“A STUDY TO ASSESS THE EFFECTIVENESS OF PLANNED TEACHING PROGRAMME ON PREVENTION OF IRON DEFICIENCY ANEMIA
AMONG ADOLESCENT GIRLS IN SELECTED PU COLLEGE AT
TUMKUR”.
PROFORMA FOR REGISTRATION OF SUBJECTS FOR
DISSERTATION
Mr.Ravi Choudary
COMMUNITY HEALTH NURSING
Akshaya College of Nursing,
Tumkur, Karnataka.
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA
PROFORMA FOR REGISTRATION OF SUBJECTS FOR
DISSERTATION
1. Name of the Candidate: Mr.Ravi Choudary
And address M.Sc Nursing, 1st Year
Akshaya College of Nursing,
Tumkur, Karnataka.
2. Name of the Institution: Akshaya College of Nursing
3. Course of Study: M.Sc. Nursing 1st year,
And Subject COMMUNITY HEALTH NURSING
4. Date of Admission to:13/06/2011
Course
5. Title of the Topic:“A study to assess the effectiveness of planned teaching programme on prevention of iron deficiency anemia among adolescent girls in selected PU College at Tumkur”.
6.Introduction
"Pleasant words are as honey comb, Sweet soul and health to bone"
Anemia develops when there are not enough healthy Red blood cell in the body. This condition can be detected when there is below normal level of Hb in blood. Hemoglobin contain iron & protein in the red blood cells that carried oxygen from the lungs to all the parts of body. As a result body does not get enough oxygen rich blood and leads to anemia.1
Adolescent has been defined by the World Health Organization as period of life spanning the ages between 10-19 years. This is the formation period of life, When maximum amount of Physical and Psychological and behavioral changes take place. This is vulnerable period in life cycle for the development of nutritional anemia, which has been constantly neglected by public health programme. Girls are more likely to the victim due to the various reason person's added burden of menstrual blood loss, hormonal abnormal, precipitate the crisis for often.2
Iron deficiency anemia to be described in about 1500 B.C. in the egyptionebers pabyrus. It was termed green sickness in Medieval Europe. Iron, Salt were used for treatment in France by mid - 17th century. Thomas syndronham recommended Iron salt as treatment anemia, but treatment with Iron was controversial until 20th when its mechanism of action was more fully elicited.3
Nutritional anemia is prevalent all over the world, with on estimated 1 billion people being iron deficient in 16 districts of 11 states are prevalence of anemia in non pregnant adolescent girls (11-18 years) showed rates high as 90.1% with severe anemia (hb > 7gm/d) in 7.11% anemia among adolescent girls was high as 50.8% comparing to other age groups.4
Iron deficiency is prevalent nutritional deficiency and the most common cause of anemia in Unted Staes (USA), Iron deficiency characterized by defect in hemoglobin synthesis, resulting in the blood cells that are abnormally small and contain a decreased amount of hemoglobin2. The capacity of blood to deliver oxygen to body cells and tissues is thus reduced and lead to anemia.5
Iron is an essential nutrient, playing a central role in Oxygen transport and cellular energy metabolism, importance of ensuring adequate biovailable dietary iron stems from the severe consequences associated with deficiency (1) and anemia including reduced immune functions and resistance to infection, development delay irreversible cognitive deficit in young children's impaired physical work performance.6
Adolescence is a state of growing up from puberty to maturity. Adolescent account for 1/5 of world's population and in India thy account for 22.80% of total population.
The nutritional requirement of adolescent are included primarily by normal event of puberty and spurt of growth. Puberty is an anabolic period with increase in height and weight, alteration in body composition resulting from increased lean body mass and change in quantity and distribution of fat and enlargement of many organ systems. Adolescent are particularly securable to iron deficiency anemia in the view of increased need for dietary iron for hemoglobin and myglobin synthesis during the rapid period of growth when blood volume and muscle mass are increasing. Iron deficiency is not life threatening but it can have detrimental effect on work capacity, learning ability, and resistance to disease.7
6.1.Need for Study
Iron deficiency is the most common cause of anemia and blood loss is the most cause of Iron deficiency in adults. Iron deficiency usually indicates bleeding in digestive tract, menstrual bleeding is the most common cause or iron deficiency. Iron deficiency may result from little iron in the diet, Iron deficiency usually develops slowly. Because it may take several months for bodies iron reserved to be used up. As the iron reserve are decreasing, the bone marrow gradually produces fewer Red blood cells.
When the reserves are depleted the Red blood cells are not only fewer in the numbers but also abnormally small. Iron deficiency anemia results from low or depleted stores of iron, which is needed to produce blood cells.
- Excessive bleeding is the most common cause.
- People may be weak & have short of breath.
- Blood test can detect low level of Iron.
- Iron supplement are used to restore Iron level.8
India has highest prevalence of Iron deficiency anemia among women in the world, including 60-70% of India's girls are anemic (hemoglobin <12 gms/dl). Anemia among adolescent girls can result in adverse out comes and reduced work productivity and impaired physical capabilities. Adolescent, as a period of growth in development is considered the best time to intervene, to assist in physical and mental development, and to prevent later maternal anemia despite the magnitude of problems, no strategies are exist in the Indian Public Health Programme to tackle iron deficiency in adolescent girls.9
Iron deficiency is one of most prevalent intention deficiency in the world, affecting in estimated 2 billion people (Stoltzfus - Dreytuss, 1998).Young women are most commonly and severly affected because of the high iron demand of growth. However diet are based mostly on staple food with little meal intake, Iron deficiency may occurs throughout the life span. The health consequences of Iron deficiency continued to be subject research debate. This is partly because in many region of the world iron supplement are standard of care for individual with anemia. There is relatively small body of Iron depletion to humans with functional Iron deficiency with mortality as primary objective. There is surprisingly little evidence to either support casual link between Iron deficiency and these important adverse health outcome.10
Adolescent constitutes nearly 20% of the population of India. They are vulnerable group, especially in terms nutrition and health, Adolescent in particular have considerable unmet needs in terms of health, especially nutrition. This is in large part due to lack of targeted services. For adolescent wide spread gender discrimination and son preference that prevail and limit adolescent girls access to health services and nutrition.11
Adolescent girls who are mere likely to have unhealthy perception about nutrition, and tend to have more menstrual blood loss. Hence, Investigator felt that there is need to give the structured teaching programme regarding Iron deficiency anemia and to evaluate the effectiveness of teaching plan also to develop healthy life style among adolescent girls.
6.2.Review of Literature
Review of the literature is a key strop in research process. Nursing research may be considered as a continuing process in which knowledge gained from earlier studies is an integral part of research in general. In review of literature researcher analyses existing knowledge before delving in to new study and when making judgment about application of new knowledge in nursing practice. The literature review is an extensive, systematic, in critical review of the most important published scholarly literature on particular topic.
A study was conducted to examine the frequency of iron in iron deficiency with common disease among adolescent girl, pregnant women of Bangladesh. They essayed the blood hemoglobin concentration in 335 adolescent girls and 263 pregnant women, the urinary iodine concentration of those adolescent girls and pregnant women, and the iron level of all house hold salt specimen. The anemia was found in 24.8% of adolescent girls and 44.4% of pregnant women using different cutoff value (hb less than 11gms/dl for the under -2 children and pregnant women; less than 12 gms/dl of for adolescent girls) The relative rise and 95% confidence intervals were estimated and adjusted for age, sex, and gestational age to explode the association of iron and iodine deficiencies with common disease. They concluded that iron and iodine deficiency are quite high among the Bangladeshi population. 12
A cross sectional study was conducted to investigate the prevalence of anemia, iron, folite, zinc, copper deficiencies amongst adolescent school girls an new Halfa, eastern sudans, in to examine, their relationship of these micro nutrients with hemoglobin levels out 187 adolescent schools girls, 181 had anemia (hb<12 gms/dl) 21% had mild anemia (hb,11-11.9 gms/dl) 66.8% had moderate anemia (hb, 8-9 gms/dl) and 12.1% severe anemia (hb< 8 gms/dl) respectively. Iron deficiency anemia (<12 milligram/dl) and ferritin (< 12 micro gram/ltr) and folate deficiency (Sa. Folate < 3 mg/ml) were prevalent in 17.6%, 16.5% and 69% of these girls respectively. 26 girls (14% had < equal to micro nutrient deficiency). Hemoglobin level were significantly positively who related zinc level (R = 0.169, p =0.03)13
A cross sectional study was conducted to investigate prevalence of anemia and iron deficiency anemia among adolescent school girls in peri-urban Bangladesh, and to identify various factors associated with anemia in this population. Girls high school in fine sub district of Dhaka, Adolescent girls (n=548) aged 11-16 yrs from many school in Dhaka district participated in the study. Socio economic, anthropometric and dietary information were collected. Blood hemoglobin serum iron, total iron binding capacity, transferin saturation serum ferretin and serum rational were determined. The prevalence of anemia (hb,120 gm/1) among the participant was 27%, 17% had depleted iron stores (SR<12 meg/I) of all anemic girls 32% had iron deficiency anemia (hb<120gm/I) and sf <12 mcg/I) when the girls were classified by serum vitamin A, the third with lowest serum retinol levels had significantly lower hb and sf level. Significant positive correlation were observed between hb and serum iron, Ts, Sf and retional, while there was a negative correlation with serum T,B,C occupancy, frequency of consumption of large fish, serum, iron, T,B,C, TS, SF and serum vitamin A were strongly related to hemoglobin by multiple regression analysis. Anemia among these adolescent school girls in peri urban Bangladesh can be explained by iron deficiency alone and other causes may also exist in this population.14
A study was conducted to estimate prevalence of anemia among adolescent female and to study the socio-demographic factor, associated with anemia. A cross sectional surveys are conducted in an urban area under urban health training center, department of preventive and social medicine, govt. medical college Hospital, Nagpur, A total of 296 adolescent female (10-19 years old) were included in this study statistic analysis was done using percentage, standard error of proportion, chi-square test and student - "t" test. Prevalence of anemia was found to 35.1%. a significant association of anemia was found with socio-economic status and literacy status of parents. High prevalence of anemia among adolescent has found, was higher in the lower socio-economic strata and among those whose parents were less educated it was seen that anemia affects the overall nutrition status of adolescent girls.15
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 school located in three educational area of Kermanshah, the capital of Kermanshah province in western Iran. The prevalence of anemia (hb<12 mg/dl) among adolescent school girls was 21.4%. Iron deficiency using a ferritin levels <12 micro gms/L was found in 23.7% studied girls. There were 47 girls (12.2%) with iron deficiency anemia (hb<112 gms/dl and ferritin <20 micro gms/1) around 57.3% of anemia girls were iron deficient. There were no significant difference between the presence of anemia and the level of education of parents. The mean levels of hemoglobin (hb), (HC+) Hematocrit, MCH 9Mean cell hemoglobin), MCHC, mean cell hemoglobin concentration in studied adolescents girls western iron were found to be lower than those reported for females aged 12-18yrs.16
A study was conducted to determine the prevalence of iron deficiency anemia in children among five year of age in south west Iran. The study was sought to investigate the association between socio-economic, demographic, cultural and iron deficiency anemia in the selected area. A randomized cross sectional study was performed of the children 6-5 months of age living in urban and rural areas of Shwaz district in Khuzestan province. Blood sample were taken 33% randomly selected children. The result showed that 43.4% of the children had anemia and 9.1% iron deficiency anemia. The highest prevalence of iron deficiency anemia was in 18-24 months age group in the urban areas, instant 6-11 months age group had highest prevalence of non deficiency anemia. The high prevalence of iron deficiency anemia among children in south west Iran indicates major nutrition and health problem.17
A community based cross sectional study was conducted to determine the prevalence of anemia among unmarried adolescent south Indian girls in urban slum settings. A total of hundred a parentally healthy girl between the ages of 11-18 yrs were recruited. Their socioeconomic, dietary and anthropometric information was conducted and blood hemoglobin was estimated the prevalence of anemia (hb<12 gm/dl) was 29%, most had mild ferritin (<12 meg/l) significant association were observed between anemia and low socio economical status, religion and reporting frequent/non consumption of meat (hemo iron) only meat consumption was related to hemoglobin by multiple regression analysis. Anemia is a common problem among adolescent girls in these settings, through since anemia is rare. There is need to improve their hemoglobin status through dietary modification along with preventive supplementation and nutritional education.18
A study was conducted to assess the status of anemia among adolescent girl from 16 district of 11 state of India. A two stays random sampling method was used to select 30 clusters among the basis of probability proportional to size. Anemia was diagnosed by estimating the hemoglobin concentration in blood with the age of indirect cyanmethe hemoglobin method. The survey data showed 84.9% of pregnant women (en equal to 6923) were anemia (hb<11 gm/l) 13.1% had severe anemia (hb<70 gm/l) and 60.1% had moderate anemia (hb<or equal to 70-100 gm/l) Among adolescent girls (v= to 4337) from 16 districts, the overall prevalence of anemia (defined as hb<120 gm/l) was 90.1%, with 1-1 having severe anemia (hb<70 gm/l).19
A study was conducted on iron absorption from whole diets have examined relationship between dietary iron, bio availability, absorption; iron loses and amount of stored iron. New in sight have been obtained into regulation of iron absorption and expected rates of changes or iron stores or hemoglobin iron detect when bioavailability or iron content of the diet has been modified and when loses of iron occurs. Negative effects of loses of iodine deficiency are probably related to age, up to about 29 yrs explaining related to earlier controversies. The degree of under estimation of prevalence of mild iodine deficiency when using multiple diagnostics centers is discussed. It is suggested that current low energy, the style are common denominators for the current high prevalence not only of iodine deficiency but also obesity, diabetes and osteoporosis.20
A survey has shown that Magnitude of an Iron deficiency anemia is of Public Health concern in India. Increased intake or imbalance in consumption their utilization contributes to Iron deficiency. According to estimates of Iron less than 50% of the recommended dietary allowances are consumed. It is now established that iron bioavailability from habitual Indians diets is low due to low ascorbic acid/iron ratio. The other dietary factor affecting iron status are inadequate intake of folic acid and Vit B (10), A, C and other Vitamins of B Complex group, Food based approaches to increase the intake of Iron and other haemotopoedio nutrient through dietary diversification and provision of Hygienic environment are important strategies for correction of Iron deficiency anemia.21
A cross sectional study was conducted, through a pre test and structured interview. Student of eleventh and twelve classes were included in the study. The student and were asked about their age, dietary habits, menstrual problems, all the student and were then clinically examined for, later 10% of students were selected by systematic random sampling technique and tested for anemia by hemoglobin meter. WHO definition of Anemia in adolescent was used. (hb/below 1 gm) Total 390 female participated in study. Of them 13.31 were diagnosed with anemia, and prevalence of anemia was 73.10% and prevalence’s of anemia in age group 10-13 years has more in the female 44 (84.6%) anemia subject had history of worm intestinal and the relationship to poor diet, it was also seen that 56.6% anemic females had menstrual problems as compared to (6.6%)non anemia female.22
National family health survey results the statistics that mark a growth in cases pertaining to anemia, most of girls suffer from mild to moderate anemia. The hemoglobin count in most of adolescent girls in India is less than the standard 12g/deciliter. Iron deficiency anemia is prevalent form of anemia in India, while heavy menstrual bleeding in adolescent girls cause anemia lack of uneasiness among aggravates the situation as now a days, they attach more importance to losing weight with a little consciousness, situation may improve adding that prevention is better than cure.23
A cross sectional survey was conducted in Urban area under health training centre, Nagpur. A total of 296 adolescent females 10-19 were included statistical analysis were done using percentage, standard error of proportion Chi-square test and standard 'T' test. The prevalence of anemia was found to be 35% a significant association of anemia was found with socioeconomic status and literacy status of parents. Mean height and weight of subjects with anemia was significantly less than subject without anemia. The high percentage of anemia among adolescent girls was found, which was higher in lower socio-economic starts, and among those whose parents were less educated. It was seen that anemia all nutritional status of adolescent females.24