RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1. Name of Candidate and Address R.NEVIS SUTHA
(In Block Letters)
1st YEAR M.Sc (NURSING)
KTG COLLEGE OF NURSING,
BANGALORE
2. Name of the Institution
KTG COLLEGE OF NURSING
BANGALORE
3. Course of Study and subjects
M.Sc (NURSING)
CHILD HEALTH NURSING
4. Date of Admission to the Course
15.05.2009
TITLE:
A STUDY TO ASSESS THE KNOWLEDGE AND ATTITUDE
REGARDING THE PREVENTION OF IRON DEFICIENCY
ANEMIA AMONG ADOLESCENT GIRLS WITH SELF
INSTRUCTED MODULE IN SELECTED SCHOOL AT
BANGALORE.
BRIEF RESUME OF THE INTENDED WORK
1
INTRODUCTION:
“ADOLESCENT WOULD BE THE BEST INVESTMENT FOR FUTURE”
- SUNDARLAL
Health is a fundamental human right and health is central to the concept
of quality of life1.
Adolescent is a period of second decade of life. They constitute over one
fifth of India’s population1. Adolescence begins when the secondary sex
characteristics appear and ends when somatic growth is completed and the
individual is psychologically mature, capable of becoming a contributing
member of society2.
Adolescents are in the age group of 12 to 18 years. Girls begin to
menstruate at this age. The girl should have weight approximately 42-64 kg
and height approximately 155-169 cm. Total nutrient requirements are increase
during adolescence age to support a period of dramatic growth and
development. Eating right food at right time will prevent the nutritional
deficiencies especially Iron deficiency disorders2.
2
Iron is one of the micronutrient. It is used for formation of hemoglobin,
oxygen transportation, brain development, regulation of body temperature and
muscle activity. When the iron is deceased in human body, it is called as iron
deficiency. Iron deficiency is the most common etiological factor in anemias.
The deceased hemoglobin level is called as iron deficiency anemia3.
According to world health organization (WHO) the hemoglobin level
should be 12 g/dl for adolescent girls. When the hemoglobin level less than 12
g/dl is considered as iron deficiency anemia. WHO graded the hemoglobin
level 10 g/dl is considered as mild iron deficiency anemia, hemoglobin between
7 g/dl to 10 g/dl is considered as moderate iron deficiency anemia and
hemoglobin less than 7 g/dl is considered as severe iron deficiency anemia3.
The decreased dietary iron intake, poor absorption, worm infestation,
increased body demand, menstruation are the major causes of iron deficiency
anemia among adolescent girls4.
The iron deficiency anemia signs and symptoms are pallor of the eyes,
irritability, fatigue, husky voice, loss of appetite, desire to have gnaw solid
substance (pica), ice (pagophagia) or clay (geophagia), nails are dry, brittle,
3
concave, angular stomatitis, irritation of the tongue, sore mouth, difficulty in
swallowing, breathing difficulty due to decreased oxygen carrying capacity of
the blood and it affects immune system also. Iron deficiency anemia is a major
problem for adolescent girls due to expansion in blood volume and muscle
mass5.
Nowadays the young adolescent faces many problems because of their
life style modifications such as eating Jung foods, fast foods, snacking,
skipping of the meals which is common in urban adolescent girls6.
Some are malnourished due to lack of knowledge about dietary iron,
poor socio economic status, low income family which is common in rural areas
and also in menstrual period the adolescent girls used to loose 45 ml of blood
(i.e.) 22 mg of iron7.
Iron deficiency anemia will be prevented by adequate dietary intake or
iron such as green leafy vegetables such as amaranth, spinach, coriander leaves,
drumstick leaves, radish leaves, vegetables such as beet root, drumstick, cereals
like ragi, barley, cholam (Sorghum), rice (raw milled), legumes like Bengal
gram dhal, Black gram dhal, soyabean, Nuts and oil seeds like dates, cherry,
fruits such as chickoo, pomegranate and jaggary8.
4
Periodic de-worming should be encouraged for every 6 months once,
maintaining hygienic practices like hand washing, wearing regular foot wear
practices while going to toilet2.
Education about low cost iron rich foods such as drumstick leaves,
dates, jaggary, ragi, green leaves, chickoo to the rural areas, and avoiding the
meal skipping to eat jung foods and fast foods will prevent the iron deficiency
anemia. Regular hemoglobin screening tests will identify the iron deficiency
anemia in early stage2.
Weekly Iron supplementation for adolescent girls will prevent the severe
iron deficiency anemia and its complications such as myocardial infarction,
and angina. Iron supplementation should be given before meals because iron
will absorb easily in acidic nature or it may be given along with citrus juice like
lime or orange juice. The Nurse should encourage the preventive measures
among adolescent girls2.
5
6.1
NEED FOR THE STUDY:
Iron deficiency anemia is one of the most prevalent common nutritional
deficiencies in the world especially among adolescent girls. Adolescents gain
20% of adult weight and 30% adult height in the adolescent period itself4.
High prevalence of iron deficiency anemia reflects their poor status of
nutrition because of their rapid growth combined with poor eating habits and
menstruation4.
In world health report of World Health Organization (WHO) states that
the world wide morality rate of iron deficiency anemia is 60,404,000 in 20059.
In Victoria 1996, the incidence rate of iron deficiency anemia was
1,87,979 cases among adolescent girls10.
In USA, the incidence rate of iron deficiency anemia was 1 in 24 cases
or 4.12% or 11.2 million people10.
In Australia the incidence rate of iron deficiency anemia is 2,17,000
adolescent girls in 200410.
6
National Family Health survey in 2006 showed that 56% of adolescent
girls are anemic in India12.
World health report of World Health Organization states that the
mortality rate of iron deficiency anemia is 13,704,953 cases in India 20059.
The study was conducted on Prevalence of iron deficiency anemia
among adolescent girls in 16 districts of India in 2006. The survey showed that
90.1% of adolescent girls are having iron deficiency anemia. In this 60.1% of
adolescent girls were exposed to moderate iron deficiency anemia and 7.1% of
adolescent girls were exposed to severe iron deficiency anemia13.
The prevalence of iron deficiency anemia among adolescent girls are
consistently high. Nowadays most of the adolescent girls are having an
intension to maintain a slim structure. So they are eating very less quantity of
food. An influence of Jung foods and fast foods will reduce the intake of
dietary iron rich foods7.
Changes in the educational system and improvement in the standards of
education will increase the workload of students. This will increase the stress
among adolescents. It will leads to meal skipping and gives a way to develop
iron deficiency anemia. Due to iron deficiency the adolescent girls may get
7
impaired physical work, poor intelligent quotient, decreased motor and
cognitive function6. So all adolescent girls should know about iron rich foods,
importance of iron intake and functions of iron in Human body.
If the iron deficiency is prolonged, the functions of heart is also affected
gradually, because of an excessive oxygen demand. It will increase the extra
workload of the heart, so it can produce myocardial infarction and angina in the
later years11. Complications of iron deficiency anemia should be prevented
strictly, to create a healthy human being.
In order to tackle this public health problem a multi-prolonged 12 x 12
initiative has been launched by Family and Community Health Department in
India. The initiative is targeted at all adolescents across the country with the
aim for achieving hemoglobin level of 12 g/dl by the age of 12 years by 2012.
The important elements of the initiative are as follows13:
 Capacity building
 Health and nutrition education
 Increasing iron intake
 Weekly supplementation of iron tablets
 Parasite control through periodic de-worming
 Appropriate immunization
8
This initiative has been launched with the support of Government of
India, Indian Council of Medical Research, World Health Organization,
UNICEF, Federation of Obstetrics and Gynecological Societies of India,
Professional bodies and others13.
Based on these information the researcher feels that it is important to
prevent the iron deficiency anemia among adolescent girls.
9
6.2
REVIEW OF LITERATURE:
Review of literature is a broad, comprehensive, systematic identification
and summary of written materials that contains information on related problem.
Review of literature is the one integral component of any study or research
project. It inspires insight and enhances the depth of knowledge into the
problem. The review of literature shows light on the study and their findings
related to the study14.
 The study was conducted to assess the Prevalence of anemia and
determine serum ferritin status among 1120 healthy adolescent (12-18
years) girls in a rural school at Chandigarh in India. The cross sectional
study was conducted. The results were 23.9% of adolescent girls having
a high prevalence of iron deficiency anemia15.
 The study was conducted on deleterious functional impact of anemia on
young adolescent school girls, Gujarat, India. A standard methods were
used among 9-14 years of adolescent girls. The result was the
prevalence of iron deficiency was 67%. It is a higher incidence rate16.
 The study was conducted on anemia among adolescent females in the
urban area of Nagpur, Maharastra in India. A cross sectional survey was
10
conducted among 296 adolescent girls (10-19 years). The results were
the prevalence of anemia among adolescent females was found to be
35.1%. A higher prevalence was found17.
 The study was conducted on effectiveness of weekly supplementation of
iron to control the iron deficiency anemia among adolescent girls of
Nashik, Maharastra in India. The cluster sampling technique was
followed in each stratum 30 clusters were identified. 10 adolescent girls
from each cluster were identified. The prevalence of iron deficiency
anemia came down significantly 54.3% from 65.3%18.
 The study was conducted on risk factors for anemia in school children in
Tanga region, Tanzania. A total of 845 school children were randomly
selected in a cross sectional survey conducted. The prevalence of iron
deficiency anemia was 79.6%19.
 The study was conducted on prevalence of iron deficiency anemia
among adolescent school girls from Kermanshah, West Iran. A cross
sectional study was conducted to determine the prevalence of Iron
deficiency anemia. The result was 47 girls 12.2% with iron deficiency
anemia20.
11
 The study was conducted on excess adiposity and iron deficiency
anemia in female adolescent. The cross section study was conducted to
assess the iron status and excess adiposity, menarche, diet, physical
activity and poverty status included in the National Health and Nutrition
examination survey 2003-2004. The results were the heavier weight
girls had an increased prevalence of iron deficiency anemia compare to
those with normal weight21.
 The study was conducted on iron deficiency anemia among adolescent
girls in Bangladesh. The sample size was 355 adolescent girls. The
result was iron deficiency anemia has 24.8% of adolescent girls22.
12
6.3
STATEMENT OF THE PROBLEM:
A STUDY TO ASSESS THE KNOWLEDGE AND ATTITUDE
REGARDING THE PREVENTION OF IRON DEFICIENCY ANEMIA
AMONG ADOLESCENT GIRLS WITH SELF INSTRUCTED MODULE
IN SELECTED SCHOOL AT BANGALORE.
6.4
OBJECTIVES:
 To assess the knowledge regarding the prevention of iron deficiency
anemia among adolescent girls.
 To assess the attitude regarding the prevention of iron deficiency anemia
among adolescent girls.
 To correlate the knowledge and attitude regarding the prevention of iron
deficiency anemia among adolescent girls.
 To find out the association between knowledge and demographic
variables such as age, education, occupation of the family, income of the
family, dietary pattern and area of residence.
 To find out the association between attitude and demographic variables
such as age, education, occupation of the family, income of the family,
dietary pattern and area of residence.
 To develop a self instructed module regarding the prevention of iron
deficiency anemia.
13
6.5
HYPOTHESIS:
 There will be significant association between knowledge and
demographic variables such as age, education, occupation of the family,
income of the family, dietary pattern and area of residence.
 There will be significant association between attitude and demographic
variables such as age, education, occupation of the family, income of the
family, dietary pattern and area of residence.
6.6
OPERATIONAL DEFINITION:
KNOWLEDGE
: It is defined as the information, understanding and
skills that you gain through education or
experience.
ATTITUDE
: The term refers, to the way you think and feel
about something.
IRON DEFICIENCY : It is defined as decreased hemoglobin level in the
ANEMIA
ADOLESCENT
blood (i.e.) <12 gm/dl.
: The term refers to children who are aged between
13 to 17 years.
14
6.7
ASSUMPTIONS:
 The adolescent girls will have an adequate knowledge and positive
attitude regarding the prevention of iron deficiency anemia.
 The adolescent girls will follows the preventive measures for iron
deficiency anemia such as increased dietary iron intake, maintaining
personal
hygiene,
periodic
de-worming,
periodic
screening
of
hemoglobin, avoiding Jung foods and fast foods and regular intake of
weekly iron supplementation.
6.8
DELIMITATIONS:
The study is delimited to
 Samples are restricted to a selected Sunrise School at Bangalore.
 Sample size is restricted to 60 adolescent girls.
 Data collection period is limited to 4 weeks.
7.
MATERIALS AND METHODS:
7.1
SOURCES OF DATA:
The data will be collected from Sunrise School at Bangalore. The
subjects will be adolescent girls among 13 to 17 years.
15
7.1.1 RESEARCH DESIGN AND APPROACH:
Descriptive survey design will be used for this study and survey
approach will be used for this study.
7.1.2 SETTING:
The study will be conducted in a Sunrise School at Bangalore. It is
situated 1 km away from the college.
7.1.3 POPULATION:
The population of present study compose of an adolescent girls in the
age group of 13 to 17 years.
7.2
METHOD OF DATA COLLECTION:
7.2.1 SAMPLING TECHNIQUE:
Purposive sampling technique.
7.2.2 SAMPLE SIZE:
The sample size will be 60 adolescent girls.
7.2.3 INCLUSION CRITERIA:
 Age group between 13 to 17 years.
 Those who are willing to participate in this study.
 Girls who know Kannada & English read & write.
16
7.2.4 EXCLUSION CRITERIA:
 Those who are sick at the time of data collection.
 Those who are not present at the time of data collection
7.2.5 INSTRUMENT USED:
Section A:
Items of demographic variables like age, education, occupation of the
family, income of the family, dietary pattern and area of residence.
Section B:
The structured Questionnaire will be used to assess the knowledge and
attitude regarding the prevention of iron deficiency anemia among
adolescent girls.
The 30 structured Questionnaires will be formulated.
The procedure will be
For correct answer the score is - 1
For incorrect answer the score is – 0
Section C:
The self instructed module will be issued to 60 adolescent girls.
17
7.2.6 METHOD OF DATA COLLECTION:
The 30 structured questionnaires will be used to assess the knowledge
and attitude regarding the prevention of iron a deficiency anemia among
adolescent girls in sunrise school at Bangalore.
The data will be collected within four weeks. Each day 3 datas will be
collected from the subjects and self instructed module will be issued at the time
of data collection.
7.2.7 PLAN FOR ANALYSIS:
The collected data will be planned and analyzed in the form of
descriptive statistics and inferential statistics. The analyzed data will be
presented in the form of tables and figures by using mean, percentage, standard
deviation, X2 test and t test.
7.3
Does the study require any investigation or intervention to be collected
on patients or other human or animals? If any please describe briefly.
-YES-
18
7.4
ETHICAL CLEARANCE:
Ethical clearance will be obtained from the research committee of “KTG
College of Nursing”. The permission will be obtained from Head of the
Institution of Sunrise School at Bangalore and consent will be obtained from
the adolescent girls during the data collection.
19
8.
LIST OF REFERENCE:
1. Sundar Lal, Text book of Community Medicine, published by CBS
publisher, published in New Delhi 2007, Page No. 115-130.
2. Dorothy, R.Morlow Text book of Paediatrics, 6th edition, published by
Elesevier publisher, published in New Delhi 2007, Page No. 1133-1136.
3. K. Park, Text book of Preventive and Social Medicine, 18th Edition,
published by Bhanot, published in Jabalpur 2007, Page No. 449-450.
4. Wongs, Essentials of Paediatric Nursing, 8th Edition published by Mosby
publisher, published in India 2009, Page No. 915-917.
5. Dr. U.N.Panda, Hand book of Paediatrics, published by CBS publisher,
published in New Delhi, 2007, Page No. 115-130.
6. Indian Academy of Paediatrics, Text book of Paediatrics, 4th Edition,
Volume 1, published by Jaypee brothers, published in New Delhi 2007,
Page No. 101-103.
7. Suraj Gupta, Text book of paediatrics, 11th edition, published by Jaypee
brothers, published in New Delhi 2009, Page No. 212-214.
8. Dr. M. Swaminathan, Advanced Text book on Food and Nutrition,
Volume 1, published by Bappco Publisher, published in Bangalore 2008,
Page No. 392-394.
20
9. World Health Organization (WHO) statistics for iron deficiency anemia
2005, from www.pubmed.com.
10. Dr. Huntleys Diagnosis checklist, Health statistics, www.wrongdiagnosis.com
11. Centers for disease control and Prevention, Anemia Statistics (Iron
deficiency anemia) MMWR MORB MORTAL WKLYREP. 2002,
Page No. 897-899.
12. Jeteja G.S. Singh, “Prevalence of Anemia among Adolescent Girls”,
Journal of Food and Nutrition bulletin 2006, December Page No. 311-315.
13. Department of Family and Community Health, National Family Health
Servey-3 (2005-2006), www.indiastat.com.
14. BT, Basavanthappa, Nursing Research, published by Jaypee brothers,
published in New Delhi 1998, Page No 49.
15. Sabitha Basu, “Prevalence of Anemia among Adolescent School going
Girls” at Chandigarh in India, published in Journal of Indian Paediatrics,
Volume 42, June 17, 2005, Page No. 593-597.
16. Sen A “Deleterious Functional Impact of Anemia among Adolescent
School Girls”, published in the Journal of Indian Paediatrics, Volume 43,
March 2006, Page No. 219-226.
17. Chaudhry SM, “A study of Anemia among Adolescent Females” in the
urban area of Nagpur in India, published in the Journal of Community
Medicine, Volume 33, October 2008, Page No. 243-245.
21
18. Deshmuk P.R, “Effectiveness of Weekly Supplementation of Iron to
Control Anemia among Adolescent Girls”, published in the Journal of
Health Population and Nutrition, Volume 26, March 2008, Page No. 74-78.
19. Tatala SR, “Risk Factors for Anemia in School Children” in Tanga region,
Tanzania, published in the Tanzan Journal of Health Volume 10, October
2008, Page No. 189-202.
20. A. Kramipour R, “Prevalence of Iron Deficiency Anemia among
Adolescent School Girls” form Kermanshah, western Iran, published in the
Journal of Haematology, Volume 13, December 2008, Page No. 352-355.
21. Tussing-Humphreys LM, “Excess Adiposity and Iron Deficiency Anemia in
Female Adolescents”, published in the Journal of American Dietary
Association, Volume 109, February 2009, Page No. 297-302.
22. Choudhry N, “Iron Deficiency Anemia among Adolescent Girls”, published
in Nagoya Journal of Medical Science, Volume 17, February 2009,
Page No. 39-49.
ELECTRICAL MEDIA
 www.pubmed.com
 www.wrongdiagnosis.com
 www.indiastat.com
 www.WHO.com
22
R. Nevis Sutha
9.
NAME OF THE CANDIDATE
10. REMARKS OF THE GUIDE
:
:
The study is suitable and
feasible
11. 11.1 NAME AND
DESIGNATION OF THE
:
Nirmala Florence.S
GUIDE
11.2 SIGNATURE
:
11.3 HEAD OF THE
:
Nirmala Florence.S
DEPARTMENT
:
11.4 SIGNATURE
: Biju Ramachandran
12. 12.1 NAME OF THE
PRINCIPAL
:
12.2 REMARKS OF THE
The study is suitable and
feasible
PRINCIPAL
:
12.3 SIGNATURE
23