Data collection.

Between 1990 and 2016 the number of adolescents with anemia world-wide increased by 20% to almost one in four. Iron deficiency in adolescence results in compromised growth, decreased cognitive function, and depressed immune function, and can increase the risk of negative outcomes in pregnancy, especially in the case of young adolescents. In India, despite several decades of governmental investment in anemia prevention and treatment, more than half of women of reproductive age are anemic, with rates even higher in the adolescent population. Although awareness of adolescence as a nutrition-sensitive developmental stage is increasing, there is a lack of qualitative research on the perspectives of adolescents and families on anemia and related services. In this study, we explored the issues influencing adolescents’ awareness of anemia in three rural areas of Karnataka. Sixty-four in-depth interviews and six focus group discussions were conducted with adolescents (those who had never been pregnant, pregnant adolescents, and young mothers), community members, and nutrition-related service providers in the health and education sectors. An inductive analytical approach was used. We found that adolescent girls, particularly those who have not experienced pregnancy or motherhood, had very low awareness of anemia. State programs including school-based distribution of iron and folic acid supplements and nutrition talks were not seen to be resulting in knowledge and acceptance of the importance of preventing anemia. Pregnancy represents a turning point in which adolescents are systematically tested for anemia as part of routine antenatal care, increasing their awareness of, and access to, treatment for the condition. At the same time, pregnancy represents to family and community a period to insist on a nutritious diet. For progress in anemia reduction to be made, improved age-appropriate measures specific for adolescence are required. Improving school-based nutrition outreach is an important opportunity to reach adolescents.

1990年至2016年，全球贫血（anemia）青少年患者数量增长20%，占比接近四分之一。青春期缺铁会引发生长发育受损、认知功能下降及免疫功能减退，还会增加妊娠不良结局的发生风险，对于青春期早期群体尤为显著。在印度，尽管政府数十年来投入资金开展贫血防控工作，但仍有超半数育龄女性罹患贫血，青少年群体的贫血患病率甚至更高。尽管学界与公众逐渐意识到青春期是营养敏感型发育阶段，但针对青少年及其家庭对贫血及相关服务的认知视角的质性研究仍较为匮乏。本研究于印度卡纳塔克邦（Karnataka）的三个农村地区开展，旨在探究影响青少年贫血认知水平的相关因素。研究共招募未妊娠青少年、妊娠青少年及年轻母亲三类群体，联合社区居民与卫生、教育领域的营养相关服务提供者，完成64次深度访谈与6次焦点小组讨论，并采用归纳式分析（inductive analytical approach）方法。研究发现，青春期女性，尤其是未经历妊娠或为人母者，对贫血的认知水平极低。包括学校发放铁叶酸补充剂（iron and folic acid supplements）及营养宣讲在内的国家公共卫生项目，并未有效提升公众对贫血防控重要性的认知与接受度。妊娠则是一个关键转折点：作为常规产前检查（antenatal care）的一部分，青少年会系统性接受贫血筛查，这提升了她们对该病的认知水平及治疗可及性。与此同时，妊娠也让家庭与社区意识到需要为该群体提供营养充足的膳食。若要推进贫血防控工作，需制定适配青春期群体的针对性改进措施。优化学校营养推广服务，则是触达青少年群体的重要契机。