Prevalence and associated factors of anemia among female high school students in Depok City

Thesia Ekawati* -  Master in Nutrition Faculty Of Public Health University Of Indonesia, Indonesia
Sandra Fikawati -  Master in Nutrition Faculty Of Public Health University Of Indonesia, Indonesia
Dian Fitri Nurisfanti -  Bachelor of Nutrition Science Faculty of Public Health University of Indonesia, Indonesia
Hilmi Friska -  Master in Nutrition Faculty of Public Health University of Indonesia, Indonesia
Anemia among adolescent girls remains a public health issue that can affect their nutritional status, learning abilities, and reproductive health. However, studies that simultaneously analyze nutritional intake, behavioral, and physiological factors associated with anemia among high school girls in Depok City are limited. This study aimed to identify the factors associated with anemia among female high school students in Depok City, Indonesia. Methods: This cross-sectional study included 165 students from 15 public high schools selected by quota sampling between February and April 2024. Data were collected through hemoglobin measurements using the HemoCue Hb 201+, anthropometry, two 24-hour dietary recalls, and structured questionnaires. Data were analyzed using chi-square tests and multiple logistic regressions. Results: The prevalence of anemia was 53.3%. Low protein intake had the strongest independent association with anemia (odds ratio [OR] = 6.18; 95% confidence interval [CI]: 2.74–13.94; P < 0.001). Other associated factors included undernutrition (OR = 5.27; p = 0.015), low energy intake (OR = 4.84; p = 0.001), insufficient iron intake (OR = 4.76; p = 0.002), nonadherence to weekly iron supplementation (OR = 4.50; p = 0.009), irregular menstrual cycles (OR = 3.95; p = 0.004), and low zinc intake (OR = 2.51; p = 0.034). In conclusion, anemia was prevalent and was associated with nutritional, behavioral, and menstrual factors. Integrated interventions should improve dietary quality, supplementation adherence, menstrual health education, and counseling for undernourished female students.

Keywords : Adolescent health, anemia, dietary intake, iron supplementation, menstruation, nutritional status

  1. Adamu, A. L., Crampin, A., Kayuni, N., Amberbir, A., Koole, O., Phiri, A., Nyirenda, M., & Fine, P. (2017). Prevalence and risk factors for anemia severity and type in Malawian men and women: Urban and rural differences. Population Health Metrics, 15(1), Article 12. https://doi.org/10.1186/s12963-017-0128-2
  2. Al Rahmad, A. H. (2023). Scoping Review: The Role of Micronutrients (Fe, Zn, Iodine, Retinol, Folate) During Pregnancy. Jurnal Kesehatan Manarang, 9(1), 1–13. https://doi.org/https://doi.org/10.33490/jkm.v9i1.812
  3. Azzeh, F. S., Alazzeh, A. Y., Wazzan, H., Jazar, A. S., Obaid, R. S., & Subih, H. S. (2023). Dietary protein intake and anemia risk among adolescent girls: A cross-sectional study. Nutrients, 15(3), Article 612. https://doi.org/10.3390/nu15030612
  4. Balarajan, Y., Ramakrishnan, U., Özaltin, E., Shankar, A. H., & Subramanian, S. V. (2022). Anaemia in low-income and middle-income countries: Determinants and intervention strategies. The Lancet Global Health, 10(3), e312–e322. https://doi.org/10.1016/S2214-109X(22)00084-3
  5. Baye, K., Laillou, A., & Chianu, J. (2021). Food fortification for reducing anemia in low- and middle-income countries: A systematic review. Maternal & Child Nutrition, 17(2), Article e13096. https://doi.org/10.1111/mcn.13096
  6. Dinas Kesehatan Kota Depok. (2023). Profil kesehatan Kota Depok 2023.
  7. Belay, D. G., Amlak, B. T., Chilot, D., Alem, A. Z., & Merid, M. W. (2025). Pooled prevalence of anaemia and its associated factors among adolescent girls in East and West Africa: A systematic review and meta-analysis. BMC Public Health, 25, Article 2482. https://doi.org/10.1186/s12889-025-23701-4
  8. Gebremedhin, S., Bekele, A., & Tadesse, T. (2022). Dietary risk factors of anemia among adolescent girls in sub-Saharan Africa: A systematic review and meta-analysis. Nutrients, 14(7), Article 1423. https://doi.org/10.3390/nu14071423
  9. GBD 2021 Anaemia Collaborators. (2023). Prevalence, years lived with disability, and trends in anaemia burden by severity and cause, 1990–2021: Findings from the Global Burden of Disease Study 2021. The Lancet Haematology, 10(9), e713–e734. https://doi.org/10.1016/S2352-3026(23)00160-6
  10. Geng, F., Mai, X., Zhan, J., Xu, L., Zhao, Z., Georgieff, M. K., Shao, J., & Lozoff, B. (2015). Impact of fetal-neonatal iron deficiency on recognition memory at 2 months of age. The Journal of Pediatrics, 167(6), 1226–1232. https://doi.org/10.1016/j.jpeds.2015.08.035
  11. Hossain, M. S., Shanta, Z., Islam, R., & Begum, F. (2023). Dietary diversity and anemia among adolescent girls in rural Bangladesh: A cross-sectional study. BMC Nutrition, 9(1), Article 45. https://doi.org/10.1186/s40795-023-00698-4
  12. Jeng, S., & Chen, W. (2022). Zinc–iron interactions and implications for adolescent hematologic health. Journal of Clinical Nutrition, 41(3), 215–223. https://doi.org/10.1016/j.jcn.2022.03.001
  13. Kementerian Kesehatan Republik Indonesia. (2021). Mengenal dampak anemia pada remaja.
  14. Kementerian Kesehatan Republik Indonesia. (2023). Survei Kesehatan Indonesia 2023.
  15. Kinyoki, D., Osgood-Zimmerman, A. E., Bhattacharjee, N. V., Local Burden of Disease Anaemia Collaborators, Kassebaum, N. J., & Hay, S. I. (2021). Anemia prevalence in women of reproductive age in low- and middle-income countries between 2000 and 2018. Nature Medicine, 27(10), 1761–1782. https://doi.org/10.1038/s41591-021-01498-0
  16. Kolarš, B., Mijatović Jovin, V., Živanović, N., Minaković, I., Gvozdenović, N., Dickov Kokeza, I., & Lesjak, M. (2025). Iron Deficiency and Iron Deficiency Anemia: A Comprehensive Overview of Established and Emerging Concepts. Pharmaceuticals, 18(8), 1104. https://doi.org/10.3390/ph18081104
  17. Low, M. S. Y., Speedy, J., Styles, C. E., De-Regil, L. M., & Pasricha, S.-R. (2016). Daily iron supplementation for improving anaemia, iron status and health in menstruating women. Cochrane Database of Systematic Reviews, 2016(4), Article CD009747. https://doi.org/10.1002/14651858.CD009747.pub2
  18. Mengistu, G., Azage, M., & Gutema, H. (2019). Iron deficiency anemia among in-school adolescent girls in rural area of Bahir Dar City Administration, North West Ethiopia. Anemia, 2019, Article 1097547. https://doi.org/10.1155/2019/1097547
  19. Prentice, A. M., Mendoza, Y. A., Pereira, D., Cerami, C., Wegmüller, R., Constable, A., & Spieldenner, J. (2017). Dietary strategies for improving iron status: Balancing safety and efficacy. Nutrition Reviews, 75(1), 49–60. https://doi.org/10.1093/nutrit/nuw055
  20. Sekiyama, M., Jiang, H., Gunawan, B., Dewi, M., Ermayani, E., & Abdoellah, O. S. (2022). Menstrual health and anemia among adolescent girls in rural Indonesia: Implications for school-based interventions. International Journal of Environmental Research and Public Health, 19(8), Article 4612. https://doi.org/10.3390/ijerph19084612
  21. UNICEF. (2023). The state of the world’s children 2023: For every child, vaccination. https://www.unicef.org/reports/state-worlds-children-2023
  22. World Health Organization. (2014). Global nutrition targets 2025: Anaemia policy brief.
  23. World Health Organization. (2025). Anaemia in women and children: WHO global anaemia estimates. https://www.who.int/data/gho/data/themes/topics/anaemia_in_women_and_children
  24. Wirth, J. P., Woodruff, B. A., Engle-Stone, R., & Namaste, S. M. (2022). Anemia, micronutrient deficiencies, and menstrual health in adolescent girls: Evidence and implications for programs. The Journal of Nutrition, 152(3), 670–681. https://doi.org/10.1093/jn/nxab350
  25. Yani, M., Azhari, A., Al Rahmad, A. H., Bastian, F., Ilzana, T. M., Rahmi, C. R., Andriaty, S. N., Chanda, A., & Salsabila, S. (2023). The relationship between menarche and nutritional status in Junior High School students in Aceh Besar. A study from 30 years of armed conflict area, Aceh, Indonesia. AcTion: Aceh Nutrition Journal, 8(4), 635–641. https://doi.org/10.30867/action.v8i4.1310

Open Access Copyright (c) 2026 Thesia Ekawati, Sandra Fikawati, Dian Fitri Nurisfanti, Hilmi Friska
Creative Commons License
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.

AcTion: Aceh Nutrition Journal
Published by: Department of Nutrition at the Health Polytechnic of Aceh, Ministry of Health.
Soekarno-Hatta Street, No. 168. Health Polytechnic of Aceh, Aceh Besar, 23352. Telp/Fax: 0651 46126 / 0651 46121.
Website: https://gizipoltekkesaceh.ac.id/
E-mail: jurnal6121@gmail.com

e-issn: 2548-5741, p-issn: 2527-3310

All content is licensed under a: Creative Commons Attribution ShareAlike 4.0 International License

View My Stats

Get a feed by atom here, RRS2 here and OAI Links here