Discussion
Infection, adolescents, anemia, helminths
INFLAMMATION, ANEMIA, INFECTIOUS DISEASE, SEVERE ANEMIA, INFECTION
In this cross-sectional survey of school-going adolescents in Zanzibar, we found that slightly over 50% of the population had hemoglobin levels below the cutoff for anemia. Though most anemia cases were mild, over 20% of the population had moderate or severe anemia. While we cannot compare our results to previous findings on the prevalence of anemia in this particular sub-population due to the inexistence of such studies, the high prevalence of anemia among adolescents is consistent with findings from the TDHS showing high anemia levels in Zanzibar among children under five years of age (65.4% in 2015) and women of reproductive age (60% in 2015) [Odds of anemia in our sample were higher among females, adolescents with stunting, and those who used shared toilets (compared to personal household toilets). Females who had experienced menarche also had higher odds of moderate or severe anemia than those who had not yet starting menstruating, demonstrating the likely importance of blood losses contributing to low hemoglobin levels and to the progression of anemia beyond mild cases [The association of stunting with anemia as found in our sample has also been demonstrated previously [These findings support the idea that in addressing anemia, it is important to focus on the cycle between infectious disease, inflammation, and anemia, in addition to dietary factors that may influence nutritional status. Infection (with helminths or other parasites) due to poor hygiene conditions has been strongly linked to anemia among school children [The limitations of this study include the fact that it was conducted in only two out of the seven districts in Zanzibar, so we do not have representation from all sub-regions of Zanzibar, and that it was conducted solely among school-going adolescents, which may limit generalizability of the results. In addition, we did not collect dietary quantity data, and formulate conclusions related to diet based only relative food frequencies. Nevertheless, the study included a large sample size of adolescents in Zanzibar and is to date the only study to have investigated the prevalence of anemia among adolescents in Zanzibar, and the factors associated with anemia in the same population.