INTRODUCTION:

“ADOLESCENCE IS LIKE HAVING ONLY ENOUGH LIGHT TO SEE THE STEP DIRECTLY IN FRONT OF YOU”.

The world’s adolescent population is facing a series of serious nutritional challenges which are not only affecting their growth and development but also their livelihood as young adults. Yet, adolescent remain a largely neglected, difficult to measure and hard to reach population, in which the needs of adolescent girls in particular are often ignored.

Adolescents are in the age group of 12 to 18 years. The girls and boys should have weight approximately 42-64 kgs., 53-73 kgs., respectively, and height approximately 155-169 CMS, 162-174 CMS. Adolescents gain 20% of adult weight and 30% adult height in the adolescent period itself⁴. Hence, nutritional requirements are increased during adolescence period for dramatic growth and development. Eating right food at right time will prevent the nutritional deficiencies especially Iron Deficiency disorders².

Iron is one of the micronutrient used for formation of haemoglobin, oxygen transportation, brain development, regulation of body temperature and muscle activity. When the Iron is decreased in human body, it is called as Iron Deficiency. Iron Deficiency is the most common etiological factors in Anaemia. The decreased haemoglobin level leads to Iron Deficiency Anemia³.

Anaemia is one of the most prevalent common nutritional deficiencies in the world especially among adolescents. High prevalence of Anaemia 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 organisation (WHO) states that the world-wide mortality rate of Anaemia is 60,404,000 in 2008⁹. In Victoria 1996, the incidence rate of Anaemia was 1,87,979 cases among adolescent girls¹⁰.

In USA the incidence rate of Anaemia was 1 in 24 cases or 4.12% in 11.2 million people¹⁰. In Australia the incidence rate of Anaemia is 2, 17,000 adolescent girls in 2004¹⁰. National family health survey in 2006 showed that 56% of adolescent are anaemic in India¹². World health organization states that the mortality rate of Anaemia is 13,704,953 cases in India 2005⁹.

The Iron Deficiency Anaemia among adolescent girls is consistently high. Now days most of the adolescent girls are having an intension to maintain a slim structure. So, they are eating very less quantity of food⁷. An influence of junk foods and fast foods will reduce the intake of dietary Iron rich foods. Changes in the educational system and improvement in the standards of education will increase the stress among adolescents. It will lead to meal skipping and gives a way to develop Anaemia. Due to deficiency of Iron in body, the adolescent may get impaired physical health, poor intelligent quotient, decreased motor and cognitive function⁶.

According to world health organization (WHO) the haemoglobin level should be 12.5gm|dl to 15.5gm|dl for women. When the haemoglobin level is less than 12.5gm|dl is considered as Iron Deficiency Anaemia. The haemoglobin level less than 10gm|dl is considered as mild Iron Deficiency Anaemia, haemoglobin between 7gm|dl to 10gm|dl is considered as the moderate Iron Deficiency Anaemia and the haemoglobin level is less than 7gm|dl is considered as severe Iron Deficiency Anemia⁵. The decreased dietary Iron intake, poor absorption, worm infestations, poor socio-economic status, low family income, increased body demand during menstruation are the major causes of Iron Deficiency Anaemia.

The signs and symptoms of Iron Deficiency Anaemia are pallor eyes, irritability, fatigue, husky voice, loss of appetite, desire to have solid substance (PICA) like ice (pagophagia) or clay (geophagia), nails are dry, brittle 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 Anaemia is a major problem for adolescent due to expansion in blood volume and muscle mass⁵.

Iron Deficiency Anaemia will be prevented by adequate dietary intake of Iron rich sources such as green leaves like spinach, Swiss chard, drumstick leaves, vegetables such as beet roots, cereals like rage, barley, legumes like nuts, soya beans, nuts and oil seeds like dates, cherry fruits such as chickee, pomegranate and jaggary⁸. Periodic de-worming should be encouraged for once in every 6 months, maintaining hygienic practices like hand washing, wearing regular foot wear practices while going to toilets².

Weekly Iron supplementation for adolescents will prevent severe Iron Deficiency Anaemia 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 of Iron Deficiency Anaemia among adolescents.

So, all adolescents 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 are 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 Anaemia should be prevented strictly, to create a healthy human being. In order to tackle this public health problems a multi prolonged 12x12 initiative has been launched by family and community health department in India. The initiative is targeted at all adolescent across the country with the aim for achieving haemoglobin level of 12.5gm|dl by the age of 12 years by 2012¹³. In 2013 launched “National Iron Plus” initiative as comprehensive strategy to combat the public health challenge of Anaemia across the life cycle.

OBJECTIVES OF THE STUDY:

1. To assess the level of knowledge of adolescent girls regarding Iron Deficiency Anaemia.

2. To find the associative between knowledge of adolescent girls regarding Iron Deficiency Anaemia, with their selected demographic variables.

HYPOTHESIS:

H₁: Significance difference will be there between the age and level knowledge of adolescent girls regarding Iron Deficiency Anaemia.

H₂: Association will be significant between the class studying and level of knowledge of adolescent girls regarding Iron Deficiency Anaemia.

H₃: There will be significant association between the religion and level of knowledge of adolescent girls regarding Iron Deficiency Anaemia.

H₄: Significant association will be there between the mother’s educational status and level of knowledge of adolescent girls regarding Iron Deficiency Anaemia.

H₅: Significance will be between the type of family and level of knowledge of adolescent girls regarding Iron Deficiency Anaemia.

H₆: Association will be there between the family monthly income and level of knowledge of adolescent girls regarding Iron Deficiency Anaemia.

H₇: Significant association will be there between the age at menarche and level of knowledge of adolescent girls regarding Iron Deficiency Anaemia.

H₈: Association will be significant between the dietary pattern and level of knowledge of adolescent girls regarding Iron Deficiency Anaemia.

H₉: There will be significant association between the any previous knowledge and level of knowledge regarding Iron Deficiency Anaemia of adolescent girls regarding Iron Deficiency Anaemia.

H₁₀: Significant association will be there between the source of information and level of knowledge of adolescent girls regarding Iron Deficiency Anaemia.

MATERIALS AND METHODS:

Research approach and design:

Quantitative research approach and non-experimental, descriptive research design was used to conduct the study.

Setting of the study:

The study was conducted at St. Francis English medium school, Mangalagiri, Guntur district, Andhra Pradesh.

Sample and sampling technique:

Non-probability, convenient sampling technique was used to select the sample. The sample size for the present study is 100 adolescent girls were studying 8^th, 9th, and 10^th classes.

Criteria for sample selection:

Inclusion criteria:

The study included the school going adolescent girls who are

· studying 8^th, 9^th and 10^th class only.

· willing to participate in the study.

· having age between 13 – 16 years.

· available at the time of data collection.

· able to understand, read and write English.

· studying at St. Francis English medium school only.

Description of the tool:

A structured knowledge questionnaire was developed and used for collecting the data. It consists of two parts namely section-A and section-B.

Section A:

This section consists of 10 items on demographic characteristics of the participants in relation to their age, class studying, religion, mother’s educational status, type of family, family monthly income, age at menarche, dietary pattern, any previous knowledge and source of information.

Section B:

This section consists of 30 items on knowledge regarding Iron Deficiency Anaemia. The item was developed as to cover the entire aspects of Iron Deficiency Anaemia. Each item is closed ended multiple choice question. Each correct answer allotted a score of “one” and score “zero” for incorrect answer. The maximum score for section “B” is 30.

Score Interpretation:

· 75% and above - Adequate knowledge.

· 51% to 74% - Moderately adequate knowledge.

· Less than 50% - Inadequate knowledge.

Content Validity:

The prepared tool along with the objectives were submitted to 2 Doctors and 3 Nursing faculty. The modifications and suggestions of expert were incorporated in the final preparations of the tool.

Reliability:

Reliability of the tool was checked by split half technique by using spearman’s brow prophecy formula. It is found that “r” value of knowledge items is 0.9 which indicates that, the tool is highly reliable.

Pilot study:

Pilot study was conducted at C.K. girls high school, Mangalagiri, Guntur district. Data were collected by structured questionnaire. It took 30 to 40 minutes to complete the entire tool. These subjects are not included in the main study.

Ethical consideration:

Ethical clearance was taken from the institutional ethical committee.

Collection of data:

After obtaining prior permission from the school authority, the investigation informed the purpose of the study and requested sample to co-operate during the study. The written consent was taken from the participants, instructions were given to the participants with the help of particular class teacher. The structured knowledge questionnaire was distributed to required member of samples. The researcher had collected back the filled in form after 40 minutes. It took a period of 10 days to collect the data.

Plan for data analysis:

The data obtained were analysed in terms of the objectives and hypothesis of the study by using descriptive and inferential statistics. Frequency and percentage, mean, standard deviation and chi-square test were used to analyse the data.

RESULTS:

Section: I

Characteristics of the study sample

Age:

This revealed that, out of 100 adolescent girls 07 (7%) belongs to 13 years, 35 (35%) belongs to 14 years, 23 (23%) belongs to 15 years and 35 (35%) belongs to 16 years.

Class studying:

Among 100 adolescent girls none of them are studying 7^th class (0%) 02 (02%) of them belongs to 8^thclass, 36 (36%) belongs to 9^th class and 62 (62%) belongs to 10^thclass.

Religion:

Regarding Religion 41 (41%) belong to Hindu religion, majority i.e., 47 (47%) belongs to Christian religion, 08 (08%) belongs to Muslim religion and least of 04 (04%) belongs to other type of religion.

Mother’s educational status:

Regarding Mother’s Educational Status revealed that 28 (28%) belongs to Illiterates, majority 33 (33%) studied Primary Education, 19 (19%) studied up to Secondary Education and 20 (20%) mothers education level is Graduation and above.

Type of Family:

Regarding the Type of Family majority 75 (75%) belongs to Nuclear family and least of 25 (25%) living in the Joint family and none 0 (0%) of them are living in Extended family.

Family Monthly Income:

Regarding Family Monthly Income majority 52 (52%) earns below Rs. 10,000 per month, 27 (27%) earns Rs. 10,001 – Rs. 20,000 per month and 15 (15%) of people earns Rs. 20,001 – Rs. 30,000 per month and least of them 06 (06%) earns Rs. 30,000 and above.

Age at Menarche:

The Age at Menarche revealed that 16 (16%) attained menarche between 9 to 11 years of age, majority 59 (59%) attained menarche between 12 to 14 years, 18 (18%) attained menarche between 15 years and above and least 07 (07%) children not yet attained menarche.

Dietary pattern:

Regarding Dietary Pattern were least 18 (18%) adolescent girls are in vegetarian category, 22 (22%) follows Non-vegetarian and majority 60 (60%) follows mixed diet pattern.

Any previous knowledge:

Majority of the adolescent girls 81 (81%) had previous knowledge about Iron Deficiency Anaemia and least 19 (19%) did not have knowledge.

Source of getting information:

Regarding the source of getting information 30 respondents (30%) gathers the information by Print Media (Newspapers | Posters | Pamphlets), 22 adolescents (22%) by Mass Media (Internet | TV), 27 (27%) knows by Health Professionals (Nurses | Doctors), least 09 (09%) knows by Neighbours and 12 (12%) knows by other sources.

Section-II:

Table.1: Mean and standard deviation based on their knowledge score of adolescent girls regarding iron deficiency Anaemia.

S.no	Variable	Mean	Standard Deviation
1	Knowledge	2.44	4.59

The Mean knowledge score of sample is 12.44 with the Standard deviation 4.59.

FIG: 1 Distribution of sample by their level of knowledge with regard to iron deficiency anaemia. SECTION

Significant association was found between score of adolescent girls with their selected demographic variables like age (X²=9.28), class of studying (X²=13.48), religion (X²=13.40), mother’s educational status (X²=10.99), family monthly income(X²=13.82), age at menarche (X²=5.72), dietary pattern (X²=3.96), any previous knowledge (X²=2.77) and source of information (X²=7.14) at p<0.05. Hence H₁, H₂, H₃, H₄, H₆, H₇, H₈, H₉ and H₁₀ is retained.

DISCUSSION:

The present study was conducted with a aim to assess the knowledge among adolescent girls regarding Iron Deficiency Anemia. The results revealed that among 100 adolescent girls 38% had inadequate knowledge, majority of the girls 56% had moderately adequate knowledge and least girls 06% have adequate knowledge.

The present study was also supported by, other researchers Niba Johnson, Noufeena D, Parvathi (2016) had conducted co-relative study. The study result showed that majority (84%) of study sample had moderately adequate knowledge, (11%) had inadequate knowledge and least (5%) had adequate knowledge.

CONCLUSION:

1. The study findings concluded that the adolescent girls had moderate knowledge on iron deficiency anaemia.

2. Parent and teacher should create awareness regarding iron deficiency anaemia by various teaching techniques. It should be incorporated in the curriculum which enables the students to develop advanced knowledge there by iron deficiency anaemia can be prevented.

REFERENCES:

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, 6^th edition, published by Elesevier Publisher, Published in New Delhi 2007, page No.1133-1136.

3. K. Park, text book of Preventive and Social medicine, 18^th Edition, published by Bhanot, Published in Jabalpur 2007, page No.449-450.

4. Wongs, Essentials of Paediatrics Nursing, 8^th Edition published by Mosby Publisher, Published in India 2009, page No. 915-917.

5. Dr. UN Panda, Hand Book of Paediatrics, Published CBS Publisher, Published in New Delhi, 2007, Page No. 115-130.

6. Indian Academy of Paediatrics, Text Book of Paediatrics, 4^th Edition, Volume 1, Published by Jaypee Brothers, Published in New Delhi 2007, Page No.101-103.

7. Suraj Gupta, Text book of Paediatrics, 11^th 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.

Received on 30.12.2019 Modified on 19.01.2020

Asian J. Nursing Education and Research. 2020; 10(2):219-223.

DOI: 10.5958/2349-2996.2020.00047.6