الفهرس 
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Abstract
Iron deficiency anemia is the most prevalent anemia in the world. It constitutes a problem of significant public health importance, given its impact on psychological and physical development, behavior and work capacity.
The study was conducted to fulfill the following aims:
1- To estimate the extent of IDA among secondary school students in El-Kharga.
2- To identify the determinants of IDA including socio-cultural, behavioral and biological and dietary aspects.
3- To describe the association between IDA and students’ scholastic performance.
4- To determine the availability and types of services provided to students with IDA.
The study was conducted using the following methodology:
A cross-sectional study was conducted in secondary schools in El Karga among 330 adolescents. The sample was selected using multistage stratified random sampling technique. The sample was proportionately allocated to different study settings according to the number of secondary school students attending each school.
Data were collected using the following tools:
1- A predesigned structured interviewing questionnaire to collect data on sociodemographic characteristics, habits, general health status, health services and dietary intake, measurements including weight, height and body mass index (BMI) and pulse and laboratory investigations (blood and stool).
2- Record review: School records were also reviewed for the grades of the previous exams.
The collected data were revised, coded and analyzed using SPSS version 21, 2014 software for tabulation and analysis. Multivariate logistic regression analysis was used to assess the predictors of IDA.
The study revealed the following main results:
1- The overall prevalence of anemia among secondary school adolescents was 51.8%. Females significantly had a higher prevalence of anemia (59.1%) than males (40.9%).
2- Rural school students had about half the risk of developing anemia than urban school students.
3- The determinants of anemia included the fathers’ and mothers’ education, work status, family income, crowding index, and socioeconomic conditions.
4- The prevalence of parasites among examined adolescents was 26.4%. The prevalence of parasites among anemics was 98.9%. The most prevalent parasites were ascaris lumbricoid, trichuris trichuria and ancylostoma.
5- Drinking tea immediately after meals played an important role in occurrence of anemia.
6 - Anemic students had more than four and half times less scholastic achievements than the normal students.
7- The mean intake of all nutrients was below the RDA for adolescents.
8- The means of total energy calories, plant protein, total carbohydrate, iron plant were significantly higher among normal school students than anemic students.
9- Only plant protein and total carbohydrate calories were significantly correlated with hemoglobin percentage.
10- The mean dietary adequacy was directly related to the socioeconomic levels.
11- The hemoglobin level ranged from 9 to 14 g/dl with mean hemoglobin level of 11.8 ± 1.3 g/dl. The hemoglobin percentage ranged from 56.3% to 88.1% with mean percentage of 73.9 ±7.9%.
12- The logistic regression model showed that only those who were infected with parasites and plant protein were the predictors for anaemia.
Recommendation:
I - Recommendations to Ministry of Health:
A - Supplementation with medical iron, to be given especially to adolescent girls to build up iron stores before pregnancy. Daily iron dose under the observation of the school health visitor for three months and repeated examination after the end of the intervention period could be a highly effective measure.
B - Food fortification with iron is a highly effective measure.
C - Effective monitoring system (nutritional surveillance) and formats for evaluation, programs may be effective in influencing adolescents to choose healthier diets and reporting must be set up.
II - Recommendations to schools and school students:
A- Increase iron intake:
1- Since students spend extensive time at schools, nutritional educational programs in these settings are ideal. These educational programs can be conducted by the school doctors and should involve both the adolescents and their parents. The aim of these programs is to educate students on how to increase their own intake of iron.
2- The fortified foods as biscuits can be given during the school day.
B - Increase bioavailability of iron which can be done through:
1- Increasing consumption of food rich in vitamin C together with food containing iron of non haem origin.
2- Avoiding drinking tea with or shortly after meals.
3- Food processing using methodologies that free the iron e.g. fermentation, germination, use of yeast and food pricing policies.
4- Introduction of nutrition as a basic subject in school curricula can enhance healthful eating behavior.
C - Reduction of iron losses:
- Support school lunch program provided to adolescent students with a balanced diet with about one third of RDA of iron and vitamin C. This could markedly reduce the prevalence of anemia among adolescents.
III - Recommendations to researchers
- There is a great need to conduct research specifically targeting adolescents as one of the high risk groups for anemia.