IMPACT OF EDUCATION INTERVENTION ON NUTRITION KNOWLEDGE OF IRON DEFICIENCY ANAEMIA AMONG POST ADOLESCENT GIRLS

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1 Asian J. Dairy & Food Res., 32 (3) : , 2013 AGRICULTURAL RESEARCH COMMUNICATION CENTRE / indianjournals.com IMPACT OF EDUCATION INTERVENTION ON NUTRITION KNOWLEDGE OF IRON DEFICIENCY ANAEMIA AMONG POST ADOLESCENT GIRLS S.M. Savita,* Kamal G. Nath and Sunanda Sharan Dept. of Food Science and Nutrition, GKVK, Bangalore , India Received: Accepted: ABSTRACT Approximately 70% of adolescents in India suffer from anaemia, making it one of the most important public health issues. Public intervention programs are essential to combat iron deficiency. Nutrition knowledge and nutrition is also considered a long term approach to combat iron deficiency anaemiaa total of 207 girls in the age group of 18 to 25 were screened for the hemoglobin status and the knowledge assessed among the volunteer subjects (156 girls) using the tool developed for the purpose. Nutrition intervention was carried out through a short lecture using the visual aids (flash cards, posters and display of raw foods such as rich sources, enhancers and inhibitors of iron absorption) followed by discussion. A folder was developed consisting brief information regarding iron, anaemia, sources, enhancers, inhibitors, consequences of anaemia, fortification. The knowledge assessment tool was tested thrice during the study period - initially before the, soon after the nutrition and one month later and the subjects were classified on the scores obtained. The classification was made as low, medium and high based on mean ± ½ SD. Thirty percent of the subjects scored low (< 17), per cent scored medium (17-23) and per cent scored high (> 23) before the. Assessment of the knowledge immediately after the programme revealed that per cent of subjects scored high (> 23) where as 2.56 per cent scored medium (17-23) and one month later, the knowledge level revealed that per cent scored high (> 23) and 4.49 per cent scored medium (17-23) reflecting that the retention of knowledge is quite satisfactory during follow up assessment. The percentage of correct response ranged from 39 to 69 percent previously followed by 71 to 96 percent at immediately after intervention and 70 to 91 per cent at one month after intervention. The response improved after intervention that could help to combat micronutrient malnutrition. Key words: Anaemia, Education intervention, Nutrition knowledge, Post adolescent girls. INTRODUCTION Adolescents account for 22.8 per cent of Indian population; that means 230 million Indians are adolescents in the age group of 10 to 19 years. Further, the adolescent girl s population is found to be 22.8 per cent in Karnataka which accounts for 5.9 lakhs (Census of India, 2001). Iron deficiency is the most prevalent nutritional problem in the world. Approximately 1.3 billion individuals in the world suffer from anaemia, making it one of the most important public health issues on the nutritional agenda (Berger et al., 1997). The South Asian region is seen to have the highest prevalence of anaemia and iron deficiency. Countries in South Asia particularly India (50-90%), Bangladesh (40-74%) and Srilanka (58%) have very high prevalence among school children and adolescents (Florentino, 2003). The prevalence of anaemia among adolescents in India is estimated to be 69.7 per cent for years (INACG, 2004). The major causative factor of iron deficiency and anaemia is not only the low iron intake, but also low iron absorption which could be due to the consumption of insufficient absorbable iron from cereal based vegetarian diets coupled with excessive body needs among women (Mann et al., 2002). Other possi ble causes are i ntestinal worm infestations, malaria and vitamin A deficiency. Iron * Corresponding author s savitagkvk@gmail.com and address KVK, Hadonahaili

2 deficiency has been specifically linked with depressed immune function and resistance to infection, diminished work capacity and increased risk of delivery of preterm and low birth weight infants. In infants and children it has been associated with diminished cognitive development and learning capacity with effects that may last into adulthood. Thus, Public intervention programs are essential to combat iron deficiency. Most of the government programmes of health and nutrition are being beamed to children, adolescents (11 to 18 years), pregnant and nursing mothers, where as young adult girls (18-25 years) still remain a largely neglected and difficult to measure population. Hence, the proposed study is focused to assess the impact of nutrition on nutrition knowledge of the subjects with special reference to dietary intake of iron.. Nutrition knowledge and nutrition are also considered a long term approach to combat iron deficiency anaemia. Nutrition is equally important as that of any as it helps to build up good nutritional status, firstly the women herself, then her family and thus the community there by increasing the work out put and on the whole benefits the national economy. MATERIALS AND METHODS A total of 207 girls in the age group of 18 to 25 years were screened for the hemoglobin status (Cyanomethemoglobin method, Raghuramulu et al., 2003) residing at Ladies Hostel, University of Agricultural Sciences, H ebbal, Bangalore, Karnataka. A schedule to assess the knowledge of the subjects with respect to iron and its importance in human nutrition was developed and tested. The schedule consisted of 15 questions with multiplechoice answers and 15 true or false statements (Annexure I). The tool was administered thrice during the study period initial (before the ), Vol. 32, No. 3, 2013 TABLE 1: Distribution of subjects by hemoglobin status. 215 soon after the nutrition and one month later. A total of 156 volunteer girls out of 209 screened for hemoglobin status were assessed for their nutritional knowledge. Nutrition intervention was carried out for 156 girls in 8 batches consisting 20 girls per batch. The visual aids used for the programme consisted of flash cards, posters and display of raw foods (Rich sources, enhancers and inhibitors of iron absorption). A folder was developed consisting brief information regarding iron, anaemi a, sources, enhancers, i nhibitors, consequences of anaemia and fortification. This was distributed to all the subjects immediately after the lecture. A short lecture for 30 minutes was delivered using the visual aids followed by discussion and reassessment of the knowledge after the nutrition class. RESULTS AND DISCUSSION H emoglobin status of the study population: Hemoglbin level is the most commonly used indicator to detect anaemia at the field level. Thus, a preliminary screening of the study population (n = 207) for hemoglobin status was carried out and the same has been presented in Table 1 The classification of different grades of anaemia as given by ICMR 2001 was used. It may be observed that majority of the subjects (53.14 %) were found to be moderately anaemic (7-9.9 g / dl) with a mean of 8.87 ± 0.88 g/dl. A slightly lower percentage (42.51%) of the subject was mildly anaemic ( g/dl) with a mean of ± 0.43 g/dl. A very small percentage of the subjects (1.44%) were in the normal hemoglobin level of > 12 g/dl with a mean of ± 0.10 g/dl. Some subjects (2.89 %) were severely anaemic (< 7 g/dl) with a mean of 6.34 ± 0.62 g/dl. Thus, the prevalence of anaemia in the study population was very high (98.66%) with a mean Hemoglobin Status 1 n Percent Mean ± SD(g/dl) Range (g/dl) < 7 (Severe) ± (Moderate) ± (Mild) ± > 12 (Normal) ± Total ± : ICMR 2001 (n = 207)

3 216 ASIAN JOURNAL OF DAIRY & FOOD RESEARCH hemoglobin level of 9.59 ± 1.28 g/dl. Gawarikar et al., (2002) reported the prevalence rate of 96.5% among adolescent girls of Ujjain city. Machado and Prakash (2004) reported 92 per cent of women to have hemoglobin less than 12 g/dl. The prevalence of moderate and mild anaemia among adolescent girls based on the data of 16 districts of country was 50.9 and 32.1 per cent respectively (ICMR, 2001). In the present study the prevalence of moderate and mild anaemia among the subjects was found to be and per cent respectively. Ten per cent higher prevalence in mild anaemia category was observed in the present study as compared to the data given by ICMR (2001) and the reason could be the consumption of only vegetarian foods with less absorbable iron in the hostel diet. Malhotra and Passi (2004) studied the hemoglobin status of adolescent girls in rural blocks of Delhi, Rajasthan and Uttar Pradesh, and reported that the incidence of mild, moderate and severe anemia was found to be 50 per cent, 44.4 per cent and 2.8 per cent respectively and only 2.8 per cent of the subjects had normal hemoglobin levels. Similarly the prevalence of anaemia in the present study showed a similar trend to that of above-mentioned study. This emphasizes the need of this group (Young adults or post adolescent girls) to be considered as the vulnerable group so that several long term strategies could be planned for them, which can improve their iron status. Impact of intervention on nutrition knowledge of the subjects: Adolescent girls, particularly need proper nutrition support as it is a period of increased nutritional requirements. There is a need for these adolescents to be aware of their requirements which could be imparted to them through nutrition. Nutri tion knowledge assessment is a necessary step before planning nutrition for any population. Based on the level of present nutrition knowledge a proper nutrition could be planned with follow-up to make it more efficient. Thus the objective was to assess the knowledge of the subjects regarding iron and associated factors followed by intervention program. The subjects were classified based on the scores obtained before, immediately after the and one month later. The classification was made as low, medium and high based on mean ± ½ SD. The results of the same are presented in Table 2. Thirty percent of the subjects scored low (< 17), per cent scored medium (17-23) and per cent scored high (> 23) before the. Assessment of the knowledge immediately after the programme revealed that per cent of subjects scored high (> 23) where as 2.56 per cent scored medium (17-23) and one month later, the knowledge level was reassessed using the same questionnaire which revealed that per cent scored high (> 23) and 4.49 per cent scored medium (17-23) reflecting that the retention of knowledge is quiet satisfactory during follow up assessment. Meenakshi and Vyas (2003) used a questionnaire to assess the nutritional knowledge of adolescent girls which contained 100 questions with multiple choices. A pre-test and post test study was conducted within the interval of seven days on the same questionnaire. The results indicated about 30 per cent gain in knowledge by comparing the scores of pre-test and post test, as against to a high score (> 23) by the subjects in the post tests in the present study. Upadhyay et al., (2002) observed the impact of single vs. combination of media on nutrition knowledge and hemoglobin status. After a period of 60 days a significant rise in post exposure knowledge scores of both the groups was observed. Between TABLE 2: Classification of subjects based on nutrition knowledge (n = 156) Nutrition Knowledge Previous n % Immediately after n % One month after n % Low (< 17) Medium (17-23) High (> 23)

4 the groups multimedia group scored significantly higher than print media group. Mean hemoglobin concentrations were found to be higher though nonsignificant. Similarly in the present study the subjects were exposed to short lecture, and other visual aids such as folder, flash cards, posters and display of raw foods which showed a significant rise in post exposure knowledge scores. Table 3 showed the percent improvement in the knowledge level after intervention. The subjects, who had scored low previously, scored medium (2.13%) and high (97.87%) immediately after. The subjects who scored medium previously per cent scored high and 1.52 per cent scored medium itself. Of the subjects scored high previously percent scored high itself (> 23) and 4.65 percent scored medium (17-23). Of the subjects scored medium at immediately after 50 per cent scored high (> 23) and 50 per cent scored medium itself at one month after nutrition. Of the subjects who scored high Vol. 32, No. 3, at immediately after percent scored high itself whereas 3.29 percent scored medium (17-23). The mean score increased after. Thus, intervention can bring a significant increase in the knowledge levels Nagi et al., (2003) revealed that Dietary counseli ng and supplementation as ideal and favorable solution to the problem of anaemia. Table 4 shows the impact of intervention on nutrition knowledge of subjects. The under graduate subjects scored ± 3.34 previously which increased to 24.8 ± 2.84 at immediately after intervention and further increased to ± 3.2 at one month after intervention. In postgraduate subjects the previous score was ± 4.38, which increased to 25 ± 2.87 and further changed to ± 3.79 at immediately after and one month later after respectively. In Ph.D. subjects the previous score was ± 3.78, which increased TABLE 3: Per cent improvement in the knowledge level after intervention (n = 156) Nutrition knowledge Immediately after One month after Medium High Medium High N % n % n % n % Low (< 17) Medium (17-23) High (> 23) TABLE 4: Impact of intervention on nutrition knowledge of subjects. (n = 156) Educational status Previous Immediately after 1 month after UG Mean SD PG Mean SD Ph.D. Mean SD **: 1% level NS: Non significant Between previous and Immediately after t value Between Immediately after and one month after Between previous and one month after 1.79E-39* * 1.79E-39* * 5.45E-37* * 1.40E-17* * 0.65 NS 4.21E-14* * 4.78E-06* * 0.10 NS 8.3E-05**

5 218 ASIAN JOURNAL OF DAIRY & FOOD RESEARCH TABLE 5: Percentage of correct response as answered by the subjects. Subject Previous (%) Soon after (%) 1 month after (%) Causes (3) Consequence (2) Enhancer (5) Fortification (2) General (4) Inhibitors (4) Processing (2) Requirement (2) Sources (6) Note: Figures in parenthesis represent the number of questions to ± 2.37 and further changed to ± 2.7 at immediately after and one month later. Thus the knowledge scores obtained by each group pre and post programme increased significantly at one per cent level. Table 5 depicts the percentage of correct response as answered by the subjects. The percentage of correct response ranged from 39 to 69 percent previously followed by 71 to 96 percent at immediately after intervention and 70 to 91 per cent at one month after intervention. Thus, the response improved after intervention. The results of study conducted by Dutta et al., 2004 revealed that 60 per cent of the girls (17-19 years) had correct knowledge about sign of anaemia and cheapest source of iron, 72 percent of them knew the dietary cause of the disease. Their knowledge regarding the prevalence of anaemia among Indian women and the normal hemoglobin level of them, however was poor as only 26 per cent and 37 per cent of the girls could correctly answer in these respects. Similarly in the present (n = 156) study 69 per cent answered correctly for consequences, 57 percent for sources and 53 per cent for the requirement of iron. Hence basic and nutrition is very essential especially for women in order to improve the nutritional status of a community. CONCLUSION There is a need to create nutrition programmes in elementary schools, colleges at community levels for young adult girls as most eating habits are more likely to be shaped in younger ages. It is considered a long term strategy to over come nutrient deficiencies and thereby help to combat the nutrient deficiencies of the family as a whole when adolescents and young adult girls are educated. Similar study can be conducted in government run hostels and al intervention could be included in the ongoing programmes (State and Central) to empower young adults, regarding health and nutrition. Thus intervention brings a significant increase in the knowledge level, which could be used as one of the long-term strategies to combat micronutrient mal nutrition among young girls. REFERENCES Berger, J., Aguoyo, V.M., Miguel, J.L., Lujan C., Tellez, W. and Traissac, P., 1997, Definition and prevalence of anemia in Bolivian women of child bearing age living at high attitudes: The effect of iron-folate supplementation. Nutr. Rev., 55 (6): Census of India, 2001, Office of the Director of Census Operations, Karnataka Dutta, S., Singh, R. and Chaudhuri, D., 2004, A study on nutritional awareness of adolescent (17-19 years) college girls. Applied Nutrition, 29 (1&2): Florentino, R.F., 2003, The burden of iron deficiency and anaemia in Asia: Challenges in prevention and control. Iron deficiency anaemia. Proc. IX Asian congress of Nutrition. Nutrition Goals for Asia vision 2020: Gawarikar, R.S., Gawarikar, S.B. and Tripathi, B.C., 2002, Prevalence of anaemia in adolescent girls of Ujjain in western M.P. Ind. J. Nutr. Dietet., 39: ICMR, 2001, Micronutrient deficiency disorders in 16 districts of India. Part- I Report of an ICMR Task force study District Nutrition Project, New Delhi. 30

6 Vol. 32, No. 3, 2013 INACG, 2004, India country paper, Department of Women and Child Development, Ministry of Human Resource Development, Government of India. Symposium, Lima, Peru Machado, P.A. and Prakash, J., 2004, Assessment of Hemoglobin status and Anaemia among women of child bearing age of Honavar taluka- A coastal area of Karnataka. XXXVI Annual Meeting of NSI: 92. Malhotra, A. and Passi, S.J., 2004, Incidence of iron deficiency anaemia among adolescent girls in rural blocks of North India. Proceedings of National Symposium on child health and nutrition. Maharaja Sayajirao University, Baroda: Mann, S.K., Kaur, S. and Bains, K., 2002, Iron and energy supplemetnation improves the physical work capacity of female college students. Food and Nutrition Bulletin. 23 (1): Meenakshi, M. and Vyas, 2003, Nutritional knowledge to adolescent girls. IX Asian congress of Nutrition: 237. Nagi, M., Jain, R. and Malhotra, J., 2003, Impact of dietary counseling and supplementation of the nutritional status of selected anaemic adolescent girls. IX Asian Congress of Nutrition: 237. Raghuramulu, N., Nair, M.K. and Kalyanasundaram, S., 2003, proteins, aminoacids and metabolites. A manual of laboratory techniques, NIN, ICMR: Upadhyay, S., Kumar, A.R., Raghuvanshi, R.S. and Singh, B.B., 2002, Impact of Nutrition Education on knowledge and haemoglobin status of Hill women of India, Proceedings of Workshop on Research Methodologies for Micronutrient Research:

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