The goal of this observational study is to assess the causes of anemia in women of reproductive age. The main questions it aims to answer are:

• What are the causes of anemia among women of reproductive age?
• What is the contribution of iron deficiency to overall anemia?
• What is the prevalence of hemoglobinopathies among women of reproductive age with anemia?

Participants will be asked to respond to the interview questions, and provide blood, urine, and stool samples.

One-third of the global population is affected by anemia making it one of the major public health problems at the global level. Women of reproductive age are at risk for anemia. The prevalence of anemia reported in 2016 Ethiopian Demographic and Health Survey (EDHS) is a moderate public health problem at the national level, but it is a severe public health problem in the Somali regional state among women of reproductive age (WRA). The purpose of this study is to assess the etiology and determinant factors of anemia among women of reproductive age. A cross-sectional design will be employed for the current study. In the current study, the investigators will assess the causes and contributing factors for anemia and their relationship with anemia. Women of reproductive age 18-49 years old residing in the Kebribeyah district are the target population for this study. The sample size determined for the current study is 881. The Somali region was selected for the current study due to its highest prevalence of anemia (60.6%%) among women of reproductive age according to the EDHS 2016. Kerbribeyah district was selected from the Somali regional state. Simple random sampling was employed to select three kebeles (villages) from the available kebeles with no other nutrition interventions in the Kebribeyah district. Two enumerations areas (EAs) from each of the three kebeles will be selected by simple random sampling. The sample size determined will be allocated to three kebeles and two EAs within the Kebeles on probability proportional to size (PPS). The study participants will be selected by systematic random sampling from a list of participants in a sampling frame obtained by house-to-house listing. After obtaining written informed consent, the data will be collected from the selected participant in their homes. All study participants who take part in the current study will be interviewed. They will also provide blood, urine, and stool samples. The prevalence of anemia and iron status biomarkers are the primary outcomes for the current study. The participants will be tested for anemia by measuring hemoglobin concentration. In addition, a complete blood count (CBC) test will be done for all study participants. The current study will fill the evidence gap by identifying major causes and contributors to overall anemia among women of reproductive age in the Kebribeyah district. The researchers anticipate that determining the causes of anemia will be a crucial first step in tackling the high prevalence of anemia among women of reproductive age in the Somali regional state and beyond.

Inclusion Criteria:

• age range 18-49 years
• Permanent resident in the selected kebele (have lived for at least six months) in the kebele (village).

Exclusion Criteria:

• Women below or above the age range 18-49 years
• All pregnant women
• Women who are severely ill and incapacitated.
• Non-permanent resident women in the kebele (village)

The participants are expected to have the same gender identity as their biological sex.

Women of reproductive age who are living in Kebribeyah district are the target population for this study. All non-pregnant women in the age range of 18-49 years living in three selected kebeles within the Kebribeyah district will be the study population. Our sample will be selected by systematic random sampling from a list of eligible women in the sampling frame. When there are two eligible women in the same household, one woman will be selected randomly.

Individual Participant Data (IPD) can be shared upon request and signing agreement between Ethiopian Public Health Institute and the interested party.