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RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA
SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECT
FOR DISERTATION
Mrs. DARLIN SANTHINI. M.
NAME OF THE CANDIDATE
I YEAR M. Sc NURSING,
AND ADDRESS
E.T.C.M. COLLEGE OF NURSING,
1.
P.O. BOX No. 4, KOLAR-563101,
KARNATAKA
NAME OF THE
E.T.C.M. COLLEGE OF NURSING,
2.
INSTITUTION
P.O. BOX No. 4, KOLAR-563101, KARNATAKA.
COURSE OF STUDY AND
M. Sc NURSING,
SUBJECT
OBSTETRICS AND GYNECOLOGICAL NURSING
DATE OF ADMISSION TO
15/06 /2012
3.
4.
COURSE
“EFFECTIVENESS
OF
NUTRITIONAL
INTERVENTION ON IRON DEFICIENCY ANEMIA
5.
TITLE OF THE TOPIC
AMONG
LATE
ADOLESCENT
SELECTED COLLEGES AT KOLAR”
1
GIRLS
IN
6. BRIEF RESUME OF THE INTENDED WORK
6.1 NEED FOR THE STUDY
Adolescence more broadly refers to the phase of human development which
encompasses the transition from childhood to adulthood. This period is very crucial,
since these are the formative years in the life of an individual, when major physical,
psychological and behavioural changes take place. The nutritional and the health
needs of the adolescents are also more because of the growth spurt and the increase in
physical activity in them.1
The word adolescence is derived from the Latin word, ‘adolescere’; meaning
“to grow, to mature”. The WHO has defined adolescence as the age period between
10 to 19 years of age for both the sexes (married and unmarried). There are about 1.2
billion adolescents in the world, which is equal to 1/5th of the world’s population and
their numbers are increasing. Out of these, 5 million adolescents are living in
developing countries. India’s population has reached the 1 billion mark, out of which
21% are adolescents.2
In females, adolescence marks the beginning of the menstrual cycle or
reproduction. Adolescents gain 30% of their adult weight and more than 20% of their
adult height between 10-19 years, which we call as growth spurt.3
The world’s adolescent population is facing a series of serious nutritional
challenges which are not only affecting their growth and development but also their
livelihood as adults. Yet, adolescents remain a largely neglected, difficult- to-
2
measure and hard -to- reach population, in which the needs of adolescent girls in
particular, are often ignored .4
Adolescent girls are at a high risk for anaemia and malnutrition. Inadequate
nutrition during adolescence can have serious consequences throughout the
reproductive years of life and beyond. Very often, in India, girls get married and
pregnant even before the growth period is over, thus doubling the risk for anaemia.5
Anaemia is the most prevalent nutritional problem worldwide and it is mainly
caused due to iron deficiency. Its prevalence is highest among young children and
women of childbearing age; particularly in pregnant women. The prevalence of
anaemia is disproportionately high in the developing countries, due to poverty,
inadequate diet, worm infestations, pregnancy/lactation and poor access to the health
services.6
Anaemia is the decreased ability of the red blood cells to provide adequate
oxygen to body tissues.
It may be due to a decreased number of red blood cells, a
decreased amount of substance in red blood cells, which transports oxygen
(hemoglobin), or a decreased volume of red blood cells. There are over a dozen
different types of anaemia, some due to a deficiency of either a single or several
essential nutrients and others from conditions that are not related to nutrition such as
infections. “Nutritional Anaemia” describes a condition in which the haemoglobin or
red blood cell content of the blood is lower than normal because of too little iron and
is the most common anaemia in South Asia.7
3
The nutritional anaemia in adolescent girls attributes to the high maternal
mortality rate, the high incidence of low birth weight babies, high perinatal mortality
and the consequent high fertility rates. This phase of life is also important due to the
ever-increasing evidence that the control of anaemia in pregnant women can be more
easily achieved if a satisfactory iron status can be ensured during adolescence. About
43% of the adolescent deaths are related to pregnancy. Pregnancy during adolescence
deprives the girls from achieving their full growth according to their genetic
potential.8
India has the world’s highest prevalence of iron deficiency anaemia among
women, with 60 to 70 percent of the adolescent girls being anaemic. Adolescence is
considered as a nutritionally critical period of life. The pre-pregnancy nutritional
status of young girls is important as it impacts on the course and the outcome of their
pregnancy. Hence, the health of adolescent girls demands special attention.9
The causes of iron deficiency are: too little iron in the diet, poor absorption of
iron by the body, and loss of blood (including from heavy menstrual bleeding). It is
also caused by lead poisoning in children. Nutritional Anaemia develops slowly after
the normal stores of iron have been depleted in the body and in the bone marrow.
Women, in general, have smaller stores of iron than men and have increased loss
through menstruation, placing them at higher risk for nutritional anaemia. High-risk
groups include: women of child-bearing age who have blood loss through
menstruation; pregnant or lactating women who have an increased requirement for
iron; infants, children, and adolescents in rapid growth phases; and people with a poor
dietary intake of iron through a diet of little or no meat or eggs for several years. 10
4
Almost one sixth of India’s population comprises of adolescents. An
adolescent boy or girl is still a developing child. Among adolescents, girls constitute a
vulnerable group, particularly in developing countries where they are married at an
early age and exposed to a greater of reproductive morbidity and mortality. Anemia is
established if the hemoglobin is below the cut-off points of World Health
Organization. Most frequent cause of nutritional anemia is iron deficiency, and less
frequently folate or Vitamin B12. In India iron deficiency anemia is most wide spread
micro nutrient deficiency affecting all age groups irrespective of gender, caste, creed
and religion. As per district level health survey (2002-2004), prevalence of anemia in
adolescent girls is very high (72.6%). In India, with prevalence of severe anemia
among them is much higher (21.1%) than that in preschool children (2.1%).Daily iron
requirements for female adolescents are 2.8mg. According to ICMR recommended
dietary intake of iron for 13-15years is 28mg and 16-18years is 30mg. And the daily
allowances of vitamin C for adolescents are 30-50mg.11
NEED FOR THE STUDY
Adolescent girls are particularly prone to iron deficiency anaemia because of
the increased demands of iron by the body. This anaemia not only affects the present
status of health of the adolescent girls, but also shows a deleterious effect when these
girls become future mother. A satisfactory haemoglobin status at the time of
conception results into safe pregnancy and healthy child birth. This could be attained
only when the status of haemoglobin is improved in adolescent girls. So in order to
prevent high maternal mortality and high incidence of low birth weight babies in
India, there is a need to combat anaemia in adolescent girls. Protein and iron rich diet
can improve the haemoglobin status only to some extent. The best way to combat
anaemia is supplementation with iron and folic acid tablets, since the absorption of
5
iron from Indian dietaries is too low. Iron status during adolescence may be
complicated further by low dietary intake.12
Nutritional Anemia continues to be a major public health problem worldwide,
particularly among growing children, females of reproductive age and elderly people,
especially in the developing countries. The World Health Organization (WHO)
estimates that anemia affects approximately 1.62 billion people worldwide,
corresponding to 24.8% of the human population.13
India has one of the fastest growing youth populations in the world with an
estimated 190 million of which 22% are girls. According to WHO there are 2 billion
people affected with anemia, in India nearly 43,904,406 people are affected with
anemia. In Karnataka nearly 39% of women are affected and 69% are iron deficient,
in kolar approximately 1200 women are affected with anemia.14
The causes of anemia are diverse and multifactorial, but among the leading
etiologies in the developing countries are: nutritional deficiencies (especially of iron,
folate and vitamin B12), chronic or acute blood loss, inherited genetic defects (e.g.
thalassemia), chronic diseases and/ or inflammatory disorders, malaria, parasitic
infestations (e.g. hookworm), hemolytic disorders, drug-induced hemolysis or marrow
suppression or it may be unexplained.15
Anemia is one of the most commonly recognized disorders. Its prevalence in
women and preschool children is high; therefore, it needs more attention. Evidence
from studies showed that adolescents are at an increased risk of developing anemia
6
due to increasing iron demand during puberty, menstrual losses, limited dietary iron
intake and faulty dietary habits.12
Anemia is the most common form of malnutrition among adolescents today. It
is of public Health significance in our country. Adolescents (10-19 years) constitute
> 20% of our population in India and 50 % suffer from Iron deficiency Anemia. Both
urban and rural, suffer from Anemia and being more in girls than boys. Poor
economical status faulty dietary pattern, lack of awareness and education,
urbanization prevalence of malaria, hookworm and other infestations, repeated
bacterial infections also influence the incidence and nature of Anemia among growing
children and adolescents.16
There are various types of treatment for anemia, depending on the severity
and underlying cause. Iron supplements may be given to some patients but they must
follow the recommended doses because iron levels that are too high can also have illeffects. Vitamin C and other supplements to help absorb iron may also be added.
Blood transfusions for those who have anemia related to mass blood loss and
hyperbaric oxygen for those who have blood cell destruction are methods that are
used to assist the respective disorders. Herbal and nutritional treatments may help
when used along with medical treatment.13
A balanced vegetarian diet that includes legumes, fortified grains, and green
vegetables easily provides adequate iron. Fruits and vegetables contain vitamin C and
organic acids (eg, citric acid) that keep iron in a reduced form, allowing for better
absorption of non-heme iron.17
7
Iron is needed for hemoglobin synthesis, mental function and body
defence. Plant foods like legumes, dried fruits and green leafy vegetables like spinach,
fenugreek (methi), mustard (sarson), bathua, coriander and mint contain iron and so
do jaggery, ragi, bajra, wholegrain flour and sesame seeds. Fruits rich in iron include
pomegranates, apricots, (especially when dried or semi dried), plums, bananas, and
black grapes. Meat, liver, kidney, fish and poultry are also rich sources of iron with
good bioavailability of the mineral as compared to plant foods. Fruits rich in vitamin
C like amla, guava and citrus fruits improve iron absorption from plant foods.18
Citrus fruits are high in vitamin C, which is a nutrient known to significantly
increase iron absorption. Iron-rich food with a food high in vitamin C, it can increase
body's absorption of the iron by up to 20 times. Citrus fruits such as grapefruit, lemon
and oranges, Guava are notably high in vitamin C. Among the vegetables high in
vitamin C are broccoli, cauliflower, Brussels sprouts, cabbage, potatoes and
tomatoes. 19
Guavas are rich in dietary fiber, vitamins A and C, folic acid, and the dietary
minerals, potassium, copper and manganese. Having a generally broad, low-calorie
profile of essential nutrients, a single common guava (P. guajava) fruit contains about
four times the amount of vitamin C as an orange. 100 gms of raw guava contains
Calories 68,
Total
Fat 0.95g,
Sodium 2mg,
Potassium 417mg,
Total
Carbohydrate 14.32g, Dietary Fiber 5.4g, Sugars 8.92g, Protein 2.55g, Vitamin C
380%, Calcium 2%,Iron 1%.20
A pre experimental study was conducted to assess the effectiveness of Nutritional
intervention on Anaemia among adolescent girls with iron deficiency anaemia in
8
Nachiyampalayam at Dharapuram, Tamil Nadu. A sample of 50 adolescent girls was
selected by using non probability purposive sampling technique. The samples that had
less than 11gm of Haemoglobin were selected as study participants. On the first two
days demographic variables were collected and the level of anemia for 50 samples
was assessed by checking the hemoglobin using Sahli’s hemometre, and signs and
symptoms was assessed by structured observational checklist. Samples were visited
every day in their homes and made to consume nutritional balls and one guava. The
intervention was done continuously for 30 days. After 30days hemoglobin level was
checked and the anemia signs and symptoms were assessed by using observational
checklist to find out the level of iron deficiency anemia. The study result shows that in
before nutritional intervention among 50 adolescent girls with iron deficiency anemia
depicts that 8(16%) had mild levels of anemia, 33(66%) had moderate levels of
anemia and 9(18%) had severe levels of anemia. In the after nutritional intervention
29(58%) had mild levels of anemia and 21(42%) had moderate levels of anemia. the
mean scores of pre test and post test level of anemia among adolescent girls 14.828
(SD + 1.16) and 13.54 (SD + 0.55) respectively. Thus the difference in pretest and
posttest mean was 1.29. The overall pretest mean percentage was 29.656, where as the
post test mean percentage was 27.08. Post test level of anemia mean score is less than
the pre test score. Paired‘t’ value is 8.94 which was significant at 0.05 level. The
mean and standard deviation findings showed that the nutritional intervention was
effective in increasing the hemoglobin level among adolescent girls with iron
deficiency anemia.21
The nurse has a major role in identifying the prevalence of anaemia mainly
among adolescents’ girls. Most important is to instigate the intake of low cost iron
rich diet among the people, by which anaemia can be prevented. Hence the
9
investigator realized the necessity to assess Anemia among the late adolescent girls.
This study concentrates mainly on nutritional intervention on Iron deficiency Anemia
among late adolescent girls with use of Nutritional ball.
6.2 REVIEW OF LITERATURE.
The literature relevant to this is reviewed and arranged in the following section
1. Literature related to Iron deficiency Anaemia among Adolescent girls
2. Literature related to Use of Nutritional Interventions
3. Literature related to Nutritional Intervention on Iron deficiency Anaemia
1. Literature related to Iron deficiency Anaemia among Adolescent Girls
A cross-sectional survey was executed to estimate the prevalence of iron
deficiency anemia among adolescent school girls in Chennai, Tamil Nadu. A sample
of 400 female school students in the age group of 13-17 years were selected by using
stratified random sampling method. Socio demographic details, anthropometric
measurements were obtained. Haemoglobin was estimated using cyan method.
Statistical analysis was done using IBM SPSS (Statistical Package for the Social
Sciences). Study results shows that the prevalence of anemia was found to be 78.75%
among school students. Chi-square statistics shows significant association (p<0.05) of
anemia is with type of family, socioeconomic status and diet. In this study 42.5% of
girls with BMI<18 were found to be anemic. This study predicts that hemoglobin
level tends to decrease as age progresses especially in their maternal life that gives an
alarming effect on infant and maternal mortality rates. Health programs for
housewives should insist the utilization of easily available and affordable iron rich
10
diet, forming kitchen garden etc. School health programs, antenatal programs should
focus on anemia, targeting on individual’s benefit. Strategies on anemia prevention
can be formed at primary health care level.22
A cross sectional community based study was conducted to estimate
prevalence of anemia among adolescent girls in an urban slum and to study sociodemographic and menstrual factors associated with it. The study was conducted
among 272 adolescent girls in an urban slum area under Urban Health Training
centre, department of Community Medicine, NKP Salve Institute of Medical science,
Nagpur from June 2009 to February 2010. Out of five areas one area was selected by
simple random sampling. Information regarding socio-demographic and menstrual
factors was recorded in pre-designed, pre -tested proforma. Hemoglobin estimation
was done by Sahli’s haemoglobinometer. Data was analyzed by mean, standard
deviation and chi square test. The study result shows that the prevalence of anemia
was found to be very high (90.1%) among adolescent girls. Majority of the girls were
having mild or moderate anemia (88.6%). A significant association was found
between adolescent girl’s education, mother’s occupation and anemia. No association
was found between menstrual factors and anemia. The study concluded that nutrition
education along with nutritional supplementation and iron folic acid tablets should be
provided to all girls.23
A cross sectional survey was conducted in selected Anganwadi centres of rural
area of Hassan district. The study was conducted to estimate the prevalence of anemia
among adolescent girls and to study the socio demographic factors associated with
anemia. A sample of 314 adolescent’s girls (10-19 yrs old) was included in the study.
The study was conducted from February to April 2011 (3 moths).Data analysis was
11
done by using proportions and Chi-square test. The study result shows that the
prevalence of anemia was found to be 45.2%. A statically significant association was
found with iron deficiency anemia, weight loss and anemia, pallor and anemia. In the
present study it was seen that among the 45.2% of anaemic adolescent girls 40.1%
had mild anaemia, 54.92% had moderate anaemia and 4.92% had severe anaemia. The
study was concluded that a high prevalence of anemia among adolescent girls was
found, which was higher in low economic strata. It was seen that anemia affects
overall nutritional status of adolescent girls.24
A study was designed to investigate the prevalence of anaemia, a common low
haemoglobin condition, in young female population of Aurangabad region (MS).108
female college students participated in the study. The haemoglobin (Hb), level was
measured using Sahli’s haemoglobinometer. Anaemia was defined as a situation
where Hb is less than 12 g/dL. Further the anaemia was categorized into severe,
moderate and mild based on the Hb levels. The study result shows that the complete
data was available for 108 young female students of Aurangabad region (MS). The
prevalence of anaemia was 83.34 percent. Normal haemoglobin status was found in
16.66 percent of the subjects. The study was concluded that anaemia is common
among 18 to 25-year old females of Aurangabad region (MS). Iron supplementation is
thus required for the target group.25
A cross-sectional study was conducted to assess the prevalence and the severity
of anaemia among adolescent girls in rural areas which was conducted for a period of
one year from Jan 2008 – Dec 2008 at villages which were under Vantamuri PHC, a
field practice area of J.N Medical College, Belgaum. A total of 840 adolescent girls
(10-19 years of age) were included in the study. A pre-designed and pre-tested
proforma was used to obtain the details of the socio-demographic variables. A
12
relevant clinical examination of the participants was done. Following this, 2ml of
blood was obtained by venipuncture. The blood samples were analyzed by using an
automated cell counter. The diagnosis was established as anaemia when the
haemoglobin level was less than 12gm/dl. The study results revealed that the
prevalence of anaemia was 41.1% (with that of severe anaemia being 0.6%, that of
moderate anaemia being 6.3% and that of mild anaemia being 34.6%. It was observed
that the prevalence of anaemia was high in late adolescents (15-19yrs) as compared to
that in the early adolescents (10-14yrs). A majority of the girls had mild anaemia. The
prevalence of anaemia was considerably high among the girls who belonged to the
low socio-economic status. The study concluded a high prevalence of anaemia was
found among the adolescent girls, which was considerably high in the late
adolescents. There was a significant association of anaemia with the socio-economic
status.26
A cross sectional study was conducted to investigate the prevalence of anemia,
iron deficiency anemia and related risk factors in adolescent school girls in Kavar
urban area in southern Iran. A total of 363 adolescent school girls were evaluated.
Socioeconomic, demographic and related risk factors were obtained by a
questionnaire. Hematological parameters and serum iron indices were measured. The
study results shows that there were 21 cases of anemia (5.8%), 31 (8.5%) iron
deficiency and 6 (1.7%) iron deficiency anemia. Most of anemic girls (85.7%) had
mild anemia. MCV, TIBC, age, and BMI had statistically significant relationship
with hemoglobin. Only parasites infestation in the last three months had a 6.83 times
more risk of anemia than those without this history (95% CI, 1.66-28.11).27
A cross-sectional study was conducted to investigate the prevalence of
selected micronutrient deficiencies amongst anaemic adolescent schoolgirls in rural
13
Bangladesh and to examine their relationship with haemoglobin (Hb) levels. The
study was conducted among Girls’ high schools in rural areas of Dhaka District in
Bangladesh.310 anaemic adolescent girls aged 14–18 years from eight schools
participated in the study. Information on personal characteristics and food habits were
collected by interview. Parents were asked about their socio-economic conditions.
Anthropometric data and blood samples were collected following the interview. The
study result shows that the 28% of the girls had depleted iron stores (serum ferritin
o12.0 mg/l), 25% had folic acid deficiency (red blood cell folic acid o317 nmol/l),
89% had vitamin B2 (erythrocyte glutathione reductase activity coefficient X1.4) and
7% had vitamin B12 deficiencies (serum vitamin B12 o150 pmol/l). Although the
prevalence of vitamins A and C deficiency was very low, a significant proportion had
low vitamin A (serum retinol between 0.70 and o1.05 mmol/l) and vitamin C status
(plasma ascorbic acid between 11.4–23.0 mmol/l). Frequency of consumption of
meat, serum ferritin and vitamin B2 status were found to be strongly related to Hb by
multiple regression analysis. For 1 mg/l change in serum ferritin, there was a 0.13 g/l
change in Hb when adjusted for other factors. The study concluded that there is
coexistence of micronutrient deficiencies among anaemic adolescent girls in rural
Bangladesh, although they do not suffer from energy deficiency. Of all
micronutrients, only iron and vitamin B2 concentrations were found to be related to
the Hb concentration.28
A cross-sectional survey was conducted to estimate the prevalence of anemia
among adolescent females and to study the socio-demographic factors associated with
anemia in an urban area under Urban Health Training Center, Department of
Preventive and Social Medicine, Government Medical College and Hospital, Nagpur.
A total of 296 adolescent females (10–19 years old) were included in this study. The
14
study took place from October 2002 to March 2003 (6 months). Statistical analyses
were done using percentage, standard error of proportion, Chi-square test, and
Student‘s‘t’ test. The study result shows that the prevalence of anemia was found to
be 35.1%. A significant association of anemia was found with socio-economic status
and literacy status of parents. Mean height and weight of subjects with anemia was
significantly less than subjects without anemia. The study concluded a high
prevalence of anemia among adolescent females was found, which was higher in the
lower socio-economic strata and among those whose parents were less educated. It
was seen that anemia affects the overall nutritional status of adolescent females.29
2. Literature related to use of Nutritional Intervention
The daily requirements of iron are 1–3 mg/day; these requirements increase
during the growth period, in women of childbearing age, and in pregnant women,
and decrease due to the cessation of menses. Because gastrointestinal absorption
of iron is limited, the diet must contain between 15 and 30 mg/day. The primary
goal of dietary modification, that is, improving and maintaining the iron status of
a population, involves changes in behavior, leading to an increase in the selection
of iron-containing foods and a meal pattern that favors increased bioavailability.
Efforts should be focused on promoting the access to iron-rich foods (eg, meat and
organs from cattle, fowl, fish, and poultry, and non-animal foods such as legumes
and green leafy vegetables) and foods that enhance iron absorption (some fruits,
vegetables, and tubers).30
Government of India has launched some of the programs for controlling
anemia. This program includes Prophylaxis against Nutritional anemia launched
by the government of India during 4th five year plan. This programme was focused
15
in the distribution of iron and folic acid tablets to pregnant women and young
children. National Institute of Nutrition in Hyderabad has launched iron
fortification in salt for reducing the prevalence of anemia.11
Ragi is rich in minerals like thiamine, calcium and iron. It is also rich in
carbohydrates, and low in fat, and hence helps in reducing obesity. Ragi is a boon
for people suffering from diabetes. It is a good laxative for people suffering from
constipation. It can be used as a substitute for people allergic to milk. Ragi is good
for obese people because its digestion is slow and glucose is released very slowly
into the blood. Eating roasted green ragi is a tonic for the people suffering from
high blood pressure, liver diseases, heart weakness, asthma and lack of milk
production in lactating women. Regular use of ragi protects from malnutrition,
degenerative diseases and premature aging. Ragi, being a good source of iron, can
be considered as a useful cereal for anemic patients. 100 gms of Ragi contains
Carbohydrate - 72.6,Protein - 7.7, Fibre - 3.6, Fat - 1.3, Calcium - 350 mg, Iron 3.9 mg, Niacin - 1.1 mg, Thiamin - 0.42 mg, Riboflavin - 0.19 mg.31
Groundnuts contain five important nutrients namely food energy, protein,
phosphorous, thiamin and niacin. It maintains and repairs body tissues. Eating fresh
roasted groundnuts with jaggery and goat's milk is very nutritious for growing
children, pregnant women and nursing mothers. It builds a resistance against all
infections, such as Hepatitis and tuberculosis and prevents anaemia. It contains 13
different vitamins (including Vitamin A, B, C and E) along with 26 essential trace
minerals, including calcium and iron, and also contains zinc, good for protecting brain
function, and boron, which helps to maintain strong bones. It has good dietary fiber
content so they are very good for digestion. Groundnuts are valuable in diabetes. It is
also useful in diarrhea, especially chronic diarrhea, which is more frequent
16
immediately after a meal. 100 grams Groundnuts contains water- 6.50 gm, Energy567 Kcal, Protein- 25.80g, Fat-49.24g,Carbohydrate-16.13, Fibre-8.5g, sugar-3.97g,
calcium-93mg, Iron-4.58mg, Magnecium-168mg, Phopherus-376mg, potassium705mg, sodium-18mg, Zinc-3,27mg,Copper-11.44mg, manganese-1.9 mg, Selenium7.2mcg.32
3. Literature related to Nutritional Intervention on Iron Deficiency Anaemia
A pre experimental study was conducted to assess the effectiveness of Nutritional
intervention on Anaemia among adolescent girls with iron deficiency anaemia in
Nachiyampalayam at Dharapuram, Tamil Nadu. A sample of 50 adolescent girls was
selected by using non probability purposive sampling technique. The samples that had
less than 11gm of Haemoglobin were selected as study participants. On the first two
days demographic variables were collected and the level of anemia for 50 samples
was assessed by checking the hemoglobin using Sahli’s hemometre, and signs and
symptoms was assessed by structured observational checklist. Samples were visited
every day in their homes and made to consume nutritional balls and one guava. The
intervention was done continuously for 30 days. After 30days hemoglobin level was
checked and the anemia signs and symptoms were assessed by using observational
checklist to find out the level of iron deficiency anemia. The study result shows that in
before nutritional intervention among 50 adolescent girls with iron deficiency anemia
depicts that 8(16%) had mild levels of anemia, 33(66%) had moderate levels of
anemia and 9(18%) had severe levels of anemia. In the after nutritional intervention
29(58%) had mild levels of anemia and 21(42%) had moderate levels of anemia. the
mean scores of pre test and post test level of anemia among adolescent girls 14.828
(SD + 1.16) and 13.54 (SD + 0.55) respectively. Thus the difference in pretest and
17
posttest mean was 1.29. The overall pretest mean percentage was 29.656, where as the
post test mean percentage was 27.08. Post test level of anemia mean score is less than
the pre test score. Paired‘t’ value is 8.94 which was significant at 0.05 level. The
mean and standard deviation findings showed that the nutritional intervention was
effective in increasing the hemoglobin level among adolescent girls with iron
deficiency anemia.21
An experimental study was conducted to assess the effectiveness of nutritional
intervention among women with anemia in selected village Thiruvallur District. The
objective of the study was to assess the pretest and post test level of hemoglobin
among women with anemia and to determine the effect of consuming nutritive balls
on Hb level of women with anemia. Sample size was 60. The result showed there was
a reduction in the percentage level of 7-9gms/dl in women from 30% to 3.3% and
60% to 86.7. In experimental group, pretest Hb is 9.59gm and post test Hb is
10.18gm. The gain score is 0.59gm whereas in control group, 0.07gmscore is
observed. Hence the effect of nutritional ball was proved. This study was concluded
that consuming nutritive balls along with vitamin C is an effective method of
increasing the Hb of women.33
A randomized controlled study was conducted to find out the efficacy of a Local
Vitamin-C Rich Fruit (Guava) in Improving Iron Absorption from Mungbean Based
Meals and Its Effect on Iron Status of Rural Indian Children (6-10 Years). Objective
of the study was to assess the effect of Mungbean based test meal on iron status (as
body iron stores, defined and calculated by the ratio of serum ferritin and serum
transferring receptor) of school age children (6-10 years) with and without the
consumption of guava, a vitamin C rich fruit, in a school feeding program for seven
months. Study population was three hundred school children aged between 6-10 years
18
will be recruited from two government school of Mangali village situated in Hisar
district of Haryana state. This intervention study will be carried out in a randomized
controlled design. Main study parameters/endpoints: Primary outcome will be the
measurement of body iron stores (mg/kg of body weight) based on the ratio of serum
transferrin receptor to serum ferritin. Three weeks before the trial available children
(6-10 years) in selected schools will be screened for eligibility of the study on the
basis of medical health questionnaire. Deworming will be done at least 20 days before
the start the feeding trial with a single dose of Albendazole (400 mg), that will be
given again after three months. These 300 children will be assigned to three groups
(100 children each group). Group-1 will be served with the normal school feeding
program (SFP) meal (see annexure-1) and this group will also serve as control group
for the study. Group-2 will be served with mungbean test meal and group-3 will be
served with guava fruit in addition of mungbean test meal. Meals to all children will
be provided for six days in a week up to seven months. All meals will be served at
mid morning (11.00 am to 11.30 am). Effect of intervention will be assessed in terms
of iron status of children.34
STATEMENT OF THE PROBLEM
“A study to assess the effectiveness of Nutritional Intervention on Iron
deficiency Anaemia among late Adolescent Girls in selected colleges, Kolar”.
6.3
OBJECTIVES OF THE STUDY
1. To assess the level of Hemoglobin among late adolescent girls before
Nutritional intervention.
19
2. To assess the level of Hemoglobin among late adolescent girls after
Nutritional Intervention.
3. To evaluate the effectiveness of Nutritional Intervention on Iron deficiency
Anemia among late adolescent girls.
4. To find out the association between the selected demographic variables and
the Post test level of Hemoglobin among late adolescent girls.
6.4 OPERATIONAL DEFINITIONS
Effectiveness
In this study it refers to the outcome of Nutritional Intervention and it is
measured in terms of level of hemoglobin among late adolescent girls before and after
Nutritional Intervention.
Late adolescent girls
In this study it refers to girls who are studying in educational institution,
between the age group of 17 to 18 years.
Iron deficiency Anemia
In this study it refers to late adolescent girls who are having iron deficiency
anemia with hemoglobin level between 7-12g/dl. (Moderate anemia 7-10 g/dl, Mild
anemia 10.1-12g/dl).
Nutritional Intervention
Nutritional intervention can be defined as “purposely – planned actions
designed with the intent of changing nutrition – related behavior, risk factor,
environmental condition, or aspect of health status for an individual, a target group, or
population at large.”35
20
In this study it refers to preparation and distribution of the one nutritional ball
along with one guava for the improvement of hemoglobin level among the late
adolescents’ girls for the period of 30 days. Each Nutritional Ball contains 20 grams
of Roasted Ragi (10.8 mg iron) ie, 2 tablespoon, 10 grams of Roasted Ground nut
(3.2 mg iron) 20 piece, Jaggery 20 gram (22.8 mg iron) 50ml. Total weight of each
nutritional ball is 50 grams (36.8mg iron), and one fresh guava weighing
100gram.(Vitamin C 380mg).
6.5 ASSUMPTIONS
The study assumes that
 Nutritional anemia is prevalent among adolescents.
 Anemia affects the scholastic performance.
 Anaemia impaired the cognitive performance at all stages of life.
 Anaemia significantly reduces the physical work capacity and productivity
 Increase in physical growth during adolescent age group leads to anemia.
 Iron supplements help to increase the hemoglobin level.
 The adolescent girls may consume fewer amounts of iron and vitamin C in
their daily dietary intake.
 Nurse has the major role in educating the adolescent girls about the
importance of consuming iron rich diet.
6.6
NULL
HYPOTHESES
H01
There will be no significant difference in the level of hemoglobin among late
adolescent girls before and after nutritional intervention.
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H02
There will be no significant association between the selected demographic
variables and the Post test level of hemoglobin of late adolescent girls.
7. MATERIALS AND METHODS
7.1 SOURCES OF DATA
Data will be collected from late adolescent girls (17-18yrs) with Haemoglobin
levels between 7-12 gm/dl studying in selected colleges, kolar.
7.1.1 RESEARCH APPROACH
Evaluative Research Approach
7.1.2 RESEARCH DESIGN
Pre experimental research design with one group pre test and post test design.
7.1.3 VARIABLES UNDER THE STUDY
Independent Variable – Nutritional Intervention
Dependent Variable – Late Adolescent girls having Haemoglobin levels between 712 gm/dl.
Extraneous variables - In this study, the extraneous variables are Age, Religion,
Type of Family, Family Monthly Income, Dietary habits, and previous treatment for
anemia, Duration and Length of menstrual cycle.
22
7.1.4 SETTING OF THE STUDY
The study will be conducted in selected colleges, kolar.
7.1.5 POPULATION
Target Population
The target population for the study will be the adolescent girls with
Haemoglobin levels between 7-12 gm/dl.
Accessible Population
In this study the accessible population will be the adolescent girls with
Haemoglobin levels between 7-12 gm/dl, who are studying in selected colleges, kolar,
and available during the period of data collection.
7.1.6 SAMPLING TECHNIQUE
Non probability Purposive Sampling technique.
7.1.7 SAMPLE SIZE
Sample size consists of 50 Late adolescent girls (17-18yrs) studying in
selected colleges, kolar.
7.1.8 CRITERIA FOR SELECTION OF THE SAMPLE
Inclusion criteria
The study included adolescent girls
 Between the age group of 17-18 years.
 Who are willing to participate in the study.
 Hemoglobin levels between 7- 12gm/dl.
 Who are able to read and understand English.
23
Exclusion criteria
 Students who are already taking iron supplementations in the form of
medicine.
 Anemic students who are associated with other systemic disease
condition.
7.2 METHOD OF DATA COLLECTION
7.2.1 DATA COLLECTION TOOL
The instruments used in this study are demographic variables performa Bio
physical variable proforma and Check list on Signs and symptoms of anemia. The tool
consists of 3parts.
Part I - Demographic variable proforma
The demographic variables included in the proforma were Age, Religion,
Type of family, Family Monthly Income, Dietary habits, and consumption of tea or
coffee, and previous treatment for anemia, Duration and length of menstrual cycle.
Part: II - Bio-physiological profile
The Bio-physiological profile consists of variables such as height, weight,
level of hemoglobin and body mass index.
Part – III Check list on signs and symptoms of anemia
The check list to be developed by the investigator to do clinical examination
of the participants regarding signs and symptoms of anemia. There are about 20 items
for which a score is given for yes or no response. The total score is 20 which are
arbitrarily classified into mild (0-7), moderate (8-14) and severe (15-20) anemia.
24
DESCRIPTION OF THE INTERVENTION
Nutritional intervention (Nutritional Ball)
Nutritional intervention is preparing and giving the nutritional balls along with
guava for the improvement of hemoglobin level among the late adolescents’ girls.
Each Nutritional Ball contains 20 grams of Roasted Ragi (10.8 mg iron) ie, 2
tablespoon, 10 grams of Roasted Groundnut (3.2 mg iron) 20 piece, Jaggery 20 gram
(22.8 mg iron) 50ml. Total weight of each nutritional ball is 50 grams (36.8mg iron).
This ball to be administered along with one fresh guava weighing 100gram (Vitamin
C 380mg) to eligible adolescent girls in the college once a day at morning for 30 days.
7.2.2 DATA COLLECTION PROCEDURE
The written permission from the authorities of the selected institution will be
obtained prior to data collection. Formal permission will be obtained from study
participants after explaining the objectives of study. The study participants will be
selected by using purposive sampling technique. A sample of 50 adolescent girls are
selected after initial screening for haemoglobin level and basis of inclusion criteria.
On the first day Demographic variables, Bio physical profile to be collected and signs
and symptoms of anemia to be assessed by Observational check list and Hemoglobin
was checked by Sahli’s hemometre method. The investigator will do deworming of
the selected samples with antihelmintic T. Albendazole 400mg before nutritional
intervention. The adolescent girls who had the hemoglobin level between 7-12gms/dl
to be included as samples and made to consume one nutritional ball after breakfast
along with one guava once in a day for 30 days. On 31st day adolescent girls
Hemoglobin level to be checked and the signs and symptoms of iron deficiency
anemia to be assessed by using the same observational checklist.
25
7.2.3. METHOD OF DATA ANALYSIS
 Demographic data will be analyzed by using descriptive statistics like
frequency distribution, percentage, mean and standard deviation.
 Analysis of effectiveness of Nutritional Intervention on Anaemia by
comparing pre test, and post test level of Haemoglobin will be assessed by
using inferential statistics like paired‘t’ test.
 Chi – square test will be used to find the association between selected
demographic variables and post test level of Haemoglobin.
7.3
DOES THE STUDY REQUIRE ANY INVESTIGATION OR
INTERVENTIONS TO BE CONDUCTED ON PATIENT OR
OTHER HUMANS OR ANIMALS?
Yes, non – invasive intervention will be done. On the first day by using
Demographic variables, Bio physical profile to be collected and signs and symptoms
of anemia to be assessed by Observational check list and Hemoglobin was checked by
Sahli’s hemometre method. The investigator will do deworming of the selected
samples with antihelmintic T. Albendazole 400mg before nutritional intervention. The
adolescent girls who had the hemoglobin level below 7-12gms/dl to be included as
samples and made to consume one nutritional ball after breakfast along with one
guava once in a day for 30 days. On 31st day adolescent girls Hemoglobin level to be
checked and the signs and symptoms of iron deficiency anemia to be assessed by
using the same observational checklist.
26
7.4
HAS ETHICAL CLEARANCE BEEN OBTAINED FROM
YOUR INSTITUTION?
1. Permission will be taken from the Research Committee.
2. Permission will be taken from the authorities of selected colleges at kolar.
3. Informed consent will be obtained from the subjects before the study
27
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Publications; 2006; 82-84.
2. Mathur JSS. Preventive and Social Medicine, A comprehensive text book.1st ed.
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7. Chatterjee R, Nutritional needs of adolescents. Paediatrics Today 2008; 3: 11014.
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10. Prevention and Control of Nutritional Anaemia: A South Asia Priority
Available from: URL: http://www.unicef.org/rosa/Anaemin.pdf.
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11. Park K. Text –book of preventive and social medicine, 20th ed, Jabalpur: h/S
banaridas bhanot publishers.2009.
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Supplementation on anaemic adolescent school girls. Health and PopulationPerspectives and Issue.2007; 30 (1): 45-55.
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pregnancy.php
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enhance-iron-absorption-in-humans/#ixzz2Hocpg2y5
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Dharapuram, Tamil Nadu. Unpublished Thesis; 2011.
22. Premalatha T, Valarmathi S, Srijayanth P, Sundar JS, Kalpana S. Prevalence of
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Tamil Nadu, INDIA. Epidemiol ogy 2012. 2:118.
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23. Meenal VK, Durge PM, Kasturwar NB. Prevalence of Anemia among Adolescent
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2012; 3-1.
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Adolescent Girls in Rural Area of Hassan district, Karnataka, South India.
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in young female population of Aurangabad region (MS). International Journal of
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27. Ramzi M, et al. Prevalence of anemia, iron deficiency anemia and related risk
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28. Ahmed F, Khan MR, et al. The coexistence of other micronutrient deficiencies in
anaemic adolescent schoolgirls in rural Bangladesh. European Journal of Clinical
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the Urban Area of Nagpur. Indian Journal of Community Medicine. 2008
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groundnuts/view/78
33. Mohanraj J., et.al. (2008). Nature cures for anemia. Herald of health. 2008; p 810.
34. Rani, V., Brouwer, Inge., Khetarpaul, N., Zimmerman, M.B. Iron status and
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35. Available from URL: http://quizlet.com/dictionary/nutrition-intervention/
31
9. SIGNATURE OF THE CANDIDATE
10. REMARKS OF THE GUIDE
The research topic selected is relevant and
feasible for the study.
MRS.JEYALAKSHMI.S
ASSOCIATE PROFESSOR
11. NAME & DESIGNATION
E.T.C.M. COLLEGE OF NURSING,
11.1. GUIDE
P.O. BOX NO. 4, KOLAR-563101,
KARNATAKA.
11.2. SIGNATURE OF THE GUIDE
11.3 CO–GUIDE (If any)
11.4. SIGNATURE OF T HE CO–
GUIDE
MRS.JEYALAKSHMI.S
11.5 HEAD OF DEPARTMENT
OBSTETRIC AND GYNECOLOGICAL
NURSING DEPARTMENT
11.6 SIGNATURE OF TH E HOD
12.1 REMARKS OF THE
12
PRINCIPAL
The topic was discussed with the members
of research committee and was finalized.
She is permitted to conduct the study.
12.2 SIGNATURE
32