{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T02:29:03Z","timestamp":1785551343613,"version":"3.56.0"},"reference-count":42,"publisher":"Public Library of Science (PLoS)","issue":"4","license":[{"start":{"date-parts":[[2023,4,5]],"date-time":"2023-04-05T00:00:00Z","timestamp":1680652800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000272","name":"National Institute for Health Research","doi-asserted-by":"publisher","award":["GHRUG 17\/63\/26"],"award-info":[{"award-number":["GHRUG 17\/63\/26"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100016270","name":"Global Challenges Research Fund","doi-asserted-by":"publisher","award":["HEFCE GCRF 164252"],"award-info":[{"award-number":["HEFCE GCRF 164252"]}],"id":[{"id":"10.13039\/100016270","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:p>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\u2019 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.<\/jats:p>","DOI":"10.1371\/journal.pone.0283631","type":"journal-article","created":{"date-parts":[[2023,4,5]],"date-time":"2023-04-05T17:51:18Z","timestamp":1680717078000},"page":"e0283631","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":26,"title":["Attention for and awareness of anemia in adolescents in Karnataka, India: A qualitative study"],"prefix":"10.1371","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1833-209X","authenticated-orcid":true,"given":"Bronwen","family":"Gillespie","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Geetanjali","family":"Katageri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shumona","family":"Salam","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Umesh","family":"Ramadurg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shrinivas","family":"Patil","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jayaraj","family":"Mhetri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1726-2798","authenticated-orcid":true,"given":"Umesh","family":"Charantimath","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8680-7053","authenticated-orcid":true,"given":"Shivaprasad","family":"Goudar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashwini","family":"Dandappanavar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chandrashekhar","family":"Karadiguddi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashalata","family":"Mallapur","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Phaniraj","family":"Vastrad","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6594-8615","authenticated-orcid":true,"given":"Subarna","family":"Roy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Basavaraj","family":"Peerapur","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dilly","family":"Anumba","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2023,4,5]]},"reference":[{"key":"pone.0283631.ref001","article-title":"Anemia epidemiology, pathophysiology, and etiology in low\u2010 and middle\u2010income countries","author":"CM Chaparro","year":"2019","journal-title":"Ann N Y Acad Sci"},{"key":"pone.0283631.ref002","author":"World Health Organization","year":"2021","journal-title":"WHO Global Anaemia estimates"},{"key":"pone.0283631.ref003","author":"World Health Organization","year":"2019","journal-title":"Essential nutrition actions: mainstreaming nutrition through the life-course"},{"issue":"7","key":"pone.0283631.ref004","doi-asserted-by":"crossref","first-page":"1577","DOI":"10.1017\/S1368980020004292","article-title":"Iron deficiency anaemia and low BMI among adolescent girls in India: the transition from 2005 to 2015.","volume":"24","author":"S Bellizzi","year":"2021","journal-title":"Public Health Nutr.May"},{"issue":"10320","key":"pone.0283631.ref005","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1016\/S0140-6736(21)01593-2","article-title":"Strategies and interventions for healthy adolescent growth, nutrition, and development","volume":"399","author":"D Hargreaves","year":"2022","journal-title":"The Lancet"},{"issue":"10036","key":"pone.0283631.ref006","doi-asserted-by":"crossref","first-page":"2423","DOI":"10.1016\/S0140-6736(16)00579-1","article-title":"Our future: a Lancet commission on adolescent health and wellbeing","volume":"387","author":"GC Patton","year":"2016","journal-title":"The Lancet"},{"issue":"10320","key":"pone.0283631.ref007","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1016\/S0140-6736(21)01590-7","article-title":"Nutrition in adolescent growth and development","volume":"399","author":"SA Norris","year":"2022","journal-title":"The Lancet"},{"issue":"3","key":"pone.0283631.ref008","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1177\/0379572118785054","article-title":"Strengthening Nutrition-Specific Policies for Adolescents in Indonesia: A Qualitative Policy Analysis.","volume":"39","author":"DD Soekarjo","year":"2018","journal-title":"Food Nutr Bull.Sep"},{"issue":"11","key":"pone.0283631.ref009","doi-asserted-by":"crossref","first-page":"9033","DOI":"10.3390\/nu7115449","article-title":"Examining Means of Reaching Adolescent Girls for Iron Supplementation in Tigray, Northern Ethiopia.","volume":"7","author":"A Mulugeta","year":"2015","journal-title":"Nutrients."},{"issue":"5","key":"pone.0283631.ref010","doi-asserted-by":"crossref","first-page":"615","DOI":"10.1182\/blood-2013-06-508325","article-title":"A systematic analysis of global anemia burden from 1990 to 2010.","volume":"123","author":"NJ Kassebaum","year":"2014","journal-title":"Blood"},{"issue":"9809","key":"pone.0283631.ref011","doi-asserted-by":"crossref","first-page":"2123","DOI":"10.1016\/S0140-6736(10)62304-5","article-title":"Anaemia in low-income and middle-income countries","volume":"378","author":"Y Balarajan","year":"2011","journal-title":"The Lancet"},{"issue":"1","key":"pone.0283631.ref012","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1186\/s12937-019-0433-7","article-title":"Factors that influence dietary behavior toward iron and vitamin D consumption based on the theory of planned behavior in Iranian adolescent girls.","volume":"18","author":"A Alami","year":"2019","journal-title":"Nutr J."},{"key":"pone.0283631.ref013","article-title":"National Family Health Survey (NFNS-5) 2019\u20132021.","author":"International Institute for Population Sciences","year":"2021","journal-title":"Mumbai, India"},{"key":"pone.0283631.ref014","article-title":"National Family Health Survey (NFHS-4) 2015\u20132016.","author":"International Institute for Population Sciences","year":"2016","journal-title":"Mumbai, India"},{"issue":"4","key":"pone.0283631.ref015","doi-asserted-by":"crossref","first-page":"213","DOI":"10.52403\/ijhsr.20210428","article-title":"Understanding the Determinants of Anemia amongst Indian Adolescents","volume":"11","author":"A Gupta","year":"2021","journal-title":"Int J Health Sci Res"},{"issue":"7\u20138","key":"pone.0283631.ref016","doi-asserted-by":"crossref","first-page":"764","DOI":"10.1016\/j.nut.2013.11.022","article-title":"Issues in prevention of iron deficiency anemia in India.","volume":"30","author":"T Anand","year":"2014","journal-title":"Nutrition."},{"issue":"6","key":"pone.0283631.ref017","doi-asserted-by":"crossref","first-page":"523","DOI":"10.1007\/s12098-019-02932-5","article-title":"Prevention and Control of Anemia Amongst Children and Adolescents: Theory and Practice in India.","volume":"86","author":"U Kapil","year":"2019","journal-title":"Indian J Pediatr."},{"key":"pone.0283631.ref018","article-title":"Sustainability of integrated anaemia prevention activities implemented through non-government organizations and schools, and its effect on haemoglobin status of adolescent girls in urban slums of Pune, in Maharashtra, India.","author":"A Jeyakumar","year":"2021","journal-title":"Nutr Health."},{"issue":"3","key":"pone.0283631.ref019","doi-asserted-by":"crossref","first-page":"447","DOI":"10.1177\/0379572117712791","article-title":"Applying Positive Deviance for Improving Compliance to Adolescent Anemia Control Program in Tribal Communities of India.","volume":"38","author":"V Sethi","year":"2017","journal-title":"Food Nutr Bull."},{"issue":"4","key":"pone.0283631.ref020","doi-asserted-by":"crossref","first-page":"401","DOI":"10.1177\/0017896920980043","article-title":"Addressing adolescent anaemia in vulnerable urban Indian communities: A qualitative exploration.","volume":"80","author":"V Ajgaonkar","year":"2021","journal-title":"Health Educ J.Jun"},{"issue":"3","key":"pone.0283631.ref021","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1177\/0972063418779900","article-title":"Socio-economic Correlates of Anaemia Awareness in Adolescent Schoolgirls: Insights from a District in India.","volume":"20","author":"Josyula LK Patnaik SPLN","year":"2018","journal-title":"J Health Manag.Sep"},{"key":"pone.0283631.ref022","article-title":"Global accelerated action for the health of adolescents (\u200e AA-HA!)","author":"World Health Organization","year":"2017","journal-title":"\u200e: guidance to support country implementation."},{"issue":"2","key":"pone.0283631.ref023","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1177\/0379572116637721","article-title":"Determinants of Persistent Anemia in Poor, Urban Pregnant Women of Chandigarh City, North India: A Mixed Method Approach.","volume":"37","author":"NG Diamond-Smith","year":"2016","journal-title":"Food Nutr Bull."},{"issue":"7","key":"pone.0283631.ref024","doi-asserted-by":"crossref","first-page":"e35","DOI":"10.1016\/j.midw.2012.07.014","article-title":"Interventional study to strengthen the health promoting behaviours of pregnant women to prevent anaemia in southern India.","volume":"29","author":"JA Noronha","year":"2013","journal-title":"Midwifery"},{"issue":"4","key":"pone.0283631.ref025","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1016\/S0277-9536(01)00185-X","article-title":"Women\u2019s perceptions of iron deficiency and anemia prevention and control in eight developing countries.","volume":"55","author":"R Galloway","year":"2002","journal-title":"Soc Sci Med."},{"issue":"1","key":"pone.0283631.ref026","doi-asserted-by":"crossref","first-page":"457","DOI":"10.1186\/s12889-020-08574-z","article-title":"Moving beyond individual barriers and identifying multi-level strategies to reduce anemia in Odisha India.","volume":"20","author":"E Sedlander","year":"2020","journal-title":"BMC Public Health.Dec"},{"issue":"5","key":"pone.0283631.ref027","doi-asserted-by":"crossref","first-page":"e0249646","DOI":"10.1371\/journal.pone.0249646","article-title":"Examining intentions to take iron supplements to inform a behavioral intervention: The Reduction in Anemia through Normative Innovations (RANI) project. Lazuras L,","volume":"16","author":"E Sedlander","year":"2021","journal-title":"PLOS ONE."},{"issue":"4","key":"pone.0283631.ref028","doi-asserted-by":"crossref","first-page":"S29","DOI":"10.1016\/j.jadohealth.2016.06.022","article-title":"Interventions to Improve Adolescent Nutrition: A Systematic Review and Meta-Analysis.","volume":"59","author":"RA Salam","year":"2016","journal-title":"J Adolesc Health."},{"issue":"3","key":"pone.0283631.ref029","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1016\/j.jneb.2006.01.003","article-title":"Differing Perspectives of Inner-City Parents and Pediatric Clinicians Impact Management of Iron-Deficiency Anemia","volume":"38","author":"MB Pierce","year":"2006","journal-title":"J Nutr Educ Behav"},{"issue":"1","key":"pone.0283631.ref030","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1016\/j.pec.2021.04.032","article-title":"Improving iron folic acid consumption through interpersonal communication: Findings from the Reduction in Anemia through Normative Innovations (RANI) project.","volume":"105","author":"R Ganjoo","year":"2022","journal-title":"Patient Educ Couns."},{"issue":"1","key":"pone.0283631.ref031","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1016\/j.jneb.2021.07.014","article-title":"Health Communication Patterns and Adherence to a Micronutrient Home Fortification Program in Rural China","volume":"54","author":"R Ye","year":"2022","journal-title":"J Nutr Educ Behav"},{"issue":"12","key":"pone.0283631.ref032","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1301\/nr.2005.dec.S109-S115","article-title":"Weekly Iron-Folic Acid Supplementation to Improve Iron Status and Prevent Pregnancy Anemia in Filipino Women of Reproductive Age: The Philippine Experience through Government and Private Partnership.","volume":"63","author":"LS Paulino","year":"2005","journal-title":"Nutr Rev."},{"issue":"4","key":"pone.0283631.ref033","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1177\/156482659902000408","article-title":"Increase in Compliance with Weekly Iron Supplementation of Adolescent Girls by An Accompanying Communication Programme in Secondary Schools in Dar-Es-Salaam, Tanzania.","volume":"20","author":"GS Muro","year":"1999","journal-title":"Food Nutr Bull."},{"issue":"2","key":"pone.0283631.ref034","first-page":"81","article-title":"Challenges in scaling up successful public health interventions: Lessons learnt from resistance to a nationwide roll-out of the weekly iron-folic acid supplementation programme for adolescents in India.","volume":"28","author":"S Malhotra","year":"2015","journal-title":"Natl Med J India"},{"issue":"06","key":"pone.0283631.ref035","first-page":"47","article-title":"A Study on Weekly Iron and Folic Acid Supplementation (WIFS) Programme in a School at Rural Area of West Bengal, India.","volume":"15","author":"DrA Sau","year":"2016","journal-title":"IOSR J Dent Med Sci.Jun"},{"issue":"1","key":"pone.0283631.ref036","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1186\/s12889-016-2724-7","article-title":"Influences on eating: a qualitative study of adolescents in a periurban area in Lima, Peru.","volume":"16","author":"JC Banna","year":"2015","journal-title":"BMC Public Health."},{"issue":"5","key":"pone.0283631.ref037","doi-asserted-by":"crossref","first-page":"370","DOI":"10.1016\/j.jneb.2014.01.007","article-title":"A Cross-Cultural Comparison of Eating Behaviors and Home Food Environmental Factors in Adolescents From S\u00e3o Paulo (Brazil) and Saint Paul\u2013Minneapolis (US).","volume":"46","author":"CCP Estima","year":"2014","journal-title":"J Nutr Educ Behav"},{"issue":"9","key":"pone.0283631.ref038","doi-asserted-by":"crossref","first-page":"e0137735","DOI":"10.1371\/journal.pone.0137735","article-title":"Trials of Improved Practices (TIPs) to Enhance the Dietary and Iron-Folate Intake during Pregnancy- A Quasi Experimental Study among Rural Pregnant Women of Varanasi, India. Gutman J,","volume":"10","author":"S Shivalli","year":"2015","journal-title":"PLOS ONE."},{"issue":"4","key":"pone.0283631.ref039","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1177\/156482651103200402","article-title":"Community-Led Initiative for Control of Anemia among Children 6 to 35 Months of Age and Unmarried Adolescent Girls in Rural Wardha, India.","volume":"32","author":"AR Dongre","year":"2011","journal-title":"Food Nutr Bull."},{"issue":"1","key":"pone.0283631.ref040","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1186\/s12978-018-0490-y","article-title":"Community approval required for periconceptional adolescent adherence to weekly iron and\/or folic acid supplementation: a qualitative study in rural Burkina Faso.","volume":"15","author":"A Compaor\u00e9","year":"2018","journal-title":"Reprod Health."},{"issue":"10320","key":"pone.0283631.ref041","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1016\/S0140-6736(21)01687-1","article-title":"Food choice in transition: adolescent autonomy, agency, and the food environment","volume":"399","author":"LM Neufeld","year":"2022","journal-title":"The Lancet"},{"issue":"5","key":"pone.0283631.ref042","first-page":"e0251427","article-title":"Community-level women\u2019s education and undernutrition among Indian adolescents: A multilevel analysis of a national survey.","volume":"16","author":"AR Shah","year":"2021","journal-title":"Spradley FT, editor."}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0283631","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,4,5]],"date-time":"2023-04-05T17:51:49Z","timestamp":1680717109000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0283631"}},"subtitle":[],"editor":[{"given":"Chiranjivi","family":"Adhikari","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2023,4,5]]},"references-count":42,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2023,4,5]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0283631","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,4,5]]}}}