Brabin B (2003): An analysis of the effects of malaria chemoprophylaxis in children on haematological responses, morbidity and mortality. Bull. World Health Organ. 81, 205–216.

    Google Scholar 

  • Senderowitz J (1995): Adolescent Health: Reassessing the Passage to Adulthood. Washington DC.

    Book  Google Scholar 

  • Shaker ZA, Hassan SI, el-Attar GM, Talaat M, el-Nahal HM, el-Behairy NM, Mansour MM & Kamel LM (1994): Use of Kato and nucleopore techniques for qualitative diagnosis of schistosomiasis. J. Egypt Soc. Parasitol. 24, 656–662.

    CAS  PubMed  Google Scholar 

  • Skikne BS, Flowers CH & Cook JD (1990): Serum transferrin receptor: a quantitative measure of tissue iron deficiency. Blood 75, 1870–1876.

    CAS  Google Scholar 

  • Stephenson LS (1993): The impact of schistosomiasis on human nutrition. Parasitology 107(Suppl), S107–S123.

    Article  Google Scholar 

  • Stephenson LS, Latham MC & Ottesen EA (2000): Malnutrition and parasitic helminth infections. Parasitology 121(Suppl), S23–S38.

    Article  Google Scholar 

  • Stoltzfus RJ, Chwaya HM, Tielsch JM, Schulze KJ, Albonico M & Savioli L (1997): Epidemiology of iron deficiency anemia in Zanzibari schoolchildren: the importance of hookworms. Am. J. Clin. Nutr. 65, 153–159.

    Article  CAS  Google Scholar 

  • Tanner J (1962): Growth at Adolescence. Oxford: Blackwell Scientific Publications..

    Google Scholar 

  • Tatala S, Svanberg U & Mduma B (1998): Low dietary iron availability is a major cause of anemia: a nutrition survey in the Lindi District of Tanzania. Am. J. Clin. Nutr. 68, 171–178.

    Article  CAS  Google Scholar 

  • ter Kuile FO, Terlouw DJ, Kariuki SK, Phillips-Howard PA, Mirel LB, Hawley WA, Friedman JF, Shi YP, Kolczak MS, Lal AA, Vulule JM & Nahlen BL (2003a): Impact of permethrin-treated bed nets on malaria, anemia, and growth in infants in an area of intense perennial malaria transmission in western Kenya. Am. J. Trop. Med. Hyg. 68, 68–77.

    Article  Google Scholar 

  • ter Kuile FO, Terlouw DJ, Phillips-Howard PA, Hawley WA, Friedman JF, Kariuki SK, Shi YP, Kolczak MS, Lal AA, Vulule JM & Nahlen BL (2003b): Reduction of malaria during pregnancy by permethrin-treated bed nets in an area of intense perennial malaria transmission in western Kenya. Am. J. Trop. Med. Hyg. 68, 50–60.

    Article  Google Scholar 

  • Tietz NW (1995): Clinical Guide to Laboratory Tests. Philadelphia, PA: W.B. Saunders Company.

    Google Scholar 

  • UNICEF (2000) MICS-2 National Report Kenya. UNICEF Statistics. Website accessed June 2003 http://www.childinfo.org/MICS2/Newreports/Kenya/KenyaTables.pdf

  • van Eijk AM, Ayisi JG, ter Kuile FO, Misore A, Otieno JA, Kolczak MS, Kager PA, Steketee RW & Nahlen BL (2001): Human immunodeficiency virus seropositivity and malaria as risk factors for third-trimester anemia in asymptomatic pregnant women in western Kenya. Am. J. Trop. Med. Hyg. 65, 623–630.

    Article  CAS  Google Scholar 

  • WHO (2001): Iron Deficiency Anaemia: Assessment, Prevention and Control. Geneva: World Health Organization.

  • WHO Expert Committee on Physical Status (1995): Physical status: the use and interpretation of anthropometry. Geneva.

  • WHO Working Group (1986): Use and interpretation of anthropometric indicators of nutritional status. Bull World Health Org. 64, 929–941.

  • Woolhouse ME & Hagan P (1999): Seeking the ghost of worms past. Nat. Med. 5, 1225–1227.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

We express our gratitude to the schoolgirls, parents, and teachers who participated in the study and the many people who assisted with this project. We are grateful to Professor Bernard J Brabin (Liverpool School of Tropical Medicine) for reviewing this manuscript. We thank Dr AH Zwinderman (Academic Medical Center, University of Amsterdam) and Dr Hans Verhoef (Wageningen University) for their statistical advice. We are thankful to Chris P Nixon (International Health Institute, Brown University) for carrying out the immunoassays. We thank the Director of the Kenya Medical Research Institute (KEMRI) for his permission to publish this work. This study was supported by a grant from The Netherlands Foundation for the Advancement of Tropical Research (WOTRO), the Netherlands.

Author information

Authors and Affiliations

Authors

Contributions

Guarantors: TL and FOtK.

Contributors: FOtK, TL, PAK and AJOl were responsible for the study design. SKK and JDK were responsible for laboratory work. TL and FOtK were responsible for data collection and analysis, interpretation of results and writing the manuscript, with contributions from all other authors.

Corresponding author

Correspondence to T Leenstra.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Leenstra, T., Kariuki, S., Kurtis, J. et al. Prevalence and severity of anemia and iron deficiency: cross-sectional studies in adolescent schoolgirls in western Kenya. Eur J Clin Nutr 58, 681–691 (2004). https://doi.org/10.1038/sj.ejcn.1601865

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.ejcn.1601865

Keywords

This article is cited by

Search

Quick links