Iron-rich food consumption, dietary diversity, and associated factors among adolescent schoolgirls in Gondar City, Northwest Ethiopia

Abstract

Abstract Introduction Iron requirements increase during adolescence, especially among girls. In low- and middle-income countries, inadequate intake of iron-rich and diverse foods contributes to anemia and poor health outcomes. This study assessed iron-rich food consumption (IRFC), minimum dietary diversity score (MDDS), and associated factors among adolescent schoolgirls in Gondar City, Northwest Ethiopia. Methods A school-based cross-sectional study was conducted from 28 April to 9 May 2025 in Gondar City, Northwest Ethiopia. Of 634 selected participants, 617 took part (response rate 97.3%). Dietary intake was assessed using a 24-h recall. Adequate IRFC was defined as consumption of ≥ 5 of 10 food groups including ≥ 1 animal-source food; adequate MDDS as ≥ 5 of 10 food groups. Logistic regression was used to estimate the crude and adjusted odds ratios (AORs) with 95% confidence intervals (CIs). Results Adequate IRFC was observed in 43.3% (95% CI: 39.1–47.2) and adequate MDDS in 47.2% (95% CI: 42.9–50.9) adolescent schoolgirls. IRFC was most strongly associated with adequate MDDS (AOR = 6.74; 95% CI: 4.32–10.54), private school attendance (AOR = 4.18; 95% CI: 2.08–8.38), and higher maternal/caregiver education (AOR = 4.57; 95% CI: 2.44–8.53). MDDS was positively associated with urban residence (AOR = 4.87; 95% CI: 2.58–9.18), higher wealth (AOR = 5.04; 95% CI: 2.81–9.06), and private schooling (AOR = 2.78; 95% CI: 1.51–5.00). In subgroup analysis, adolescents from private schools, and higher wealth households consistently demonstrating higher MDDS and IRFC compared with their counterparts. Conclusions Fewer than half of adolescent schoolgirls consumed adequate iron-rich foods or achieved MDDS. Socioeconomic, educational, and behavioral factors strongly influenced dietary practices. Public health interventions should prioritize school-based feeding programs, nutrition education, family engagement, and targeted support for low-income and rural households. Addressing body image perceptions is essential to improve adolescent nutrition and prevent intergenerational consequences.