ORIGINAL ARTICLE
Year : 2019  |  Volume : 2 |  Issue : 2 |  Page : 11-14 |  DOI : https://doi.org/10.46319/RJMAHS.2019.v02i02.003

Study of Anemia amongst school going Adolescent girls in rural Tumkur

Mohan CR¹, GK Cheluve Gowda², BR Chandrika³, Anupama D^4*
1 MOH, PHC Siriwara, Tumakuru, ² Assistant Professor, Department of Community Medicine Sri Siddhartha Medical College & Research Centre, SSAHE, Agalakote, Tumakuru, ³ District Health & Family Welfare Officer, Tumakuru, 4Professor, Department of Anatomy Sri Siddhartha Medical College & Research Centre, SSAHE, Agalakote, Tumakuru

*Corresponding author:
Dr Anupama D, Professor, Dept of Anatomy, Sri Siddhartha Medical College, Tumkur.
E-mail: dranupama7373@gmail.com

Abstract
Introduction: Anemia is defined as decrease in the total number of red blood cells (RBCs) or hemoglobin in the blood, or a lowered ability of the blood to carry oxygen. Anemia is one of the important health problems in both developing and undeveloped countries. Adolescent girls constitute 1/5 of the female population in the world and more than 60% in the adolescent population of India. Occurence of Anemia is an important health Indicator which is more commonly seen in girls from low socioeconomic status. Aim & objectives: To determine Anemia amongst adolescent school girls and to assess the factors influencing Anemia. Material and methods: A cross sectional study was done among 106 all adolescent school girls in rural areas. A detailed personal and family history was obtained which included socioeconomic levels, educational qualification of parents and menstrual details of the participant. Girls with hemoglobin concentration less than 11g/dl are termed as anemic and then they were grouped into 3 mild, moderate and severe based on WHO Guidelines following collection of peripheral blood sample and hemoglobin estimation by Sahli's method. Results: Anemia was found to be 74.52% which is high for adolescent girl population. Conclusion: Regular screening for Anemia along with thrust on extending the nutritional supplementation and enhancing the Iron Folic acid supplementation to all adolescent girls with proper health education should be included.

Keywords: Anemia, adolescent, school going girls.
-------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Introduction
Anemia is defined as decrease in the total number of red blood cells (RBCs) or hemoglobin in the blood, or a lowered ability of the blood to carry oxygen. Anemia is one of the important health problems in both developing and undeveloped countries. Occurrence of Anemia is an important health Indicator which is more commonly seen in girls from low socioeconomic status. Hence detection and management of Anemia has been a prime focus of present national health programme not only for their optimal growth but also to reduce the future risk of maternal and neonatal morbidity & mortality. Adolescence is defined as a period between 13-19 yrs of age according National youth policy of India. It is defined as period of life beginning with appearance of secondary sexual characters and terminating with cessation of somatic growth.[1] Adolescence in girls has been recognized as most vulnerable.[1,2] Adolescent girls constitute 1/5 of the female population in the world and more than 60% in the adolescent girl population of India.[3] Overall health status of an individual is judged by their Hemoglobin levels and hence occurrence of Anemia is an important health Indicator which is more commonly seen in girls from low socioeconomic status.[4,5] It gets worsened by excessive menstrual blood loss. Hence detection and management of Anemia has been a prime focus of present national health programme not only for their optimal growth but also to reduce the future risk of maternal morbidity & mortality.[3] Hence this study is undertaken to assess the prevalence of Anemia amongst adolescent school girls residing in rural areas and risk factors associated to aid in planning management at the earliest.

Materials and Methods
A cross sectional study was conducted from June to August 2019, among 106 adolescent school girls aged between 13-19 yrs in rural areas of PHC Sirivara after taking permission from higher authorities. Both the schools of that area were included. Ascent to consent was taken. Ethical committee clearance was taken. Confidentiality of the respondance was maintained. Sample size was divided equally among two schools. Convenient sampling was done to attain the sample size. Severely ill, debilitated or with other underlying diseases or those who denied for the study were excluded. Pretested semi-structured questionnaire consisting of general information and factors influencing anaemia was used. Two to three ml of blood was collected from pheripheral vein after aseptic precautions. Hemoglobin estimation was done by Sahli's method. Girls with hemoglobin concentration less than 11g/dl are termed as anemic and then they were grouped into 3 categories - mild(10.9-9), moderate(8.9- 7) and severe (<7), based on WHO Guidelines.

Results
Out of 106 adolescent girls, 79 (74.52%) were found to be anemic. 70 girls had mild anemia (88.61%), 7 of them had moderate anemia (8.86%) and only 2 of them had severe anemia (2.53%).( Figure 1) Anemia was most common in the age group of 14yrs (35.8%). Anaemia was most commonly observed in joint families than nuclear families. Anaemia was associated with parents with agricultural background. There was no significant association between anaemia and socioeconomic status, age at menarche, birth order, menstrual flow and cycle. (Table 1)

 

Table-1: Factors influencing anaemia in adolescent girls

Sl No	Variable	Adolescent Girls
		With Anemia n(%)	Without Anemia n(%)
1	TYPE OF FAMILY			=10.339 p<0.05
	Nuclear	20(25.3)	16(59.3)
	Joint	59(74.7)	11(40.7)
2	SOCIOECONOMIC STATUS			=1.70 p>0.05
	I	3(3.8)	2(7.4)
	II	9(11.4)	5(18.5)
	III	46(58.2)	13(48.2)
	IV	21(26.6)	7(25.9)
3	PARENTS OCCUPATION			=10.179 p<0.05
	Laborer	33(41.8)	12(44.5)
	Agriculturist	36(45.6)	5(18.5)
	Self employed	10(12.6)	10(37)
4	AGE AT MENARCHE			=1.829 p>0.05
	<13	7(8.9)	2(7.4)
	13	31(39.2)	7(25.9)
	14	36(45.5)	14(51.8)
	15	4(5.1)	3(11.1)
	16	1(1.3)	1(3.7)
5	MENSTRUAL FLOW			=1.95 p>0.05
	Normal	61(77.2)	23(85.2)
	Heavy	17(21.5)	3(11.1)
	Less	1(1.3)	1(3.7)
6	MENSTRUAL CYCLES			=1.851 p>0.05
	Regular	64(81)	25(92.6)
	Irregular	15(19)	2(7.4)
	Total	79(100)	27(100)

 

Figure 1: Hb% of adolescent girls in number

Discussion
Anemia is a major concern in the undeveloped and developing countries because of its burden on the health status of the community. Period of adolescence is a stage of transition which requires lot of attention and care with rapid growth spurt and unmet nutritional needs in the rural areas because of low socioeconomic and literacy levels and majority of Indian population reside in rural areas. [2,6,7] Prevalence of anemia was found to be 74.5% in the present study. A higher prevalence was noted by Minal Vinay Kulakarni in Nagpur in Maharashtra[7], Toteja GS et al found 90. 1% from 16 districts of India, with 7.1% having severe anemia.[3] Lower Prevalence of anemia of about 40.7% was found in another study conducted by Puja Dhuppar et al in Raipur and about 23.9 in another study by Basu.[5] Recent reports say that prevalence of anaemia among adolescents was around 30% and severe anaemia was less than 1%.[8] In another study by P M Siva et al says that the prevalence of was 21%. Risk factors associated with anaemia found were worm infestation and poor health hygiene. In this study, a significant association of anemia was found with type of family and parents occupation, which may be due to the lack of availability of nutritious food.[2, 7, 8] In another study by Upadhye, it was found to be 90% along with significant association of low socio-economic status and low literacy status of parents.[9] Bulliyy et al found 96.5% prevalence among non school going adolescent girls in three districts of Orissa. They found significant association between Hb% and the educational level of girls, their parents' family income.[10] In another study, the prevalence of anemia was found to be 39% in adolescent girls with history of excessive menstrual bleeding and vegetarian diet.[11] Anemia results from plenty of causes, and some times more than one cause is involved and most common being iron deficiency.[12] There are stages of life when demand for iron is high as during childhood, adolescent growth and pregnancy for maximum growth and development. Other major causes may be attributed to impaired nutrition, worm infestations, associated diseases, poverty, poor hygiene, medication, alcohol, heavy blood loss during menstruation. Among 1000 adolescent girls in another study 60 percent found to be anaemic with high prevalence of anaemia among adolescent girls belonging to class III, IV, V as per modified Kuppuswamy classification. In another study higher proportion (42.1%) of the anemias were aged between 13-15 years.[13] According to NFHS data, over 56% of adolescent girls are anaemic as they are more vulnerable to anaemia due to the rapid growth of the body and loss of blood during menstruation. [3] The Weekly Iron and Folic Acid Supplementation programme of the Ministry of Health and Family Welfare has been rolled out in 18 states and remaining States and UTs are at different stages of preparedness for implementing the programme.[14, 15]

Conclusion
High prevalence of anemia in adolescent school girls is an alarming sign because of its grave future consequences such as increased maternal and neonatal morbidity and mortality rates. School health programmes should be strengthened in such a way that there should be regular screening for anemia, deworming, nutritional supplementation along with iron folic acid tablets and frequent health education programmes to be conducted to create awareness regarding the same. As the sample size is small, further qualitative studies covering a large population are required to substantiate and strengthen the results found in this study.

Financial support and sponsorship: Nil
Conflict of interest: Nil

References
1. DC Dutta’s Text book of Gynecology. Gynecologic problems from birth to adolescence. 6th edition Jaypee publications (p) ltd, Calcutta, India 2013;546 -550.
2. Sanjeev M Chaudhary and Vasant R Dhage. A Study of Anemia Among Adolescent Females in the Urban Area of Nagpur. Indian J Community Med. 2008;33(4):243–45.
3. Toteja GS1et al. Prevalence of anemia among pregnant women and adolescent girls in 16 districts of India. Food Nutr Bull. 2006;27(4):311-15.
4. Veena Melwany, Manju Dubey, Amreen Khan, Manju Toppo, Yachana Choudhary, Angelin Priya. A study to assess prevalence of anemia amongst adolescent girl residing in selected slum of Bhopal city. International journal of community Medicine and Public health 2018;5(3):1096-99.
5. Basu S, Basu S, Hazarika R, Parmar V. Prevalence of anemia among school going adolescents of Chandigarh Indian Pediatr. 2005;42(6):593-97.
6. Dhuppar P, Patel S, Maski R, Bhattar A. Anemia prevalence in adolescent school going girls. International Journal of Recent Scientific Research 2017;8(4):16364-66.
7. Meenal Vinay Kulkarni, P M Durge, N B Kasturwar. Prevalence of anemia among adolescent girls in an urban slum. National Journal of Community Medicine 2012;3(1):108
8. P S Rakesh Prevalence of Anaemia in Kerala State, Southern India - A Systematic Review. J Clin Diagn Res. 2017;11(5):LE01–LE04.
9. Upadhye JV, Upadhye JJ. Assessment of anaemia in adolescent girls. Int J Reprod Contracept Obstet Gynecol. 2017;6(7):3113-3117.
10. Bulliyy G1, Mallick G, Sethy GS, Kar SK Hemoglobin status of non-school going adolescent girls in three districts of Orissa, India. Int J Adolesc Med Health. 2007;19(4):395-406.
11. Kumar A et al. Study of anemia among adolescent school girls and young adults International Journal of Advances in Medicine Int J Adv Med. 2018 Aug;5(4):877-881 http://www.ijmedicine.com
12. Anisa M Durrani. Prevalence of Anemia in Adolescents: A Challenge to the Global Health. Acta Scientific Nutritional Health 2018;2(4): 24-27.
13. Anurag Srivastava, Rakesh Kumar, Mukesh Sharma. Nutritional anaemia in adolescent girls: an epidemiological study IJCMPH 2016;3(4):276-80.
14. Adolescent Anaemia Press Information Bureau, Government of India, Ministry of Health and Family Welfare 12-March-2013 13:18 IST
15. CMS Rawat SK Garg, JV Singh, M Bhatnagar, H Chopra, SK Bajpai. Socio Demographic Correlates of Anaemia among Adolescent Girls in Rural Area of District Meerut (U.P.) Indian journal of community medicine 2001;26(4):173.