RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BENGALURU, KARNATAKA

A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON KNOWLEDGE OF STUDENTS REGARDING IRON DEFICIENCY ANAEMIA IN SELECTED PRE UNIVERSITY COLLEGE, TUMKUR.

PROFORMA FOR REGISTRATION OF SUBJECT FOR

DISSERTATION

JINSON JOSE

IST YEAR M.Sc NURSING

MEDICAL SURGICAL NURSING

2011-2012

BHARATHI COLLEGE OF NURSING

4TH CROSS, K. R. EXTENSION

TUMKUR

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

PROFORMA FOR THE REGISTRATION OF

SUBJECT FOR DISSERTATION

1 / NAME OF CANDIDATE AND ADDRESS / MR.JINSON JOSE
I YEAR M Sc NURSING
BHARATHI COLLEGE OF
NURSING,
4TH CROSS, K R EXTENSION
TUMKUR
2 / NAME OF THE INSTITUTION / BHARATHI COLLEGE OF NURSING
3 / COURSE STUDY AND
SUBJECT / I YEAR M.SC. NURSING
MEDICAL SURGICAL NURSING
4 / DATE OF ADMISSION TO COURSE / 4 - 7 - 11
5 / TITLE OF THE TOPIC / “A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON KNOWLEDGE OF STUDENTS REGARDING IRON DEFICIENCY ANEAMIA IN SELECTED PRE UNIVERSITY COLLEGE, TUMKUR”.

1

6. BRIEF RESUME OF THE INTENDED WORK

INTRODUCTION

Iron deficiency anaemia is a global public health problem. Iron is a necessary mineral for body function and good health. Every red blood cell in the body contains iron in itshemoglobin, the pigment that carries oxygen to the tissues from the lungs. But a lack of iron in the blood can lead to iron-deficiency anemia, which is a very common nutritional deficiency in children.1

Adolescence is a significant period of human growth and maturation. Due to rapid accretion of new tissue and other widespread developmental changes, nutritional needs are also more during this period of life cycle. (WHO) Many adolescents make poor nutritional habits and lifestyle choices that put them at risk of health problems.1

Many people are not consuming a sufficiently diverse diet, as a result, the estimation of food and agriculture organisation show that 250 million children’s are at the risk of iron deficiency and 1.5 million people are at risk for iodine deficiency.2

The diagnostic criteria for anaemia in IDA vary (Hb <10–11.5 g/dl for women and <12.5–13.8 g/dl for men) between studies. The lower limit of the normal range of haemoglobin concentration for the laboratory performing the test should therefore probably be used to define anaemia. It is not known at what level of haemoglobin investigations should be initiated. However, there is no a prior reason why mild anaemia should be less indicative of important disease than severe anaemia.3

Iron deficiency anaemia (IDA) occurs in 2–5% of adult men and post-menopausal women in the developed world and is a common cause of referral to a gastroenterology clinic.While menstrual blood loss is the commonest cause of IDA in pre-menopausal women, blood loss from the gastrointestinal (GI) tract is the commonest cause in adult men and post-menopausal women.Asymptomatic colonic and gastric

carcinoma may present with IDA and exclusion of these conditions is of prime concern. Malabsorption (most frequently from coeliac disease), poor dietary intake, previous gastrectomy, and NSAID use are not unusual but there are many other possible causes. The management of IDA is often suboptimal with most patients being incompletely investigated if at all. 4

Estimates suggest that over one third of the world’s population suffers from anaemia, mostly iron deficiency anaemia.Indiacontinues to be one of the countries with very high prevalence. National Family Health Survey (NFHS-3) reveals the prevalence of anaemia to be 70-80% in children, 70% in pregnant women and 24% in adult men. Prevalence of anaemia inIndiais high because of low dietary intake, poor availability of iron and chronic blood loss due to hook worm infestation and malaria. While anaemia h as well known adverse effects on physical and cognitive performance of individuals, the true toll of iron deficiency anaemia lies in the ill-effects on maternal and foetal health. Poor nutritional status and anaemia in pregnancy have consequences that extend over generations. During infancy and adolescence, the body demands more iron. Kids are at higher risk for IDA through these periods of rapid growth because they may not be getting enough iron in their diet to make up for the increased needs. Iron-deficiency anemia (IDA), often caused by insufficient iron intake, is the major cause of anemia in childhood.5

Iron deficiency anaemia is a global problem, with global population of 6,700 million at least 3,600 million have iron deficiency and out of these 2,000 million suffering from iron deficiency anaemia. Adolescence is a crucial phase of growth in the life cycle of an individual. Due to rapid requirement and 65-70%adolescence girls in India are estimated to be anaemic .anaemia not only affect the present health status but also has deleterious effect in the future. (Health initiatives, 2005).6

6.1 NEED FOR THE STUDY:

Iron-deficiency anaemia is a common anaemia that occurs when iron loss (often from intestinal bleeding or menses) occurs, and/or the dietary intake or absorption ofironis insufficient. In iron deficiency, haemoglobin, which contains iron, cannot be formed.7

Iron deficiency anaemia is the most common nutritional deficiency worldwide .it can cause reduced work capacity in adults and impact motor and mental development in children and adolescents. There is some evidence that iron deficiency without anaemia effects cognition in adolescent’s girls and causes fatigue in adult women .IDA may affect visual and auditory functioning and is weakly associated with poor cognitive development in children.8

Men and no menstruating women lose about 1 mg of iron per day .menstruating women lose from 0.6 to 2.5 % more per day. An average 132 lb (60kg) women might lose an extra 10 mg of iron per menstruation cycle, but the loss could be more than 42 mg 1 cycle depending on how heavily she menstruates .a pregnancy takes about 700 mg of iron and a whole blood donation of 500 cc contains 250mg of iron.8

A recent study showed a significant decline in the number of newborns weighing less than 5lbs 8oz (2.5kg) when the mothers used routine prenatal vitamins with iron to all pregnant women, which are the current standard of care in the United States.8

Iron deficiency is the most common single cause of anaemia worldwide, accounting for about half of all anaemia cases. It is more common in women than men. Estimates of iron deficiency worldwide range vary widely, but the number almost certainly exceeds one billion persons globally.9

Worldwide, the most important cause of iron-deficiency anaemia is parasitic infection caused byhookworms,whipworms, androundworms, in which intestinal bleeding caused by the worms may lead to undetected blood loss in the stool. These are especially important problems in growing children.9

Iron-deficiencyanaemiais one result of advanced-stageiron deficiency, which is even more common. When the body has sufficient iron to meet its needs (functional iron), the remainder is stored for later use, mostly in thebone marrow,liver, andspleen(although all cells store some iron) as part of a finely tuned system ofhuman iron metabolism. The store of iron present in all animal cells is deposited mostly inferritincomplexes. In humans each of these are made up of 24 subunit protein molecules of two different types, with each ferritin complex carrying about 4500 iron atoms, asferrousions.10

In adults, 60% of patients with iron-deficiency anaemia have underlying gastrointestinal disorders leading to chronic blood loss, and this percentage increases with patient age. Iron deficiency in adult men from purely dietary causes is quite rare, and in such cases other causes of iron loss must be vigorously sought until found.11

Recent research suggests the replacement dose of iron, at least in the elderly with iron deficiency, may be as little as 15mg per day of elemental iron. An experiment done in a group of 130 anaemia patients showed a 98% increase in iron count when using an iron supplement with an average of 100mg of iron. Women who develop iron deficiency anaemia in mid-pregnancy can be effectively treated with low doses of iron (20–40mg per day). The lower dose is effective and produces fewer gastrointestinal complaints. There is evidence that the body adapts to oral iron supplementation, so that iron is often effectively started at a comparatively low dose, then slowly increased.11

Some studies have found that iron supplementation can lead to an increase ininfectious diseasemorbidity in areas where bacterial infections are common. For example, children receiving iron-enriched foods have demonstrated an increased rate

indiarrhoeaoverall and enteropathogen shedding. Iron deficiency protects against infection by creating an unfavourable environment for bacterial growth. Overall, it is sometimes difficult to decide whether iron supplementation will be beneficial or harmful to an individual in an environment that is prone to many infectious diseases; however this is a different question than the question of supplementation in individuals who are already ill with a bacterial infection.11

Prevalence--Iron deficiency is the most common cause of anaemia worldwide . The WHO estimates that 66% to 80% of the world's population (4 to 5 billion people) may be iron deficient and that 25% (1.6 billion people) may have iron deficiency anaemia . In the US, the prevalence of Iron Deficiency Anaemia according to the National Center for Health Statistics is 3.4 million people . Other estimates suggest that

Iron Deficiency Anaemia in the US occurs in <1% in men, 2% in children 1-2 years of age, 3% in women 12-49 years of age, and 1-3% in females ≥50 years of age .12

6.2 REVIEW OF LITERATURE

Review of literature is a key step in research process. This refers to the activities involved in sear1ching for information on a topic and developing a comprehensive picture of the state of knowledge on that topic. The written literature review provides a background for understanding what has already been learned on a topic and illuminates the significance of the new study.13

Review of literature is a critical summary of research on a topic of interest generally prepared to put a research problem in context or to identify gaps and weakness in prior studies so as to justify a new investigation.13

The review of literature for the present study has been organized under the following headings.

A. Studies related to incidence and prevalence of IRON

DEFICIENCY ANEAMIA

b. Studies related to causes and risk factors of IRON DEFICIENCY

ANAEMIA

C. Studies related to Management of IRON DEFICIENCY ANAEMIA

D. Studies related to importance of prevention of IRON DEFICIENCY ANAEMIA

A.STUDIES RELATED TO INCIDENCE AND PREVALENCE OF IRON DEFICIENCY ANAEMIA

A study conducted to describe the distribution of total body iron and the prevalence of iron deficiency (ID) on the basis of total body iron in 1999–2006 for 1171in US pregnant women. The study found thatID prevalence in US pregnant women, which was defined as total body iron <0 mg/kg, was 18.0 ± 1.4%. Pregnant women in the first trimester had a higher mean total body iron than did pregnant women in the second or third trimesters. The study concluded thatour knowledge, these are the

first data on total body iron distributions for a representative sample of US pregnant women. Low total body iron is more prevalent in pregnant women in the second or third trimesters, in Mexican American pregnant women, in non-Hispanic black pregnant women, and in women with parity ≥2.14

A new index to determine body iron promises a simpler approach to monitoring iron deficiency (ID) prevalence. We used measures of iron status and inflammation from 486 children aged 1-2 y, 848 children aged 3-5 y, and 3742 non pregnant females aged 12-49 y from the National Health and Nutrition Examination Survey 2003-2006.The result shows that ID prevalence’s based on the body iron model in children and in females were 14.4 +/- 1.9%, 3.7 +/- 0.8%, 9.3 +/- 1.0%, and 9.2 +/- 1.6%, respectively. ID prevalence’s based on the ferritin model in children and females were 4.5 +/- 0.9%, 15.6 +/- 1.2%, and 15.7 +/- 0.8%, respectively. The kappa statistics for agreement between the 2 models were 0.5-0.7. The study concluded that the agreement between the 2 indexes was fair to good. Among females, the body iron model produced lower estimates of ID prevalence, better predicted anaemia, and appeared to be less affected by inflammation than the ferritin model.15

A cross-sectional study was conducted to determine the prevalence of iron deficiency, iron deficiency anaemia and anaemia 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. The prevalence of anaemia (Hb<12 mg/dl) among adolescent school girls was 21.4%. There were no significant differences between the presence of anaemia and the level of education of parents. In conclusion, regarding the detrimental long-term effects and high prevalence of iron deficiency, iron deficiency anaemia and anaemia 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.16

A study conducted to determine which factors influenced GPs to investigate the anaemia. A cohort of patients presenting to their general practitioners (GPs) with IDA was identified and clinical outcomes recorded. The findings of the study suggest

that43% of patients had investigations within three months and serious pathology was found in 30% of these; 13% of patients were considered unfit for further investigation and 8% refused to have any. During the entire study period gastrointestinal cancer was diagnosed in 48 patients (11%); 17% of men had colorectal cancer. Of 263 patients alive

at 12 months without a confirmed diagnosis, 113 (43%) had recurrent or persistent anaemia during the study period. They concluded that although the overall prevalence of gastrointestinal cancer in patients presenting to primary care is similar to that seen in secondary care, the diagnosis may be delayed due to lack of appropriate investigations resulting in significant morbidity.17

A study conducted to evaluate the prevalence of anaemia, iron deficiency and IDA before and after the campaign. In addition, knowledge about IDA and its prevention, as well as awareness about fortified wheat flour, was assessed. The subjects of the study were women aged 15-49 years and children aged 2-14 years. The study was carried out in urban and rural areas of Kyzyl-Orda region in 2003 before (March) and after (December) the campaign. The surveys found that most women knew about IDA and its prevention and that the numbers were similar both in March and in December. The knowledge of the anti-anaemic effect of wheat fortified flour improved significantly over the period of the campaign among women both in urban and rural areas. The study concluded that the communication campaign before implementation of WFF program was effectively carried out, giving a biological impact on haematological indices.18