RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
BANGLORE, KARNATAKA.
ANNEXURE II
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION.
1. / NAME AND ADDRESS OF THE CANDIDATE / Mrs.DEEPA SAHU1ST YEAR M.S.c. NURSING
N.D.R.K COLLEGE OF NURSING, B.M.ROAD, HASSAN, KARNATAKA-573201
2. / NAME OF THE INSTITUTION / N.D.R.K COLLEGE OF NURSING, B.M.ROAD, HASSAN.
3. / COURSE OF STUDY AND SUBJECT / 1ST YEAR MASTER IN NURSING (OBSTETRICAL AND GYNAECOLOGICAL NURSING)
4. / DATE OF ADMISSION TO THE COURSE / 6TH MAY 2008
5. / TITLE OF THE STUDY / “EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON KNOWLEDGE REGARDING IRON DEFICIENCY ANEMIA AMONG ADOLESCENT GIRLS”
5.1. / STATEMENT OF THE PROBLEM / “A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON KNOWLEDGE REGARDING IRON DEFICIENCY ANEMIA AMONG ADOLESCENT GIRLS STUDYING AT C.K.S. SCHOOL HASSAN, KARNATAKA.”
6. BRIEF RESUME OF INTENDED WORK
6.1 INTRODUCTION
“We’ve got the mile, where we’re strong. We just need to keep our girls healthy and mentally strong”.
-Marveghanhn
Adolescence is a period of transition between child hood & adult hood, a time of profound biologic, intellectual, psychosocial and economic changes.1
Adolescence is characterized by a large growth spurt and the acquisition of adult phenotypes and biologic rhythm. During this period, iron requirement increases dramatically in both boys & girls as a result of the expansion of total volume, the increase in lean body mass & the onset of menses in young females. The overall iron requirement increases from a preadolescent level of approximately 0.7-0.9mg fe/d to as much as 2.2mg fe/d or perhaps more in heavily menstruating young women.2
Iron deficiency anemia is the most common nutritional deficiency worldwide. It can cause reduced work capacity in adult and impair motor and mental development in children and adolescents.3
Anemia is a reduction in Red Blood Cells which in turn decrease the oxygen carrying capacity of the blood. Not a disease itself, anemia reflects an abnormality in RBC’s number structure or function.4
Iron deficiency anemia is characterized by a defect in hemoglobin synthesis result in red blood cells that are abnormally small (microcytic) and contain a decreased amount of hemoglobin. The capacity of the blood to deliver oxygen to the body cells and the tissues is thus reduced. Iron deficiency anemia is associated with either inadequate absorption or excessive loss of iron.5
Anemia can result from decreased erythrocyte production which occurs due to decrease Hemoglobin synthesis. The heme in hemoglobin accounts for 2/3 of the body’s iron. Iron is lost by acute or chronic bleeding, excessive menses. When the stored iron is not replaced, hemoglobin production is reduced leads to iron deficiency anemia.6
The available data on iron intake in adolescents suggest that adolescent girls are unlikely to acquire substantial iron stores during sexual maturation period because intake may average as little as 10-11 mg Fe/day.2It is therefore advisable to provide them supplements of medicinal iron and folate, preferably with vitamin C. A public health awareness comprising once weekly distribution of iron /folate supplementation through school and welfare centers is a desirable strategy.7Control of anemia improves the quality of life by increasing the school attendance, better learning, enhance capacity to work and is less expensive.8
6.2 NEED FOR THE STUDY
“Preventing risk, Promoting healthy life”.
W.H.O.
Iron is essential to all cells. Functions of iron include involvement in energy metabolism, gene regulation cell growth & differentiation, oxygen binding and transport, muscle oxygen use & storage, enzyme reactions, neurotransmitter synthesis & protein synthesis.5
Iron deficiency anemia is one of most prevalent nutritional disorder worldwide. 4-5 billion people (66-80%) of the global population are iron deficit. 30% of the global population in the world are anemic (2 billion anemic people). It is estimated that south east Asia contributes 1/5th of the population but contributes to more than 40% of death due to anemia and almost 1/3rd of the DALY (disability adjusted life year) loss due to anemia.
The WHO 2002 report titled “Preventing risk, Promoting healthy life” mentioned iron deficiency as the 9th of 26 preventable risks to disease, disability and death in the world today. The goal of Anemia control strategy in tenth five year plan (2002-2007) was to reduce prevalence of anemia by 25% and moderate and severe anemia by 50% in children, pregnant & lactating women and adolescents.8
Nutritional anemia is one of India's major public health problems. The prevalence of anemia ranges from 33% to 89% among pregnant women and is more than 60% among adolescent girls. Under the anemia prevention and control program of the Government of India, iron and folic acid tablets are distributed to pregnant women, but no such program exists for adolescent girls.9
The low iron stores in these young women of reproductive age will make them susceptible to iron deficiency anemia during pregnancy.2
It is prudent to recommend the correction of iron stores before the women become pregnant. Efficacy of weekly supplementation of iron has been proved to improve iron stores in adolescence in many studies abroad and in India.
The study was conducted by Deshmukh P R et al (2008) in India to assess the effectiveness of a weekly iron-supplementation regimen among urban-slum, rural, and tribal girls of Nashik district, Maharashtra, India, using cluster sampling techniques. The result revealed that the overall prevalence of anemia came down significantly to 54.3% from 65.3% after administration of iron supplement. The decline was statistically significant in tribal girls (48.6% from 68.9%) and among rural girls (51.6% from 62.8%) but not among urban slum girls. The study concluded that weekly supplementation of iron to adolescent girls should be started to correct the iron stores of a woman before she becomes pregnant.10
Iron deficiency anemia is known to affect the health, physical work capacity & cognitive functions of children and adolescents.
A study was done by Sen A et al (2006), Department of Food and Nutrition, M.S University of Baroda, Gujarat, India, to assess the physical work capacity and cognition of underprivileged anemic schoolgirls in Vadodara in early adolescence as compared to their non-anemic counterparts. Schoolgirls from four municipal primary schools in the age of 9 - 14 years were studied (n=230). Hemoglobin of subjects was assessed using standard methods. Physical work capacity was assessed using Modified Harvard’s Step test and cognitive functions using selected tests from the modified Wechsler Intelligence Scale for Children (WISC). The result shown that the mean hemoglobin was 11.32 g/dL, and anemia prevalence was 67%. A higher number of steps were climbed and a shorter time was taken to revert to the basal pulse rate by non-anemic girls compared to anemic girls. Significantly lower scores in digit span and visual memory test were seen in anemic compared to non-anemic girls. The adverse impact of anemia remained after controlling for under nutrition .The study concluded was anemia is likely to adversely affect physical work capacity and cognition in young adolescent girls undergoing pubertal development.11
One of the keys to effective nutrition education and counseling of teenager is a good understanding of normal adolescent psychosocial development. Adolescent are striving to achieve independence yet they are highly influenced by the beliefs and behaviors of peers. Adolescence is an opportune time to train students to assess their own eating behaviors and set goals for dietary changes.3
Based on world wide prevalence and its deleterious effect on health, it is felt that creating awareness on iron deficiency anemia among adolescent girls is very important. It is significant to improve their knowledge on the term anemia, iron deficiency anemia, the symptoms of anemia, blood test, the importance of diet in preventing anemia and the role of menstruation in increasing iron needs during adolescent period. The investigator believes that this structured teaching programme will improve the attitude and increase awareness in relation to health status and prevent anemia among adolescent girls.
6.3 STATEMENT OF THE PROBLEM
“A study to assess the effectiveness of structured teaching programme on knowledge regarding Iron Deficiency Anemia among adolescent girls studying at C.K.S School, Hassan, Karnataka”.
6.4 OBJECTIVES
1. To assess the knowledge of adolescents girls regarding Iron Deficiency Anemia.
2. To prepare and conduct structured teaching programme on Iron Deficiency Anemia.
3. To assess the knowledge of adolescents girls regarding Iron Deficiency Anemia after structured teaching programme.
4. To evaluate the effectiveness of structured teaching programme on Iron Deficiency Anemia.
5. To find out the association between the pretest knowledge score and selected demographic variables.
6.5 Research HYPOTHESIS
There will be significant difference between pre-test and post-test knowledge score regarding Iron Deficiency Anemia among adolescent girls.
6.6 ASSUMPTIONS
· This study will enhance the knowledge on Iron Deficiency Anemia among adolescent girls.
· This study will create awareness among adolescent girls about necessary dietary modification to prevent and manage Iron Deficiency Anemia.
6.7 OPERATIONAL DEFINITION
§ Assess:
It is the process of judging the worth of structured teaching program on Iron Deficiency Anemia.
§ Effectiveness:
It refers to gain in knowledge scores of students regarding Iron Deficiency Anemia
§ Structured Teaching Programme:
It refers to set of systematically organized instructions and discussion of Iron Deficiency Anemia among adolescent girls.
§ KNOWLEDGE:
It refers to understanding of adolescent girls regarding Iron Deficiency Anemia.
§ Adolescent girl:
It refers to a girl in the age group of 12-14 years, studying at Chenna Keshava Swamy School, Hassan, Karnataka.
6.8 CRITERIA FOR SAMPLE SELECTION:
1. INCLUSION CRITERIA :
§ Adolescent girls aged between 12-14years studying in 7th standard at Chenna Keshava Swamy School, Hassan, Karnataka.
§ Adolescent girls who are willing to participate.
§ Adolescent girls who are present at the time of study.
2. EXCLUSION CRITERIA :
§ Adolescent girls who are not willing to participate.
§ Adolescent girls who are not present at the time of study.
6.9 LIMITATIONS OF THE STUDY
This study is limited to
1. Adolescent girls aged between 12-14years studying in 7th standard at Chenna Keshava Swamy school, Hassan, Karnataka.
2. Sample size of 60.
3. The period of 4 weeks.
6.10 SIGNIFICANCE OF THE STUDY
The purpose of the study is to create awareness on prevention and management of iron deficiency anemia among adolescent girls as they are going to be the future of tomorrow and reflect the nation’s health.
6.11 CONCEPTUAL FRAMEWORK
Theoretical framework is based on “Ludig Bertanlaffy’s general system theory (1968).
6.12 REVIEW OF LITERATURE
Review of literature is a key step in research process. Review of literature refers to an extensive, exhaustive and systematic examination of publications relevant to the research project. Before any research can be started whether it is a single study or an extended project, a literature reviews of previous studies and experiences related to the proposed investigations should be done. One of the most satisfying aspects of the literature review is the contribution it makes to the new knowledge, insight and general scholarship of the researches.12
A cross-sectional study was conducted by Tupe R et al (2008) at Agharkar Research Institute, Pune, India, to explore the influence of dietary factors of iron bioavailability and socio-demographic conditions on blood iron status of married adolescent girls (MAG). The study included 173 MAG (15-19 years old) from urban slums near Pune city. Diet was assessed by two random 24-hour recalls. The age, weight, height, education, family size, income, physical work, and number of days of menstrual loss were recorded. Fasting blood was analyzed for hemoglobin and serum ferritin. The result shown that the mean bioavailable iron intake was 0.76+/-0.3 mg/day, which is one-half of the basal iron requirements of adolescent girls. The prevalence of iron deficiency was 25.1%, and anemia was seen in 46.4% of MAG. Multiple regressions including socio-demographic factors revealed that the family size, number of menstrual days lost and total bio available iron intake were the influencing factors for low iron status. In conclusion, there is a need to increase intakes of vitamin C and other micronutrients of the MAGs and to improve iron bioavailability through diet modifications.13
A cross-sectional community study was conducted by Bullliyy G, et al (2007) at Regional Medical Research Center, Bhubaneswar, India, to determine the prevalence of anemia in non-school going adolescent girls and its association between hemoglobin concentration and socioeconomic and nutritional factors on a sample of 1937 healthy adolescent girls aged 11-19 years from three district of Orissa, India. Sample size was determine using a probability proportionate to size cluster sampling The adolescent girls were interviewed and anthropometric measurements were collected. Anemia and nutritional status were evaluated according to standard procedures. The results shown that the mean Hemoglobin concentration was 9.7 +/- 1.4 g/dL. Of the total adolescent girls, 1869 (96.5%) were anemic, of which, 45.2%, 46.9% and 4.4% had mild, moderate, and severe anemia, respectively. Significant positive associations were found between Hemoglobin concentration and pre-menarche, community, education levels of girls and their parent’s family income, body mass index, and mid-upper arm circumference. This study revealed that prevalence of anemia was extremely high in non-school going adolescent girls (most were moderately anemic) and stressed the need for more research and public health interventions.14
A study was conducted by Toteja GS et al (2006) at Indian Council of Medical Research, Ansari Nagar, New Delhi, to assess the status of iron deficiency anemia among pregnant women and adolescent girls from 16 districts of 11 states of India. A two-stage random sampling method was used to select 30 clusters on the basis of probability proportional to size. Anemia was diagnosed by estimating the hemoglobin concentration in the blood with the use of the indirect cyanmethemoglobin method. The survey data showed that 84.9% of pregnant women (n = 6,923) were anemic; 13.1% had severe anemia, and 60.1% had moderate anemia. Among adolescent girls (n = 4,337) from 16 districts, the overall prevalence of anemia was 90.1%, with 7.1% having severe anemia. The research concluded that any intervention strategy for this population must address not only the problem of iron deficiency, but also deficiencies of other micronutrients, such as B12 and folic acid and other possible causal factors.9