Adolescence is a distinct transitional phase characterized by accelerated linear growth, rapid accrual of lean body mass, hormonal maturation, and increased micronutrient requirements. Among girls, this period assumes particular public health importance because growth-related nutritional demand coincides with the onset of menstruation, changes in body composition, and evolving dietary behavior [1-5]. When these demands are not met, girls become vulnerable to undernutrition, stunting, and anemia, each of which can adversely affect physical capacity, cognition, school performance, immunity, and later maternal health [1-6]. Anemia remains one of the most widespread nutritional problems in Indian adolescents. Evidence from systematic and community-based studies has shown that the burden of anemia among adolescent girls in India continues to be high, with considerable variation across geographical regions, socioeconomic strata, and rural-urban settings [1,2,6-8]. Rural and underserved populations are particularly vulnerable because of inadequate dietary diversity, poverty, reduced access to health services, recurrent infections, and limited awareness regarding menstrual and nutritional health [2,6-9]. In addition, nutritional anemia in this age group is not explained by iron deficiency alone; folate, vitamin B12, and other micronutrient inadequacies also contribute to the overall burden [2-4]. Alongside anemia, poor nutritional status among adolescent girls remains an equally important concern. Indian studies from rural, urban-slum, tribal, and socioeconomically deprived settings have documented substantial levels of thinness, stunting, and dietary inadequacy among adolescent girls [5,9-14]. These deficits are especially concerning because adolescents represent the future reproductive-age population. Poor nutritional reserves carried into adulthood can perpetuate intergenerational cycles of undernutrition, poor pregnancy outcomes, and impaired infant growth. Therefore, assessing both anthropometric status and hemoglobin levels offers a more comprehensive understanding of adolescent health than evaluating anemia alone [1,2,9-14]. Despite national programs focused on iron-folic acid supplementation, deworming, and school or community-based adolescent health services, local evidence from field practice areas remains necessary for targeted planning and implementation [2,3]. The nutritional and anemia profile of adolescent girls varies by setting, and institution-specific community data help identify subgroups at greater risk and guide practical intervention strategies. In this context, the present study was undertaken in the field practice areas of KIMS & RF, Amalapuram, Andhra Pradesh. The objectives of the study were to assess the nutritional status of adolescent girls, estimate the prevalence and severity of anemia, and examine the distribution of anemia across age groups and nutritional categories. Adolescence therefore offers an important window for correction through timely community identification, counselling, and supplementation before nutritional deficits become entrenched in adulthood.

Study design and setting: This observational cross-sectional study was conducted in the field practice areas affiliated with KIMS & RF, Amalapuram, Andhra Pradesh, India, over a six-month period from October 2021 to March 2022. The study focused on adolescent girls residing in the institutional rural and peri-urban practice areas covered by routine community health activities. Study participants: Adolescent girls aged 10 to 19 years who were available during the study period and willing to participate were included. Girls with incomplete records or with missing essential anthropometric or hemoglobin data were excluded from the final analysis. A total of 100 adolescent girls constituted the study sample. Data collection procedure: Data were collected using a predesigned and structured proforma. Information regarding age, residence, education, and socioeconomic profile was obtained through direct interview. Anthropometric assessment included measurement of body weight and standing height using standard field techniques. Body mass index [BMI] was calculated as weight in kilograms divided by height in meters squared. Nutritional status was assessed using BMI-for-age categories and height-for-age status, consistent with adolescent nutritional assessment approaches used in Indian community studies [5,9-14]. Clinical examination included screening for visible pallor. Assessment of anemia: Hemoglobin estimation was performed using a standardized hemoglobin assessment procedure available through the study setting. Participants were classified as having normal hemoglobin, mild anemia, moderate anemia, or severe anemia according to accepted cut-offs used for adolescents in national and pediatric guidance documents [3,4]. For analytic presentation, the overall prevalence of anemia was derived by combining mild, moderate, and severe anemia categories. Operational definitions: Undernutrition referred to low BMI-for-age, while overweight and obesity were categorized using age-appropriate BMI status. Stunting was defined as reduced height-for-age. These indicators were selected because they reflect both current nutritional depletion and chronic growth compromise in adolescent populations [9-14]. Clinical pallor was recorded as present or absent on physical examination. Statistical analysis: Data were entered in Microsoft Excel and analyzed descriptively. Categorical variables were summarized as frequencies and percentages. Continuous variables such as age, weight, height, BMI, and hemoglobin were expressed as mean ± standard deviation. Results were organized into tables to describe sociodemographic characteristics, nutritional status, hemoglobin distribution, and the pattern of anemia across age groups and nutritional categories. Ethical considerations: Participation was voluntary. Assent from adolescent girls and consent from parents or guardians were obtained before data collection wherever applicable. Confidentiality of personal information was maintained throughout the study, and findings were reported in aggregate form without identifying individual participants.

A total of 100 adolescent girls from the field practice areas of KIMS & RF, Amalapuram were included in the study. The age of the participants ranged from 10 to 19 years, with a mean age of 14.8 ± 2.1 years. The largest proportion belonged to the 14–16 year age group [44.0%], followed by 10–13 years [28.0%] and 17–19 years [28.0%]. Most participants were from rural areas [68.0%], and 74.0% belonged to lower-middle or upper-lower socioeconomic classes. The baseline sociodemographic profile is shown in Table 1. Table 1. Sociodemographic profile of study participants [N = 100] Variable Category n % Age group [years] 10–13 28 28.0 14–16 44 44.0 17–19 28 28.0 Residence Rural 68 68.0 Urban/peri-urban 32 32.0 Socioeconomic status Upper middle 8 8.0 Middle 18 18.0 Lower middle 26 26.0 Upper lower 48 48.0 Education level Middle school 37 37.0 High school 43 43.0 Intermediate 20 20.0 The mean body weight of the participants was 43.6 ± 8.4 kg, the mean height was 151.2 ± 6.8 cm, and the mean body mass index [BMI] was 19.0 ± 3.1 kg/m². Based on BMI-for-age assessment, 38.0% of the girls were undernourished, 52.0% had normal nutritional status, 8.0% were overweight, and 2.0% were obese. Stunting, assessed by height-for-age, was observed in 21.0% of participants. Clinical pallor was noted in 58.0% of girls. The nutritional profile of the study population is presented in Table 2. The mean hemoglobin level in the study population was 10.8 ± 1.8 g/dL. Overall, anemia was detected in 64.0% of the adolescent girls. Among those with anemia, mild anemia was the most common category [34.0%], followed by moderate anemia [24.0%] and severe anemia [6.0%]. Only 36.0% of participants had normal hemoglobin levels. The distribution of anemia severity is shown in Table 3. Table 2. Nutritional status of study participants [N = 100] Parameter Category n % BMI-for-age nutritional status Undernourished 38 38.0 Normal 52 52.0 Overweight 8 8.0 Obese 2 2.0 Height-for-age Stunted 21 21.0 Normal stature 79 79.0 Clinical pallor Present 58 58.0 Absent 42 42.0 Table 3. Distribution of anemia among study participants [N = 100] Hemoglobin status n % Normal 36 36.0 Mild anemia 34 34.0 Moderate anemia 24 24.0 Severe anemia 6 6.0 Total anemia 64 64.0 When anemia prevalence was assessed across age groups, it was found to be higher among older adolescents. Anemia was present in 50.0% of girls aged 10–13 years, 70.5% of those aged 14–16 years, and 67.9% of those aged 17–19 years. A higher proportion of anemia was also observed among undernourished girls compared with those having normal or higher BMI. Among undernourished participants, 78.9% were anemic, whereas anemia was seen in 54.8% of girls with normal or above-normal BMI. This overlap between poor nutritional status and anemia is presented in Table 4. Table 4. Association of anemia with age group and nutritional status Variable Category Anemia present n [%] Anemia absent n [%] Total Age group [years] 10–13 14 [50.0] 14 [50.0] 28 14–16 31 [70.5] 13 [29.5] 44 17–19 19 [67.9] 9 [32.1] 28 Nutritional status Undernourished 30 [78.9] 8 [21.1] 38 Normal/overweight/obese 34 [54.8] 28 [45.2] 62 Overall, the findings demonstrate a substantial burden of both undernutrition and anemia among adolescent girls in the field practice areas of KIMS & RF, Amalapuram. More than one-third of the participants were undernourished, nearly one-fifth were stunted, and almost two-thirds were anemic. Mild and moderate anemia together accounted for the majority of cases, while severe anemia was present in a smaller but clinically important proportion. The coexistence of undernutrition and anemia was particularly prominent, indicating that nutritional deprivation remains a significant public health concern in this adolescent population.

The present study highlights a substantial dual burden of undernutrition and anemia among adolescent girls in the field practice areas of KIMS & RF, Amalapuram. Overall anemia was observed in 64.0% of participants, with mild and moderate anemia accounting for most cases. This finding closely parallels the pooled national estimate reported in a systematic review of Indian adolescent girls, which documented a very high anemia burden across community settings [1]. It also supports the broader Indian public health concern emphasized in review literature and national pediatric recommendations, which identify adolescence as a nutritionally vulnerable period requiring focused screening and intervention [2,3]. The mean hemoglobin level in the present study was 10.8 ± 1.8 g/dL, and anemia was more common among middle and late adolescents than among younger girls. This age-gradient is biologically plausible and is consistent with earlier Indian observations showing that anemia increases with advancing adolescent age, likely because menstrual blood loss, cumulative dietary deficiency, and increased growth requirements become more prominent in older girls [7,8,14]. The predominance of mild anemia in the present study is also in agreement with several community-based reports, where most affected girls were in the mild-to-moderate category rather than the severe category [6-8,14]. Undernutrition was present in 38.0% of participants, and 21.0% were stunted. These findings are in line with Indian literature showing persistent thinness and chronic growth faltering among adolescent girls from rural, tribal, and socioeconomically constrained settings [5,9-13]. Studies from West Bengal, South India, North India, tea garden communities, tribal Maharashtra, and rural eastern India have all reported that adolescent girls often experience inadequate nutritional intake, poor diet quality, and measurable anthropometric deficits [9-14]. Although the degree of malnutrition varies across settings, the present findings indicate that nutritional deprivation remains a continuing concern even outside tribal or extreme-poverty populations. A notable observation in this study was the higher anemia prevalence among undernourished girls compared with those who had normal or higher BMI. This overlap suggests that inadequate overall nutrient intake and poor diet quality are likely contributing factors, rather than isolated iron deficiency alone. Contemporary Indian guidance has stressed that nutritional anemia in children and adolescents often reflects multiple deficiencies, including iron, folate, and vitamin B12, and that hemoglobin screening should be interpreted within the broader context of dietary and anthropometric assessment [2-4]. The coexistence of low BMI, stunting, pallor, and anemia in the present study strengthens this integrated interpretation. The rural predominance and concentration of participants in lower socioeconomic categories provide an additional explanation for the observed burden. Community studies have repeatedly shown that socioeconomic disadvantage, reduced diet diversity, limited awareness, and barriers to preventive services contribute to poor adolescent nutrition and anemia [6-8,14]. From a programmatic perspective, the findings support routine school- and community-based screening, nutrition counselling, menstrual health education, deworming, and strengthening of iron-folic acid supplementation coverage. Local field-practice-area evidence such as this study is valuable because it helps institutions align adolescent health activities with the nutritional realities of the communities they serve. Limitations This cross-sectional study was conducted in the field practice areas of a single institution, which restricts wider generalization. Dietary intake, menstrual blood loss, worm infestation, and biochemical markers such as serum ferritin, folate, and vitamin B12 were not assessed, so etiological characterization remained limited. The sample size was modest, and temporal or causal relationships between nutritional status and anemia could not be established.

The present study demonstrates that adolescent girls in the field practice areas of KIMS & RF, Amalapuram carry a considerable burden of both undernutrition and anemia. More than one-third of participants were undernourished, one-fifth were stunted, and nearly two-thirds were anemic, with mild and moderate anemia forming the largest share. Anemia was more frequent in older adolescents and in girls with low BMI, indicating a close relationship between nutritional deprivation and hematological vulnerability. These findings support the need for regular community-based screening, strengthened iron-folic acid supplementation, nutrition education, dietary diversification, and focused adolescent health services to improve present wellbeing and future maternal health outcomes in this population.

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