KNOWLEDGE AND PREVALENCE OF ANEMIA AMONG ADOLESCENT GIRLS ...
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KNOWLEDGE AND PREVALENCE OF ANEMIA AMONG ADOLESCENT GIRLS BY USING HEMOGLOBIN COLOURING SCALE By Naveena. P A DISSERTATION SUBMITTED TO THE TAMIL NADU DR. M.G.R MEDICAL UNIVERSITY, CHENNAI, IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR DEGREE OF MASTER OF SCIENCE IN NURSING MARCH 2011
Transcript of KNOWLEDGE AND PREVALENCE OF ANEMIA AMONG ADOLESCENT GIRLS ...
KNOWLEDGE AND PREVALENCE OF ANEMIA AMONG
ADOLESCENT GIRLS BY USING HEMOGLOBIN COLOURING SCALE
By
Naveena. P
A DISSERTATION SUBMITTED TO THE TAMIL NADU DR. M.G.R MEDICAL
UNIVERSITY, CHENNAI, IN PARTIAL FULFILLMENT OF THE
REQUIREMENTS FOR DEGREE OF MASTER
OF SCIENCE IN NURSING
MARCH 2011
KNOWLEDGE AND PREVALENCE OF ANEMIA AMONG
ADOLESCENT GIRLS BY USING HEMOGLOBIN COLOURING SCALE
Approved by the dissertation committee on : _________________________
Research Guide : ________________________ Prof. S. Anigrace Kalaimathi M.Sc (N)., PGDNA., DQA., Ph.D. Principal, MIOT College of Nursing, Chennai.
Nurse Guide : ________________________ Prof. S. Kanakambujam M.Sc (N)., M.Phil., Ph.D. H.O.D, Community Health Nursing, MIOT College of Nursing, Chennai.
Medical Guide : _______________________ Dr. Baskar, M.D. General Physician (Consultant), MIOT Hospitals, Chennai.
A DISSERTATION SUBMITTED TO THE TAMIL NADU DR. M.G.R MEDICAL
UNIVERSITY, CHENNAI, IN PARTIAL FULFILLMENT OF THE
REQUIREMENTS FOR DEGREE OF MASTER
OF SCIENCE IN NURSING
MARCH 2011
DECLARATION
I hereby declare that the present dissertation entitled “KNOWLEDGE
AND PREVALENCE OF ANEMIA AMONG ADOLESCENT GIRLS BY
USING HEMOGLOBIN COLOURING SCALE” is the outcome of the original
research work undertaken and carried out by me, under the guidance of
Prof. S. Anigrace Kalaimathi M.Sc (N)., PGDNA., DQA., Ph.D. Principal and
Prof. S. Kanakambujam, M.Sc., M.Phil., Ph.D. H.O.D, Community Health
Nursing, MIOT College of Nursing, Chennai. I also declare that the material of this
has not found in any way, the basis for the award of any degree or diploma in this
university or other universities.
Ms. Naveena. P.
II year M.Sc (N).
ACKNOWLEDGEMENT
I wish to express my heartful gratitude to my God Almighty for the
abundant blessings, health and confidence throughout the dissertation.
I sincerely express my heartfelt thanks to the Managing Trustee, MIOT
College of Nursing, Chennai for providing me an opportunity to do the post
graduate in Nursing.
I owe my whole hearted gratitude and sincere thanks to Prof. S. Anigrace
Kalaimathi, M.Sc., (N),PGDNA., DQA., Ph.D. Principal and Research Guide,
MIOT College of Nursing for her valuable guidance, innovative suggestions,
constant motivation and extreme patients which enabled me to complete the
dissertation successfully.
I am privileged to express my whole gratitude and sincere thanks to
Prof. S. Kangambujam, M.Sc (N.), M.Phil, Ph.D. H.O.D., Community Health
Nursing Department, MIOT College of Nursing, Chennai for her constant
motivation timely help and valuable suggestions for completing the study.
I extend my thanks to Dr. Baskar, M.D. General Physician (Consultant)
MIOT Hospital, Chennai for his valuable suggestions and encouraging and giving
guidance for this study.
I am grateful to Prof. N. Jayasri, M.Sc (N)., M.Phil., Ph.D. Vice Principal,
MIOT College of Nursing for her valuable guidance, motivation, suggestions,
throughout the study.
My special thanks are conveyed to Prof. Dr. Amal Raj Antony, M.Sc.,
Ph.D., Professor in Bio statistics, for his help in statistical analysis.
My heartfelt gratitude to Mrs. Kavitha, M.Sc (N)., Lecturer, MIOT College
of Nursing for her guidance and support throughout the study.
I am thankful to Mrs. Padmapriya, Ms. Amudha and Ms. Sharmila – M.Sc.,
Nursing, Lecturers in Community Health Department for their unceasing
assistance and support throughout the study.
I thank our librarian Mrs. Buvaneshwari, M.L.I.S for their constant help in
reviewing the literature during the course of my work.
I express my whole hearted gratitude and sincere thanks to my parents
Mr. S. Palani and Mrs. Sworna for their constant support and motivation and I
express my heartfelt thanks to my beloved brother Mr. Sridhar who supported me
in all stages of work to complete my study.
With my deep gratitude, I acknowledge my friends and classmets for their
concern and contribution.
I thank all the participants in this study for their interest and cooperation.
I thank Ethical committee experts for giving ethical clearance for
conducting the study.
I wish to express my thanks to Fast Computers, Ms. Vijayalakshmi for her
in computer work throughout the study.
ABSTRACT
The study is to assess the knowledge and prevalence of anemia among
adolescent girls. A conceptual frame work of the study was developed on the basis
of Pender’s health promotion model. A quantitative research approach with
descriptive design was used to achieve the objectives of the study. Stratified
random sampling technique was adopted with a sample size of 120 adolescent
girls.
The findings revealed that majority of them (74.2%) were having mild to
moderate anemia and only 25.8% of them were not anemic. Among the sampled
adolescent girls 45% had moderately adequate knowledge, 26.7% of the girls had
adequate knowledge and 28.3% of the girls had inadequate knowledge regarding
anemia.
There was significant association between the level of hemoglobin value
and the level of knowledge among adolescent girls at P < 0.05. Hence the research
hypothesis, H1 was accepted. It revealed that negative correlation existed between
knowledge and hemoglobin level. The correlation was found statistically
significant at P<0.05.
The association between the knowledge on anemia and demographic
variables was highly significant between the age, education, family income and
source of information of adolescent girls at P<0.05.
There was no significant relation between the hemoglobin value and
demographic variables such as religion, father’s education, occupation of the
father, type of the family, family income, food pattern, birth order, source of
information and history of anemia of the adolescent girls at P>0.05.
The study revealed on overall (45.0%) of them had moderately adequate
knowledge regarding anemia and high prevalence rate 74.20% of anemia. Hence
an information booklet of anemia was provided to the school students by the
investigator.
TABLE OF CONTENTS
Chapter Contents Page No.
I INTRODUCTION 1-8
Need for the study
Statement of the problem
Objectives of the study
Operational Definition
Hypothesis
Assumptions
Delimitation
Projected outcome
II REVIEW OF LITERATURE 9-18
Review related to prevalence of anemia
Review related to knowledge of anemia
Conceptual Frame work
III RESEARCH METHODOLOGY 19-24
Research Approach
Research Design
Setting
Population
Sample
Sample Size
Sampling Technique
Inclusion criteria
Exclusion criteria
Data collection tool
Chapter Contents Page No.
Validity and reliability
Pilot study
Data collection procedure
Human rights protection
IV DATA ANALYSIS AND INTERPRETATION 25-45
V DISCUSSION 46-48
VI SUMMARY, CONCLUSION, LIMITATION, IMPLICATION AND RECOMMENDATIONS
49-54
REFERENCES 55-60
APPENDICES i - xxx
LIST OF TABLES
TABLE NO.
TABLES PAGE NO.
1. Describes the distribution of socio demographic among
adolescent girls.
27-28
2. Describes the distribution of menstrual history among
adolescent girls.
29
3. Describes the distribution of level of knowledge on anemia among adolescent girls.
31
4. Mean and standard deviation of overall knowledge score on anemia among adolescent girls
32
5. Describes the association between level of hemoglobin value and level of knowledge on anemia among adolescent girls.
34
6. Describes the correlation coefficient between knowledge and prevalence on anemia among adolescent girls.
35
7. Describes the association between level of knowledge on anemia and demographic variables among adolescent girls.
36-38
8. Describes the association between level of knowledge on anemia and menstrual history among adolescent girls.
39-40
9. Describes the association between level of hemoglobin value and demographic variables among adolescent girls.
41-43
10. Describes the association between level of hemoglobin and menstrual history among adolescent girls.
44-45
LIST OF FIGURES
FIGURE NO. DESCRIPTION PAGE NO.
1. Mean and standard deviation of clinical data among adolescent girls
30
2. Distribution of level of hemoglobin value among adolescent girls
33
LIST OF APPENDICES
APPENDIX DESCRIPTION PAGE NO.
A Letter seeking permission to conduct the study x
B Research participant consent form xi
C Data Collection Tool xii – xxiii
D Information Booklet xxiv - xxx
CHAPTER I
INTRODUCTION
“We must turn to nature itself to the observations of the body in health
and in disease to learn the truth” HIPPOCRATES
“Health of today’s youth is hope for tomorrow’s World”
LEWIN
According to WHO health is defined as a state of well being and not merely
an absence of disease or infirmity. Levy (1980) states the Health care and good
nutrition improves people standard of living by reducing sickness, mortality and
increase life expectancy. Health is not only an individual issue, but also a
community issue. Poor health reduces the physical and cognitive capacities of an
Individual. When people identify health problems, their health seeking process is
influenced by availability, accessibility, affordability, adequacy and acceptability
of health infrastructure.
Adolescence is a period of transition from childhood to adulthood.
Adolescence girls has been recognized as a special period in their life cycle that
requires specific and special attention. Adolescence constitute a very vital age
group being an “entrant” population for parenthood. The status of health during
the period is a major determinant of the health and nutrition of her future children.
The adolescence experiences markedly accelerated growth during 2 to 3 years
growth spurt, dramatic alteration in the adolescence body size and proportion
occur.
Health and Nutritional needs of adolescent girls are mostly ignored. The
cumulative effect of poverty, under nourishment and neglect is reflected by their
poor body size, growth and narrow pelvis as they grow into adolescence, making
child bearing a risk. Girls between 13-18 years of age show lower percentage of
iron, and with the onset of menarche become highly susceptible to anemia.
In anemia, a large number of girls from poor households are pushed into
early marriages, which are consummated almost immediately after menarche of the
4.5 million marriages that take place in India every year. Three million marriages
involves girls in the 15-19 years of age group (Glimpses of girlhood in India).
Girls bearing their first baby between the ages of 14-18 years resulting in low birth
weight babies and postnatal complications.
Adolescent girls health plays an important role in determining the health of
future population, because adolescent girls health has an intergenerational effect.
The cumulative impact of the low health situation of girls is reflected in the high
maternal mortality rate, the incidence of low birth babies, high perinatal mortality,
foetal wastage and consequent high fertility rates.
WHO (2005) had reported that iron deficiency anemia is the common
nutritional disorder in the word. Globally anemia affected 1.62 billion people
which corresponds to 24.85% of the population. However the population with the
greater number of individuals that is nearly 95% of them were non-pregnant
woman.
National nutritional anemia control programme In India implemented
through the primary health centers and sub centers. It aims at decreasing the
prevalence and incidence of anemia in woman of reproductive age.
Iron deficiency is the most prevalent micro nutrient deficiency and anemia
were associated with impaired cognitive functioning, lower school achievement
and most likely lower physical work capacity. Adolescent girls are at risk of
developing iron deficient anemia because of the increased iron requirement for
growth.
Sharadha Sidha (2005) conducted a study on prevalence of anemia among
adolescent girls of schedule caste community of Punjab. The study concluded that
only 29.43% girls were normal and 70.57% were affected with various grades of
anemia condition among them 30.57% girls were mildly anemic and 27.17%
moderately anemic and 12.83% suffered from severe anemic.
Shoba (2005) had stated that adolescent girls were particularly vulnerable
group as there requirements of iron as well as its uses from the body are high.
Anemia during adolescence limits growth and delay the onset of menarche, which
in turn may later lead to Cephalo Pelvic disproportion. Every of ten in India, girls
get married and become pregnant even before the growth period is over by making
anemic double risky.
18 point programme (2000) reported the prevalence of Anemia among
adolescent girls is 50-60%.
National family Health survey (1999) conducted a study on prevalence of
anemia among reproductive age group & reported that anemia among adolescent
age group of 15 to 19 years was 59.5%.
Need for the study
In developing country like India, anemia is the major health problem.
Anemia is defined as a reduction in red cell mass or rather a decline in the number
of red blood cells necessary for our blood to be able to carry oxygen to our tissues.
Severe anemia can result in a stroke or a heart attack.
Sanjeev M, et al. (2008) conducted a study on prevalence of anemia,
among adolescent girls. The study concluded that high prevalence of anemia
among adolescent females was found, which was higher in lower economic strata
and among those whose parents were less educated. Anemia affects to overall
nutritional status of adolescent females.
S. Kavel PR, et al. (2006) conducted a study on prevalence of anemia
among adolescent girls. It reveals that the prevalence of anemia was found to be
59.8%. In unvaried analysis, low socioeconomic status, low iron intake, vegetarian
diet, history of worm infestation and history of excessive menstrual bleeding
showed significant association with anemia. While multivariate logistic regression
analysis suggested that strongest predictor of anemia was vegetarian diet followed
by excessive menstrual bleeding, iron intake followed by history of worm
infestation. However, age, education, socio economic status, BMI and status of
menarche did not contribute significantly.
As per district level health survey (DLHS) (2002-2004) prevalence of
anemia among adolescent girls was very high (72.6%) in India, with prevalence of
severe anemia among there much higher (21.1%). In adolescent girls, educational
or economic status does not seen to make much of a difference in terms of
prevalence of anemia. Prevention, detection, or management of anemia in
adolescent girls has till now not received much attention.
Indian Scenario (2003) had reported that adolescents comprises nearly one
fifth of the total population in the country (21.8%). Female adolescents comprise
47% and male adolescents 53% of the total population. It was estimated that there
were almost 2000 million adolescents in India, and in which 56% of girls were
found to be anemic.
According to national health survey (1998) 65% to 75% adolescent girls are
anemic.
Prevalence
World wide
Anemia afflicts an estimated to one billon people world wide, mostly due to
iron deficiency. The prevalence of anemia is disproportionately high in developing
countries, due to poverty Inadequate diet, certain diseases, pregnancy and lactation
and poor access to health services.
Family health survey 2000 reveals that 12-18 years girls in rural India
found an anemic prevalence rate of 82.9% among school going girls.
District level
Indian council of Medical research conducted a Nutritional project it
reveals that, anemia is prevalent all over the world. District nutrition project
conducted in 16 district of 11 states, prevalence of anemia in adolescent girls 11-18
years showed the rate as high as 90.1% with severe anemia. Government schools in
Delhi shows anemia among adolescent girls was high as 50.8% compared to the
vast amount worked done in pregnant mother and young children.
Urban and rural areas
In urban areas the adolescent Indian girls ages between 11-18 years the
prevalence rate of anemia is 49%. Agarwal in North East Delhi, reported the
prevalence of anemia is 45%.
Today’s circumstances due to various factors, the prevalence of anemia
arises as a burning problem due to which people all going to be roped up with great
troubles to their future generations viz, cognitive impairment, high maternal
mortality rate, cardiac failure and fetal wastage.
In olden days when girls attained menarche, they were taken care with
nutritious food like raw eggs, gingely oil, green leaves and vegetables which
strengthen their body and bones. Now-a-days the impact of urbanization, the
menarche of the girl is not that much noticed. So which the girls go to the state of
anemic. It is so wondering-that, though the life style, diet everything has been
changed still the adolescent girls were suffering from anemia.
Keeping these views in mind the researcher is motivated to do the study the
knowledge and prevalence of anemia among adolescent girls. The purpose of the
study was to find out the adolescent knowledge and prevalence of anemia.
Statement of the problem
A study to assess the knowledge and prevalence of Anemia among
adolescent girls by using hemoglobin colouring scale in St. Helen’s Government
Aided School at Chennai.
Objectives of the study
• To assess the knowledge of anemia among adolescent girls.
• To assess the prevalence of anemia among adolescent girls.
• To find out the relationship between knowledge and prevalence of anemia
among adolescent girls.
• To associate the knowledge of anemia with selected demographic variables.
• To associate the prevalence of anemia with selected demographic variables.
Operational definitions
Knowledge: Adolescent girls can able to understand and answer the questions
regarding anemia.
Prevalence: The term prevalence refers to all current cases (Old and New) at a
given point in time or over a period of in a given population.
Anemia: Anemia is a condition in which the hemoglobin level lies between 8 to
4 mg mainly due to the deficiency of iron.
Adolescent Girls: Refers to the girls between the age group of 13-18 years and
those who attained the menarche.
Hemoglobin colouring Scale: It is a scale where hemoglobin level was detected
by using the special test strips that are provided with the scale.
Hypothesis
H1 = There is a significant relationship between knowledge and hemoglobin level.
Assumptions
• Adolescent girls having adequate knowledge on anemia.
• Prevalence of anemia high among adolescent girls.
• Health message will be spread from school students to community people.
• Information booklet is an effective strategy for imparting knowledge of
anemia.
De-limitation
• The study will be limited to the Government aided schools of adolescent
girls between the age group of 13-18 years.
• The study was delimited to 6 weeks.
• The sample size was delimited to 120.
Projected outcome
• The result of the study will help the health team members, to motivate the
community in the prevention of anemia and to improve the level of
Hemoglobin.
• Based on the results of the study, the investigator would be able to develop
an information booklet on anemia.
CHAPTER II
REVIEW OF LITERATURE
Review of literature is an essential component of the research process. It is
critical examination of publication related to a topic of interest. Review should be
comprehensive and evaluative. Review of literature helps to plan and conduct the
study in a systematic manual.
This Chapter deals with the review of published research studies and from
related material for the present study. The review helped the investigator to
develop an insight into the problem area. This helped the investigator in building
the foundation of the study. For the present study literature is reviewed and
organized under face broad headings.
a. Literature related to prevalence of anemia.
b. Literature related to knowledge of anemia.
(a) Literature related to prevalence of anemia
Baral KP, et al. (2009) conducted a study on “Prevalence of anemia among
adolescents in Nepal. A total sample of three hundred and eight adolescents
participated 157 females and 151 males. It reveals that the overall prevalence of
iron deficiency anemia among adolescent population in female was 78.3% and
male was 52.3% sufficiency or deficiency of iron makes the living of adolescents
different as it affects their growth requirement and cognitive performance. Iron
reserve in female results better reproductive outcome.
Sunita, et al. (2007) conducted a descriptive study to assess the prevalence
of anemia among adolescent girls in Trichy. Random sampling technique was used
and 105 schools going adolescents were selected and blood samples were taken.
Samples were collected and analyzed and a record of one-week dietary recall was
maintained. The result showed that 82% of girls were anemic based on their
dietary intake. The report was concluded that anemia is in emerging problems
among the world population, nearly 2000 million adolescent girls were suffering
from iron deficiency anemia.
Rohini, et al. (2007) conduted a study “on prevalence of anemia among
adolescent girls” in 16 slums at Pune. Data collection was done based on
biophysiological measures, dietary history, morbidity history, anthropomentric
measures, mental history, preparing of lemon consumption with meals,
consumption of locally available iron rich foods. The result showed that 10% of
the girls were severely anemic, 32% of them were mild anemic and 58% of girls
were moderately anemic (P<0.01) with the study population.
Togeja GS, et al. (2006) conducted a study on prevalence of anemia among
pregnant women and adolescent girls in 16 districts of India. The study revealed
that the overall prevalence of anemia among adolescents girls was 90.1%.
Pawashe, (2006) conducted a study on iron nutritional status of adolescent
girls belonged to an urban slum and rural areas. A study reveals that higher
percentage of the rural girls (37.5%). Therefore the prevalence was similar in both
urban and rural girls who had not attend menarche with increasing age, urban girls
who had attained menarche showed an increase in the prevalence of anemia.
Public Health Nutrition project (2005) was conducted a study on
prevalence of anemia among different population groups in Bangladesh. The study
concluded that the prevalence of anemia is 53% among adolescent girls and 49% in
pregnant women.
Gawarikar, et al. (2005) conducted a study on prevalence of anemia among
adolescent girls. The study reveals that overall prevalence of anemia among the
adolescent girls of weaker economic group was 96.5%, middle income group was
65.18% with severe anemia higher income group was 2.65%.
Basu, et al. (2005) conducted a cross-sectional study on prevalence of
anemia among adolescent girls. It was concluded that significantly higher among
adolescent girls (25.9%) as compared to boys. Anemia was observed more in rural
(25.4%) as compared to urban(14.2%) adolescent girls.
Abalkhail B, et al. (2002) conducted a study to assess the prevalence of
anemia among Government school girls. The findings reveals that anemia was
more marked among governmental school attendees and those born to low
educated mothers. Menstruating girls were at around double the risk of being
anemic than non menstruating girls. Anemia was associated with negative impact
on school performance and was more marked among those failed there exams as
compared to students with excellent results. Skipping breakfast was reported by
14.9 % of students and this habit did not differ by age, sex, body mass index or
social class. At age 12 and over low social class and menstruating girls constitute
the high risk groups.
Binay Kumar shah, et al. (2002) conducted a study on prevalence of
anemia among adolescent Nepalse girls and concluded that supervised iron and
folic acid therapy once a week was an effective attentive to daily administration
and helps to lower the prevalence of anemia in adolescent girls.
Madhavan Nair, (2001) He suggested that the prevalence of anemia in
developing countries can be reduced by the administration of prophylactic doses of
Iron & Folic acid along with antioxidant like vitamin E and C rich foods .
(b) Studies related to knowledge of anemia
Literature related to causes of anemia
Bharati P, et al. (2009) conducted a study on burden of anemia and its socio
economic determinants among adolescent girls in India. The study reveals that
enhancement of the economic status of families, especially poor families, was a
prerequisite to the amelioration of anemia among adolescent girls.
Alaof H, et al. (2009) conducted a study on the impact of socio economic
and health related factors on the iron status of adolescent girls. He concluded that
iron deficiency is related to the occupation of the mother, family size, auto
medication and menstruation.
Studies related to diagnostic measures of anemia
Julia Critchely, et al. (2005) conducted a study on Hemoglobin colour
scale may improve anemia diagnosis where there was no laboratory. But there was
a need for policy relevant diagnostic research which is pragamatic implementation
focused and assesses clinical outcomes. His sensitivity for detecting anemia was
high in most of the studies (75-95%). Sensitivity and specificity were higher for
laboratory based studies compared with more pragmatic real life studies.
Studies related to treatment of anemia
Mozaffari, et al. (2010) conducted a study on once weekly low dose iron
supplementation efficiently improved Iron status in adolescent girls. The study
concluded that once weekly supplementation of 150 mg ferrous surface for 16
weeks significantly improved Iron status in female adolescent and effectively
treated iron deficiency anemia. There is no need for higher dosage of Iron for
supplementation that may cause adverse effects and bear higher costs.
Vyas S, et al. (2010) conducted a study on leaf concentrate as an alternative
to iron & Folic acid supplements for treating anemia in adolescent girls. A total
sample of 102 adolescent girls (14-18 yrs) were selected. The study revealed that
leaf concentrate is an effective, and were palatable, alternative to iron and folic
acid supplements for treating anemia in adolescent girls.
Prakash VB, et al. (2010) conducted a study on sustainable effect of non
iron containing ayurvedic preparations sootshachal Rasa Plus sitopaladi chuena in
improving the nutritional anemia in adolescent students. The study reveals that a
daily dose of sootsheknae Rasa (250 mg) plus sitopaladi chuena (400mg) can
produce sustainable improvement of nutritional anemia in adolescent girls.
Indupalli AS, (2009) conducted a study on health status of adolescent girls
in an urban community of Gulbarga district. The study revealed that 94% had
anemia, 27.6% suffered coronary artery disease while 46% had other health
problems and 37.2% had menstrual problems. Anemia appeared to be a great
public health problem, which could be addressed though distribution and intake of
IFA, tablets either in schools or at home had once.
Kotecha, et al. (2009) conducted a study on anemia control programme in
India among adolescent girls. The study reveals that surprised once a week IFA
supplementation to adolescent girls through Institutions specially, schools was
found to be an effective Intervention to reduce anemia and was scalable with the
system.
Vir Sc, et al. (2008) conducted a study, on weekly iron and folic acid
supplementation with counseling reduces anemia in adolescents girls. The study
revealed that weekly iron – folic and supplementation combined with monthly
education was reduced the prevalence of anemia among adolescent girls.
Appropriate counseling, irrespective of supervision, as critical for achieving
positive outcomes.
Goudari A, et al. (2008) conducted a study to evaluate the effect of iron
deficiency on intelligence of 11-17 years students. The study revealed that Iron
deficiency anemia was significantly higher in girls as compared with boys.
Murry, et al. (2007) conducted a study on Iron treatment and cognitive
functioning in young women. The study reveals that Iron status was significant
factor in cognitive performance in women of reproductive age. Severity of Iron
deficiency affects accuracy of cognitive function over a broad range of tasks.
Literature related to effect of nutrition on hemoglobin level
Yegammai C, (2004) conducted a study to assess the impact of iron
supplementation an anemic adolescent girls at corporation high school in
Coimbatore. One hundred girls in age group of 13 to 15 years were selected and
the selected girls were divided into four groups (A, B, C, D) for supplementation.
Among them group C were fed with 92 gms of sirukeeri poriyal per day. The result
showed that significant increment of hemoglobin in group C.
Yadav and Sehagal, (2000) had conducted a study with amaranth and
spinach to find out the iron availability by a nutritional supplement preparation.
The ratio of amaranth, spinach, jiggery and bengal gram in the supplement as
2:2:3:2. They also tested its iron availability after blanching and cooking. The
results revealed an increase in the hemoglobin, serum ferritin levels and there was
significant reduction in the oxalic acid and phytic acid contents.
Syubhada and Shervani, (2000) had conducted a study to reveal the
improvement of consuming Vitamin – C foods to improve the hemoglobin Vitamin
C rich Guava, citrus fruits and lemon juice. At the end of nine months
interventional trail there was a very significant rise in hemoglobin levels of the
study participants.
CONCEPTUAL FRAME WORK
This chapter deals with conceptual framework adopted for this study. A
conceptual framework is comprised of interrelated concepts that natural
Phenomena.
As the investigator aimed at assessing the prevalence of anemia among
adolescent girls to improve their reproductive health the Pender’s health promotion
model was found suitable.
The Pender’s health promotion model helps to assess the health status of
individual and seeks to increase and individual well being. The model focuses on
cognitive (perceptual) factor, modifying factor and likelihood of participation in
health promoting behavior.
Cognitive Perceptual Factors
In this study cognitive perceptual factors refers to be adolescent girls
knowledge on various aspects of anemia such as definition, causes, habits, risk
factors, signs and symptoms, diagnosis, treatment and prevention.
Modifying Factors
In this study modifying factors refers to students age, sex, standard, parents
education, occupation, income, information gained through multiple sources and
history of anemia in the family.
Likelihood of Action
The knowledge of anemia and modifying factors are directly related to the
health promotion activity. The investigator assess the knowledge and estimate the
hemoglobin level by using hemoglobin colouring scale, monitoring the height,
weight and provide informal teaching to improve the hemoglobin level. The
likelihood of participation of adolescent girls in this health promotion behavior as a
positive effects leads to improvements in hemoglobin level and ultimately safe
motherhood. Unlikely to participate in health promotion behavior leads to unsafe
motherhood. So I reinforce to improve their safe motherhood.
CONCEPTUAL FRAME WORK BASED ON PENDERS HEALTH PROMOTION MODEL
CHAPTER III
RESEARCH METHODOLOGY
This chapter describes the methodology to assess the knowledge and
prevalence of anemia among adolescent girls by using hemoglobin colouring scale
in selected St. Helen’s Government Aided school, Chennai. It consist of research
approach, research design, settings, population, sample, sample size, sampling
techniques and sample selection criteria.
It also deals with the development of data collection tool, blue print of the
tool, validity and reliability, pilot study, procedure for data collection and human
rights protection.
Research Approach
Quantitative Research approach was used in this study.
Research design
Descriptive design was adopted for the study.
Setting of the study
The study was conducted in St. Helen’s Government Aided Higher
Secondary School at Chennai. Totally 600 students are studying in the school. In
each class there are 3 sections and each section contains 40 students. The classes
are 8th, 9th, 10th, 11th & 12th Std., Students.
Population
The study population comprised of adolescent girls between the age group
of 13 to 18 years studying in St. Helen’s Government Aided Higher Secondary
School at Chennai.
Sample
The sample consisted of adolescent girls who were studying in St. Helen’s
Government Aided Higher Secondary School at Chennai.
Sample size
The sample was 120 adolescent girls (13-18 years).
Sampling technique
A probability stratified random sampling technique was adopted to select
the samples in the study.
Inclusion criteria
The study included the adolescent girls who were:
• aged between 13-18 years who attained menarche.
• who are willing to participate in the study.
• who knows Tamil and English language.
• available during the data collection procedure.
Exclusion criteria
Adolescent girls who were
• absent during the study period.
• under the treatment of anemia.
• not willing to participate.
Data collection tool
• A structured interview, schedule was developed on the basis of review of
literature, discussions with experts and from personal experience of the
investigator.
• The structured interview schedule designed for the study consist of two
sections.
• For the convenience of the data collection procedure, the tool was
translated to Tamil language.
Description of the tool
Section 1: It consist of socio-demographic variables of adolescent girls which
include the age, religion, standard, occupation of the father, type of
the family, family income, food pattern, birth order, source of
information and history of anemia in the family.
Section 2: (i) It consists of bio-physical data of adolescent girls which includes
height, weight and hemoglobin level.
(ii) It includes the menstrual history of adolescent girls.
Section 3: Knowledge questionnaire consist of meaning of anemia, causes,
clinical features, treatment and prevention of anemia.
Criteria for scoring
Section A : No Scoring.
Section B : The knowledge questionnaire consisted of twenty six
questions totally each question had only one correct response which carry one
mark and incorrect response no score. The total scoring for overall knowledge was
twenty six.
To interpret the level of knowledge of anemia the scores were converted to
percentage and were classified as follows:
Adequate : If the score obtained lies between 76% to 100%
Moderately adequate : If the score obtained lies between 51% to 75%.
Inadequate : If the score obtained false below 50% and 50%.
To interpret the prevalence of anemia among adolescent girls the hemoglobin level
was distributed as:
Above 14 gram % : Healthy
About 12 gram % : No anemia
Between 8-11 gram % : Mild anemia to moderate anemia
Between 6-7 gram % : Marked anemia
Below 4-5 gram % : Severe anemia
Less than 4 gram % : Critical
BLUE PRINT OF THE TOOL
S.No. Contents Items Total
1. Definition and Meaning 1, 2, 3, 4 4
2. Causes 5, 6, 7 3
3. Patho Physiology 8, 9 2
4. Signs and Symptoms 10, 11, 12 3
5. Diagnostic evaluation 13, 14 2
6. Medical Management 15, 16, 17 3
7. Dietary Management 18, 19, 20, 21, 22 5
8. Prevention 23, 24, 25, 26 4
Validity and Reliability
The tool was sent to experts in the field of nursing and medicine for
approving the validity and modifications were made according to the suggestions.
Spilt of method was used for testing the reliability of knowledge questionnaire by
using brown prophecy formula r value = 0.86.
Pilot study
The pilot study was conducted for one week after getting approval from
ethical committee and permission from the principal of St. Hussain’s Government
aided school at Chennai. Before preceding the study, participant consent was
obtained. All information about samples was kept confidential. Probability
stratified random sampling technique was adopted and 12 samples were selected
Data collection procedure
Written permission was obtained from the Principal, St. Helen’s
Government Aided School at Chennai to conduct the study. The purpose of the
study was explained to every respondent to get their full co-operation and consent.
The data was collected 6 weeks. Initially the hemoglobin level was assessed
followed by height and weight. Knowledge questionnaire was given to all the
selected participants and data were collected. About 30 minutes timings was given
to fill up the demographic and knowledge questionnaires.
Human Rights Protection
The pilot and main study were conducted only after approval of the
research proposal by the college of Nursing and the institutional ethical committee.
Permission was obtained from the Principal of the school prior to the
commencement of the study.
CHAPTER IV
ANALYSIS AND INTERPRETATION
This chapter describes the analysis of the numerical data collected by the
study instruments and their meaning and relevance. Statistics is a field of study
concerned with techniques or methods of collection of data, classification,
summarizing, interpretation, drawing inferences, testing of hypothesis, making
recommendation, etc.,
The data was collected from 120 adolescent girls and analyzed according to
objectives and hypothesis of the study. This chapter deals with analysis and
interpretation includes both descriptive and inferential statistics the findings of the
study were organized and presented under the following headings.
Section I : Describes the distribution of socio demographic among
adolescent girls.
Describes the distribution of menstrual history among
adolescent girls.
Descriptive statistics (mean and standard deviation) of clinical
data among adolescent girls.
Section II : Describes the distribution of level of knowledge on anemia
among adolescent girls.
Descriptive statistics (mean and standard deviation) of overall
knowledge score on Anemia among adolescent girls.
Section III : Describes the distribution of level of hemoglobin value among
adolescent girls.
Section IV : Describes the association between level of hemoglobin value
and level of knowledge on anemia among adolescent girls.
Section V : Describes the correlation coefficient between knowledge and
hemoglobin value on anemia among adolescent girls.
Section VI : Describes the association between level of knowledge on
anemia and demographic variables among adolescent girls.
Describes the association between level of knowledge on
anemia and menstrual history among adolescent girls.
Section VII: Describes the association between level of hemoglobin value
and demographic variables among adolescent girls.
Describes the association between level of hemoglobin and
menstrual history among adolescent girls.
SECTION – I
This section deals with the description of sample characteristics according to the
basic variables, menstrual history and clinical data Table 1: distribution of demographic variables among adolescent girls
Demographic Variables Frequency Percentage
1. Age
a) 12 - 13 yrs
b) 14 – 15 yrs
c) 16 - 17 yrs
d) 18 yrs
24
35
40
21
20.0
29.2
33.3
17.5
2. Religion
a) Hindu
b) Muslim
c) Christian
92
6
22
76.7
5.0
18.3
3. Education
a) 8th Standard
b) 9th Standard
c) 10th Standard
d) 11th Standard
e) 12th Standard
24
24
24
24
24
20.0
20.0
20.0
20.0
20.0
4. Father’s Education
a) Illiterate
b) Primary School
c) Hr. Sec. School
d) Graduate
19
54
43
4
15.8
45.0
35.8
3.3
5. Occupation of Father
a) Business
b) Coolie
c) Self Employment
d) Govt. Employee
28
60
21
11
23.3
50.0
17.5
9.2
6. Type of Family
a) Nuclear Family
b) Joint Family
c) Extended family
98
21
1
81.7
17.5
0.8
7. Family Income
a) Rs. 1000-3000
b) Rs. 3001-5000
c) Rs. 5001-7000
d) Rs. 7001-10000
65
36
10
9
54.2
30.0
8.3
7.5
8. Food Pattern
a) Vegetarian
b) Non Vegetarian
29
91
24.2
75.8
9. Birth Order
a) First Child
b) Second Child
c) Third Child
d) Fourth Child
49
52
14
5
40.8
43.3
11.7
4.2
10. Source of Information
a) Television
b) Radio
59
2
49.2
1.7
c) Newspaper
d) Family Member
8
51
6.7
42.5
11. History of Anemia in the Family
a) Yes
b) No
18
102
15.0 %
85.0 %
Table 1 reveals that majority of them (81.7%) were belonging to nuclear
family. 17.5% of them belonged to joint family and only 1% of them belonged to
extended family.
Table 2: Distribution of menstrual history among adolescent girls
Menstrual History Frequency Percentage
1. Age at Menarche
a) 9 - 10 yrs
b) 11 – 12 yrs
c) 13 – 15 yrs
d) 16 - 17 yrs
2
37
79
2
1.7
30.8
65.8
1.7
2. Discomfort during Menstruation
a) Stress
b) Lower Abdomen Pain
c) Stomach Pain
d) Lack of Interest
6
49
46
19
5.0
40.8
38.3
15.8
3. Duration of Menstrual Cycle
a) Every 28 days
b) Every 30 days
c) Before 28 days
d) More than 30 days
43
52
11
14
35.8
43.3
9.2
11.7
4. Days of Menstrual
a) 3 days
b) 4 days
c) 5 days
d) Above 5 days
29
19
44
28
24.2
15.8
36.7
23.3
5. Grade of Menstrual Flow
a) Scanty
b) Normal
9
75
7.5
62.5
c) Excessive
d) Not known
25
11
20.8
9.2
6. Additional Iron Foods
a) Yes
b) No
55
65
45.8
54.2
Table 2 shows that majority of them (65.8%) were attained menarche at the
age of 13-15 years, 30.8% of the adolescent girls attained menarche at the age of
11-12 years and only 1% of the girls were attained at the age of 9-10 years and
16-17 years.
Fig. 1 : Mean and standard deviation of clinical data among adolescent girls
The data presented in the above Figure 1 shows that mean height of the
adolescent girls was M = 152.18, SD = 7.22. The mean weight of the adolescent
girls was M = 44.93, SD = 14.28. The mean and standard deviation of hemoglobin
level of the adolescent girls was M = 10.63, SD = 1.27.
SECTION - II
This section deals knowledge of anemia, mean and standard deviation of overall
knowledge of anemia among adolescent girls
Table 3: Distribution of level of knowledge on anemia among adolescent girls
Inadequate Knowledge
Moderately Adequate
Knowledge
Adequate Knowledge Knowledge Aspects
No. % No. % No. %
Definition 33 27.5 40 33.3 47 39.2
Cause 33 27.8 36 30.0 51 42.5
Patho Physiology 61 50.8 0 0.0 59 49.2
Sings & Symptoms 34 28.3 47 39.2 39 32.5
Diagnosis Evaluation 87 72.5 0 0.0 33 27.5
Management 62 51.7 40 33.3 18 15.0
Dietary Management 46 38.3 35 29.2 39 32.5
Prevention 66 55.0 28 23.3 26 21.7
Overall Knowledge 34 28.3 54 45.0 32 26.7
Table 3 reveals that 45% of the girls had moderately adequate knowledge,
26.2% of the girls had adequate knowledge and 28.3% of the girls had inadequate
knowledge regarding anemia.
Table 4 : Mean and standard deviation of overall knowledge score on anemia
among adolescent girls
Knowledge Aspects Mean Standard
Deviation
Definition 75.83 24.24
Cause 70.00 30.68
Patho Physiology 63.75 39.94
Sings & Symptoms 65.00 3.41
Diagnosis Evaluation 52.92 35.08
Management 46.94 33.33
Dietary Management 58.83 23.95
Prevention 60.62 28.00
Overall Knowledge 62.27 17.62
The table 4 shows that overall means score for knowledge is 62.27 and the
standard deviation 17.62
SECTION - III
This section deals with the distribution of Hemoglobin value among adolescent girls
Fig 2 : Distribution of level of hemoglobin value among adolescent girls
The data presented in Figure 2 shows that 74.2% are having mild to
moderate anemia and only 25.8% of them are not anemic .
SECTION – IV
Table 5: Association between level of hemoglobin value and level of knowledge
on anemia among adolescent girls
Inadequate Knowledge
Moderately Adequate
Knowledge
Adequate Knowledge
Level of HB value
No. % No. % No. %
Mild Anemia to
Moderate Anemia (8-11)
21 23.6 40 44.9 28 31.5
No Anemia (12- 14)
13 41.9 14 45.2 4 12.9
Chi- Square value and P
value χ 2 = 5.699, d.f = 6, P < 0.05 (Significant)
Table 5 shows that there was a significant association between the level of
hemoglobin value and the level of knowledge among adolescent girls at P < 0.05.
SECTION - V
Table 6: Correlation coefficient between knowledge and hemoglobin level on
anemia among adolescent girls
r - value p - value
r = -0.181 p < 0.05 (Significant)
Table 6 indicates a negative correlation existed between knowledge and
hemoglobin level. The correlation was found statistically significant at P<0.05.
Hence the research hypothesis H1 was accepted. It shows that constant motivation
is required to the school students in preventing anemia.
SECTION - VI
Table 7: Association between level of knowledge on anemia and demographic
variables among adolescent girls
Inadequate Knowledge
(0 - 50%)
Moderately Knowledge
(51-75%)
Adequate Knowledge
(75-100%) Demographic Variables
No. % No. % No. %
Chi Square value & P
value
1. Age
a) 12 - 13 yrs
b) 14 – 15 yrs
c) 16 - 17 yrs
d) 18 yrs
12
13
8
1
50.0
37.1
20.0
4.8
12
18
24
0
50.0
51.4
60.0
0.0
0
4
8
20
0.0
11.4
20.0
95.2
χ 2 = 69.081,
d.f = 6
P<0.01
2. Religion
a) Hindu
b) Muslim
c) Christian
26
2
6
28.3
33.3
27.3
43
3
8
46.7
50.0
36.4
23
1
8
25.0
16.7
36.4
χ 2 = 1.618,
d.f = 4
P=0.806 (N.S)
3. Education
a) 8th Standard
b) 9th Standard
c) 10th standard
d) 11thstandard
e) 12th Standard
12
12
9
0
1
50.0
50.0
37.0
0.0
4.2
12
11
13
18
0
50.0
45.8
54.2
75.0
0.0
0
1
2
6
23
0.0
4.2
8.3
25.0
95.8
χ 2 = 93.659,
d.f = 8
P<0.01
4. Father’s
Education
a) Illiterate
b)Primary School
c) Hr. Sec. School
d) Graduate
6
13
15
0
31.6
24.1
34.9
0.0
10
23
20
1
52.6
42.6
46.5
25.0
3
18
8
3
15.8
33.3
18.6
75.0
χ 2 = 9.189,
d.f = 6
P=0.163 (N.S)
5. Occupation of
Father
a) Business
b) Coolie
c) Self Employment
d)Govt. Employee
8
18
5
3
28.6
30.0
23.8
27.3
13
29
7
5
46.4
48.3
33.3
45.5
7
13
9
3
25.0
21.7
42.9
27.3
χ 2 = 3.669,
d.f = 6
P=0.721 (N.S)
6. Type of Family
a) Nuclear Family
b) Joint Family
c) Extended family
27
7
0
27.6
33.3
0.0
45
8
1
45.9
38.1
100.0
26
6
0
26.5
28.6
0.0
χ 2 = 1.699,
d.f = 4
P=0.791 (N.S)
7. Family Income
a) Rs. 1000-3000
b) Rs. 3001-5000
c) Rs. 5001-7000
d) Rs. 7001-10000
21
10
2
1
32.3
27.8
20.0
11.1
35
10
4
5
53.8
27.8
40.0
55.6
9
16
4
3
13.8
44.4
40.0
33.3
χ 2 = 14.425,
d.f = 6
P<0.01
8. Food Pattern
a)Vegetarian
b)Non Vegetarian
10
24
34.5
26.4
13
41
44.8
45.1
6
26
20.7
28.6
χ 2 = 1.022,
d.f = 2
P= 0.600 (N.S)
9. Birth Order
a) First Child
b) Second Child
c) Third Child
d) Fourth Child
9
21
4
0
18.4
40.0
28.6
0.0
22
23
6
3
44.9
44.2
42.9
60.0
18
8
4
2
36.7
15.4
28.6
40.0
χ 2 = 10.768,
d.f = 6
P=0.096 (N.S)
10. Source of
Information
a) Television
b) Radio
c) Newspaper
d)Family Member
17
2
6
9
28.8
100.0
75.0
17.6
27
0
1
26
45.8
0.0
12.5
51.0
15
0
1
16
25.4
0.0
12.5
31.4
χ 2 = 16.619,
d.f =62
P<0.01
11. History of
Anemia
a) Yes
b) No
8
26
44.4
25.5
9
45
50.0
44.1
1
31
5.6
30.4
χ 2 = 5.597,
d.f = 2
P=0.061 (N.S)
Table 7 reveals that there was significant association between the age,
education, Family Income and Source of information of adolescent girls at P<0.05
level. There is no significant association between the level of knowledge such as
Religion, Father's education, occupation of father, Type of family, food Pattern,
birth order and history of anemia of the adolescent girls at p > 0.05.
Table 8: Association between level of knowledge on anemia and menstrual history among adolescent girls
Inadequate
Knowledge
(0 - 50%)
Moderately
Knowledge
(51-75%)
Adequate
Knowledge
(75-100%) Menstrual History
No. % No. % No. %
Chi Square
value & P
value
1. Age at
Menarche
a) 9 - 10 yrs
b) 11 – 12 yrs
c) 13 – 15 yrs
c) 16 - 17 yrs
1
11
22
0
50.0
29.7
27.8
0.0
1
21
30
2
50.0
56.8
38.0
100.0
0
5
27
0
0.0
13.5
34.2
0.0
χ 2 = 9.427,
d.f = 6
P=0.151 (N.S)
2. Discomfort
a) Stress
b) Lower Abdomen Pain
c) Stomach Pain
d) Lack of Interest
2
14
12
6
33.3
28.6
26.1
31.6
1
19
25
9
16.7
38.8
54.3
47.4
3
16
9
4
50.0
32.7
19.6
21.1
χ 2 = 5.594,
d.f = 6
P=0.470 (N.S)
3. Duration
a) Every 28 days
b) Every 30 days
c) Before 28 days
d) More than 30 days
6
21
3
4
14.0
40.0
27.3
28.6
22
19
6
7
51.2
36.5
54.5
50.0
15
12
2
3
34.9
23.1
18.2
21.4
χ 2 = 9.080,
d.f = 6
P=0.169 (N.S)
4. Days of Menstrual
a) 3 days
b) 4 days
c) 5 days
d) Above 5 days
10
4
10
10
34.5
21.1
22.7
35.7
11
8
22
13
37.9
42.1
50.0
46.4
8
7
12
5
27.6
36.8
27.3
17.9
χ 2 = 3.951,
d.f = 6
P=0.683 (N.S)
5. Grade of Menstrual
Flow
a) Scanty
b) Normal
c) Excessive
d) Not known
1
18
11
4
11.1
24.0
44.0
36.4
5
32
10
7
55.6
42.7
40.0
63.6
3
25
4
0
33.3
33.3
16.0
0.0
χ 2 = 10.557,
d.f = 6
P=0.103 (N.S)
6. Additional Iron
Foods
a) Yes
b) No
15
19
27.3
29.2
24
30
43.6
46.2
16
16
29.1
24.6
χ 2 = 0.306,
d.f = 2
P=0.858 (N.S)
Table 8 reveals that there was no significant association between level of
knowledge and menstrual history such as age at menarche, discomfort, duration
days of menstrual cycle, grade of menstrual flow and additional iron foods.
SECTION – VII
Table 9: Association between level of Hemoglobin value and demographic
variables among adolescent girls
Mild to Moderate
Anemic (8 - 11)
No Anemic
(12-14) Demographic Variables
No. % No. %
Chi Square value
& P value
1. Age
a) 12 - 13 yrs
b) 14 – 15 yrs
c) 16 - 17 yrs
d) 18 yrs
13
25
32
19
54.2
71.4
80.0
90.5
11
10
8
2
45.8
28.6
20.0
9.5
χ 2 = 8.773,
d.f = 3
P<0.01
2. Religion
a) Hindu
b) Muslim
c) Christian
65
6
18
70.7
100.0
81.8
27
0
4
29.3
0.0
18.2
χ 2 = 3.355,
d.f = 2
P=0.187 (N.S)
3. Education
a) 8th Standard
b) 9th Standard
c) 10th Standard
d) 11th Standard
e) 12th Standard
12
18
14
23
22
50.0
75.0
58.3
95.8
91.7
12
6
10
1
2
50.0
25.0
41.7
4.2
8.3
χ 2 = 20.181,
d.f = 4
P<0.01
4. Father’s Education
a) Illiterate
b) Primary School
c) Hr. Sec. School
d) Graduate
14
40
33
2
73.7
74.1
76.7
50.0
5
14
10
2
26.3
25.9
23.3
50.0
χ 2 = 1.371,
d.f = 3
P=0.712 (N.S)
5. Occupation of Father
a) Business
b) Coolie
c) Self Employment
d) Govt. Employee
22
42
16
9
78.6
70.0
76.2
81.8
6
18
5
2
21.4
30.0
23.8
18.2
χ 2 = 1.208,
d.f = 3
P=0.751 (N.S)
6. Type of Family
a) Nuclear Family
b) Joint Family
c) Extended family
71
17
1
72.4
81.0
100.0
27
4
0
27.6
19.0
0.0
χ 2 = 1.004,
d.f = 2
P=0.605 (N.S)
7. Family Income
a) Rs. 1000-3000
b) Rs. 3001-5000
c) Rs. 5001-7000
d) Rs. 7001-10000
46
30
7
6
70.8
83.3
70.0
66.7
19
6
3
3
29.2
16.7
30.0
33.3
χ 2 = 2.325,
d.f = 3
P= 0.508 (N.S)
8. Food Pattern
a) Vegetarian
b) Non Vegetarian
20
69
69.0
75.8
9
22
31.0
24.2
χ 2 = 0.540,
d.f = 1
P= 0.462 (N.S)
9. Birth Order
a) First Child
b) Second Child
c) Third Child
d) Fourth Child
39
36
10
4
79.6
69.2
71.4
80.0
10
16
4
1
20.4
30.8
28.6
20.0
χ 2 = 1.558,
d.f = 3
P=0.669 (N.S)
10. Source of
Information
a) Television
b) Radio
c) Newspaper
d) Family Member
42
2
6
39
71.2
100.0
75.0
76.5
17
0
2
12
28.8
0.0
25.0
23.5
χ 2 = 1.114,
d.f =3
P= 0.774 (N.S)
11. History of Anemia
a) Yes
b) No
13
76
72.2
74.5
5
26
27.8
25.5
χ 2 = 0.042,
d.f = 1
P=0.838 (N.S)
Table 9 reveals that there was no significant relationship between
hemoglobin value and demographic variables as Religion, Father's Education,
Occupation of the Father, Type of the Family, Family Income, Food Pattern, Birth
Order, Source of Information and History of Anemia of the adolescent girls at
P>0.05 level. There is highly significant association between age and education of
the adolescent girls at P<0.05 level.
Table 10: Association between level of hemoglobin and menstrual history
among adolescent girls
Mild to Moderate
Anemic (8 - 11)
No Anemic
(12-14) Menstrual History
No. % No. %
Chi Square value &
P value
1. Age at Menarche
a) 9 - 10 yrs
b) 11 – 12 yrs
c) 13 – 15 yrs
c) 16 - 17 yrs
2
26
60
1
100.0
70.3
75.9
50.0
0
11
19
1
0.0
29.7
24.1
50.0
χ 2 = 1.730,
d.f = 3
P=0.630 (N.S)
2. Discomfort
a) Stress
b) Lower Abdomen Pain
c) Stomach Pain
d) Lack of Interest
6
35
33
15
100.0
71.4
71.7
78.9
0
14
13
4
0.0
28.6
28.3
21.1
χ 2 = 2.650,
d.f = 3
P=0.449 (N.S)
3. Duration
a) Every 28 days
b) Every 30 days
c) Before 28 days
d) More than 30 days
31
38
10
10
72.1
73.1
90.9
71.4
12
14
1
4
27.9
26.9
9.1
28.6
χ 2 = 1.793,
d.f = 3
P=0.616 (N.S)
4. Days of Menstrual
a) 3 days
b) 4 days
c) 5 days
d) Above 5 days
21
15
31
22
72.4
78.9
70.5
78.6
8
4
13
6
27.6
21.1
29.5
21.4
χ 2 = 0.873,
d.f = 3
P=0.832 (N.S)
5. Grade of Menstrual
Flow
a) Scanty
b) Normal
c) Excessive
d) Not known
7
58
16
8
77.8
77.3
64.0
72.7
2
17
9
3
22.2
22.7
36.0
27.3
χ 2 = 1.814,
d.f = 3
P=0.612 (N.S)
6. Additional Iron Foods
a) Yes
b) No
40
49
72.7
75.4
15
16
27.3
24.6
χ 2 = 0.110,
d.f = 1
P=0.740 (N.S)
Table 10 reveals that there was no significant association between the level
of Hemoglobin and menstrual history such as age at menarche, discomfort,
duration, days of menstrual cycle and grade of menstrual flow and additional iron
foods.
CHAPTER V
DISCUSSION
A study was conducted to assess the knowledge and prevalence of anemia
among adolescent girls by using hemoglobin colouring in St. Helen’s Government
aided school at Chennai. The samples were selected by stratified Random sampling
techniques and their level of knowledge was assessed by structured questionnaire.
The result of the study have been discussed based on the objectives stated for the
study.
The findings of the demographic variables shows that majority of the
adolescent girls (81.7%) belonged to nuclear family, 17.5% of the girls belonged to
Joint family and only 0.8% of the girls belonged to extended family. Regarding
history of anemia in the family 85.0% of them had no family history and only
15.0% of them had family history. The study found that majority of the adolescent
girls had attained menarche at the age of 13-15 years.
The first objective was to assess the knowledge of anemia among
adolescent girls.
As per table 3 (45%) of the adolescent girls had moderately adequate
knowledge, 26.7% of the girls had adequate knowledge and 28.3% of the girls had
inadequate knowledge regarding anemia.
The Second objective was to assess the prevalence of anemia among
adolescent girls.
As per figure 2 reveals that most of the adolescent girls had 74.2% mild to
moderate anemia, remaining 25.8% of the girls were not anemic.
The finding of the study is consistent with other studies like Gawarikar R.S,
et al. (2002) had conducted a school based survey to find out prevalence of anemia
in adolescent girls of Ujjain city, MP. The study revealed that the mean
hemoglobin was found to be 9.80 gldl. The prevalence of mild, moderate and
severe anemia among adolescent girls was 42.9%, 42.48% and 11% respectively.
This shows that majority of the adolescent girls are anemic. So constant care and
motivation should be given during adolescent period for better reproductive health.
The third objective was to find out the relationship between knowledge
and prevalence of anemia among adolescent girls.
The study revealed that negative correlation r = -0.181 existed between
knowledge and hemoglobin value among adolescent girls. The correlation was
found statistically significant at P<0.05 level. Hence the research hypothesis H1
was accepted. Though 45% of them had moderately adequate knowledge,
prevalence of anemia was high, it might be due to factors like attaining menarche,
not consuming adequately nutritious foods and worm infestations.
The fourth objective was to associate the knowledge of anemia with
selected demographic variables.
As per table 7 reveals that there was significant association of knowledge
with socio demographic variables like age x2 = 69.081 of P< 0.05 level, education
x2 = 93.659 of P < 0.05, family income x2 = 14.425 of P<0.05 source of
information x2 = 16.619 of P<0.05 level and not significant association of
knowledge with religion x2 = 1.618 of P>0.05, occupation of father x2 = 3.669 of
P>0.05, Father education x2 = 9.189 of P>0.05, type of family x2 = 1.699 of
P>0.05, food pattern x2 = 1.022 of P<0.05, birth order x2 = 10.768 of P>0.05 and
history of anemia x2 = 5.597 of P>0.05 level. This shows that as age and education
goes up, knowledge regarding anemia increases.
The fifth objective was to associate the prevalence of anemia with
selected demographic variables.
As per table 10 reveals that there was significant association between age
x2 = 8.773 of P<0.001 education x2 = 20.181 of P<0.01 of the adolescent girls, not
significant association between hemoglobin level of adolescent in religion
x2 = 3.355 of P>0.05, Fathers education x2 = 1.371 of P>0.05, type of familyx2 =
1.004, P>0.05. family income x2 = 2.325 of P>0.05, food pattern x2 = 0.540 of
P>0.05, Birth order x2 = 1.558 of P>0.05, source of information x2 = 1.114 of
P>0.05, and history of anemia x2 = 0.042 of P>0.05. It reveals that prevalence of
anemia increases with increasing age and education.
The study findings are inconsistent with other study findings of
Emel Guer et al. (2005) stated the overall prevalence of anemia was found to be
27.6% there was no significant relation between the prevalence of anemia and the
students age, gender, parents, educational level and family income.
CHAPTER VI
SUMMARY, CONCLUSION, LIMITATIONS, IMPLICATIONS AND
RECOMMENDATION
Summary
The focus of the study was to assess the knowledge and prevalence of
anemia among adolescent girls in St. Helen’s Government Aided School at
Chennai.
Objectives of the study
• To assess the knowledge of anemia among adolescent girls.
• To assess the prevalence of anemia among adolescent girls.
• To find out the relationship between knowledge and prevalence of anemia
among adolescent girls.
• To associate the knowledge of anemia with selected demographic variables.
• To associate the prevalence of anemia with selected demographic variables.
Assumptions
• Adolescent girls having adequate knowledge on anemia.
• Prevalence of anemia high among adolescent girls.
• Health message will be spread from school students to community people.
• Information booklet is an effective strategy for imparting knowledge of
anemia.
Hypothesis
H1 = There is a significant relationship between knowledge and hemoglobin level.
Conceptual frame work
The conceptual framework was based on the Pender’s health promotion
model.
Research Design
Description design was adopted for the study.
The Major findings of the study
The findings revealed that majority of them 74.2% were having mild to
moderate anemia and only 25.8% of them are not anemic. The overall percentage
of knowledge 45% of anemia among adolescent girls had moderately adequate
knowledge, 26.7% of the girls had adequate knowledge and 28.3% of the girls had
inadequate knowledge.
There was highly significant association between the level of hemoglobin
value and the level of knowledge among adolescent girls at P < 0.05. Hence the
research hypothesis H1 was accepted. It revealed that negative correlation existed
between knowledge and hemoglobin level. The correlation was found statistically
significant at P<0.05.
The association between the knowledge on anemia and demographic
variables was highly significant between the age, education, family income and
source of information of adolescent girls at P<0.05.
There was no significant relation between the HB value and demographic
variables such as religion, father’s education, occupation of the father, type of the
family, family income, food pattern, birth order, source of information and history
of anemia of the adolescent girls at P>0.05.
Conclusion
The study concluded that majority 74.02% of them are having mild to
moderate anemia and only 25.8% of them are not anemic. Regarding knowledge of
anemia 45% of them had moderately adequate knowledge, 26.7% had adequate
knowledge, 28.3% had inadequate knowledge. So constant motivation and
education is required for the adolescent school girls for preventing anemia and
thereby improving the reproductive health.
Limitations
• The study was limited to adolescent girls between the age group of 13-18
years.
• The study was limited to a smaller Number of samples, so generalization of
the results was not possible.
• The study was limited to 6 weeks.
Nursing implications
The investigator had drawn the following implications from the study
which is vital concern for nursing services, nursing education, nursing
administration and nursing research.
Nursing practice
The community nurse place a vital role in educating, motivating, school
children for preventing anemia. Repeated education or emphasis on the importance
of intake of iron rich sources and other preventive sources should be stressed. The
nurse should train the teachers to identify the anemia among adolescent girls by the
clinical signs and to act as a liaison between the adolescent girls and the Health
Care agency.
The nurse should create awareness among the teachers and the adolescent
girls regarding the programmes available to prevent and could non deficiency and
other such as National Anemia control programme. The result of the study will
help the nurses to enlighten there knowledge on importance of giving health
education information booklet.
Nursing Education
The nursing students will be able to understand the Importance of anemia
among adolescent girls. It helps the students to understand that the students to
understand the anemia is the commonest one among adolescent girls which may
lead to public health problems like MMR. It helps them to know that simple
measures like diet, hygiene and healthy practices can drastically make a change in
the indicators of the health followed promptly by the people. Educators can
encourage the nurse to bring about innovative and creative ideas pertaining to the
effective management of anemia.
Nursing Administration
Nursing administrators can formulate policies which will include all
nursing staff to be actively involved in health education programmes. The school
health nurse administrator should initiate to carryout periodic survey on prevalence
of anemia (HB estimation) among the adolescent girls to take corrective or
preventive measures by deworming and supplying iron and folic acid tablets and
insisting to take iron rich foods.
They should involve in distributing the health education materials like flash
cards, pamphlets, leaflets, etc., The study can create awareness regarding anemia
and the importance of health education to prevent and control through from
information booklets.
Nursing Research
The Instinct of research is to buildup a body of knowledge in Nursing as an
evolving profession. The result of the study can be developed on insight into the
adolescent girls to improve the level of hemoglobin to prevent further
complications.
Recommendations
A similar study can be conducted for a larger group of sample, there by
finding can be generalized.
A true experimental study can be conducted with the teaching module on
anemia.
A similar study can be conducted among women.
A comparative study can be conducted among rural and urban school girls.
A comparative study can be conducted among Government schools and
private schools.
A comparative study can be conduct among adolescent boys and girls.
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APPENDIX-A
APPENDIX-B
RESEARCH PARTICIPANT CONSENT FORM
Dear Participant,
I am a M.Sc., (Nursing) student at MIOT College of Nursing, Chennai.
As a part of my studies a research on “A study to assess the knowledge and
prevalence of anemia among adolescent girls by using hemoglobin colouring scale
in selected Government Aided School at Chennai. The findings of the study will be
helpful for further prevention of anemia.
I hereby seek your consent and cooperation to participate in the study.
Please be frank and honest in your response. The information collected will be kept
confidently and anonymity will be maintained.
(Signature of the Investigator)
I, ____________________________________________, hereby consent to
participate and undergo the study.
Place :
Date : (Signature of the Participant)
APPENDIX - C
RESEARCH TOOLS
Code No: 1 S.No.
Section – I Structured Questionnaire to collect demographic data:
Kindly tick ( ) the appropriate answers for each question
Demographic Variables
1. Name of the Student :
2. Age of the Student
a) 12-13 years b) 14-15 years c) 16-17 years (d) 18 Years
3. Religion
a) Hindu b) Muslim c) Christian d) others
4. Standard
a) 8th Standard b) 9th Standard c) 10th Standard
d) 11th Standard (e) 12th Standard
5. Education of the Father
a) Illiterate b) Primary School c) Higher Secondary
School
d) Graduate
6. Occupation of the Family
a) Business b) Coolie c) Self Employment d) Govt.
Employee
7. Type of Family
a) Nuclear Family b) Joint Family c) Extended family
8. Family Income
a) 1000-3000 b) 3001-5000 c) 5001-7000 d) 7001-10000
9. Food Pattern
a) Vegetarian b) Non Vegetarian 10. Birth Order
a) First Child b) Second Child c) Third Child d) Fourth Child
11. Source of Information
a) Television b) Radio c) Newspaper d) Family Members
12. History of anemia in the family
a) Yes b) No
CLINICAL VARIABLE PROFORMA
Clinical Data :
Purpose :
This proforma is used to measure the Clinical Variables such as
haemoglobin level, height, weight and menstrual History.
Instruction :
Please tick the appropriate option.
Please be frank in answering the following questions except question
number 1, 2, 3 which will be filled by the investigator.
13. Weight in kg :
14. Height in kg :
15. Hemoglobin level :
MENSTRUAL HISTORY
16. Age at menarche in years
a)9-10 years b) 11-12 years c) 13-15 years d) 16-17 years
17. Are you having any discomfort during menstruation
a) stress b) Lower abdomen pain
c) stomach pain d) lack of interest
18. What is the duration of your menstrual cycle_________
a) every 28 days b) every 30 days
c) before 28 days d) more than 30 days
19. How many days your menstrual period last every month
a) 3 days b) 4 days c) 5days d) above 5 days
20. Grade your menstrual flow every month
a)Scanty b) Normal c) Excessive d) Not known
21. Do you have the habit of taking additional iron rich foods or
supplements during menstruation?
(a) Yes (b) No
KNOWLEDGE QUESTIONNAIRE
Definition:
1) Anemia is
a) Hematological disorder b) Metabolic disorder
c) Endorine disorder d) Neurological disorder
2) Oxygen is carried to all body tissues by
a) Hemoglobin b) WBC c) Platelets d) Bodyfluids
3) Which are the Normal Constituents of blood
a) Blood corpuscles b) Vitamins
c) Proteins d) all of the above
4) The normal Hemoglobin value for adolescent girls is
a) 14% b) 10-12gm% c) 14gm% d) 10-11 gm %
Causes
5) The Primary cause for anemia in adolescent girl is
a) Heavy Menstrual flow b) Heavy work c) Anorexia (d) vomiting
6) Among the Communicable disease anemia is caused by
a) Malaria b) Filaria c) Typhoid d) Measles
7) Which worm Infestations leads to anemia.
a) Pinworm Infestation b) Tapeworm Infestation c) Hook worm
Infestation d) Round worm Infestation
Patho Physiology
8) In the Human body Iron is stored in _________ Organ
a) Intestine b) Heart c) Liver d) Pancreas
9) The life span of red Blood cell is____________
a) 120days b) 100days c) 80 days d) 110 days
Sings & Symptoms
10) What is the common symptom of anemia
a) Fatigue b) Fever c) Vomiting d) sweating
11) The eyes of the anemic girl looks …………..
a) Yellow b) Red c) Pale d) Swollen
12) The symptom of severe anemia is ………….
a) Palpitation b) Polyuria c) Back Pain d) Fever
Diagnostic Evaluation
13) What are diagnostic measures for anemia
a) Hemoglobin test b) Sputum test (c) Blood Test (d) Urine Test
14) Hemoglobin Screening should be done …………..
a) Every 6 months b) Every 1year
c) Every 2 years d) every month
Management
15) The daily requirement of Iron for adolescent girls is
a) 20-30 mg b) 40 – 60mg c) 70-80 mg d) 90 – 100mg
16) The recommended dose of elemental Iron tablet for
adolescent girls is
a) 300mg b) 100mg c) 200mg d) 400mg
17) The treatment for Severe anemia is …………
a) Exercise b) Iron Tablets
c) Iron Injection d) Iron containing foods
DIETARY MANAGEMENT
18) Which vegetable is rich in folic acid
a) lady’s finger b) Brinjal c) carrot d)potato
19) Richest source of iron in non vegetarian foods is
a) Egg b) Liver c) Intestine d) bone
20) Richest source of iron in sweets are
a) Sugar b) jaggery c) jam d) juices
21) Richest sources of iron in leaves is
a) Agathi b) drumstick leaves c) amaranth d) mint leaves
22) The side effects of oral intake of iron is
a) Abdominal pain b) Constipation c) chest pain d) Insomnia
PREVENTION
23) The important way of preventing anemia is ___________
a) Intake of iron rich foods b) Fluid therapy c) Immunization d) Exercise
24) How foods to be cooked
a) Cut vegetable in small pieces b) Cut vegetable in big pieces
c) Avoid over cooking d) All of the above
25) The beverage which inhibits the absorption of iron is _________
a) Tea b) Lemon Juice c) Orange Juice d) Butter milk
26) The factors which influence of iron absorptions is
a) vitamin C b) vitamin A c) vitamin D d) vitamin K
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APPENDIX - D
INFORMATION BOOKLET OF ANEMIA
DEFINITION:
Anemia is defined as a reduction in the number of redblood cells that is
hemoglobin level below 11 gm/dl. Hemoglobin level between 5-10 gm / dl suggest
moderate anemia and less than 5 gm/dl indicates severe anemia.
CAUSES:
• Inadequate production of red blood cells.
• Increased destruction of red blood cells.
• Excessive loss of red blood cells through hemoglobin.
• Less intake of iron rich foods.
• Communicable disease like hookworm.
• Congenital anemia.
• Excessive blood loss.
TYPES OF CLASSIFICATION:
• Iron deficiency anemia
• Nutritional anemia
• Hemoglobin anemia
• Folic acid deficiency anemia
• Vitamin B12 anemia.
FACTORS INFLUENCING IRON ABSECPTION:
• Vitamin C
• Gastric Acidity
INHIBITOR:
• Tea
• Coffee
• Alkalinity
• Increased gas to intestinal mobility
• Oxalic acid
• Excess phosphates, less amount of phytates.
CLINICAL FEATURES:
• Pallor of the skin
• Dyspnea
• Tachycardia
• Weak
• Fatigue
• Less Immunity
• Odema
• Retarded Growth
• Irritablity
• Dizziness
• Decreased attentions
• Apathy with depression.
DIAGNOSTIC FINDINGS:
• Hemoglobin test
• CBC Count
• Iron binding capacity.
MEDICAL MANAGEMENT:
This specific treatment consist in replacing the iron deficiency in which
iron may be administered orally or parentally.
ORAL THERPY:
The dose of elemental iron is 3-6 g per kg in divided dose. The most
economic and most easily available one is simple ferrous sulphate, containing 20%
iron and available as 200 mg tablets, oral iron caused gastric irritation if given in
excess dose.
SIDE EFFECTS:
The side effects of iron include nausea vomiting, diarrhea, constipation,
abdominal cramps, straining of teeth and tongue, discolourization of tools.
For optimal absorption iron should be administered in between meals.
Concurrent administration of vitamin C enhances its absorption. The total duration
of treatment where is from 3 to 6 months. Therapy must continue in the same dose
for another 6 months. Hemoglobin rise following oral therapy is account 0.4 g / dl
per day.
PARENTAL THERAPY:
If oral medication is not feasible because of intolerance or presence of
diarrheal disease the parental therapy is advisable.
Daily dose of intramuscular injection should not exceed 5mg / kg.
Blood transfusion should be reserved for the life threatening situation when
anemia is very severe and has associated symptoms warranting a rapid rise in
hemoglobin level. The transmission must be given slowly to prevent cardiac
complication.
PREVENTIVE MEASURES:
Iron rich foods includes Green vegetables, leafs, dolls should be taken
along with food.
Using of slippers while going to bathroom to avoid any hookworm
infestations.
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