|Year : 2019 | Volume
| Issue : 2 | Page : 144-148
Anemia-related knowledge, attitude, and practices in adolescent schoolgirls of Delhi: A cross-sectional study
Monika Singh1, Om Prakash Rajoura2, Raghavendra A Honnakamble1
1 Department of Community Medicine, SN Medical College, Bagalkot, Karnataka, India
2 Department of Community Medicine, UCMS and GTBH, Delhi, India
|Date of Web Publication||14-May-2019|
Dr. Raghavendra A Honnakamble
Department of Community Medicine, SN Medical College, Bagalkot - 587 102, Karnataka
Source of Support: None, Conflict of Interest: None
BACKGROUND: Anemia is a serious public health problem, especially in a developing country like India. Gap in nutritional knowledge is one of the major reasons for nutritional problems. Consequently, improper practices can lead to intergenerational impact.
OBJECTIVES: To examine anemia-related knowledge, attitude, and practices (KAP) in adolescent schoolgirls and to find health-seeking behavior regarding anemia among adolescent schoolgirls.
MATERIALS AND METHODS: This cross-sectional survey was conducted in a northwest district of Delhi. A total of 210 adolescent schoolgirls were included in this study. A predesigned, pretested, semi-structured questionnaire was used to asses KAP about anemia.
RESULTS: The present study observed that adolescent schoolgirls had less knowledge about anemia. Out of 210 girls, only 60 (28.5%) had heard the term anemia and among them, 50 (83.3%) considered that anemia is a health problem. Very few girls correctly answered questions regarding the symptoms, prevention, and treatment of anemia. Most of the students (170 [80.9]) used soap for washing their hands and the rest (19%) cleaned with just water. Only 52% of girls cleaned their hands with soap before consuming food. Trimming of nails regularly was practiced by 160 (76.2%) girls, and there was a practice of barefoot walking outside the home in 28.5% of girls.
CONCLUSION: Adolescent girls exhibited knowledge toward anemia but not adequate attitude and practice. Propagation of comprehensive nutritional knowledge regarding diet and supplements rich in iron should be made mandatory.
Keywords: Adolescent, anemia, knowledge
|How to cite this article:|
Singh M, Rajoura OP, Honnakamble RA. Anemia-related knowledge, attitude, and practices in adolescent schoolgirls of Delhi: A cross-sectional study. Int J Health Allied Sci 2019;8:144-8
|How to cite this URL:|
Singh M, Rajoura OP, Honnakamble RA. Anemia-related knowledge, attitude, and practices in adolescent schoolgirls of Delhi: A cross-sectional study. Int J Health Allied Sci [serial online] 2019 [cited 2019 Jul 21];8:144-8. Available from: http://www.ijhas.in/text.asp?2019/8/2/144/258190
| Introduction|| |
Adolescents, especially girls, are considered to be a nutritionally vulnerable section of the population. Due to enhanced growth during adolescence, the requirement of some minerals is of principal importance. This is a susceptible period in the human life cycle for the development of nutritional anemia.,, Anemia is a serious public health problem worldwide. According to the National Family Health Survey-III, almost 56% of adolescent girls aged 15–19 years suffer from some form of anemia.
As per the Indian Council of Medical Research, anemia is defined as hemoglobin [Hb] <120 g/L) was 90.1% in adolescent girls from 16 districts of 11 states of India, and 7.1% of girls had severe anemia (Hb <70 g/L). In a family with inadequate resources, the female child is more likely to be ignored. She is deprived of good food and education. The further burden of menstrual blood loss, normal or abnormal, precipitates the crises too often. It causes generalized weakness and a feeling of lethargy which later reduces work efficiency. Adolescent schoolgirls nutritional status has great intergenerational impact meaning it affects more than one generation and therefore it can even affect future of the nation.,, Dietary knowledge and access to resources are critical to improve the health and nutrition in a sustainable way., Adolescence is the time to learn and adopt healthy habits to avoid many health and nutritional problems later in life. Health education in schools plays an essential role in increasing the knowledge of the students., The present study aimed at investigating appropriate knowledge, attitude, and practices (KAP) and treatment-seeking behavior about anemia among adolescent schoolgirls.
| Materials and Methods|| |
A cross-sectional study was conducted among 210 adolescent schoolgirls in the age group of 10–19 years in Delhi in April 2012. The aim of the study was to observe the KAP about anemia, especially iron-deficiency anemia (IDA), and to find health-seeking behavior regarding anemia among adolescent schoolgirls.
After taking permission from school health services and principal of the school as well as written consent from the parents, students were interviewed by using a predesigned, pretested, semi-structured questionnaire. The study was conducted in one of the nine administrative districts of Delhi chosen randomly by lottery method. All government senior secondary schools in that district (northwest) were included in the sampling frame. For this purpose, a list of schools located in the chosen district was obtained from the Directorate of Education. Finally, two schools were selected by lottery method. Out of all classes, class XI was randomly selected by lottery method, and all the girls in Class XI were included in the study. Those students who were willing to participate in the study were included. Students present on the day of visit were chosen as participants. A pretested and semi-structured questionnaire was used to obtain data regarding KAP and health-seeking behavior regarding anemia. The response was assessed using percentage analysis. Data analysis was done using SPSS software version 17.0 (SPSS Inc., Chicago, USA).
Sample size calculation was calculated based on a study conducted in Karnataka in which 91% of girls had heard about anemia; with absolute error of 5%, design effect of 1.5, and 95% confidence interval, the sample size came out to be 189. Considering 10% nonresponse rate, the final sample size came out to be 208 and was rounded off to 210. Adolescent girls not willing to participate and girls whose parents refused to give consent were not included in the study.
| Results|| |
The knowledge about anemia among adolescent schoolgirls is described in [Table 1]. The study questionnaire had some questions with multiple options to choose. The present study observed that out of 210 girls, only 60 (28.5%) had heard the term anemia. Knowledge assessment of anemia was done in sixty adolescent schoolgirls only. Of these sixty girls, 50 (83.3%) felt that anemia is a health problem. When assessed for understanding of anemia, 46 (76.7%) girls answered that anemia is caused by decreased iron blood and 12 (20%) did not know the reasons for anemia. Thirty-eight (63.3%) adolescent schoolgirls felt that decreased dietary intake of iron causes anemia and 18 (30%) girls also said that worm infestation causes anemia. Regarding symptoms of anemia, majority (42 [70%]) of the girls answered that anemia causes pale skin. Twenty-eight (46.6%) girls opined that anemia affects growth and development, 10 (26.6%) girls said that it decreases learning abilities, and 17 (28.3%) girls said that it decreases the working capacity of a person. Regarding prevention of anemia, 46 (76.4%) girls felt that increased intake of dietary iron will prevent anemia, 47 (78.3%) girls reported that iron and folic acid (IFA) supplementation can treat anemia, and 16 (26.6%) girls reported that deworming can also help in the treatment of anemia.
|Table 1: Knowledge and attitude toward anemia among adolescent schoolgirls|
Click here to view
[Table 2] describes the behavior of the adolescent schoolgirls. Among the 210 girls, most of the girls (170 [80.9%]) used soap for washing their hands and the rest (19%) cleaned with just water. Only 52% of the girls cleaned their hands with soap before consuming food. Trimming of nails regularly was practiced by 160 (76.2) girls, and there was a practice of barefoot walking outside home in 28.5% of girls.
[Table 3] describes the health-seeking behavior among the adolescent schoolgirls. Only 10 (4.8%) adolescent schoolgirls in the school were checked for Hb in the past 1 year, 6 (2.8%) girls consumed IFA, and 8 (3.8) girls consumed deworming tablets in the past 6 months.
|Table 3: Health-seeking behavior toward anemia among adolescent schoolgirls (n=210)|
Click here to view
| Discussion|| |
This study was conducted in 2012 in Delhi with an intention to assess the knowledge of adolescent schoolgirls regarding anemia and their attitude and health-seeking behavior. In India, the prevalence of anemia in adolescent schoolgirls ranges from 60% to 90%. A study observed a prevalence of 90% of nutritional anemia in adolescent girls of 16 districts of India. In the present study, out of the 210 girls, 28% had heard of anemia, and among them, 83% knew that anemia is a health problem. Only 46 (76.7%) students answered correctly that decrease in body iron causes anemia. This result was higher than an observation made by another study (12.1%). In another study, 73% of the students had heard about anemia, but only 36% knew that it is a health problem. In India, anemia appears to be caused chiefly by lower dietary intake and poor absorption of iron. This causes nutritional anemia in more than 80% of women because of excessive body needs. In our study, 20% of the girls told that decreased dietary iron in the body leads to anemia. When girls were asked about the treatment of anemia, it was observed that (78.3%) felt IFA can treat anemia (28.3%) answered Vitamin C tablets and (26.6%) said deworming tablets can treat anemia., Majority (56%) of the participants told that the only source of iron-rich food is green leafy vegetables. Seventeen percentage of the adolescent girls knew that increased menstrual loss causes anemia. A study quantified menstrual blood loss and also found heavy menstrual bleeding (12.1%) to be one of the most significant contributing factors to IDA. In current study only 13%nt girls adolescent girls said that worm infestation causes anemia and only 4.7% knew that adolescents are more prone to anemia. While in another study, 2% of girls reported that worm infestation causes anemia and 69% knew that adolescents are more at risk for anemia. Studies observed that menstruating girls are more prone to be anemic.,
This study observed that only 28% of the students knew about the different signs and symptoms of anemia, which is higher than other studies. This is lower than the observation made in other studies conducted elsewhere in India., It was observed that girls are aware of different symptoms such as decreased appetite (33%), fatigue (26.7%), shortness of breath (30%), irritability (35%), and paleness of the skin (70%), the knowledge about anemia was less as compared to studies conducted in other parts of the country..,, Majority of the girls had limited knowledge about the effects of anemia; 46.6% of the girls told that anemia decreases growth and development, 26.6% felt that it decreases learning abilities, and 28.3% told that it decreases the working capacity. Other studies have observed higher knowledge among girls. When we inquired about the preventive measures against anemia, out of sixty girls, 76.4% reported consumption of iron-rich food, 13.3% reported avoiding tea and coffee, 26.6% reported consuming Vitamin C-rich fruits, and 36% reported maintaining personal hygiene. These findings are lower than that of other studies.,,,
Similarly, a study showed that poor knowledge regarding diet was associated with IDA. It has been observed that consumption of tea along with meals hinders iron absorption in the body which could be the reason for their low Hb levels.
When girls were asked about the treatment of anemia, it was observed that (78.3%) felt IFA can treat anemia (28.3%) answered Vitamin C tablets and (26.6%) said deworming tablets can treat anemia. On the other hand, a study conducted in Madhya Pradesh observed that 81.4% of the adolescent girls did not know that anemia could be prevented or treated. In another study 56% of girls felt IFA treats anemia and 75% felt that just deworming could reduce anemia. Food-based strategies should be energized to deal with IDA among adolescent girls. The strategies can include consumer education to encourage diversification of the diet and include iron-rich food and fruits that contain Vitamin C which enhances iron absorption.
Merely 4% of adolescent schoolgirls were having attitude that girls attaining puberty and also pregnant and lactating mothers should consume diet rich in iron. IFA supplementation in girls attaining menarche goes a long way in building up their iron stores. Adolescent girls who are in a little while to enter married life and motherhood should be targeted so that the intergenerational impact of IDA can be minimized. Among the 210 girls, 80.9% used soap for washing their hands and the rest 19% cleaned their hands with just water. Nearly 52% of the girls cleaned their hands with soap before consuming food. Trimming of nails regularly was practiced by 160 (76.2%), and there was a practice of barefoot walking outside the home in 28.5% of girls.
A study conducted in slum area of Kolkata revealed that adolescent schoolgirls' knowledge regarding personal hygiene was relatively adequate but their practice was inadequate. However, this knowledge was not always put up to correct attitude and practices. Personal hygiene practices are highly needed to prevent the related morbidities and thereby for the betterment of health. There were very few girls (4%) in the school whose Hb was checked in the past 1 year, and very hardly any consumed IFA and deworming tablets in the past 6 months. In another study, 55% of the participants stated that they will go to doctor for checkup and take iron tablet if they suffer from anemia-related symptoms. This finding is lower than that of other studies (65%)., Higher KAP and health-seeking behavior were observed in other studies.,, This reinforces that health education is very much essential in building the bridge in the continuum of care. Community-based studies can give better understanding of this subject than school-based studies.
| Conclusion|| |
Adolescent girls exhibited knowledge toward anemia but not adequate attitude and practice. However, adolescent girls' knowledge alone is not adequate to impact practices and attitudes. Physiological, socioeconomic, and behavioral limitations must be addressed proficiently. Propagation of comprehensive nutritional knowledge regarding anemia should be made mandatory. Nutritional education sessions with more focus on specific issues such as information on anemia, adverse effects of drinking tea with meals, and iron enhancers such as Vitamin C should be emphasized.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
World Health Organization. Nutrition in Adolescence-Issues and Challenges for the Health Sector. World Health Organization; 2005.
World Health Organization. The Prevalence of Anemia in Women: A Tabulation of Available Information. Geneva: World Health Organization; 1992.
Koblinsky MA. Beyond maternal mortality – Magnitude, interrelationship, and consequences of women's health, pregnancy-related complications and nutritional status on pregnancy outcomes. Int J Gynaecol Obstet 1995;48 Suppl:S21-32.
Kurz KM, Johnson WC. The Nutrition and Lives of Adolescents in Developing Countries. Findings from the Nutrition of Adolescent Girls Research Programme. Washington, DC: International Center for Research on Women; 1994.
Gillespie S. Major Issues in Controlling Iron Deficiency. Ottawa: Micronutrient Initiative; 1998.
Food and Agriculture Organization, World Health Organization, International Conference on Nutrition. Nutrition and Development: A Global Assessment. In: Micronutrient Deficiencies and Preventing Specific Micronutrient Deficiencies. Rome: Food and Agriculture Organization; 1992.
Toteja GS, Singh P, Dhillon BS, Saxena BN, Ahmed FU, Singh RP, et al.
Prevalence of anemia among pregnant women and adolescent girls in 16 districts of India. Food Nutr Bull 2006;27:311-5.
Gupta A, Parashar A, Thakur A, Sharma D. Anemia among adolescent girls in Shimla hills of North India: Does BMI and onset of menarche have a role? Indian J Med Sci 2012;66:126-30. [Full text]
Koushik NK, Bollu M, Ramarao NV, Nirojini PS, Nadendla RR. Prevalence of anaemia among the adolescent girls: A three months cross-sectional study. Women 2014;14:12.
Shrinivasa BM, Philip RR, Krishnapali VK, Suraj A, Sreelakshmi PR. Prevalence of anemia among tribal women of reproductive age-group in Wayanad district of Kerala. Int J Health Allied Sci 2014;3:120. [Full text]
Aishwarya MV, Parita Gajjar DP, Raykundaliya RS, Patel VH, Neeta D. Prevalence of anemia and epidemiological correlates among school going adolescent boys of Vallabh Vidyanagar (Gujarat). Indian J Community Med 2015. p. 2014-5.
Alam N, Roy SK, Ahmed T, Ahmed AM. Nutritional status, dietary intake, and relevant knowledge of adolescent girls in rural Bangladesh. J Health Popul Nutr 2010;28:86-94.
Bhanushali MM, Shirode AR, Joshi YM, Kadam VJ. An intervention on iron deficiency anemia and change in dietary behaviour among adolescent girls. Int J Pharm Sci 2010;3:40-2.
Alaofè H, Zee J, Dossa R, O'Brien HT. Education and improved iron intakes for treatment of mild iron-deficiency anemia in adolescent girls in Southern Benin. Food Nutr Bull 2009;30:24-36.
Amani R, Soflaei M. Nutrition education alone improves dietary practices but not hematologic indices of adolescent girls in Iran. Food Nutr Bull 2006;27:260-4.
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;5:416-9.
Kotecha PV, Nirupam S, Karkar PD. Adolescent girls' anaemia control programme, Gujarat, India. Indian J Med Res 2009;130:584-9.
] [Full text]
National Institute of Nutrition, editor. Nutritional news. In: The News. Hyderabad, India: National Institute of Nutrition; 1984.
Chaluvaraj TS, Satyanarayana PT. Change in knowledge, attitude and practice regarding anaemia among high school girls in rural Bangalore: An health educational interventional study. Natl J Community Med 2018;9:358-62.
Kaur M, Singh K. Effect of health education on knowledge, attitude and practices about anaemia among rural women in Chandigarh. Indian J Community Med 2001;26:128. [Full text]
Verma M, Chhatwal J, Kaur G. Prevalence of anemia among urban school children of Punjab. Indian Pediatr 1998;35:1181-6.
Chakma T, Rao PV, Meshram PK. Feasibility of iron-folic acid supplementation among tribal adolescent girls, Mandla district, Madhya Pradesh. Public Health Nutr 2012;16:377-80.
Pareek P, Hafiz A. A study on anemia related knowledge among adolescent girls. Int J Nutr Food Sci 2015;3:273-6.
Appanah TP, Ooogarah PB, Ruggoo A. Awareness and consumption of iron among Mauritian female factory workers. Nutr Food Sci 2009;39:168-75.
Pal J, Pal AK. Knowledge, attitude, and practice of personal hygiene and its predictors: A school-based study among adolescent girls in an urban slum. Int J Med Sci Public Health 2017;6:1411-6.
Dongre AR, Deshmukh PR, Garg BR. The impact of school health education programme on personal hygiene and related morbidities in tribal school children of Wardha district. Indian J Commun Med 2006;31:81-2.
[Table 1], [Table 2], [Table 3]