Anemia is defined as condition with less hemoglobin (Hb) level than the normal range in the body, which decreases oxygen-carrying capacity of red blood cells to tissues (Nutrition WA, 2005). World Health Organi-zation (WHO) and Center of Disease Control and Pre-vention (CDC) definitions for anemia differ with age, sex and pregnancy status. The classification is as fol-lows: children 6 months to 5 years anemia is defined as a Hb level < 11 g/dl, children 5-11 years Hb < 11.5 g/ dl, adult males Hb < 13 g/dl; non-pregnant women Hb < 12 g/dl and pregnant women Hb < 11 g/dl (Benoiste et al., 2008; Regasa and hyder, 2019). Anemia is a globally public health problem that affects both deve-loping and developed countries with a high impact on human health, social and economic growth. It is pre-valent at all stages of life, but it is more prevalent in female adolescents and young women (Nutrition WA, 2005). 

Young women including adolescent females are sus-ceptible to anemia because of their biological demands for micronutrients associated with rapid body growth and the depletion of these nutrients due to parasitic in-festations (Benoiste et al., 2008). Anemia is also com-mon in puberty due to the onset of menstruation, which alters an individuals iron status by generating more demand for iron, blood loss and pro-inflammatory pro-cesses due to menstrual cycles (Regasa and hyder, 2019). Globally, it was estimated that one-third of the total population (32.9%) is suffered from anemia with sub-Sahara African countries contributed to the highest anemia burden (Kasseeburne et al., 2014). 

More than half of young women world-wide have suffered from anemia and this figure is significantly higher than the World Health Organizations cut-off value for identifying anemia as a public health problem (Yasutahe et al., 2013). Approximately one-quarter of young women in developing countries are anemic (WHO, 2005). Most African and other low and mid-dle-income countries contribute to the highest-burden of anemia among young women. Anemia burden among young women is also common in sub-Saharan country which ranges from 13.7% in Ethiopia to 61.5% in Ghana (Yasutahe et al., 2013). Ethiopia also shares the high burden of anemia in young women which ranges from 24% to 38%, with an average rate of 29% (Gebreyesus et al., 2019). Anemia in young women is a serious condition which impedes them from reaching their full potential by reducing educational achieve-ment, labor productivity as well as their cognitive capacity and affects their mental health (WA, 2008; Sen and Rennani, 2006). Besides, in pregnant women, the risk of birth complications and the delivery of low birth weight infant are increases with anemia (Soekarjo et al., 2001; Shahen et al., 2019).

According to different studies, many factors such as educational status, marital status, wealth status, nutri-tional status, occupation, type of toilet facility, source of drinking water, contraceptive use, distance from the health facility, and region are associated with anemia in young women (Regasa & Hyder, 2019; Tembrhe et al., 2015; Kibret et al., 2019). The extra needs of nutrients because of rapid growth and physical change in young women commonly result in nutritional defici-encies which are the common causes for anemia. Des-pite its common occurrence in young women, most previous studies focused on anemia among the repro-ductive age group (15 to 49 years) (Sadeghien et al., 2013; Win & Ko, 2015) and to our knowledge, there is a scarcity of information on the prevalence of anemia among young women and its determinants in Africa including Ethiopia. Anemia due to nutritional defici-ency rises at the beginning of puberty and associated physical and physiological changes that occur in adole-scents and young women that place a major demand on their nutritional requirements, making them more vul-nerable to nutritional deficiency anemia (Benoist et al., 2008; Sharif et al., 2019). 

As many literatures reported, the potential factors affecting reproductive age and young womens anemia are not similar, as young age is the time where nutri-tional demand is highest. Besides, this study was con-ducted based on nationally representative Ethiopian Demographic and Health Survey (EDHS) data with a larger sample size that could provide valid information for countries, particularly sub-Saharan African coun-tries and other low- and middle-income countries that had similar socio-economic and socio-cultural patterns. Therefore, this study aimed to investigate the preva-lence of anemia and its determinants among young women in Ethiopia. The findings of this study could help to inform policymakers as well as governmental and non-governmental organizations about the mag-nitude of this problem as well as the potential factors associated with anemia to plan intervention strategies.

Study Area 

This study was collaboration with Bangladesh and Harar Health Science College students. Harari regional state which is located in eastern parts of Ethiopia. It is 526 km from Addis Ababa to East direction and an ele-vation of 1885 meters above sea level. It has a tem-perature that range from 23-300c, the average annual rainfall of 565mm3 and the town has an altitude of 1885m/6184ft. The total population of the region are 250903, out of those 122942 are men and 127961 are women. The Ethinic group in the region includes Oromo (52.3%), Amhara (32.6%), Harari (7.1%) and other (HRHB). Study Design Cross-sectional study was conducted from June 2021 - September 2021 in health Science College.

Study participants

The study participants were female student greater than 18 years old and who were volunteer for blood donation in Health Science College.

Inclusion and Exclusion Criteria

Inclusion

Only female students in Health Science College.

Exclusion

Those pregnant one unwilling to response was excluded.

Sample Size Determination

The sample size will be determined by using single population proportion formula by considering the assu-mption of 95% confidence interval 5% margin of error.

N = (zα/2)2 P(1-P)

                                     d2

Where,

N = sample size

P = estimate of prevalence of the proportion=50%

z = value that corresponding 95% confidence=1.96

d = margin of error=5%

n= (1.96)2×0.5×0.5/ (0.05)2

n=0.960/0.0025

n=384

By adding 10% Non-respondent rate the total sample size will be 422.

Sampling techniques and procedures

From total female students (1016) k-interval was deter-mined that is –

K =N/n = 1016/422 =2.4~2. 

So sample were taken by skipping 2 until sample size fulfilled

Method of data collection

Questionnaire 

Data on socio-demographic characteristics of study participants and determinant factors of anemia were collected using interviewer based questionnaire by the taught data collectors.

Hemoglobin determination 

A venous blood sample was taken, from interviewed female students in Harar health science college  and filed to micro cuvette, and then placed in the cuvette holder device  for measuring hemoglobin concentra-tion and anemia status was determined based on the WHO classification using the hemoglobin level of the respondents (Kennedy et al., 2021)

Operational definition

Mild anemia hemoglobin level 11.9gm to 10gm/100 ml blood

Moderate anemia hemoglobin level 9.9gm to 7gm/100 ml blood 

Severe anemia hemoglobin level < 7gm /100ml blood

Anemia in non-pregnant woman hemoglobin level <12 gm/100 ml blood 

Variables

Dependent variable

Anemia

Independent variables

Age, resident, medical history and nutritional habit.

Quality Control

Questionnaires were pre-tested prior to the actual data collection. The collected data were checked for consis-tency and completeness. All the laboratory procedures were conducted as per the standard operating proce-dures.

Data Analysis

Data was collected, checked whether missing data or outliers or incomplete and then transported to Statis-tical Package of Social Science (SPSS version 16). Univariate analysis and Independent variables which P- value <0.025 were candidate for multivariate logis-tic regression. Variables in which p-value< 0.05 will be declared as significant by adjusted odd ratio with 95% Confidence interval.

Socio-demographic characteristics

All students recruited this study were female. A total of 422 female student participated in the study. Most 304 (72%) of the participant had age of 18-25 and 115 (27.5%) student had age of 26-34 at a time of surve-yed. All most all female student participated in study were single 69.9% and the reaming 2.6%was married time of surveyed. The mean age of the study partici-pants was (ranged from 18 to 41 years). Out of 422 participants, (60.7%) were living in urban areas and the rest 87 (39.3%) in rural residents. More than half, 412 (97.6%), of the study participants occupation were student and the rest of participant (2.3%) was both house wife and student (Table 1).

Table 1: Socio-demographic characteristics of female student (n=422).

Table 2: Laboratory finding of anemic type.

Laboratory findings of female student 

Among 422 study participants 57 (13.5%) were ane-mic (Hb: < 11 g/dl) and not-anemic > 33% (> 11 gm/ dl) 365 365(86.5%). Of which 35(61.4%) mild anemia, 15(26.3) moderate and (12.3%) was severe based on the morphology of red blood cells. 

Nutritional characteristics

Vegetables were consumed weak to weak and (30.6%) of female does not regularly. Almost more than fifty present of students consume teff (61.6%) per day while small proportion (62%) did not consume per day. Meat was the least frequently consumed food item, since 99.9% of the study participants reported that they never consumed it per day (Table 3). Of all partici-pants, (89.1%) reported that they had a habit of con-suming tea and/or after a meal, (89.1%) once per day and only (1.6%) did not.

Table 3: Nutrition related characteristics of female student.

Pervious medical history of female student

Only (12.1%) of female student was taken dewor-ming regularly while 87.9% was not regularly. Of all respondents, (82.9%) did not took iron folate supple-ment at least once in the preceding four weeks but (17.1%) reported full compliance  with the supplement 

in the reference period. However all study participant was negative for HIV test (Table 4).

Table 4: Clinical history of female student in harar Health College.

Laboratory Findings of Female Student

Among 422 study participants 57 (13.5%) were anemic (Hb: < 11 g/dl) and not-anemic > 33% (> 11 gm/dl) 365 365(86.5%).Of which 35(61.4%) mild anemia, 15(26.3) moderate and (12.3%) was severe based on the morphology of red blood cells (Table 2).

Univariable logistic rig ration

The bivariate analysis showed that age, resident and iron supplementation were variable which had associa-tion, but the only variable which has association in multivariate analysis was  iron supplementation (OR = 7.39; 95% CI: 1.45-37.57) (Table 5).

Table 5: Bivariate analysis of anemia with independent variables.

Multivariate analysis

In the final multivariate analysis the only variable which has association with occurrence of anemia was folic supplementation and found to be independent explanatory variably in female student. Non folic sup-lement were at more risks for anemic than those in other (OR = 7.39; 95% CI: 1.45-37.57) (Table 6).

Table 6:  Multivariate analysis of anemia with independent variables.

In this study the overall  prevalence of anemia in the female student was 13.5% this was in line with pre-vious finding of other researcher 12.5% in Saudi (Baroot et al., 2010) 9.7% in Debra Berhan (Abere, 2014), 10% in Sudan,  (Abdelgader et al., 2014),1.6% Addis Ababa (Gebreweld and Tseey, 2018) and Iran, 13.6% (Kumari and Priya, 2016). However, our find-ing was lower than previous studies conducted in South East Ethiopia, 27.9% (kefyelew et al., 2014). The difference might be due to host sampled, geo-graphical variation, and dietary habits of the study participants. In this study, the majority of anemic cases, 61.3% were mild type followed by moderate cases of anemia 26.5%. This result was similar with reported in Kenya (62.5% and 37.5%) (Siteti et al., 2014) and Nepal (67. 1%, and 28.6%) (Singh et al., 2013). In which majority of the cases was mild anemia followed by moderate anemia respectively. However the present study were In contrast with (70.7% and 26.3%) report in Kenya (Tekeste, 2015) and (60% and 34.3%) report in southern Ethiopia (Gedefew et al., 2014). Folic supplementation was the major risk factor for increased anemia prevalence and factor remained significant in the final model. This finding was in agreement with result of (Brhane Berhe et al., 2018). This might be due to low amount of meat and vege-table in daily consumed food in the study area. In the present study, there was positive association between medical history of malaria in student and prevalence of anemia. This result was close agreement with report of (Brhane Berhe et al., 2018) that prove that having history of medical history of malaria condition was the major risk factor for increased anemia prevalence, but showed no stastically significance association.

This study found an overall prevalence of anemia among its sample of apparently healthy female student in harar health Science College was 13.5%. The study also reported that the main risk factors in relation to contracting anemia were inadequate intakes of iron, frequent tea consumption, infrequent red meat consu-mption, and a past personal history of malaria and ire-gular deworming. The findings presented here suggest a need for focused education and awareness strategies designed to improve nutritional habits by encouraging the consumption of rich sources of iron in the diet like red meat. The current work has set a standard for pos-sible future research in the form of randomized trials which would help to build greater understanding of this health issue and would also support the develop-ment of a strong and suitable public health policy which can efficiently tackle anemia. In line with the findings of the present study, the following recommen-dations are forwarded in order to mitigate the effects of the anemia:

 Based on the identified risk factors, the approach to anemia control should ensure that preventive strategies be targeted to all female student

 Stool analysis and nutrition intervention and die-tary supplement should be strongly inculcated

 Anti-helminthes should be given as prophylaxis to adolescent and young adult women, before their reproductive career

 All female student greater than 18 age joined harar health science college should be screened and treated routinely for intestinal parasitic in-fection

Ethical Approval

Ethical approval was obtained from the Institutional Health Research Ethics Review Committee (IHRERC) of Haramaya University, College of Health and Medi-cal Sciences official letter of support was sent to Ambo town health office and to other concerned bodies. This study was conducted in accordance with the Declaration of Helsinki

The authors declare that there is no conflict of interest.

We are thankful to laboratory personnel, clinicians and university authorities to the completion of the success-ful research study.