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
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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
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