Determinants of Anemia among school children and adolescents in Zanzibar

BackgroundAnemia continues to pose a substantial global health concern. Previous research in Tanzania mainland has documented high anaemia prevalence among children. However, studies specifically exploring the state of anaemia among school-aged children in Zanzibar remain limited. ObjectiveTo determine the prevalence and determinants of anaemia among children and adolescents aged 5 to 19 years in Zanzibar. MethodsThe Zanzibar National School Health and Nutrition Survey was aschool-based cross- sectional survey among school children and adolescents aged between 5 and 19 years enrolled in primary and secondary schools during the academic year 2022. A multistage systematic sampling was applied to select primary schools, class levels and students. Pre-tested structured questionnaires were used to gather demographic and economic data. Hemoglobin concentration was determined using a hemoglobinometer (HemoCue 301+). Inferencial analysis was done using Chi-Squire test and Modified Poison Logistic Regression. ResultsAlmost half of school children and adolescents 5-19 years in Zanzibar are anaemic with a prevalence of 45.7%. The determinants of anaemia included gender, age, school ownership, meal frequency and family income. Children aged 5-9 years were 1.2 more likely to be anaemic (APR: 1.2, 95% CI: 1.1-1.4; p<0.001). Adolescent girls had 10% times more significant risk of anaemia than adolescent males (APR: 1.1, 95% CI: 1.1-1.3; p=0.001). Children in public schools had a 1.7 times significantly higher risk of being anaemic than their counterparts in private schools (APR: 1.7, 95% CI: 1.2-2.3; p=0.004). Children who consumed breakfast 2-4 times a week had a significantly decreased risk of anaemia (APR: 0.8, 95% CI: 0.7-0.9p=0.015). Wealth quintile, settings, School level, regional differences, urban and rural settings, and deworming status, showed no significant difference in anaemia prevalence. ConclusionDespite massive improvements as compared to previous studies, the findings indicate a persistently higher prevalence of anaemia among school children and adolescents in Zanzibar. Both school-and-community focused interventions are needed to address the burden of anaemia in Zanzibar. The preponderance of anaemia among adolescent girls and those from public schools provides a unique opportunity for targeting such populations with anaemia prevention and control interventions, and schools are uniquely positioned to provide such interventions.