CORRELATES OF SOCIOECONOMIC, SCHOLASTIC AND NUTRITIONAL STATUS WITH HAEMOGLOBIN LEVELS OF ADOLESCENT GIRLS IN CENTRAL INDIA

Transcription

1 CORRELATES OF SOCIOECONOMIC, SCHOLASTIC AND NUTRITIONAL STATUS WITH HAEMOGLOBIN LEVELS OF ADOLESCENT GIRLS IN CENTRAL INDIA REKHA SHARMA UGC Academic Staff College, Rastrasant Tukadoji Maharaj Nagpur University, Nagpur Corresponding Author: ABSTRACT: The effect of socioeconomic conditions, dietary intake, height, weight and scholastic performance on hemoglobin status was evaluated in 100 adolescent girls aged years. Except fat and Vitamin A the mean intake of energy, protein, iron calcium and vitamin C were below the ICMR standards. Hemoglobin status revealed that 33% girls suffered mild and 4% from moderate anemia. The correlation between haemoglobin and socioeconomic and nutritional status showed following results. Mother's education (r = 0.239, p<0.05) showed positive and significant correlation whereas father's education (r = -0.04, p > 0.05), family size (r = , p>0.05) and income (r = , p>0.05) showed negative but insignificant correlation with haemoglobin. Amongst the nutrients, fat (r= -0.25, p<0.01) showed negative and significant correlation, protein (r= 0.109, p> 0.05), iron (r= 0.005, p>0.05) and Vitamin A (0.0015, p>0.05) showed positive but insignificant correlations. Calcium (r= , p>0.05) and Vitamin C (r = -0.06, p> 0.05) showed negative and insignificant correlation with hemoglobin. Weight of adolescent girls (r= 0.55, p <0.01) showed positive and significant and academic performance (r= 0.054, p >0.05) showed positive but insignificant correlation with haemoglobin status of adolescent girls. Key words: Adolescent girls, anemia, haemoglobin status, scholastic performance, Nutritional status, socioeconomic status was made to assess the correlation between hemoglobin level and socioeconomic and nutritional status of adolescent girls. INTRODUCTION: Adolescence is one of the most challenging periods in human development. The relatively uniform growth of childhood is suddenly altered by a rapid increase in the growth rate. These sudden changes create special nutritional needs. Adolescents are considered especially vulnerable nutritionally for several reasons. First, they have an increased demand for nutrients because of the dramatic increase in physical growth and development. Second, the changes in life style and food habits of adolescents affect nutrient intake and needs. Third, adolescents have special nutrient need associated with participation in sports, pregnancy, development of an eating disorder, excessive dieting, use of alcohol and drugs, or other situations common to adolescents (Spear 1996). Adolescents girls are very important section of our society as they are our potential mother and future homemakers. During adolescent period of human growth spurt, the risk of iron deficiency anaemia appears to be more for boys and girls and is common in rural and urban slums and it makes adolescents a stage of acute physiological stress (Gowarikar et al. 2002). Anaemia being a worldwide problem especially among adolescent the prevalence in India is reported to be 65.75% in under privileged community. This glaring deficiency in young adolescent girls may probably be due to low intake of haemopoietic nutrients since childhood increase demand for nutrients coupled with menstrual losses of iron (Deepa et al. 2004). Nutritional anemia, particularly iron deficiency anemia (IDA) is perhaps clinically the most wide spread nutrition deficiency disorder in the world today. The risk of iron deficiency is proportional to growth velocity and it increases during the adolescent growth spurt, the risk continues to remain high for girls because of menstrual blood loss, but subsides for boys (Tripathi et al. 2004). Numerous studies (Gowarikar et al., 2002; Prabhakaran, 2003; Shekar 2005; Kaur et al. 2006; Kalpana et al and Kowsalya et al ) among adolescent girls have shown that the prevalence of anaemia ranges from % in India. However data on prevalence of anaemia in adolescent girls of Central India is scanty hence the present study was undertaken. An attempt MATERIALS AND METHODS: 100 adolescent females aged years from a Higher Secondary Schools were randomly selected from Kaushalyadevi Maheshwari Mahila Mahavidyalaya, Nagpur, Maharashtra. The data for general information was collected by structured questionnaire. Diet survey was carried out by 24 hours dietary recall method (Thimmayamma, 1987) and was compared with Recommended Dietary Intake of ICMR (1988). The nutrient intake was calculated using Nutritive Value of Indian Foods (Gopalan et al. 2002) and were compared to Recommended Dietary Allowances of ICMR (2002). Heights and weights were taken as per the standard methods given by Jellife (1966) and were compared with fiftieth percentile of NCHS Standards (Bamji et al. 2003). The academic performance of adolescent girls of previous year was noted down. Haemoglobin estimation was done using cyanmethaemoglobin method (INACG, 1985). Anaemia was diagnosed according to WHO guidelines (Demaeyer, 1989). Simple correlation coefficient and regression equations were computed between haemoglobin, diet, nutrient, scholastic performance and anthropometric measurements (Garrett and Woodworth, 1969). RESULTS AND DISCUSSIONS : The age wise distribution of subjects showed 38% adolescent girls in 18 years of age, 18% in 16 years age group, 22% each in 17 years and 19 years age group. The mean age of adolescent girls was years. Fifty per cent girls were from joint family 38% belonged nuclear family and only 12.1 % girls were from extended family. The average number of members in the family was found to be Further data also shows that majority of parents (59% mother and 49% father) had their education up to under graduation, where as 30% mother and 41% father had their education up to graduation and very less percent parents studied up to post graduation level. With respect to total monthly income of family it was 140

2 observed that majority (40%) of the girls belong to families earning Rs. 10,000 to 20,000 per month whereas 22% girls belong to below families earning Rs 10,000. Nineteen per cent subjects belonged to each families earning Rs. 20,000 to 30,000 and above Rs 30,000 respectively. The average total monthly income of family was found to be Rs The per capita income of family was found to be Rs Food Habits and Meal Pattern : Majority (63%) of girls were vegetarian where as 35% were non vegetarian. Only two percent girls were eggetarian. Further it was observed that 57% subjects followed a three meal pattern, 25% a four meal pattern while 13 % girls were found to be consuming two meal pattern. Food Intake : The data presented in Table I shows that except the intake of other vegetables and sugar and jaggery, the intake of all the foods were below recommended intake. The intake of oils and fats and fruits was 90 % and 98.66% of the recommended intake respectively. The percent adequacy or cereals and pulses and green leafy vegetables were less than 30 %. The adolescent girls were found to be consuming staples in very less quantity. Less intake of cereals may be due to poor dietary choices and fast life style. Majority girls were found to be skipping breakfast due to early college timings and were found to be consuming fast foods and junk foods. This might have resulted in consumption of higher sugar and jaggery and oils and fats. Milk was found to be consumed in the form of coffee or tea; hence the intake of milk and milk products may also be less as compared to RDI. Several studies (Deepa, 2002; Kumari and Singh, 2003; Kowsalya et al. 2008) have also reported lower intake of foods and nutrients by the adolescent girls. Gowarikar et.al (2002) reported that the diet of adolescent girls of Ujjain city, Madhya Pradesh was basically cereal based with wheat as a staple food. Frequency of consumption of pulses, milk and milk product and fruits was very low. Tatia and Taneja (2003) studied the dietary intake of 256 tribal adolescent girls of Dhar district in Madhya Pradesh and reported that consumption of cereals and pulses was 70 per cent and 25 per cent respectively of recommended dietary allowance. The intake of green leafy vegetable was very low, while fruit intake was almost negligible. Hence the intake of nutrient was deficient in almost all the nutrients. Similarly, Zanvar et al., 2007 also noted inadequate consumption for all food groups especially for green leafy vegetables, roots and tubers, fruits and milk among 500 adolescent girls (13-18 years) of Marathawada region. Nutrient Intake : The percent adequacy of energy and protein was % and 65% respectively whereas for fats was 187%. In the current study, except the intake of fat and Vitamin A, the intake of all the nutrients were found to be below the recommended dietary intake. The iron intake of adolescent girls was very less (30.83%) than that of standards, girls need to ensure adequate intake of iron as they lose 0.5mg per day by way of menstruation.( Table II) The adolescent girls were more inclined towards fast foods than the regular meals, which might have resulted into higher intake of fats. The lower intake of nutrients by the adolescent girls have been reported by several researchers. Kumar et al. (2006) conducted a study on influence of family's vegetable cultivation on prevalence of anaemia among 80 adolescent girls in Allahabad and results also showed that intake of all the nutrients were comparatively less than the recommended dietary allowance except for fat. While assessing the prevalence of anaemia and dietary intake of blood forming nutrients of 180 adolescent girls from rural and urban areas of Dharwad taluka, Akkamahadevi (1996) found that the mean intake of energy (1532 kcal), protein (38.77 g), ascorbic acid (23.28 mg), vitamin B12 (0.56 μg), folic acid (81.63 μg) and iron (14.7 mg) was lower than the ICMR recommendations. Intake of vitamin B12 was significantly higher in urban girls (0.80 μg) compared to rural counterpart (0.32 μg/day). The restricted diets consumed by many adolescents frequently contain inadequate amounts of vitamins and minerals. Iron deficiency is one of the most common nutritional deficiencies and adolescents are at special risk (Ogunfeyitmi, 2002). Rapid growth, coupled with a fast lifestyle and poor dietary choices, can result in iron deficiency or anaemia. Teenage girls need to pay special attention to iron as the store depletes every month following menstruation. Anthropometric Measurement : The average weight of adolescent girls under study was Kg. The mean weight of 16 and 17 year old girls were 49 and kg respectively and were below NCHS standards (Table III). The mean weight of 18 and 19 years old girls were found to be kg and kg respectively which were surprisingly above the NCHS Standards. The mean height of girls was found to be The mean height of 16 year old girls was found to be where as that at 17 year old was found to be Thus the data shows that for 16 and 18 years the height of girls were below NCHS standards but for 17 and 19 years the height was above the NCHS standards. A study conducted by Kowsalya et al. (2008) on the iron nutriture of 100 adolescents (13-18 years) in Manipur also found that the mean height and weight of the selected adolescent girls were below the standard value. A study conducted by Deshmukh et al. (2006) on nutritional status of adolescents in rural Wardha showed that 53.8 per cent of the adolescents were thin, 44 per cent were normal and 2.2 per cent were overweight. Zanvar et al. (2007) compared 500 adolescents (13-18 years) from urban, rural and tribal areas of Marathwada region, found that urban adolescent girls had better height ( ± 8.6 cm) than rural and tribal counterparts ( ± 7.11, ± 9.38 cm respectively). Similar trend was observed in weight and body mass index, which ranged from ± 3.41 to ± 5.02 cm and ± 2.31 to ± 2.00 cm respectively. Menarche : It was observed that majority (65%) of girls had their age of menarche as years where as 10 had above 14 yrs. with the exception of two girls, one had it at the age of 7 yrs. and other at 9 years. The average age of menarche was found to be % girls had regular menarchial status and 73% has menstrual flow of 2 to 4 days. 62% girls reported normal flow whereas 38% reported less flow. The majority (47%) girls experienced severe abdominal pain during menstruation whereas 12% and 18 % experienced severe back pain and uneasiness respectively. Haemoglobin Status : The mean haemoglobin level of adolescent girls was found to be gm/dl. The majority girls (63%) had haemoglobin status of above gm / 100ml of blood and were classified as normal. 33% girls had haemoglobin of gm/100ml of blood and 4% of girls had haemoglobin less than gm/dl of blood and 141

3 hence were classified as mild and moderate ananemic respectively. (Table IV) The present study showed that 63 % girls had normal haemoglobin levels. The percentage of girls suffering from anemia was found to be comparatively lesser than reported in several studies. Sidhu et al. (2005) reported that only 29.49% girls were normal and 70.54% were affected with various grades of anaemic condition. Palta et al. (2003) observed that eighty six girls were anaemic whereas the remaining had normal haemoglobin level. Of the 86 girls 31 suffered from mild anaemia, 46 moderate anaemia and 9 with severe anaemia. The prevalence of anaemia in 630 adolescent girls (13-16 years) of rural Wardha was found to be 59.8 per cent. The prevalence of severe, moderate and mild anaemia was 0.6, 20.8 and 38.4 per cent respectively (Kaur et al., 2006). A study was conducted by Kalpana et al. (2007) on 500 adolescent girls (13 to 15 years) of low income families in Coimbatore, which revealed that 76.4 per cent of adolescent girls were anaemic and only 23.6 per cent were non anaemic. Kowsalya et al. (2008) conducted a study on prevalence of anaemia in 100 adolescent girls (13-18 years) in Manipur. The results revealed that, among the total subjects, 30 were moderately anaemic (710 g/dl) and 25 girls were mildly anaemic (10-12 g/dl). Ten girls were severely anaemic (<7.0 g/dl). Correlation Coefficient with Haemoglobin Status : Correlation coefficient between haemoglobin status with socioeconomic conditions, nutrient intake and anthropometric measurements is presented in Table V. Socioeconomic factor : A positive and significant correlation was observed between haemoglobin and mother's education ( r = 0.239, p<0.05). Father's education ( r = -0.04,> 0.05 ) and family size ( r= , p > 0.05) showed negative and insignificant correlation with haemoglobin. Gowarikar et al. (2002) did not find any association with prevalence of anaemia with mother's education, size of family, caste and religion. Rawat et al. (2001) reported higher prevalence of anaemia (P<0.02) in adolescent girls belonging to families having family size > 3 than those girls from families family size < 3 may be due to availability of adequate diet to all the family member in small families. They further observed significant association of anaemia with educational status (P < 0.05), birth order (P < 0.05), awareness regarding anaemia (P < 0.05) and marital & obstetric status (P < 0.05) and no association with age, anthropometry and menarcheal age (P > 0.05). However, Sajjan and Kasturiba B. (2008) observed that the per cent adequacy of energy and blood forming nutrients were independent of family size in both dry and transitional zones. Scholastic performance : The academic performance (r= 0.054, p >0.05) of adolescent girls showed positive correlation with hemoglobin status. Rawat et al. (2001) also found anaemia to be significantly associated with educational status. Nutrient intake :Amongst the nutrients, fat ( r= -0.25, p< 0.01) showed negative and significant correlation, protein (r= 0.109, p> 0.05), iron ( r= 0.005, p > 0.05) and Vitamin A (0.0015, p> 0.05)showed positive but insignificant correlations. Calcium (r= , p> 0.05) and Vitamin C(r= 0.06, p> 0.05) showed negative and insignificant correlation with hemoglobin. The review of related literature has indicated no consistent results with respect to the correlation of haemoglobin with nutrient intake of adolescent girls. Ekpo et al. (2006) reported positive correlation between protein, vitamin C, riboflavin and albumin ( r = 0.95, P < 0.01 and r = 0.27, P < 0.05). Calcium intake was also found to be correlated negatively with haemoglobin level ( r = 0.27, P<0.05). Hussain and Shukla (2007) did not find significant correlation between serum iron profile and any of the nutrients. According to Sajjan and Kasturiba B. (2008) the per cent adequacy of energy, protein, vitamin B12 and iron were found to be independent of haemoglobin level, whereas per cent adequacy of ascorbic acid and folic acid was found to be significantly associated with haemoglobin level. Anthropometric measurement :Weight of adolescent girls (r= 0.55, p <0.01) showed positive and significant correlation with haemoglobin level. However height (r =-0.12, p> 0.05) of adolescent girls showed negative and insignificant correlation with haemoglobin level. Hussain and Shukla et al. (2007) did not find any significant correlation of height and weight with serum iron profile. Rawat et al. (2001) also did not find any association of anthropometric measurements with anaemia. Table I: Mean Food Intake of Adolescent Girls (N=100) *p<0.05, **p<

4 Table II: Mean Nutrient Intake of Adolescent Girls. Table III : Mean Weights And Heights Of Adolescent Girls ( Number in parenthesis indicates number of girls) Table IV: Classification of Adolescent Girls According To Haemoglobin Levels Table V: Correlation Coefficient of Haemoglobin With Socioeconomic Factors, Academic Performance And Nutrient Intake 143

5 Kaur, S., Deshmukh, P.R. and Garg, B.S. (2006): Epidemiological correlates of nutritional anaemia in adolescent girls of rural Wardha. The Indian J. of Community Medicine, 31 (4): REFERENCES: Akkamahadevi, K.H. (1996): Dietary iron intake and prevalence of anaemia in urban and rural adolescent girls of Dharwad taluk. M.H.Sc. Thesis, Univ. Agril. Sci.,Dharwad (India). Kowsalya, S. and Crassina, A., Shimaray (2008): Impact of supplementation of lotus stem (Nelumbium nelumbo) on the iron nutriture of adolescent girls (13-18 years) in Manipur. The Indian J. Nutr. Dietet., 45 : Bamji Mahtab, Prahlad Rao, S. N., Reddy Vinodini (2003): Text book of Human Nutrition, Oxford and IBH Publishing Co. Pvt., New Delhi, Page 154 Deepa, K.S. (2002): Nutrition and health profile during menarche and testing the seasonal variations. M.H.Sc. Thesis, Univ. Agril. Sci., Dharwad (India). Kumar, A.R., Yadav, N., Gupta, A.K.., Parvin, Tripathi, V. and Verma, V. (2006): Influence of family's vegetable cultivation on prevalence of anaemia among adolescent girls. The Indian J. Nutr. and Dietetics, 43 : Deepa, K.S., Pushpabharati and Kasturiba, B. (2004): Seasonal variation in iron status of adolescent girls in Dharwad taluk. J. Human Ecology, 15 (3): Kumari, S. and Singh, S. (2003): Nutritional status of scheduled caste adolescents from deprived section of society. The Indian J. Nutr. and Dietetics, 40 : Ogunfeyitmi, S. (2002): Nutritional requirements for growing children. Natural health guardians Vol. 19. No.8, 746 pp Demaeyer, E.M. (1989): Preventing and controlling iron deficiency anaemia through primary health care. World Health Organization, Geneva. Palta, A (2003): Haemoglobin and cardiovascular efficiency of adolescent girls, The Indian Journal of Nutrition and Dietetics. 40(9) Deshmukh, P.R., Gupta, S.S., Bharambe, A.R., Dongre, C., Maliye, S., Kaur and Garg, B.S. (2006): Nutritional status of adolescents in rural Wardha. Indian J. Pediatrics, 73 (2): Prabhakaran Saroja (2003): Nutritional status of adolescent girls residing in a university hostel. The Indian J. Nutr. and Dietetics, 40 : Ekpo A, J and Jimmy E.O. (2006): Dietary and hematological evaluation of adolescent females in Nigeria. Pakistan Journal of Nutrition 5(3): Rawat, C.M.S., Garg, S.K., Singh, J.V., Bhatnagar, M., Chopra, H., Bajpai, S.K. (2001): Prevalence of anaemia among adolescent girls in rural area of district Meerut, U.P., Indian J. Public Health, 45 (1) 246. Garrett, H.E., Woodworth, R.S. (1969): Statistics in psychology and education. Published by GU Mehta for Vakils, Feffer and Simons Private Ltd. Sajjan J. and Kasturiba B. (2008): Consumption pattern of green leafy Vegetables and impact of nutrition Education on haemoglobin status of rural Adolescent girls, Ph.D. Thesis submitted to the University of Agricultural Sciences, Dharwad. Gopalan C., Rama Sastri B. V., Balasubramanian S. C.(2002): Nutritive Value of Indian Foods, National Institute of Nutrition (India), Indian Council of Medical Research, Hyderabad. Shekhar, A. (2005): Iron status of adolescent girls and its effect on physical fitness. The Indian J. Nutr. And Dietetics, 42: Gowarikar, R.S,. Gawarikar, S.B. and Tripathi, B.C. (2002): Prevalence of anaemia in adolescent girls of Ujjain in Western M.P. Indian J. Nutr. and Dietetics, 39: Sidhu S, Kumari K, Uppal M. (2002): Prevalence of anemia in schedule caste preschool children of Punjab. Indian J Med Sci. 56: Hussain M. and Shukla P. ( 2007): Blood iron profile, nutrient intake and physical growth of girls suffering from iron deficiency anaemia, th Souvenir, 39 Annual Convention of Indian Dietetic Association, Page 67. Spear B (1996): Adolescent Growth & Development, In V.I. Rickert,ed. Adolescent nutrition, assessment & Management,pp.124, Chapman & Hill. Indian Council of Medical Research (2002): Nutrient requirements and recommended dietary allowances for Indians, New Delhi. Tatia, R. and Taneja, P. (2003): Dietary intake of tribal adolescent girls of Dhar district in Madhya Pradesh. The Indian J. Nutr. and Dietetics, 40 : INACG (International Nutritional Anemia Constitutive Group) (1985): Measurement of Iron Status. INACG, Washington, D.C. Kunt, K.M. and Johnson, W.C. Thimmayamma, B.V.S. (1987): Schedules and Guidelines un Socioeconomic and Diet Surveys, National Institute of Nutrition, Hyderabad. Jellife, D.B. (1966): The assessment of nutritional status of community, WHO, Monograph series, WHO, Geneva. Tripathi S., Idris M.Z., Masood J. ( 2004): Effect of De-worming on Response of Iron-Frolic Acid Supplementation Among Adolescent School Girls of Lucknow. Indian Journal of Community medicine, October-December 2004, 29 (4) Page Nos Kalpana, C.A., Aruna Narayanan and Thangarathi, T. (2007): Effect of medicinal iron supplementation and nutrition education on anaemic adolescent girls of low income families. The Indian J. Nutr. and Dietet., 44 : Zanvar, V., Roshini Devi, Arya, A. And Nerlekar, J.P. (2007): Prevalence of anaemia among selected adolescent girls of Marathwada region. The Ind. J. Nutr. Dietetics, 44: