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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 9  |  Issue : 1  |  Page : 10-15

Prevalence, knowledge, and risk factors of anemia among school-going adolescent girls in a rural community of Telangana


1 Department of Community Medicine, Malla Reddy Institute of Medical Sciences, Hyderabad, Telangana, India
2 MBBS Scholar, Malla Reddy Institute of Medical Sciences, Hyderabad, Telangana, India

Date of Submission03-Dec-2020
Date of Decision01-Mar-2021
Date of Acceptance03-Mar-2021
Date of Web Publication30-Mar-2021

Correspondence Address:
Dr. Arun Kiran Soodi Reddy
Department of Community Medicine, Malla Reddy Institute of Medical Sciences, Suraram, Hyderabad, Telangana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mjhs.mjhs_29_20

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  Abstract 


Background: Since anemia is the most prevalent disorder in India, it got the significance to be studied and understood about. It is necessary to make people aware of the causes, the preventive measures, and the importance of nutritional supplements, proper diet required to prevent anemia.
Objective: The objective of the study was to study prevalence, knowledge, and risk factors of anemia among school-going adolescent girls.
Materials and Methods: This was a school-based cross-sectional study among 260 randomly selected adolescent school girls (10–19 years) from different private and government schools were included in the study. Study subjects were interviewed using a preformed and pretested, semi-structured questionnaire. Hemoglobin was measured using hemoglobinometer.
Results: Mean age was 12.64 ± 1.53 years. Only 10% knew about anemia. Only 20% opined that decrease in red blood cells causes anemia. Majority did not know which mineral deficiency causes anemia. Nearly 10% said that hemoglobin is measured to find anemia. Only one-fourth felt that heavy blood loss during menstruation can cause anemia. Nearly 50% felt that anemics have weakness, breathlessness, and are more prone to infectious diseases. Less than 10% of the study participants knew about iron-rich foods. Less than 5% knew that coffee, tea, and milk hamper iron absorption and Vitamin-C enhances. Half of them knew that anemia is a life-threatening condition in severe cases and may require blood transfusion. Only 20% knew about anemia prophylaxis program. There was no significant difference among different variables such as different age groups, religion, socioeconomic status, type of family, and diet. However, there was a significant difference among different categories of body mass index and anemia.
Conclusion: Prevalence of anemia is higher (96.5%) among school-going adolescents in a rural community of Telangana. Overall, the knowledge levels are quite low.

Keywords: Adolescent girls, anemia, association, knowledge


How to cite this article:
Soodi Reddy AK, Lahari P L. Prevalence, knowledge, and risk factors of anemia among school-going adolescent girls in a rural community of Telangana. MRIMS J Health Sci 2021;9:10-5

How to cite this URL:
Soodi Reddy AK, Lahari P L. Prevalence, knowledge, and risk factors of anemia among school-going adolescent girls in a rural community of Telangana. MRIMS J Health Sci [serial online] 2021 [cited 2021 Jun 20];9:10-5. Available from: http://www.mrimsjournal.com/text.asp?2021/9/1/10/312603




  Introduction Top


Globally, one of the most common nutritional disorders is anemia. As per the World Health Organization (WHO), age group of 10–19 years is called as adolescent age group.[1] The burden of anemia in terms of prevalence among adolescent girls in India is about 56% and in absolute numbers amounts to 64 million of adolescent girls on an average.[2] Adolescents especially girls are generally ignored in countries like India, and this leads to poor nutrition which in turn leads to a variety of nutritional problems such as anemia and growth retardation, resulting in stunting, etc., Anemia is thus most common nutritional problems among adolescent girls. Apart from nutritional neglect, helminthic infections and heavy blood loss during menstruation contribute to severity of anemia and its consequences among the adolescent girls.[3]

Anemia has its variety of consequences. Direct effects are on growth and indirect effects are like impaired concentration, lack of attentiveness, poor memory, defective performance in the academics, and decreased attendance in the schools. Menarche is delayed, immune system is affected which leads to more episodes of infections. Increased fetal morbidity and mortality, low birth weight, perinatal risk, increased infant mortality, and maternal mortality are some of the future consequences of anemia among the adolescent girls.[4]

Although this study has been planned to highlight the burden of anemia and to know the awareness of anemia among rural adolescent group, it will also be helpful in drawing recommendations and rendering suggestions to evaluate and enhance the existing Anemia Control Program. Since it is the most prevalent disorder in India, it got the significance to be studied and understood about. It is necessary to make people aware of the causes, the preventive measures, and the importance of nutritional supplements, proper diet required to prevent anemia.


  Materials and Methods Top


This was a school-based cross-sectional study. The study was conducted in the secondary schools which are located in the rural field practice area of the medical college from March 2018 to October 2018. Adolescent school girls in the age group of 10–19 years from different private and government schools were included in the study. Adolescent girls from all the schools in the catchment area were line listed, and study subjects were selected randomly using a random number table.

Considering the prevalence of anemia among adolescent girls as 76.3%,[5] with 95% confidence limit and allowable error 7%, the sample size of 253 was calculated using the formula: N = 4pq/E2

P = 76.3%, q = 100 − p = 23.7, E = 7% of P = 5.34

N = 4 × 76.3 × 23.7/5.34 × 5.34

N = 253 rounded off to 260.

A total of 260 adolescents were included in the study. All the randomly selected study subjects who were willing to participate were included in the study. An informed written consent (informed child assent in case of age <18 years) was obtained from all the participants before the study. Those who were not willing to participate or not willing to give their consent or not willing to give blood sample to check hemoglobin levels were excluded from the study. A formal letter was sent to the principal of each randomly selected schools in the catchment area, and a written permission was obtained before starting the study.

All the study subjects were interviewed using a preformed and pretested, semi-structured questionnaire. It included questions on basic demographic details and knowledge on various aspects of anemia. Weight was measured using a portable weighing machine by instructing the subjects to stand erect over the machine without any foot wears and facing the wall. Height is measured using a stadiometer by instructing the subjects to stand erect with heel, buttocks, scapula, and occiput in a straight line.

Hemoglobin was measured using hemoglobinometer. All standard aseptic precautions were taken while collecting the blood sample for hemoglobin. According to the WHO, anemia among adolescent girls is classified into three degrees: mild, moderate, and severe. Hemoglobin cutoff values of anemia are 11.0–11.9 g/dl (mild), 8.0–10.9 g/dl (moderate), and <8.0 g/dl (severe).[6]

Confidentiality was ensured at all stages. Ethical clearance was obtained from the institutional ethical committee of Malla Reddy Institute of Medical Sciences before conducting the study.

Modified B.G. Prasad's classification for Socioeconomic Status was used.[7]

Statistical analysis

The data were analyzed using Open-Epi version 3.1. Centers for Disease Control and Prevention, Atlanta, Georgia, United States. The association between categorical variables was tested with Chi-square test and continuous variables with t-test were used. The level of significance was fixed at P < 0.05.


  Results Top


The mean age of the population in the study was 12.64 (standard deviation [SD] ±1.53) years with range of 10–17 years. Majority 229 (88.9%) of them belonged to Hindu religion, followed by Muslims and others. Almost three-fourth of the study participants belongs to OBC community, followed by general, SC, and ST. Nearly 84.2% of them were from nuclear families. Majority of the study participants belonged to middle class [Table 1].
Table 1: Sociodemographic characteristics of study population

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Almost 6% of the study population were strict vegetarians and remain were on mixed diet. Majority of the study participants were malnourished with mean body mass index (BMI) of 17.55 (SD ±3.11) ranging from 11.0 to 27.3 kg/m2, only 30% of them were well nourished. On observation for their hemoglobin levels in the study population, the prevalence of anemia among the study population was much higher, i.e., 96.5%. Only 3.5% of the population had normal hemoglobin levels, i.e., 12 g% and above [Table 2].
Table 2: Diet, body mass index, and prevalence of anemia among study population

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On observation of the results regarding knowledge on anemia among the study participants, only 10.8% of them knew about anemia, remaining 89.2% did not knew what is anemia, few felt it is just blood loss, breathlessness, or weakness. Only 20% opined that decrease in red blood cells causes anemia. Majority did not know which mineral deficiency causes anemia, only few <10% opined that iron deficiency can cause anemia. Nearly 10% of the study population said that hemoglobin is measured to find anemia [Table 3].
Table 3: Knowledge on anemia among study population

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On observation of results on knowledge regarding cause, consequences, prophylaxis, and treatment of anemia, only one-fourth of the study population felt that heavy blood loss during menstruation can cause anemia. Around 50% of the study population felt that anemics have weakness, breathlessness, and are more prone to infectious diseases. Around two-third study population felt that anemics have pale face, tongue, nails, eyes, and decrease concentration in studies. One-third of the study participants felt that anemia can be prevented, by regular exercise and good food, and anemia can be treated by iron tablets. Only few <10% of the study participants were knew about iron-rich foods. <5% of them knew that coffee, tea, and milk hamper iron absorption and Vitamin C enhances iron absorption. Half of the study population knew that anemia is a life-threatening condition in severe cases and may require blood transfusion. Only 20% of the study participants knew about anemia prophylaxis program [Table 4].
Table 4: Knowledge on cause, signs and symptoms, prevention, and treatment among study population

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On observation of results, association of demographic variables with anemia, there was no significant difference among different variables such as different age groups, religion, socio economic status, type of family, and diet. However, there was a significant difference among different categories of BMI and anemia [Table 5].
Table 5: Association of demographic variables with anemia among study population

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  Discussion Top


In the present study among the total 260 study participants, the prevalence of anemia was much higher, i.e., 96.5%. Only 3.5% of the population had normal hemoglobin levels, i.e., 12 g% and above. The mean hemoglobin level among the study participants was 9.79 (SD + 0.78). Similarly, a study conducted by Gupta et al. the mean hemoglobin level among adolescent girls was 10.91 ± 1.32 g/dl. The prevalence was found as 76.29% in a rural community of Chhattisgarh.[8]

A study by Koushik et al. in a rural community of Andhra Pradesh found that the prevalence of anemia among adolescent girls was 77.33%, with severe anemia being 12.06%, moderate anemia being 50.86%, and mild anemia being 37.06%. In our study also, the prevalence of moderate anemia is higher 95%.[9] A study by Pattnaik et al. in a rural community of Odisha found that the prevalence of anemia among adolescent girls was 78.8%, with 75.6% were suffering from mild anemia and 24.4% were suffering from moderate anemia. Nobody was suffering from severe anemia. Similarly, in our study, only one (0.4%) was suffering from severe anemia.[10]

Similarly, a study by Siva et al. in a rural area of Kerala found that the prevalence of anemia was 21%. However, in our study, the prevalence is very high. May be the literacy rate of Kerala and awareness about the program and overall awareness might be the cause for the results.[11] In a study which was conducted by Patel et al. in rural Maharashtra found, almost 91% of the included women were anemic (65,811/72,750), over a third were underweight (25,571/72,750, 35.1%) and over a third were both anemic and underweight (23,867/72,750, 32.8%). Anemia was severe in <0.2% and moderate in nearly 48% women. Similarly, in our study, the prevalence of anemia is higher and also 178 (68.5%) were under weight.[12]

On observation of the results regarding knowledge on anemia among the study participants, only 10% of them knew about anemia, remaining 90% did not knew what is anemia, few felt it is just blood loss, breathlessness, or weakness. Only 20% opined that decrease in red blood cells causes anemia. Majority did not know which mineral deficiency causes anemia, only few <10% opined that iron deficiency can cause anemia. 10% of the study population said that hemoglobin is measured to find anemia.

On observation of results on knowledge regarding cause, consequences, prophylaxis, and treatment of anemia, only one fourth of the study population felt that heavy blood loss during menstruation can cause anemia. Around 50% of the study population felt that anemics have weakness, breathlessness, and are more prone to infectious diseases.

Around two-third study population felt that anemics have pale face, tongue, nails, eyes, and decrease concentration in studies. One-third of the study participants felt that anemia can be prevented, by regular exercise and good food, and anemia can be treated by iron tablets. Only few <10% of the study participants were knew about iron-rich foods. <5% of them knew that coffee, tea, and milk hamper iron absorption and Vitamin-C enhances iron absorption.

Knowledge regarding anemia is very poor; it is better to induce topics with regarding anemia and other basic aliments in the curriculum to improve the knowledge. According to the existing public health program on anemia prevention, community level health workers are given responsibility to impart knowledge and distribution of iron folic acid tablets weekly, which is not function in many of the places. Hence, strict monitoring mechanism is required to make the program function and a success.

Singh et al.[13] noted in their study that only 34.9% of the adolescent girls were aware about the anemia and only 38.9% of the adolescent girls felt that it was a health problem. Only 7.5% of them were knowing the cause of anemia. The author found that, after health education, there was a significant increase in the knowledge related to anemia.

Premaletha et al.[14] observed that the prevalence of anemia was 40% in their study. Overall, they noted that the prevalence of poor knowledge related to anemia was 51%, while average knowledge was found among 38% of the adolescent girls and prevalence of good knowledge was found in 11% of the adolescent girls. They did not notice any association between the degree of knowledge and the prevalence of anemia.


  Conclusion Top


The present study revealed that the prevalence of anemia is higher (96.5%) among school-going adolescents in a rural community of Telangana. This shows that anemia is a major public health problem among adolescent girls in this rural part of Telangana. This study does not show any relation with the knowledge on anemia in general, signs and symptoms, consequences, its prevention, and treatment. Overall, the knowledge levels are quite low ranging from 2% to 50%.

Acknowledgments

This study was done under Indian Council of Medical Research – Short Term Studentship (ICMR-STS) program. We are thankful to ICMR for selection and funding the study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
World Health Organization. Strategic Directions for Improving Adolescent Health in South-East Asia Region; 2011. Available from: http://apps.who.int/iris/handle/10665/205917. [Last accessed on 26 Mar 2018].  Back to cited text no. 1
    
2.
Aguayo VM, Paintal K, Singh G. The adolescent girls' anemia control program: A decade of programming experience to break the inter-generational cycle of malnutrition in India. Public Health Nutr 2013;16:1667-76.  Back to cited text no. 2
    
3.
Kattula D, Sarkar R, Ajjampur SS, Minz S, Levecke B, Muliyil J, et al. Prevalence & risk factors for soil transmitted helminth infection among school children in south India. Indian J Med Res 2014;139:76.  Back to cited text no. 3
[PUBMED]  [Full text]  
4.
World Health Organization. Prevention of Iron Deficiency Anemia in Adolescents: Role of Weekly Iron and Folic Acid Supplementation. Regional Office for South-East Asia: World Health Organization; 2011. Available from: https://apps.who.int/iris/handle/10665/205656. [Last accessed on 2018 Mar 23].  Back to cited text no. 4
    
5.
Allen A, Allen S, Rodrigo R, Perera L, Shao W, Li C, et al. Iron status and anaemia in Sri Lankan secondary school children: A cross-sectional survey. PLoS One 2017;12:e0188110.  Back to cited text no. 5
    
6.
World Health Organization. Hemoglobin Concentrations for the Diagnosis of Anemia and Assessment of Severity. Geneva, Switzerland: World Health Organization; 2011. Avaialable from: https://www.who.int/vmnis/indicators/haemoglobin/en/. [Last accessed on 2018 Mar 23].  Back to cited text no. 6
    
7.
Kumar P. Social classification-need for constant updating. Indian J Community Med 1993;18:60-1.  Back to cited text no. 7
    
8.
Gupta V, Chavhan PS, Singh SP, Umate L. Prevalence of anemia among adolescent girls in rural population of Rajnandgaon, Chhattisgarh, India. J Med Sci Clin Res 2017;5:17369-74.  Back to cited text no. 8
    
9.
Koushik NK, Bollu M, Rao NV. Prevalence of anemia among the adolescent girls: A three months cross-sectional study. World J Pharm Pharm Sci 2014;3:827-36.  Back to cited text no. 9
    
10.
Pattnaik S, Patnaik L, Kumar A. Prevalence of anemia among adolescent girls in a rural area of Odisha and its epidemiological correlates. Indian J Matern Child Health 2013;15:1-11.  Back to cited text no. 10
    
11.
Siva PM, Sobha A, Manjula VD. Prevalence of anemia and its associated risk factors among adolescent girls of central Kerala. J Clin Diagn Res 2016;10:LC19-23.  Back to cited text no. 11
    
12.
Patel A, Prakash AA, Das PK, Gupta S, Pusdekar YV, Hibberd PL. Maternal anemia and underweight as determinants of pregnancy outcomes: Cohort study in eastern rural Maharashtra, India. BMJ Open 2018;8:e021623.  Back to cited text no. 12
    
13.
Singh M, Honnakamble RA, Rajoura OP. Knowledge, attitude and practice change about anemia after intensive health education among adolescent school girls of Delhi: An intervention study. Int J Med Public Health 2019;9:71-3.  Back to cited text no. 13
    
14.
Premaletha T, Safeena S, Arora G. Prevalence of anemia and knowledge of adolescent girls regarding anemia. IP J Pediatr Nurs Sci 2019;2:74-6.  Back to cited text no. 14
    



 
 
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