6. BRIEF RESUME OF THE INTENDED WORK
Introduction:
Iron is a necessary mineral for body function and good health. Every red blood cell in the body contains iron in its hemoglobin, the pigment that carries oxygen to the tissues from the lungs. But a lack of iron in the blood can lead to iron-deficiency anemia, which is a very common nutritional deficiency in children.
Adolescence has been defined by the World Health Organization as the period of life spanning the ages between 10 to 19 years. This is the formative period of life when the maximum amount of physical, psychological, and behavioral changes take place. This is a vulnerable period in the human life cycle for the development of nutritional anemia, which has been constantly neglected by public health programs. Girls are more likely to be a victim due to various reasons. In a family with limited resources, the female child is more likely to be neglected. She is deprived of good food and education, and is utilized as an extra working hand to carry out the household chores. The added burden of menstrual blood loss, normal or abnormal, precipitates the crises too often.
The body needs iron to make hemoglobin. If there isn't enough iron available, hemoglobin production is limited, which in turns affects the production of red blood cells (RBCs). A decreased amount of hemoglobin and RBCs in the bloodstream is known as anemia. Because RBCs are needed to carry oxygen throughout the body, anemia results in less oxygen reaching the cells and tissues, affecting their function.
Iron-deficiency anemia (IDA), often caused by insufficient iron intake, is the major cause of anemia in childhood. It has become much less common in the United States over the past 30 years, primarily due to iron-fortified infant formulas and cereals.
Iron-deficiency anemia doesn't develop immediately. Instead, a person progresses through stages of iron deficiency, beginning with iron depletion, in which the amount of iron in the body is reduced while the iron in RBCs remains constant. If iron depletion isn't corrected, it progresses to iron deficiency, eventually leading to IDA.
Iron-deficiency anemia can be the consequence of several factors, including:
· insufficient iron in the diet
· poor absorption of iron by the body
· ongoing blood loss, most commonly from menstruation or from gradual blood loss in the intestinal tract
· periods of rapid growth
A diet low in iron is most often behind IDA in infants, toddlers, and teens. Kids who don't eat enough or who eat foods that are poor sources of iron are at risk for developing the condition. Poverty is a contributing factor to IDA because families living at or below the poverty level may not be getting enough iron-rich foods.
Iron deficiency can also cause the body to absorb more lead, which increases the risk of lead poisoning in kids, especially those living in older homes. The combination of IDA and lead poisoning can make kids very ill and can put them at risk for learning and behavioral problems.
In 1999, a special symposium entitled "Improving Adolescent Iron Status before Childbearing" was convened in Washington DC. The conclusions of this group were that many girls are already anemic by the time they become pregnant (16–55%), and that pregnancy is too short a period of time in which to reduce pre-existing anemia, especially when many women do not seek prenatal care until the second or third trimester. Thus, they concluded that emphasis needs to be placed on pre-pregnancy programs to increase body iron stores.
Adolescence is a time of intense physical, psychosocial, and cognitive development. Increased nutritional needs at this juncture relate to the fact that adolescents gain up to 50% of their adult weight, more than 20% of their adult height, and 50% of their adult skeletal mass during this period. The iron needs are high in adolescent girls because of the increased requirements for expansion of blood volume associated with the adolescent growth spurt and the onset of menstruation. When pregnancy is interposed during this time, problems of iron balance are compounded. Over half the world’s population is under 25 years old, and more than 80% of the world’s youth live in developing countries. Iron deficits induced by poor diet and disease, along with difficult logistics associated with supplementation programs in developing countries; compound the problem of studying the iron needs during pregnancy in much of the world’s population. For these reasons, we felt it important to study a population with adequate diets and normal pre-pregnancy iron stores. We investigated the response to supplemental iron in adolescents and adults throughout the course of normal pregnancies.
6.1 Need for the study
The Third National Health and Nutrition Examination Survey (NHANES III) found a 9 percent incidence of iron deficiency and a 2 percent incidence of anemia among American females between the ages 12 and 15 years; the respective values were 11 and 3 percent in girls between the ages of 16 and 19 years. Less than 1 percent of adolescent males had iron deficiency. Studies in other countries have found higher rates of iron deficiency in male and female adolescents. Some of the variation in incidence noted among different studies is related to the controversy regarding the appropriate laboratory cutoffs to make the diagnosis.
Risk groups—Adolescents with chronic illness, heavy menstrual blood loss (>80 mL/month), or who are underweight or malnourished are at increased risk for iron deficiency and should be screened during health supervision or specialty clinic visits.
Overweight and obese children also appear to be at increased risk for iron deficiency and should undergo screening In one study, data from NHANES III were examined for an association between iron deficiency and weight. The prevalence of iron deficiency increased as body mass index increased from normal weight to >85th percentile for age and sex to >95th percentile for age and sex (2.1 percent, 5.3 percent, and 5.5 percent, respectively). Obesity was a risk factor for iron deficiency anemia in both boys and girls, but rates were approximately three times higher in girls. The etiology of anemia in obese individuals is uncertain but may be related to low-quality diets or increased needs relative to body weight.
The world’s adolescent population (age 10–19 years) is estimated to stand at more than 1 billion, yet adolescents remain a largely neglected, difficult-to-measure, and hard-to-reach population in which the needs of adolescent girls, in particular, are often ignored. This area of adolescent health has been difficult to study, and there are many unknown factors and consequences for iron deficiency during adolescence in terms of standards, measurement indicators and health consequences.
In 1993, the World Health Organization (WHO) instituted its Safe Motherhood Initiative with a goal of reducing the number of maternal deaths by half before the year 2000. A key component was to eradicate anemia in pregnancy, focusing on the greater risk in younger women. In 1997, WHO convened a regional consultation of experts to address malnutrition issues among adolescent girls in South-East Asia? Among the recommendations for action was a need for the development of assessment, advocacy, prevention, and control initiatives, in most countries, to reduce anemia in adolescent girls. As an outcome, WHO training programs for adolescent nutrition have been initiated.
6.2 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.
A cross sectional study was conducted regarding Anemia and iron deficiency among adolescent schoolgirls in peri-urban Bangladesh. The objective of the study was to investigate the prevalence of anemia and iron deficiency among adolescent schoolgirls in peri-urban Bangladesh, and to identify various factors associated with anemia in this population. 548 adolescent girls between 11-16 years were included for the study. The study result showed that the prevalence of anemia (Hb<120 gl) among the participants was 27%. Seventeen percent had depleted iron stores (SF<12 gl). Of all anemic girls, 32% had iron deficiency anemia (Hb<120 gl and SF<12 gl). When the girls were classified by serum vitamin A, the third with the lowest serum retinol levels had significantly lower Hb and SF levels. Significant positive correlations were observed between Hb and serum iron, TS, SF and retinol, while there was a negative correlation with serum TIBC. Occupancy, frequency of consumption of large fish, serum iron, TIBC, TS, SF and serum vitamin A were strongly related to Hb by multiple regression analysis. For 1 gl change in SF concentration, there was a 0.046 gl change in Hb, when adjusted for all other factors.
A cross sectional study was aimed to identify the different nutritional and iron status characteristics of young adolescent girls 10-12 years old with iron deficiency anemia and anemia without iron deficiency in the rural coastal area of Indonesia. Anemic girls (N =133) were recruited out of 1358 girls from 34 elementary schools. Hemoglobin, serum ferritin, serum transferrin receptor and zinc protophorphyrin were determined for iron status, whilst weight and height were measured for their nutritional status. General characteristics and dietary intake were assessed through interview. Out of 133 anemic subjects, 29 (21.8%) suffered from iron deficiency anemia, which was not significantly related to age and menarche. About 50% were underweight and stunted indicating the presence of acute and chronic malnutrition. The proportion of thinness was significantly higher (P < 0.05) among subjects who suffered from iron deficiency anemia (51.7% vs. 29.8%). Furthermore, thin subjects had a 5 fold higher risk of suffering from iron deficiency anemia (P< 0.05) than non-thin subjects (OR: 5.1; 95%CI 1.34-19.00). Further study was recommended to explore other factors associated with anemia and iron deficiency anemia, such as the thalassemia trait and vitamin A deficiency. The current iron-folate supplementation program for pregnant women should be expanded to adolescent girls.
A study was conducted in rural Rajasthan regarding the prevalence of anemia. 941 adolescent girls in the age group 10-18 years were selected for this study by using random sampling method. The main objective of the study was to find out the prevalence of anemia among the adolescent girls. The study result showed that 73.7% had high prevalence of anemia.
A study was conducted among 870 adolescents (480 males and 390 females). Anemia was diagnosed clinically in 62 (12.9%) males and 52 (13.3%) females with an overall prevalence of 13.1 %. Mean age of adolescent boys suffering from anemia was 15.3 years while of girls was 15.1 years. The prevalence of anemia in both males and females were highest in 10-13 year age group and it decreased with increase in age. Almost equal prevalence of anemia was found in males. A total of 48 (77.4%) anemic males and 33 (63.5%) anemic females had poor personal hygiene. It was also observed that, 95 (23%) anemic males had history of worm infestation as compared to 378 (77%) non-anemic males (p<0.001).
A school based cross-sectional study was conducted through a pretested, semi structured interview schedule in Boileaugang, an urban field practice area of Dept. of Community Medicine, Indira Gandhi Medical College, Shimla during June 2002 to January 2003. All (870) students of eleventh and twelfth class of four senior secondary schools aged 10-19 years were included in the study. The students were asked about their age, dietary habits, water and food hygiene, history of worm infestation, menstrual problems (in females), and symptoms of anemia viz. headache, fatigue, dyspnoea, blurring of vision, parasthesia, syncopal attacks. All the students were then clinically examined for the signs of anemia. Later 10% of students were selected by systematic random sampling technique and tested for anemia using Sahli's hemoglobinorneter. WHO definition of anemia in adolescents was used (hemoglobin level below 12gm% in girls and 13gm% in boys.
A quasi experimental study was conducted to evaluate the impact of an intensive dietary program for the treatment of iron-deficiency anemia in 34 intervention and 34 control boarding-school girls aged 12 to 17 years from Benin. A quasi-experimental design consisting of 4 weeks of nutrition education combined with an increase in the content and bioavailability of dietary iron for 22 weeks was implemented in the intervention school, but not in the control school. Data were obtained from both groups from a nutrition knowledge questionnaire, 24-hour dietary recalls, anthropometric measurements, measurement of iron status indices, and screening for malarial and intestinal parasitic infections. The study result showed that Nutrition knowledge scores and mean intakes of nutrients, including dietary iron, absorbable iron, and vitamin C, were significantly higher in the intervention group (p < .05) than in the control group after 26 weeks. Mean hemoglobin and serum ferritin values were also significantly higher in the intervention group than in the control group (122 vs. 112 g/L [p = .0002] and 32 vs. 19 μg/L [p - .04], respectively), whereas the prevalence of anemia (32% vs. 85% [p = .005] and iron-deficiency anemia (26% vs. 56% [p = .04]) was significantly lower in the intervention group than in the control group. No significant differences between the groups were observed in intestinal parasitic infections or malaria status postintervention. The study concluded that multidietary strategy aiming to improve available dietary iron can reduce iron-deficiency anemia in adolescent girls.
Statement of the problem
“A stUDY TO ASSESS THE EFFECTIVENESS OF STRUctured teaching programme REGARDING PREVENTION OF IRON DEFICIENCY ANEMIA AMONG ADOLESCENT GIRLS IN SELECTED COMMUNITY AREAS BANGALORE”.
6.3 Objectives of the study
6.3.1 To assess the pre-test knowledge regarding prevention of iron deficiency anemia.
6.3.2 To assess the post –test knowledge regarding prevention of iron deficiency anemia.
6.3.3 To compare the pre test and post test finding regarding prevention of iron deficiency anemia.
6.3.4 To find out relationship with pre test finding with selected demographic variables.
6.4 HYPOTHESIS
The mean post test knowledge score of adolescent girls regarding prevention of iron deficiency anemia will be higher than mean pre-test-score.
6.5 Operational definition
1. Structured Teaching Programme