Burden and Determinants of Anemia Among Rural Adolescent Girls in Andhra Pradesh, India: A Mixed-Methods Study on Nutritional Status, KAP and Stakeholder Insights

Purpose: Anemia remains a major public health concern among vulnerable rural adolescent girls in many countries, including India. This study aimed to assess the prevalence of anemia, nutritional status, and anemia-related knowledge, attitudes, and practices (KAP) among school-going rural adolescent girls, along with predictors of KAP score, complemented by stakeholder perspectives. Methods: A mixed-methods cross-sectional study was conducted among 553 school-going adolescent girls aged 14–19, selected through a multi-stage stratified random sampling technique from three rural districts of Andhra Pradesh, India. Quantitative data were collected using a structured questionnaire assessing KAP, anthropometric measurements to collect Body Mass Index (BMI) and middle upper arm circumference (MUAC), dietary assessments using a dietary diversity score, and hemoglobin estimation using standardized procedures. Qualitative insights were obtained through focus group discussions (FGDs) with teachers, parents, frontline health workers, and community leaders and analyzed thematically. Logistic regression analysis was performed to identify predictors of KAP. Results: The prevalence of anemia among the participants was 55.3%, and 30.7% were underweight. Although over half of the girls demonstrated adequate knowledge of anemia, only 39.6% reported good anemia-preventive practices, indicating a significant gap between knowledge and practice. Dietary scores indicated micronutrient-deficient diet consumption by participants (36.2%), which might be contributing to anemia. Multivariable analysis revealed that maternal education, hemoglobin status, diet patterns, and type of school attended were significantly associated with KAP scores. Qualitative findings highlighted challenges related to health-seeking behavior, cultural misconceptions, gaps in awareness and implementation of existing adolescent health programs. Conclusions: Anemia remains highly prevalent among rural school-going adolescent girls in Andhra Pradesh, with suboptimal anemia-preventive practices despite moderate levels of knowledge. Strengthening school-based nutritional education, improving dietary diversity, and enhancing the reach and effectiveness of adolescent health programs through community engagement may help combat anemia.