School Context as an Independent Factor Associated with Anemia among Adolescent Girls: A Cross-Sectional Study in Banawa, Donggala, Indonesia

Authors

  • Nasrul Nasrul Poltekkes Kemenkes Palu
  • Taqwin Taqwin Poltekkes Kemenkes Palu
  • Fahmi Hafid Universitas Airlangga Surabaya
  • Sri Rahayu Poltekkes Kemenkes Surabaya
  • Hikmah Hikmah Sekolah Menengah Pertama 3 Banawa Donggala
  • Risma Risma Sekolah Menengah Kejuruan 2 Banawa Donggala
  • Sarina Sariman Management and Science University, Malaysia

DOI:

https://doi.org/10.36568/jone.v4i3.779

Keywords:

adolescent girls, anemia, school health, social-ecological model, iron-folic acid, supplementation

Abstract

Anemia among adolescent girls remains a major public health problem, yet prevention often emphasizes individual nutritional factors while overlooking the influence of the school environment. This study aimed to determine whether school context, operationalized as school origin, is independently associated with anemia among adolescent girls in Banawa, Donggala, Indonesia, after adjustment for individual-level factors. An observational analytic study with a cross-sectional design was conducted among 189 adolescent girls recruited through total sampling of all eligible female students in two purposively selected schools, SMP Negeri 3 Banawa (junior secondary) and SMK Negeri 2 Banawa (vocational senior secondary). Hemoglobin was measured by point-of-care testing, with anemia defined as hemoglobin below 12 g/dL. Anthropometry, a semi-quantitative food frequency questionnaire, and self-reported iron tablet consumption were assessed. Data were analyzed using the chi-square test and multivariable binary logistic regression, with model fit evaluated by the Hosmer–Lemeshow test. The overall prevalence of anemia was 41.3%. In the adjusted model, school origin remained independently associated with anemia: students from SMK Negeri 2 Banawa had higher odds than those from SMP Negeri 3 Banawa (adjusted odds ratio 2.47; 95% confidence interval 1.31–4.65; p=0.005), whereas individual nutritional variables were not significant. Because the design is cross-sectional and school context was not measured directly, the findings represent an association rather than causation. Strengthening school-based nutrition education, screening, and supportive environments may complement individual supplementation in adolescent anemia prevention.

References

Gardner WM, Razo C, McHugh TA, Hagins H, Vilchis-Tella VM, Hennessy C, et al. 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. Lancet Haematol. 2023;10(9):e713–34. https://doi.org/10.1016/S2352-3026(23)00160-6

Nasrul N, Hafid F, Taqwin T, Hikmah, Risma, Nuswantari A, et al. Iron supplement consumption, dietary intake, nutritional status, and anemia among adolescent girls in Banawa, Donggala Regency. J Health Nutr Res. 2025;4(2):892–904. https://doi.org/10.56303/jhnresearch.v4i2.549

Alfiah E, Briawan D, Khomsan A, Dewi M, Ekayanti I, Mardewi, et al. Coverage and adherence of weekly iron folic acid supplementation among school-going adolescent girls in Indonesia. J Nutr Sci Vitaminol. 2020;66(Suppl):S118–21. https://doi.org/10.3177/jnsv.66.S118

Helmyati S, Syarifa CA, Rizana NA, Sitorus NL, Pratiwi D. Acceptance of iron supplementation program among adolescent girls in Indonesia: a literature review. Amerta Nutr. 2023;7(3SP):50–61. https://doi.org/10.20473/amnt.v7i3SP.2023.50-61

Hadju V, Arundhana AI, Bahar B, Salam A, Ansariadi, Jafar N, et al. Perceived barriers and enablers for taking iron–folic acid supplementation regularly among adolescent girls in Indonesia: a pilot study. Int J Environ Res Public Health. 2025;22(2):209. https://doi.org/10.3390/ijerph22020209

snaini YS, Pihahey PJ, Bahra B, Mintaningtyas SI, Simanjuntak MK, Fabanjo IJ. Knowledge, attitude, practice and compliance to weekly iron supplementation among female public junior high school students in West Papua. Public Health Indones. 2024;10(4):38–48. https://doi.org/10.36685/phi.v10i4.858

Khanal A, Paudel R, Wagle CN, Subedee S, Pradhan PMS. Prevalence of anemia and its associated factors among adolescent girls on weekly iron folic acid supplementation (WIFAS) implemented and non-implemented schools at Tokha municipality, Kathmandu. PLOS Glob Public Health. 2024;4(1):e0002515. https://doi.org/10.1371/journal.pgph.0002515

Yewodiaw TK, Alemayehu MA, Teshome DF. Anemia status and associated factors among adolescent girls under weekly iron and folic acid supplementation (WIFAS) and non-WIFAS programs in public schools in Janamora district, Northwest Ethiopia: a comparative cross-sectional study. BMC Nutr. 2025;11:50. https://doi.org/10.1186/s40795-025-01033-1

Townsend N, Foster C. Developing and applying a socio-ecological model to the promotion of healthy eating in the school. Public Health Nutr. 2013;16(6):1101–8. https://doi.org/10.1017/S1368980011002655

Golden SD, Earp JL. Social ecological approaches to individuals and their contexts: twenty years of Health Education & Behavior health promotion interventions. Health Educ Behav. 2012;39(3):364–72. https://doi.org/10.1177/1090198111418634

Wold B, Mittelmark MB. Health-promotion research over three decades: the social-ecological model and challenges in implementation of interventions. Scand J Public Health. 2018;46(20 Suppl):20–6. https://doi.org/10.1177/1403494817743893

Upadhyay K, Singhvi B, Nakte R, Reddy MT, Panda H, Mishra P, et al. Assessing the determinants of food choices among adolescents in India: a rainbow model using the socio-ecological framework. PLOS Glob Public Health. 2025;5(9):e0004776. https://doi.org/10.1371/journal.pgph.0004776

Rai A, Chan MT, Nambiar S. Social and ecological disparities in anaemia among adolescent girls aged 15–19 years in Nepal. Public Health Nutr. 2023;26(12):2973–81. https://doi.org/10.1017/S1368980023002379

Gosdin L, Sharma AJ, Tripp K, Amoaful EF, Mahama AB, Selenje L, et al. A school-based weekly iron and folic acid supplementation program effectively reduces anemia in a prospective cohort of Ghanaian adolescent girls. J Nutr. 2021;151(6):1646–55. https://doi.org/10.1093/jn/nxab024

Hurrell R, Egli I. Iron bioavailability and dietary reference values. Am J Clin Nutr. 2010;91(5):1461S–7S. https://doi.org/10.3945/ajcn.2010.28674F

Adokorach G, Oyet SM, Obai G, Muggaga C, et al. Association of dietary diversity and odds of anemia in children and adolescents: a systematic review and meta-analysis of observational studies. BMC Nutr. 2025;11:69. https://doi.org/10.1186/s40795-025-01069-3

Dagnaw M, Belay DG, Degu T, Angaw DA, Tsheten T. Prevalence and factors associated with anaemia among sub-Saharan African adolescents: a systematic review and meta-analysis. Nutrients. 2025;18(15):2404. https://doi.org/10.3390/nu18152404

Sigit FS, Ilmi FB, Desfiandi P, Saputri D, Fajarini ND, Susianti A, et al. Factors influencing the prevalence of anaemia in female adolescents: a population-based study of a rural setting in Karanganyar, Indonesia. Clin Epidemiol Glob Health. 2024;25:101500. https://doi.org/10.1016/j.cegh.2023.101500

Kumari A, Kumari A, Mudgal SK, Patidar V, Singh AK, Ganguly A, et al. Regional burden of anemia among adolescent girls in India: a systematic review and meta-analysis. Nepal J Epidemiol. 2025;15(3):1–15. https://doi.org/10.3126/nje.v15i3.77656

Kusdalinah K, Suryani D, Nugroho A, Yunita Y. Effect of combination intake of protein, vitamin C, and blood-boost tablets on hemoglobin levels of adolescent girls. Media Gizi Indones. 2023;18(1SP):21–6. https://doi.org/10.20473/mgi.v18i1SP.21-26

Imra’atul Hasanah, Widdefrita, Sidiq R, Hayati NF, Amos J. Peran Pusat Informasi dan Konseling Remaja (PIK-R) dalam meningkatkan perilaku kepatuhan konsumsi tablet tambah darah pada remaja putri di Madrasah Aliyah Negeri (MAN) Kota Pariaman. Media Publ Promosi Kesehat Indones. 2023;6(10):1990–8. https://doi.org/10.56338/mppki.v6i10.3847

Nguyen PH, Walia M, Pant A, Menon P, Scott S. Changes in anemia and anthropometry during adolescence predict learning outcomes: findings from a 3-year longitudinal study in India. Am J Clin Nutr. 2022;115(6):1549–58. https://doi.org/10.1093/ajcn/nqac028

Jolly SP, Roy Chowdhury T, Sarker TT, Afsana K. Water, sanitation and hygiene (WASH) practices and deworming improve nutritional status and anemia of unmarried adolescent girls in rural Bangladesh. J Health Popul Nutr. 2023;42(1):127. https://doi.org/10.1186/s41043-023-00453-8

Das A, Ghosal J, Khuntia HK, Dixit S, Pati S, Kaur H, et al. Malnutrition and anemia among particularly vulnerable tribal groups of Odisha, India: needs for context-specific intervention. Indian J Community Med. 2024;49(3):519–28. https://doi.org/10.4103/ijcm.ijcm_452_23

Sheikh S, Habib A, Azam I, Barolia R, Qureshi R, Iqbal R. Dietary diversity, undernutrition and anemia among rural adolescents in Sindh, Pakistan. BMC Nutr. 2026;12(1):32. https://doi.org/10.1186/s40795-026-01249-9

Laurence MC, Titaley CR, Tahitu R, Asmin E, Kailola NE, Istia SS, et al. The effect of WhatsApp-based reminders on enhancing knowledge and adherence to weekly iron–folic acid supplementation among adolescent girls in Maluku, Indonesia. Front Digit Health. 2025;7:1542006. https://doi.org/10.3389/fdgth.2025.1542006

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Published

2026-08-20

How to Cite

Nasrul, N., Taqwin, T., Hafid, F., Rahayu, S., Hikmah, H., Risma, R., & Sariman, S. (2026). School Context as an Independent Factor Associated with Anemia among Adolescent Girls: A Cross-Sectional Study in Banawa, Donggala, Indonesia. Journal of Nutrition Explorations, 4(3), 481–493. https://doi.org/10.36568/jone.v4i3.779

Issue

Vol. 4 No. 3 (2026): August

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Copyright (c) 2026 Nasrul Nasrul, Taqwin Taqwin, Fahmi Hafid, Sri Rahayu, Hikmah Hikmah, Risma Risma, Sarina Sariman

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