Download 1. Adolescent girls are prone to develop the iron deficiency anaemia

PROFORMA FOR REGISTRATION OF SUBJECT FOR
DISSERTATION
MISS. MEERA KRISHNAN.G
FIRST YEAR M.SC (NURSING)
PAEDIATRIC NURSING
YEAR 2011-2013
PADMASHREE COLLEGE OF NURSING
GURUKRUPA LAYOUT, NAGARBHAVI
BENGALURU – 560 072
0
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BENGALURU, KARNATAKA
PROFORMA FOR REGISTRATION OF SUBJECT FOR
DISSERTATION
1.
NAME OF THE
CANDIDATE AND ADRESS
MISS MEERA KRISHNAN.G
1ST YEAR M.Sc (NURSING)
GURUKRUPA LAYOUT,
NAGARBHAVI,
BENGALURU -560 0721
2.
3.
NAME OF THE
INSTITUTION
Padmashree College of Nursing
COURSE OF THE STUDY
1st year M.Sc (nursing),
AND SUBJECT
Paediatric Nursing
4.
DATE OF ADMISSION
5.
TITLE OF THE STUDY
Bengaluru – 560 072
1-6-2011
Effectiveness of nutritional ball
in terms of increase in
haemoglobin level of
adolescent children with iron
deficiency anaemia at selected
nursing colleges Bengaluru
1
6. BRIEF RESUME OF THE INTENDED WORK
6.1 INTRODUCTION
“Adolescence is perhaps nature’s way of preparing parents to
Welcome the empty nest”
Karen Savage
A healthy adult emerges from a healthy child. A child’s nutritional status can have a
great impact on their growth and development. In the absence of proper nutrition a state of
many nutritional problems may occur.
Adolescence, a period of transition between childhood and adulthood, occupies a
crucial position in the life of human beings. This period is characterized by an exceptionally
rapid rate of growth. Adolescents (both boys and girls) are at risk of developing iron
deficiency and iron deficiency anaemia because of the increased iron requirements for
growth1.
Adolescence is a “coming of age”, as children grow into young adults. These teen
years are a period of intense growth, not only physically, but also mentally and socially.
During this time, 20% of final adult height and 50% of adult weight are attained .Because of
this rapid growth , adolescents are especially vulnerable to anaemia. Proper nutrition,
including adequate iron intake, plays an important part of teenager’s growth and
development. During adolescence, teenagers will acquire the knowledge and skills that will
help them to become independent, successful young adults. Iron deficiency and iron
deficiency anemia can affect this learning and development, but parents can help their
teenagers stay healthy by teaching them some easy ways to prevent iron deficiency2.
Iron deficiency is the most prevalent micronutrient deficiency among adolescents .In
teenagers, iron deficiency is more than just being pale and tired. It can affect their
development and school performance. Studies have shown that adolescents with anaemia
have decreased verbal learning and memory capacity. Even before anaemia might develop,
iron deficiency can cause shortened attention span, alertness and learning in adolescents.
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
2
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 screening3.
According to WHO estimates, India is one of the countries in the world that has
highest prevalence of anemia. WHO estimates that 27 percent of adolescents in developing
countries are anemic; the Inter National Centre of Research for Women (ICRW) studies
documented high rates in India (55 percent), Nepal (42 percent), Cameroon (32 percent) and
Guatemala (48 percent). Anemia prevalence in young children continues to remain over
70% in most parts of India and Asia despite a policy being in place and a program that has
been initiated for a long time.
Anaemia is not a specific entity but an indication of an underlying pathologic process
or disease. As many as 4–5 billion people i.e., 66–80% of world’s population may be iron
deficient. More than 30% of the world’s population i.e., 2 billion people are anaemic due to
iron deficiency. In total, 800,000 (15%) of deaths are attributed to iron deficiency. WHO
lists iron deficiency (ID) as one of “Top Ten Risk Factors contributing to Death . Iron
deficiency anaemia (IDA) is more common in South Asian countries including, India,
Bangladesh and Pakistan than anywhere else in the world. By contrast, the prevalence of
IDA in neighbouring countries such as Bangladesh and Pakistan has fallen to 55%. The
reduction of IDA prevalence in China is especially remarkable i.e., the prevalence was
halved from 20% to the current level of 8% within a decade. It is very difficult to ascertain
the true incidence of IDA, as the aetiology of anaemia is multifactorial4.
Not eating enough iron can lead to anaemia, which causes tiredness and reduces the
body’s ability to fight off infection. Childhood obesity figures increase as youngsters get
older so it’s vital that to make sure healthy options are both appealing and affordable are
available to young people. The UK National Diet and Nutrition Survey, which involved
more than 2,000 adults and children, found that teenage girls diets were generally less
healthy than boys.
Boys eat an average three portions of fruit and vegetables a day
compared with 2.7 for girls5.
The Third National Health and Nutrition Examination Survey (NHANES III) found a
9 percent incidence of iron deficiency and a 2 percent incidence of anaemia among
American females between the ages 12 and 18years; the respective values were 11 and 3
percent in girls between the ages of 16 and 19 years. Less than 1 percent of adolescent
3
males had iron deficiency .Studies in other countries have found higher rates of iron
deficiency in male and female adolescents. The National Family Health Survey (NFHS-3)
conducted at India in 2007-2008, While 56 per cent of adolescent girls are anaemic, boys
too are falling prey to the disease. Around 30 per cent of adolescent boys are suffering from
anaemia.6.
Iron deficiency is the most common cause of anemia in adolescents in the United
States, and an adolescent girl is 10 times more likely to develop anemia than a boy
.Teenagers are at the highest risk of anemia during their adolescent growth spurt. Among
girls, however, menstruation increases the risk for iron deficiency anemia throughout their
adolescent and childbearing years7.
Iron deficiency anaemia is primarily due to inadequate intake of food, both in
quantity and quality. In availability of nutritional food, lack of money for purchasing food,
traditional beliefs and taboos about child’s diet and in sufficient balanced diet are resulting
in anaemia. It is the underlying and associated cause of childhood illness and death among
the pre-school age group. It makes the child susceptible to infection, and lower recovery
from illness8.
In 2008, World Health Organization global estimates of anemia prevalence averaged
56%, with a range of 35–75% depending on geographic location. Prevalence of anemia in
South Asia is among the highest in the world, mirroring overall high rates of malnutrition9.
Teenage years are an important first opportunity to be responsible for their own food
choices, so it’s worrying that so many in this age group are still not getting the nutrition
properly. Malnourished children are prone to develop continuous bouts of some illness. This
condition can be easily set right if we eat the right food in the right amount daily i.e., if the
childrens consume a balanced diet every day and develop good eating habits for good
health10.
4
NEED FOR THE STUDY
‘Sadly it’s surprising that teenage girls have a worse diet than their male counterparts
as pressure on females to stay slim seems to be starting at an increasingly young age. The
youngsters’ diets are becoming increasingly unhealthy and higher numbers are becoming
overweight. This focus on weight could be taking its toll on some of their vitamin and
mineral intake, creating a nutritional gap which could lead to its own health issues in the
future11.
Estimates suggest that over one third of the world’s population suffers from anemia,
mostly iron deficiency anemia. India continues to be one of the countries with very high
prevalence. Prevalence of anemia in India is high because of low dietary intake, poor
availability of iron and chronic blood loss due to hook worm infestation and malaria. While
anemia has well known adverse effects on physical and cognitive performance of
individuals, the true toll of iron deficiency anemia lies in the ill-effects on maternal and fetal
health12.
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 weight13.
The prevalence of iron deficiency anemia is 2 percent in adult men, 9 to 12 percent in
non-Hispanic white women, and nearly 20 percent in black and Mexican-American women.
Nine percent of patients older than 65 years with iron deficiency anemia have a
gastrointestinal cancer when evaluated. The U.S. Preventive Services Task Force currently
recommends screening for iron deficiency anemia in pregnant women but not in other
groups. Routine iron supplementation is recommended for high-risk infants six to 12 months
of age5.
The study was carried out by National Nutrition Monitoring Bureau(NNMB) in
Andhra Pradesh, Karnataka, Kerala, Madhya Pradesh, Maharashtra ,Orissa, Tamil Nadu,
5
and West Bengal. Objectives of the study to estimate haemoglobin level among preschool
children, adolescent girls, and pregnant and lactating women. A total of 75600 HHs from
633 villages were covered. 3291 preschool children, 6616 adolescent girls, 2983 pregnant
women, and 3206 lactating mothers were covered for haemoglobin estimation. The lowest
mean haemoglobin level was found among adolescence (9.9g/dl), followed by preschool
children (10.3 g/dl), lactating women (10.6 g/dl). There is an urgent need for improving the
implementation of national nutrition programmes and strengthening nutrition education14.
Iron needs are higher in adolescent girls after the onset of menstruation because of
monthly blood loss. An important risk factor for iron deficiency anemia is heavier than
normal menstrual bleeding, adolescent females often do not get enough iron to keep up with
menstrual losses. They especially do not want to talk about how heavy their periods are.
They are often very sensitive about their diet and their body image. Fewer than 2% of
adolescents eat enough of all the food groups, and almost 20% of females and 7% of males
do not eat enough of even one of the food groups. Frequent dieting or restricted eating,
skipping meals, vegetarian eating styles and others listed at left are all risk factors for
anemia in adolescents. In spite of increased iron needs, many adolescents, especially
females, do not get enough iron from their diets. About 75% teenage girls, do not meet their
dietary requirements for iron, compared to only 17% of teenaged boys.15
Iron metabolism is unusual in that it is controlled by absorption rather than
excretion. Iron is only lost through blood loss or loss of cells as they slough. Men and non
menstruating women lose about 1 mg of iron per day. Menstruating women lose from 0.6 to
2.5 percent more per day. An average 132-lb (60-kg) woman might lose an extra 10 mg of
iron per menstruation cycle, but the loss could be more than 42 mg per cycle depending on
how heavily she menstruates.7 A pregnancy takes about 700 mg of iron, and a whole blood
donation of 500 cc contains 250 mg of iron16.
Cross-sectional study done in three villages near Pune city, to determine social
dimensions related to anaemia among women of child bearing age (15-35). To examine
various socio demographic aspects related to consumption of micronutrient-rich foods like
green leafy vegetables (GLV), samples are 418 women’s. Data collected to determine
socio-economic and anthropometric (weight, height) variables, Hb, dietary pattern (FFQ)
and peripheral smear examination for classifying nutritional and iron-deficiency anaemia
(IDA). The findings highlight that low consumption of GLV, which are treasures of
6
micronutrients including iron, is associated with genuine social reasons. This indicates a
need for developing action programmes to improve nutritional knowledge and awareness
leading to enhanced consumption of iron-rich foods for preventing anaemia in rural India.
The best sources of iron include iron fortified cereals , dried beans and legumes,
clams, oysters, leafy greens, nuts and whole grains. The Government advises that everyone
tries to eat at least five portions of fruit and vegetables a day to reduce the risk of heart
attacks, stroke, diabetes and bowel cancer, one of the commonest form17.
The symptoms accompanying iron deficiency depend on how rapidly the anaemia
develops. In cases of chronic, slow blood loss, the body adapts to the increasing anaemia
and patients can often tolerate extremely low concentrations of haemoglobin. For example,
< 7.0 g/dL, with remarkably few symptoms. Most patients complain of increasing lethargy
and dyspnoea. More unusual symptoms are headaches, tinnitus and taste disturbance. Iron
deficiency anaemia is caused by defective synthesis of haemoglobin, resulting in red cells
that are smaller than normal (microcytic) and contain reduced amounts of haemoglobin
(hypochromic). Iron metabolism Iron has a pivotal role in many metabolic processes, and
the average adult contains 3–5 g of iron, of which two-thirds is in the oxygen carrying
molecule haemoglobin. A normal Western diet provides about 15 mg of iron daily, of which
5–10% is absorbed (~1 mg), principally in the duodenum and upper jejunum, where the
acidic conditions help the absorption of iron in the ferrous form. Absorption is helped by
the presence of other reducing substances, such as hydrochloric acid and ascorbic acid. The
body has the capacity to increase its iron absorption in the face of increased demand, for
example, in menstruation, pregnancy and lactation 18
From the clinical experience of the investigator at Indira Gandhi Hospital many
adolescent girls admitted the diagnosis of iron deficiency anaemia. Considering magnitude
of the problem the investigator was motivated to assess the dietary intake of iron
supplement in the form of nutritional ball among adolescence for a period of time to
improve the level of haemoglobin.
7
6.3 STATEMENT OF THE PROBLEM
A study to assess the effectiveness of nutritional ball in terms of increase in haemoglobin
level among adolescent children with iron deficiency anaemia at selected nursing colleges
Bengaluru.
6.4 OBJECTIVES
1. To screen and identify the adolescent children who are having iron deficiency anemia .
2. To evaluate the effectiveness of nutritional ball among the adolescent children with iron
deficiency anaemia in improving the level of haemoglobin.
3. To associate the level of haemoglobin in adolescent children with iron deficiency
anaemia with selected demographic variables.
6.5 OPERATIONAL DEFINITION
1. EFFECTIVENESS
It refers to determine the extent to which the nutritional ball has achieved the
desired effects in improving the level of Haemoglobin among adolescent children as elicited
by blood analysis.
2. HAEMOGLOBIN(Hb) LEVEL
It refers to the extent to which the range of Hb from less than 10 mg/dl to the
desirable changes brought by the intake of nutritional ball among adolescent children.
3. NUTRITIONAL BALL
It refers to the iron rich supplement given to the adolescent children for the duration
of 30 days that contain the proportion of whole wheat powder-40 gm, Bengal gram- 16gm,
groundnut seed-10gm, raggi-14 gm and jagerry-20 gm.
4. ADOLESCENT CHILDREN
It refers the adolescent girls who are at the age group of 17-18 studying in selected
nursing colleges at Bengaluru.
8
5. IRON DEFICIENCY ANAEMIA
It refers to the decreasing the Hemoglobin level of the adolescent girls less than
10mg /dl
due to decrease intake of dietary iron, menstruation, poor absorption of iron in
the diet or any physiological illness.
6. 6ASSUMPTION
1. Adolescent girls are prone to develop the iron deficiency anaemia due to menstruation,
insufficient iron in the diet and poor absorption of iron in the body.
2. Dietary intake of iron supplement in form of nutritional ball will improve the level of
Hemoglobin among adolescent girls.
6.7 HYPOTHESIS
H1-There will be a significant difference between the mean pre test and post test
Haemoglobin level score among adolescent girls.
H2–There will be significant association between mean pre test and post test Haemoglobin
level with the selected demographical variables.
9
6.8 REVIEW OF LITERATURE
A review of literature related research and theory on a topic has become a standard
and virtually essential activity of scientific research projects “ Review of literature is a
critical summary of research on a topic of interest, often prepared to put a research problem
in contact or as the basis for an implementation project” Review of literature was undertaken to gain depth knowledge on various aspect of the problem under this study
In this study the relavant literature reviewed has been organized and presented under
the following headings.
1. Literature related to iron requirements and iron deficiencies in adolescence
2. Literature related to Prevalence of iron deficiency anemia among adolescent girls.
3. Literature related to Reducing iron deficiency anaemia and changing dietary behaviours
among adolescent girls
1. Literature related to iron requirements and iron deficiencies in adolescence
A study conducted in two distinct socio-economic areas (SEAs) in Baghdad and to
assess the importance of diet and some other factors which could be relevant in the
epidemiology of anaemia in adolescents. A random sample of 1051 adolescents were
included in the present study, 46% of them (487 adolescents) were from Al-Mansoor area
for high socio-economic area (HSEA) and 54% of them (564 adolescents) were from
AlHorya area for low socio-economic area (LSEA) in Baghdad, Iraq. Collection of data was
carried out during the period between November 2006 until the end of April 2007.
Haemoglobin concentration and packed cell volume levels were determined. Dietary intake
of iron, calories, protein and Vitamin C were estimated. The conclusion of the study was the
prevalence of anaemia among adolescents in HSEA was 12.9% compared with 17.6% in
LSEA. Haemoglobin concentration in males was significantly correlated with age and
dietary iron intake while in females it was correlated significantly with years of education of
father and mother, number of pads and age at menarche. Anaemia among adolescents was
found to be a health problem of moderate severity19.
10
A recent study focused on the iron and zinc content in selected foods and intake
of the micronutrients iron and zinc among adolescence in Kumi District, Uganda. Over a
period of 4 weeks single 24-hour dietary recall interviews were carried out on a convenience
sample of178 adolescence (15-18years old). Data from the dietary recalls was used when
selecting foods for chemical analysis. The data on food intake collected in the 24-hour recall
interviews was used as a basis to select foods for iron and zinc analyses. Both dry foods and
fresh foods that were possible to sun-dry locally were included. This selection excluded
certain foods such as tomatoes, cucumber and cabbage because of lack of facilities for
drying or freezing the samples. Results from this study showed that the iron concentrations
varied were high in some cereals and vegetables. Data from the 24-hour dietary recall
showed that the daily Recommended Nutrient Intake (RNI) was met for iron but not for
zinc. In this study it was found that adolescence of Kumi district had a predominantly
vegetable based diet. The iron content in the selected foods was high and variable, and some
vegetables and cereal exceeded the iron concentrations in meats20.
An experimental study was done to identify the impact of iron supplementation on
anaemia during adolescent girls. Salty rice flakes preparation was prepared. Sixty
volunteered girls, who were studying in school, undergo experimental trial. Ten non
anaemic girls were included in control group. A questionnaire regarding general information
was filled up. All the subjects were showing symptoms of anaemia but signs were not same.
Majority (90 %) were showing paleness of eyes. Hb values of group B and C were more
than the control group A and were found significant in comparison with group A. Thus iron
supplementation in both forms (Tablet as well as Food) is helpful in managing anemia .The
results concluded that there is a significant difference in anaemic condition of group iron
tablet supplemented group (B) and iron Rich Food Supplemented group (C) as compared to
control group (A). More improvement in hemoglobin values of group C was also noticed in
comparison to group B but statistically the difference was found non significant. It is
recommended that both kind of supplementation of iron are helpful in managing anemia
among adolescence21.
11
2. Literature related to Prevalence of iron deficiency anemia among adolescent girls.
A cross-sectional study was conducted to determine the prevalence of iron deficiency,
iron deficiency anemia and anemia among adolescent school girls aged 14-20 years from 20
different high schools located in three educational areas of Kermanshah, the capital of
Kermanshah province in Western Iran. There were 47 girls (12.2%) with iron deficiency
anemia (Hb<12 g/dl and ferritin <20 microg/l). Around 57.3% of anemic girls were iron
deficient. There were no significant differences between the presence of anemia and the
level of education of parents. The mean levels of hemoglobin (Hb), hematocrit (Hct), mean
corpuscular volume (MCV), mean cell hemoglobin (MCH) and mean cell hemoglobin
concentration (MCHC) in studied adolescent girls from Western Iran were found to be
lower than those reported for females aged 12-18 years. In conclusion, regarding the
detrimental long-term effects and high prevalence of iron deficiency, iron deficiency anemia
and anemia in Kermanshah, Western Iran its prevention could be a high priority in the
programs of health system of the country and supplementation of a weekly iron dose is
recommended.22
A recent study was carried out among girls of school going age (6-18 years) residing
in 15 randomly selected slums of the north zone of Ahmedabad city. The general
information about age, height, body weight, haemoglobin level (Sahli's method), parent's
education, parent's occupation, socioeconomic status, knowledge about anaemia, status of
menstruation and regarding the consumption of various diets factors were recorded on a
structured questionnaire. Out of the 1295 girls, 1153(89.0%) agreed to give blood samples
for haemoglobin estimation. The prevalence of anaemia (81.8%) among the girls in this
study was higher than that observed in the urban slums of north east Delhi, which had
reported 6.6 and 48.4% prevalence of anaemia in pre-menarchal and post-menarchal girls
respectively. The present study highlights the need to develop pragmatic intervention
programmes incorporating various strategies to improve dietary intake and bioavailability of
iron; nutritional supplementation of iron and folic acid tablets and fortification of edible
dietary items with iron23.
A community-based cross-sectional study was carried out over a period of two
months to assess the nutritional status of adolescent girls in selected villages of the Kolar
district. 230 adolescent girls of age 10–19 years were selected randomly. Data
12
was
collected by interviewing the adolescent girls using predesigned and pre tested Performa.
The prevalence of wasting and stunting was 54.79% and 32.17% respectively as per water
lows classification and the trend of wasting and
stunting declines with the age. The
prevalence of thinness was found to be 73.5% as per Indian standards. Prevalence of
anaemia was 34.8% percent and it was more among menstruating girls than compared to
non-menstruating girls. It is concluded that there is a high prevalence of under nutrition
among adolescent girls in the rural area of the selected villages. Health education and
nutrition interventions are needed on priority basis24.
A cross-sectional study of the prevalence of iron deficiency anaemia in Iranian
females aged 18–25 years old from October 2005 to October 2006. 295 female students
from the Tehran University of Medical Sciences, Iran, were recruited for the study. A
detailed physical examination was conducted on all the participants. Blood samples were
obtained. Serum iron and total iron binding capacity levels were measured using a
commercially available kit . The haemoglobin (Hb) and mean corpuscular volumes (MCV)
were analysed on the cell counter. The concentration levels of serum ferritin were measured
using radio-immunoassay. The conclusion of the study is
total of 295 individuals
participated in the study, out of which 237 were included in the final analysis. Their ages
ranged from 18 to 25 years, with a mean age of 19.8 years. Among the 224 participants
who were categorised into the study groups, 118 (52.7%) had a normal iron status (Group
1), nine (4.0%) suffered from Iron Deficiency Anaemia (IDA) (Group 3) and 97 (43.3%)
had Iron Deficiency (ID) without anaemia (Group 2). There were a significant differences
in terms of the ferritin, iron and TS levels between the ID and normal groups (p < 0.00005).
Considerable differences were also found for all the indices between the ID and IDA groups
(p < 0.00005). The indices of the iron status were significantly different between the normal
and IDA groups (p < 0.00005).25
3. Literature related to Reducing iron deficiency anaemia and changing dietary
behaviours among adolescent girls
A study was conducted in the registered slums under India Population Project-VIII,
MCH, located in twin cities of Hyderabad and Secunderabad, Andhra Pradesh, India. Girls
between 10 and 19 years of age were covered in the study to assess the nutritional status and
13
nutritional knowledge of adolescent girls. From each of the 100 slums, a quota of 25
adolescent girls, a total of 2500 respondents were covered, which accounted for 63% of all
adolescent girls available in the study areas. A combination of methods, anthropometry,
biochemical analysis, dietary assessment and interview schedule was used for assessing the
nutritional status and nutritional knowledge of adolescent girls. The study was conducted in
three stages. In first stage, baseline data was collected using a specially designed pre-tested
interview schedule. In the second stage intervention was carried out for a period of 6 months
mainly through Inter Personal Communication (IPC) techniques. The tools included cooked
demonstrations, posters, information booklet, innovative games and nutritious meals. In the
third stage, repeat survey was conducted to find out the impact of intervention in terms of
improvement in knowledge scores. It was revealed iron deficiency anemia was found to be
the most common nutritional problem observed in them. After the intervention significant
proportion of girls could correctly identify the foods rich in various important nutrients. A
marked increase in the intake of finger millet or 'Ragi' was observed which is a very rich
source of calcium as well as iron. It was concluded that IEC intervention resulted in
improvement of nutritional knowledge of adolescent girls as well as behavioural pattern
envisaged by better cooking methods and increase in the consumption of nutrient rich
food26.
A recent study was carried out on 1142 adolescent girls residing in 16 slums of Pune
from 2006-2009. The main objective was to increase the number of daily meals adolescent
girls eat from 2 meals to 3-4 meals, and to encourage girls to consume iron rich foods on a
daily basis. Weekly iron and folic acid tablets were given in the first 3 months; ongoing
nutrition education through home visits and meetings was done by community health
workers, participatory activities were undertaken such as food fairs, community projects
were undertaken through life skills programme; audiovisual materials such as flash cards
and posters were developed by the adolescent participants. Blood samples were collected at
baseline and end of the study, and haemoglobin was estimated. Findings showed that
anaemia is significantly more likely among girls who eat two or fewer meals in a day, have
been sick in the past year, and consume few iron rich foods. It was also found that
intervention has influenced dietary behaviour with a significant increase in the intervention
site compared to the control site in the percentage of girls who eat more than 3 meals a day,
eat lemon with their meals, as well as in the frequency of eating fruits. Blood testing showed
that mean Hb levels increased from 5.8 to 9.5 gm/ dl for severely anaemic 3girls, and from
14
8.9 to 11.2 gm/ dl for moderately anaemic girls. It was suggested that Government’s
Anaemia Prevention and Control Programme should focus on adolescents. Participatory
nutrition education can influence adolescent girls’ anaemia status and dietary behaviour27.
A recent study was conducted in the Zone 3 of the Axom Villa Libertad barrio in
Managua, the capital of Nicaragua. This research examines the impact of a nutrition
education intervention program on the nutritional status and knowledge of Nicaraguan
adolescent girls.. Data analyzed here were collected from a sample of 186 adolescent girls
ages 10 to 17 .years at three consecutive dates, two prior to the participation in the
nutritional
education Anthropometric measurements, hemoglobin values, and data
concerning nutritional knowledge were collected from adolescent girls living in Managua,
Nicaragua. Using a pre-test/post-test design,data are compared prior to and after the
nutrition intervention program. When using Mexican American reference data, statistically
significant differences in height-for-age z-scores and weight-for-age z-scores were found
when comparing the entire sample of baseline data with data collected after three years of
the nutrition intervention program (p<0.05). Significant improvement was also found
concerning the indicators of nutritional knowledge (p<0.05. This research has implications
concerning the development of successful adolescent focused nutrition intervention
programs in Nicaragua, and examines the possibility that catch-up growth occurs during
adolescence28.
A cross-sectional study was conducted among adolescents (10–16 years) enrolled in a
single public school in São Paulo, Brazil. Of 400 eligible students, 195 agreed to participate,
but 1 was excluded due to sickle cell disease. A blood sample was collected from each
subject to measure hemoglobin and ferritin. H pylori status was investigated with the 13Curea breath test. All of the subjects with either anemia or ID were given iron therapy. H
pylori prevalence was 40.7% (79/194), being higher in male subjects .There was no relation
between infection and nutritional status. Abnormally low serum ferritin was observed in 12
subjects, half of whom were positive for H pylori (odds ratio [OR] 1.49, 95% confidence
interval [CI]. The median serum ferritin was 33.6 ng/mL (interquartile range 23.9–50.9) in
infected subjects and 35.1 ng/mL (interquartile range 23.7–53.9) in uninfected subjects.
Anemia was detected in 2% (4/194) of the students, half of whom were infected. The mean
hemoglobin value in infected subjects was 13.83 g/dL ± 1.02 versus 14 g/dL ± 1.06 in
15
uninfected subjects. The study was not able to find a relation between H pylori infection and
ID or anemia29.
A cross-sectional survey was conducted in an urban area under Urban Health Training
Centre, 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 study took place from October 2008 to March 2009 (6 months). 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. Conclusions of this study
was 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 females30.
The study was to investigate nutritional status of 10-18 years school going children.A
total of 150 school going children were selected from four different schools of Allahabad
district, India. Data on dietary intake was collected by using 3 days dietary recall method.
Heights, weights and Mid Upper Arm Circumference were measured. Haemoglobin levels
of children were estimated by cyanmethaemoglobin method. Clinical status assessing
anemia was also recorded. Consumption of all the nutrients by majority of the students was
comparatively less than the recommended dietary allowances. Data on anthropometry
revealed that out of total children screened (N=150), mean height and weight in all the age
group was significantly (p<0.05%) less than the National Center for Health Statistics
standards. Hemoglobin test revealed that 65.33% had hemoglobin level below the normal
(12 g dlG ) values, indicating anemia, out 1 of which approximately half (53.33%)
were mild anemic and 12% were
moderate anemic. It
is concluded that poor
anthropometric indices, under nutrition and iron deficiency anemia may be due to lower
intake of food and nutrients than recommended31.
A study to determine if iron fortification reduces blood lead levels in urban, leadexposed, iron-deficient children in Bangalore, India. A randomized, double-blind, controlled
school-based feeding trial was done in 10- to 18-year-old iron-deficient children (n = 186).
At baseline, a high prevalence of lead poisoning was found in the younger children.
Subsequently, all 10 to 14-year-old children participating in the trial (n = 134) were
16
followed to determine if iron fortification would affect their blood lead levels. Children
were de wormed and fed 6 days/week for 16 weeks either an iron-fortified rice meal (∼15
mg of iron per day as ferric pyrophosphate) or an identical control meal without added iron.
Feeding was directly supervised and compliance monitored. Hemoglobin, serum ferritin, Creactive protein, transferrin receptor, zinc protoporphyrin, and blood lead concentrations
were measured. The prevalence of iron deficiency was significantly reduced in the iron
group (from 70% to 28%) compared with the control group (76% to 55%). There was a
significant decrease in median blood lead concentration in the iron group compared with the
control group. The prevalence of blood lead levels ≥10 μg/dL was significantly reduced in
the iron group (from 65% to 29%) compared with the control group (68% to 55%).Our
findings suggest providing iron in a fortified food to lead-exposed children may reduce
chronic lead intoxication. Iron fortification may be an effective and sustainable strategy to
accompany environmental lead abatement32
An experimental study was conducted on iron absorption among staffs and students of
St John’s Medical college at Bangalore India. a total of 40 women aged 18–35 year were
selected as sample. Each study contained 10 IDA and 10 control subjects, All subjects were
in good health and none had a history of gastrointestinal or metabolic disorders. None of the
subjects had donated blood within 6 month of the start of the study. Subjects who regularly
consumed vitamin-mineral supplements discontinued the supplementation 2 wk before the
start of the study. The criteria for the IDA group were hemoglobin values < 11.0 g/dL,
serum ferritin (SF)concentrations < 12 µg/L, and zinc protoporphyrin concentrations > 40
µmol/mol heme or soluble transferrin receptors (TfRs) > 8.5 mg/L; criteria for the control
group were hemoglobin values > 12.0 g/dL and measures of iron status (SF, zinc
protoporphyrin, and TfRs) in the normal range. At the end of study there was a different in
the hb level between the experimental and control group33.
17
7. MATERIALS AND METHODS
7.1 source of data
Data will be collected from the students who all are having iron deficiency anaemia.
7.2 METHOD OF DATA COLLECTION
i) The Research Design
The research design selected for the study will be pre experimental one group pre test post
test design.
ii)Research Variable
Dependant Variable: In this study the dependant variable is level of Haemoglobin among
adolescent children.
Independent Variable: In this study the dependant variable is nutritional ball.
Demographic variable
The demographical variable of adolescent children such as age, religion, educational status,
food pattern and menstrual cycle and any previous information relating to the study
iii) Setting
The study will be conducted in selected nursing colleges in Bengaluru depending on the
availability of the subject and feasibility for conducting study.
iv)Population
In this study population are all the adolescent children, who are studying in the selected
nursing colleges at Bengaluru.
v) Sample size
The adolescent children who are fulfilling the inclusion criteria will be the sample. Sample
size will be 60.
18
vi. Criteria for selection of samples
Inclusion criteria
The study includes the adolescent children
1. Who all are studying in selected nursing colleges at Bengaluru.
2. Who are at the age of 17 and 18 years
3. Adolescent children whose Haemoglobin level is less than 10 mg/ dl
Exclusion criteria
The study excludes the adolescent children
1. Who are having any other blood disorders such as sickle cell anaemia, haemophilia,
and thrombocytopenia.
2. Who are not interested to participate in the study.
3. Who are not available during the time of data collection.
vii. Sampling technique
Purposive sampling method will be used to select the sample.
viii. Tool for data collection
Section A- A structured interview questionnaire will be used to assess the demographical
variable of adolescent children such as age , religion ,educational status, food pattern and
menstrual cycle and any previous information relating to the study.
Section B- Haemogram will be used to assess the level of Haemoglobin of the adolescent
children who are having iron deficiency anaemia.
Section C- Administration of nutritional ball.
ix) Method of data collection
Phase-I: To screen the adolescent children who are having iron deficiency anemia by using
blotting paper.
19
Phase-II: To identify the accurate level of Haemoglobin among adolescent girls with iron
deficiency anaemia by blood analysis.
Phase III: Nutritional ball will be given to the adolescents whose Hemoglobin level less
than 10mg/dl.
Phase IV: After a period of one month the blood analysis will be done to assess the level of
Hb.
X) Plan for data analysis
Numerical data obtained from sample will be organaised and analysed with the use of both
descriptive and inferential statistics. Master coding sheet will be prepared based on the
numerical data obtained from the sample
Descriptive statistics
1. Frequency distribution and percentage will be used to study the demographic variables.
Inferential statistics
1. Paired t- test will be used to compare pre test and post test value of the Hb among
adolescent girls.
2. Chi-square test will be used to determine the association of demographic variable
XI. Projected Outcome
The investigator is planning to assess the effectiveness of nutritional ball among
adolescent girls with iron deficiency anaemia based on the findings. Nutritional ball is
effective to reduce iron deficiency anaemia in experimental groups.
7.3 Does the study require any investigations or interventions to the patients?
Or
other human beings or animals?
Yes, with prior consent from the sample, the study will be conducted in the selected nursing
colleges .No other intervention which cause any harm will be done for the subject.
7.4 Has ethical clearance obtained from your institution?
Yes, the permission obtained from the head of institution. The permission will be obtained
from concerned authority of selected nursing college .The informed consent will be obtained
from students of nursing college. Ethical committee review report has been enclosed.
20
21
22
8. LIST OF REFERANCES
1. Assuma Beevi,(2009) “Textbook of paediatrics” 1st Ed, Elsevier, Noida,P.197
2. Elizabeth .K.E (2002) “Nutrition and child development” 2nd Ed, Para’s medical,
Hyderabad; 131-133
3. Victoria Taylor, Senior Dietician at the British Heart Foundation.
4.
Kurz K and Johnson-Welch C. The nutrition and lives of adolescents in developing
countries: Findings from the nutrition of adolescent girls research program. Washington,
DC: International Center for Research on Women (1994).
5.
T. Stopler. Medical Nutrition Therapy for Anemia. Krause’s Food and Nutrition Therapy.
Ed. By LK Mahan and S Escott-Stump. 12th edition. 2008; 810-818.
6. Alton I. Iron Deficiency Anemia. In: Stang M, Story M, eds. Guidelines for Adolescent
Nutrition Services. Minneapolis, MN: Center for Leadership, Education and Training in
Maternal and Child Nutrition, Division of Epidemiology and Community Health, School of
Public Health, University of Minnesota; 2005;101-08.
7. Food and Nutrition Board of the Institute of Medicine. Iron in: Dietary reference intakes for
vitamin A, vitamin K, arsenic, boron, chromium, copper, iodine, iron, manganese,
molybdenum, nickel, silicon, vanadium, and Zinc. National Academy Press, Washington
DC, 2000; 339.
8.
DiMeglio G. Nutrition in adolescence. Pediatr Rev. 2000 Jan;21(1):32-33.
9. Beard JL. Iron requirements in adolescent females. J Nutr 2000; 130:440S.
10. Indrani.T. K (2003), “Nursing manual of nutrition and Therapeutic diet” Jaypee, New
Delhi, P.14-16
11. Dr.Frankie Phillips, independent nutrition consultant and registered dietician
23
12. M Di Santolo, G Stel, G Banfi, et al. Anemia and iron status in young fertile nonprofessional female athletes. Eur J Appl Physiol. 2008:102(6):703-9.
13. Hallberg L, Hultén L, Lindstedt G, et al. Prevalence of iron deficiency in Swedish
adolescents. Pediatr Res 1993; 34:680.
14. Rikimara T.Yarley (1998), Risk factors for the prevalence of malnutrition among urban
children, “Journal of nutritional status” 8(31) ; 391-407
15. Frith-Terhune AL, Cogswell ME, Khan LK, Will JC, Ramakrishnan U. Iron deficiency
anemia: higher prevalence in Mexican American than in non-Hispanic white females in the
third National Health and Nutrition Examination Survey, 1988-1994. Am J Clin Nutr. 2000
Oct;72(4):963-68.
16. Halterman JS, Kaczorowski JM, Aligne CA, Auinger P, Szilagyi PG. Iron deficiency
and cognitive achievement among school-aged children and adolescents in the United
States. Pediatrics. 2001;107:1381–6.
17. Patwari A.K,Sachdev H.P.S (1998) “Frontiers in Social paediatrics” 1st Ed Jaypee,
New
Delhi; 26-29
18. Looker AC, Dallman PR, Carroll MD, Gunter EW, Johnson CL. Prevalence of iron
deficiency in the United States. JAMA. 1997 Mar 26; 277(12):973-76.
19. Al- Sharbatti ss , Ai-Ward N J. Anaemia among adolescence. Feb.2003, 24(2).189-94
20. Ida Tidemann- Anderson, Hedwig Acham. Iron and sinc content of selected foods in the diet
of adolescence in kumi district east Uganda. 2011. J Nutr,2003 (133); 1064- 1069.
21. Taru Agarwal, G. K Kochar. Impact on iron supplementation on anaemia among adolescent
girls. 2008. 2(2); 149- 151.
22. Akramipour R, Rezaei M. Prevalence of iron deficiency anemia among adolescent school
girls from Kermanshah, Western Iran. 2008 December 13 (6); 352-355.
24
23. National Institute of Nutrition, Hyderabad. (2003). Prevalence of micronutrient deficiencies.
Hyderabad : NIN. 66 p.
24. Slotzfus RJ, Dreyfuss ML. Nutrition Foundation; Mimeo. Washington, DC: USA: INCAG;
1998. Guidelines for the Iron Supplements to prevent and treat iron-deficiency anemia: A
draft document prepared for the International Nutritional Anemia Consultative Group
(INCAG), 17th Jul 1997
25. Shams S, Asheri H, Kianmehr A, The prevalence of iron deficiencyanaemia in female
medical students inTehran Singapore Med 2010; 51(2) : 116
26. Saibaba, A.etal., Indian Journal of Community Medicine, 2002, 27(4) : 151-56.
27. Institute of Health Management Pachod, Pune
28. Jose O. Mora. A study of anaemia among adolescent females in the urban area of
Nicaragua. 2007.
29. Radhakrishnan S, al Nakib B, Kalaoui M, et al. Helicobacter pylori-associated gastritis in
Kuwait: endoscopy-based study in symptomatic and asymptomatic children. J Pediatr
Gastroenterol Nutr 1993; 16:126–129
30. Sanjeeve M. Chaudhary, Vasant R. Dhage. A study of anaemia among adolescent females in
the urban area of Nagpur. 2008(33); 243-245
31. Ruchika Hanta, Faizan Ahammed. Assessment of nutritional status of 10 to 18 year school
going children of Allahabad Dist.middle east journal of scientific research 2008(3);109-115.
32. Micheal B. Zimmermann, Sumithra Muthayya, Iorn fortification reduces blood lead level in
children in banglore, Official journal of the American accadamy of paediatrics.
33. Prasanth Thankachan, Thomas Walczyk. Iron absorption in young Indian women. American
journal of clinical nutrition 2008 April. 87(4). 881-886.
25
9. Signature of the candidate
:
10. Remark of the guide
:
The study will be appropriate, feasible and
relevant to enhance the knowledge in the field
of paediatric speciality.
11. Name and designation of,
11.1. Guide
:
Mrs. Arockia Mary, Professor
HOD of Child Health Nursing
11.2. Signature
:
11.3. Head of the department:
11.4. Signature
:
11.5. Co Guide
:
11.6. Signature
:
12.1 Remarks of the principal:
12.2 Signature
Mrs. Arockia Mary, Professor
This study is relevant and appropriate to the
field of nursing and speciality chosen
:
26