Background: School-Age Children in Ethiopia are affected by a wide range of health and nutrition-related problems that constraint their ability to thrive and benefit from education. Anemia has been shown to be a major public health concern in Ethiopia. Altitude of residence site of healthy individuals is critical for the definition of anemia. The objective of this study was to assess the prevalence of anemia, with consideration of altitudinal variations, and to identify factors associated with anemia among school-age children.

Methods: A community based cross-sectional study was conducted from April to May 2017 among randomly selected 391 school-age children (6 to 14 years) in Arba Minch Health and Demographic Surveillance Site, Southern Ethiopia. Hemoglobin concentration was measured on the spot using portable hemoglobinometer (HemoCue Hb 201). The hemoglobin cut off values, adjusted for child age and altitude, were used to define anemia. Stool microscopic examination was done for investigation of intestinal parasites. A binary logistic regression model was used to assess the possible association of independent and outcome variables.

Results: The overall prevalence of anemia, after the hemoglobin value adjusted, was 146 (37.3%; 95% CI: 32.5, 42.2), out of which, 110 (28.1%) and 35 (9%) had mild and moderate anemia respectively; and a single case of severe anemia. Fifty-seven (46.3%) of children living in an altitude >2,500 meters above sea level were anemic. Children who were positive for intestinal parasitic infections were 3.3 times more likely to be anemic (AOR=3.30, 95% CI: 2.04, 5.35) compared to non-infected children. The likelihood of anemia was also higher among children not-enrolled (AOR= 2.05, 95%CI: 1.26, 3.32) than children who were enrolled in schools. Anemia was less common among children who had no habit of eating vegetables in the last week prior to the survey (AOR= 0.35, 95%CI: 0.14, 0.84).

Conclusions: More than one-third of school-age children were suffering from anemia. Intestinal parasitic infections and school non-enrollment were among the major factors associated with anemia among school-age children in the study area. Interventions, focusing on identified contributing factors need to be implemented by integrating with other school or community-based health programs.

Keywords: Anemia; school-age children; altitude; Ethiopia