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Table of Contents
STUDENT SECTION
Year : 2020  |  Volume : 21  |  Issue : 1  |  Page : 100-103

The knowledge and attitude towards anaemia amongst adolescent girls


1 III Year B.Sc. Nursing, Chettinad College of Nursing, Chettinad Academy of Research and Education, Kanchipuram, Tamil Nadu, India
2 Assistant Professor, Chettinad Academy of Research and Education, Kanchipuram, Tamil Nadu, India

Date of Submission10-May-2020
Date of Decision18-Jun-2020
Date of Acceptance20-Jun-2020
Date of Web Publication14-Sep-2020

Correspondence Address:
Mrs. Ponnambily Chandy Jobin
Chettinad College of Nursing, Chettinad Academy of Research and Education, Kanchipuram, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/IJCN.IJCN_30_20

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  Abstract 

General daily iron requirement expands 2–3 folds during adolescence because of high development spurt and the loss of 12.5–15 mg iron every month during menstruation. Therefore, adolescent girls are vulnerable for iron deficiency anaemia if dietary intake is not sufficient to meet the demands. Thus, the investigators wished to conduct a study to assess the knowledge and attitude towards anaemia amongst adolescent girls in Kanchipuram district, Tamil Nadu. A descriptive research design was used. The population was adolescent girls in the age group of 18 and 19 years, and the sample size was 40. Simple random sampling was used to select the samples. A knowledge and attitude questionnaire developed by the investigators was used to collect data. The study findings showed that the majority of the study participants had a high level of knowledge regarding anaemia 37 (92.5%) and only 3 (7.5%) participants were having a moderate level of knowledge. However, 31 (77.5%) of the study participants expressed moderate level of attitude and none of them had a high level of attitude towards anaemia. All participants (40 [100%]) stated that the inclusion of iron-rich foods in the daily menu is essential to prevent anaemia. Study findings reveal generally good knowledge and moderately acceptable level of attitude.

Keywords: Adolescence, adolescent girls, anaemia, attitude, knowledge


How to cite this article:
Dhivakar M, Iswariya M, Jobin PC. The knowledge and attitude towards anaemia amongst adolescent girls. Indian J Cont Nsg Edn 2020;21:100-3

How to cite this URL:
Dhivakar M, Iswariya M, Jobin PC. The knowledge and attitude towards anaemia amongst adolescent girls. Indian J Cont Nsg Edn [serial online] 2020 [cited 2020 Oct 1];21:100-3. Available from: http://www.ijcne.org/text.asp?2020/21/1/100/295036


  Introduction Top


'Anaemia is a condition in which the number and size of red blood cells (RBCs), or the haemoglobin (Hb) concentration, falls below an established cut-off value, consequently impairing the capacity of the blood to transport oxygen around the body' (p. 1).[1] Anaemia is an indicator of both poor nutrition and poor health. Anaemia is a condition where the quantity of red platelets (RBCs) and their oxygen-carrying capacity is lacking to meet the body's physiological needs. It is a condition when the ordinary number of RBCs (<4.2 million/μl) or Hb level <12 g/dl) in females and <13 in males goes below the expected levels in blood.[2] Worldwide, it is the most widely recognised and resolute nutrition issue influencing around 2 billion of the total population having a significant effect on human well-being and social and monetary advancement, and more than 89% of this burden is reported in low-income nations.[3],[4]

Even though anaemia can happen in all phases of life, it is more common during the period of adolescence since the general iron necessity expands 2–3 folds at this time due to high development spurt and the loss of 12.5–15 mg iron every month during menstruation. Iron deficiency during puberty has irreversible negative consequences for their reproductive development throughout their life and beyond. Pregnancy during adolescence with anaemia increases the maternal morbidity and mortality as well as the occurrence of poor maternal birth results such as stillbirth, low birth weight and prematurity and decreases the iron status of the newborn baby.[5],[6] The effect of anaemia amongst adolescent girls is as yet a prevailing issue internationally, in spite of the fact that there are explicit activities such as empowering daily intake of iron-rich foods through dietary change, health-related instructions, treatment and deworming and iron supplementation to improve the iron status amongst adolescent girls.[7]

Various researchers have conducted studies on anaemia amongst adolescent girls from various settings of the world. A study conducted in Thailand to determine the prevalence and causes of anaemia amongst high school students showed that 19 out of 227 participants (8.30%) had anaemia, and iron deficiency was the main cause of anaemia.[8] Another cross-sectional study conducted in Ethiopia showed that the overall prevalence of anaemia amongst adolescent girls was 25.50%, and dietary diversity score, household food security status and living status of the adolescents were the key determinants of anaemia amongst the study participants.[9]

In South India, a cross-sectional study conducted amongst 257 adolescent girls to estimate the prevalence of anaemia and its associated factors showed that 21% of the study participants had anaemia and the risk factors associated were the presence of cysts in stool and menstruation. Hand washing after toileting and before food intake, footwear usage and jaggery consumption were identified as protective factors.[10] Similarly, another cross-sectional study conducted amongst 255 adolescent girls showed that the overall prevalence of anaemia was found to be 48.63% and the same study reported high prevalence amongst late adolescents and those belonging to low socio-economic status.[11]

The above-mentioned studies reveal the existing prevalence of anaemia amongst adolescent girls. The high prevalence can be reduced through lifestyle modifications by instilling knowledge and attitude towards anaemia amongst them. A study conducted to assess the knowledge, attitude and peer influences related to anaemia in South Africa showed that only 43.9% of them had adequate knowledge, and there was no significant relationship between knowledge and attitude towards anaemia amongst them.[12] An experimental study conducted amongst urban Tanzanian adolescent school girls to observe the effect of a communication programme on compliance with weekly iron supplementation showed that the knowledge of anaemia increased significantly in all schools after the intervention.[13] A study done in India on the knowledge and attitude of rural adolescent girls revealed that there was inadequate knowledge and neutral attitude amongst adolescent girls regarding the prevention of iron deficiency anaemia. There was a positive correlation between the knowledge and attitude of adolescent girls regarding the prevention of anaemia. The study concluded that adolescent girls should be sensitised with the knowledge of prevention of anaemia to enhance their understanding and to have a better attitude.[14] An observational study in North India revealed that 55.9% of adolescents were found to be anaemic. Knowledge and practices of personal hygiene were lower in anaemic girls compared to non-anaemic girls. The extent of deficit of iron-rich food consumption was low in both anaemic and non-anaemic girls. A study to assess the prevalence of anaemia amongst adolescent girls in the selected Allied Health Science College in 2019 showed that 56% of them had low Hb levels (<12 g/dl).[15] As a follow-up study, the investigators, who were nursing students, wished to conduct a study to assess the knowledge and attitude towards anaemia amongst adolescent girls in Kanchipuram district, Tamil Nadu.

Objectives

  • To assess the knowledge and attitude towards anaemia amongst adolescent girls
  • To find the association between knowledge on anaemia with the selected demographic variables of adolescent girls.



  Methodology Top


A descriptive research design was used. Students from the Allied Health Sciences College, in which a previous study revealed half the proportion of students (56%) to have anaemia (<12 g/dl),[15] were recruited for the study. A total of forty adolescent girls between the age group of 18–19 years who did not have a diagnosis of anaemia were randomly selected using a sampling frame from sixty students in five batches, who were willing to participate in the study. The data collection instrument was developed by the investigators. The reliability and validity of the tool was done with the help of nursing experts. It had two sections such as (1) demographic data and (2) knowledge and attitude questionnaire. The knowledge part included the questions on definition, symptoms, management and prevention of anaemia (15 questions) and attitude questionnaire included the level of perception regarding danger of anaemia, importance of implementing of healthy lifestyle to prevent anaemia and education of anaemia amongst peer groups and family (ten statements). The investigators applied the interquartile range to score the data and divided into first (Q1), second (Q2) and third quartiles (Q3). These quartiles were named as low, medium and high level of knowledge/attitude, respectively. The duration of the study was 7 days. Approvals from the Undergraduate Committee and Human Ethics Committee were obtained. Formal approval was also obtained from the principal of the selected college. The investigator introduced the self to the participants, and the purpose of the study was explained to ensure better cooperation during the data collection period. Descriptive statistics such as frequency distribution, percentage, mean and standard deviation and inferential statistics such as Chi-square test were used to analyse the data.


  Results and Discussion Top


[Table 1] shows the frequency and percentage distribution of demographic variables of adolescent girls.
Table 1: Distribution of adolescent girls based on their demographic variables

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In this study, older adolescent girls only were included in the study. Majority of them were from urban (85%) and had more than four members in the family (87.5%). Many (47.5%) had a family income of more than Rs. 20,000/month, as these participants were from urban areas of Chennai. Similarly, a study on anaemia-related knowledge amongst adolescent females in South India showed that the majority of the study participants belong to nuclear families (85%) and had a family income of more than Rs. 20,000/month (42%).[16]

The majority of the study participants had a high level of knowledge regarding anaemia 37 (92.5%) and only 3 (7.5%) were having a moderate level of knowledge. None of them reported with a low level of knowledge on anaemia [Figure 1]. However, 31 (77.5%) of the study participants expressed a moderate level of attitude and none of them had a high level of attitude towards anaemia, which supported the findings of the study on 56% prevalence of anaemia amongst adolescent girls [15] in the same setting. Despite the good knowledge on anaemia, the low-to-moderate level of attitude might be a contributory factor of high prevalence of anaemia amongst the adolescent girls [15] in the same study setting. On the contrary, another study conducted in Tamil Nadu showed that the majority of adolescent girls (57%) had inadequate knowledge, only 43% had a moderate level of knowledge and none of the adolescent girls had adequate knowledge regarding the prevention and management of anaemia.[17]
Figure 1: Distribution of adolescent girls according to the level of knowledge and attitude

Click here to view


In the present study, all the study participants (40 [100%]) correctly defined the anaemia as a state of condition with decreased Hb, listed signs and symptoms and side effects of anaemia in later stages of life. The majority of the participants answered the types of iron-rich foods (32 [80%]) and preventive measures of anaemia (25 [62.5%]) correctly. However, study results from Ethiopia showed that more than three-fourths, 332 (78.5%) of the participants, had not heard about anaemia. The majority (240 [56.7%]) of participants had poor knowledge of anaemia. Around 43.30% of adolescent girls had good knowledge of anaemia. Of all the study participants, 162 (38.3%) had good knowledge on the causes of anaemia, 178 (42%) on signs and symptoms of anaemia, 196 (46.3%) on the consequences of anaemia and 183 (38.5%) on prevention of anaemia.[18] The high knowledge level in the majority of participants in this study could be due to the fact they are allied health professionals who have learnt about anaemia.

All participants (40 [100%]) stated that the inclusion of iron-rich foods in the daily menu is essential to prevent anaemia. The majority of them showed a favourable attitude on the importance of iron tablets (31 [77.5%]), the role of Vitamin C in iron absorption (28 [70.0%]) and the necessity of prevention of anaemia (37 [92.5%]), which is a keystone for achieving public health. Similarly, another study from Karnataka showed that 160 (91%) participants had heard of anaemia; 53 (33%) girls said that poor diet is the only cause for anaemia; 49 (31%) told tiredness is the only feature of anaemia; 20 (13%) answered anaemia impacts on physical growth and learning process and decreases work capacity; and 88 (55%) girls reported they will consult a doctor and take iron tablets.[19] Even though the majority revealed a high level of knowledge in this study, the prevalence of anaemia in the same group reported in a previous study [15] suggests that there may be other factors which may lead to anaemia. This study shows the need for further study on practice related to nutritional intake, dietary habits and other factors that may affect the Hb levels in adolescent girls emphasising the fact that transfer of knowledge into practice is important. The study did not examine the practice related to the prevention of anaemia.

The present study showed a significant association between the age in years, the socio-economic background and level of knowledge on anaemia amongst adolescent girls. On the contrary, no significant associations were found between selected demographic variables and the knowledge scores in a study conducted amongst Pre-University College for girls in Mangaluru, India.[20]


  Conclusion Top


Anaemia is seen as a major public health issue in society and still prevalent amongst the adolescent girls. The present study showed that adequate knowledge versus inadequate attitude towards anaemia might be contributory factor of the same. Based on the present study findings, the investigators gave health education with an emphasis on determinants of and complications of anaemia in the later stages of reproductive life. Despite the existing educational programmes and knowledge levels, reiteration of good food habits, college-based iron and folic acid supplementation and regular nutritional screening should be implemented to help adolescent girls who are in danger of anaemia.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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World Health Organization. Global Nutrition Targets 2025: Anemia Policy Brief. World Health Organization; 2014. Available from: https://www.who.int/nutrition/publication/globaltargets2025_policybrief_anemia/en/. [Last accessed on 2020 Jun 20].  Back to cited text no. 1
    
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World Health Organization. Prevention of Iron Deficiency Anemia in Adolescents: Role of Weekly Iron and Folic Acid Supplementation. World Health Organization; 2011. Available from: http://www.searo.who.int/entity/child_adolescent/documents/sea_cah_2/en/. [Last accessed on 2020 Jun 20].  Back to cited text no. 3
    
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Kassebaum NJ; GBD 2013 Anemia Collaborators. The global burden of anemia. Hematol Oncol Clin North Am 2016;30:247-308.  Back to cited text no. 4
    
5.
Black MM. Integrated strategies needed to prevent iron deficiency and to promote early child development. J Trace Elem Med Biol 2012;26:120-3.  Back to cited text no. 5
    
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Centers for Disease Control and Prevention. Childhood Nutrition Facts. Centers for Disease Control and Prevention; 2015. Available from: https://www.cdc.gov/healthyschools/nutrition/facts.htm. [Last accessed on 2020 Jun 20].  Back to cited text no. 6
    
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Kozuki N, Lee AC, Katz J; Child Health Epidemiology Reference Group. Moderate to severe, but not mild, maternal anemia is associated with increased risk of small-for-gestational-age outcomes. J Nutr 2012;142:358-62.  Back to cited text no. 7
    
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Sarakul O, Kotepui M, Marasa R, Thepwarin W. Anemia and iron deficiency anemia in high school girls in Nakhon Si Thammarat, Thailand. J Health Sci Med Res 2018;36:197-204.  Back to cited text no. 8
    
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Gonete KA, Tariku A, Wami SD, Derso T. Prevalence and associated factors of anemia among adolescent girls attending high schools in Dembia District, Northwest Ethiopia, 2017. Arch Public Health 2018;76:79.  Back to cited text no. 9
    
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Siva PM, Sobha A, Manjula VD. Prevalence of anaemia and its associated risk factors among adolescent girls of central Kerala. J Clin Diagn Res 2016;10:LC19-23.  Back to cited text no. 10
    
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Chandrakumari AS, Sinha P, Singaravelu S, Jaikumar S. Prevalence of anemia among adolescent girls in a rural area of Tamil Nadu, India. J Family Med Prim Care 2019;8:1414-7.  Back to cited text no. 11
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Govender D, Naidoo S, Taylor M. Knowledge, attitudes and peer influences related to pregnancy, sexual and reproductive health among adolescents using maternal health services in Ugu, KwaZulu-Natal, South Africa. BMC Public Health 2019;19:928.  Back to cited text no. 12
    
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Resmi.S, Latheef DF, Vijayaraghavan DR. A descriptive study to assess the knowledge and attitude of adolescence girls regarding prevention of iron deficiency anemia in selected rural communities in Bangalore. Int J Pharm Bio Sci 2017;8:179-82.  Back to cited text no. 14
    
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Asher T, Shobana M, Abarna A, Aamina A, Bharathi B. The prevalence of anemia among the adolescent girls in a selected college in Kanchipuram. Medico Legal Update 2020;20:28-32.  Back to cited text no. 15
    
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Pareek P, Hafiz A. A study on anemia related knowledge among adolescent girls. Int J Nutr Food Sci 2015;4:273-6.  Back to cited text no. 16
    
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Kapu AK, Sadasivuni R, Mitaigiri C. Knowledge, attitudes and practices of adolescent school girls regarding prevention of iron deficiency anaemia. Int J Community Med Public Health 2019;6:2694.  Back to cited text no. 17
    
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Mengistu G, Azage M, Gutema H. Iron deficiency anemia among in-school adolescent girls in rural area of Bahir Dar city administration, North West Ethiopia. Anemia 2019;2019:1097547.  Back to cited text no. 18
    
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Angadi N, Ranjitha A. Knowledge, attitude, and practice about anemia among adolescent girls in urban slums of Davangere City, Karnataka. Int J Med Sci Public Health 2016;5:416-2.  Back to cited text no. 19
    
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Johnson N, Noufeena DY, Joseph P, Aranha PR, Shetty AP. A study on knowledge regarding prevention of iron deficiency anemia among adolescent girls in selected pre-university colleges of Mangaluru. Int J Curr Res Rev 2016;8:5.  Back to cited text no. 20
    


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