Indian J. Prev. Soc. Med. Vol. 40 No.

3& 4,2009
PREVALENCE OF ANAEMIA AMONG ADOLESCENT GIRLS IN RURAL AREA OF RAIGAD DISTRICT, MAHARASHTRA Rekha Dutt1, Shirish Patil2, Sumedha Joshi3, Ranjana Mhatre4 , Ramdev5
ABSTRACT
Objectives: To estimate the prevalence rate of anemia among adolescent girls in rural population. To ascertain the epidemiological correlates of anemia. Methodology: Type of Study: Observational cross sectional study; Setting: Village Vakdi in Nere (Raigad District, Maharastra) in field practice area of Department of Social and Preventive Medicine, DR.D.Y. Patil medical college, Navi Mumbai.; Participants: 100 adolescent girls (10-19) years of age; Statistical Analysis: percentages and chi square. Results: The prevalence of anemia was found to be 61%.A significant association of anemia was found with excessive menstrual bleeding, history of worm infestation, malaria, vegetarian diet and positive marital status. There was no significant association of anemia with age, religion, socioeconomic status and educational status of girls. Conclusions: Anemia problem is of very high magnitude in rural adolescent girls. Key Words: Anemia, adolescent girls, rural

INTRODUCTION
Adolescence has been defined by World Health Organization as period of life spanning the ages between 10 to 19 years . Adolescence being the phase of rapid growth, has an increased demand for iron requirement in both boys and girls but more so in girls because of menstruation. Anemia not only effects the present health status of girls but also has deleterious effects in future pregnancy , that puts the women at three times greater risk of delivering low birth weight & nine times higher risk of perinatal mortality, thus contributing significantly for increased infant mortality rate and 30 % maternal deaths . To plan effective interventions it is important to understand epidemiology of anemia. Hence the present study was carried out to study the epidemiological correlates of nutritional anemia among adolescent girls in rural area of Raigad district in the state of Maharastra.
2 1

MATERIAL & METHODS

A cross sectional study was carried out from March 08 to September 08 in a village called Vakdi with an approx population of 1100. The study involved hundred adolescent girls in the age group of 10-19 years. Vakadi is the field practice area of Social and Preventive Medicine department of Dr. D. Y. Patil Medical College, Navi Mumbai. The study was approved by ethical committee of Dr. D. Y. Patil Medical College & Hospital, Navi Mumbai. _____________________________ 1. Associate Professor, 2. Professor, 3. Professor & Head , 4. Technician, 5. Lecturer Biostatistics, Department of Social & Preventive Medicine of Dr. D. Y. Patil Medical College, Navi Mumbai. Address For Correspondence: Dr. Rekha Dutt, R-303, Jalvayu Vihar, Phase 2, Plot No 22, Sector -20, Kharghar, Navi Mumbai 410 210 e-mail:rekha_dutt100@rediffmail.com Indexed in : Index Medicus (IMSEAR), INSDOC, NCI Current Content, Database of Alcohol & Drug Abuse, National Database in TB &
Allied Diseases, IndMED, Entered in WHO CD ROM for South East Asia.

Rekha Dutt et al.

Prevalence of anemia in rural adolescent girls

Table -1: Relationship of various epidemiological variables and clinical symptoms with anemia A team comprising of investigators, interns & laboratory technician surveyed from house to house and obtained written informed consent from the head of the family. Information regarding socio-demographic characteristics was recorded in a pre-designed, pre-tested Performa. Girls were also questioned about diet, history of worm infestation, malaria in past 3 months, menstrual problems and symptoms of anemia viz. headache, fatigue, dyspnoea. All girls were clinically examined for signs of anemia. Socioeconomic status was estimated according to modified G B Prasads scale
660) 2(pg 659-

Variables Age in years 10-14 15-19 Religion Hindu Muslim Socio-economic status Class- I Class-II Class-III Class-IV Class- V Types of Family Nuclear Joint Educational Status Illiterate Primary Secondary Menarche Attained Not attained Excessive Menstrual Bleeding Worm Infestation Present Absent Malaria (in last 3 months) Yes No Diet Non-vegetarian Vegetarian Marital Status Married Unmarried Symptoms Headache Fatigue Dyspnoea

Anemic group 34 27 56 05 00 00 26 10 25 44 17 01 40 20 36 25 20 19 42 20 41 34 27 06 55 10 11 06

Non-anemic group 19 20 36 03 00 03 14 08 14 28 11 01 21 17 30 09 01 01 38 03 36 30 09 00 36 06 05 00

P value

>0.05

>0.05

>0.05

>0.05

Haemoglobin Estimation: - Capillary blood sample was collected from index finger with cutting needle using aseptic measures and haemoglobin estimation was done by using Sahlis haemoglobinometer. Typing of Anemia :- Peripheral blood smear was prepared on a prenumbered clean glass slide & allowed to dry. Smears were stained with Fields stain & examined under high power microscope. In the next visit results of haemotological examination were conveyed to the subjects and those found to have anemia were given appropriate treatment and advice. Criteria for Anemia: - Hb <12gm % for nonpregnant and Hb <11gm% for pregnant girls
3 .

>0.05

>0.05 <0.001

<0.001

<0.01

>0.05

The severity of anemia was graded mild (Hb 10 12 gm %), moderate (Hb 7-10 gm %) and severe (Hb <7 gm %) 4.

>0.05

>0.05

Statistical Analysis: - Analysis was done using Percentages & Chi-Square test.

Indian J. Prev. Soc. Med Vol. 40 No.3 & 4

144

July December, 2009

Rekha Dutt et al.

Prevalence of anemia in rural adolescent girls

RESULTS
The study area is inhabited by Hindus and few families belong to Muslim faith. Majority of the families are nuclear, work as farmers and belong to social class 3, 4, 5 according to modified B.G. Prasads classification of socio -economic status. Only 2% of girls were uneducated, 61% and 37% subjects were studying or studied up to primary and secondary classes respectively. Sixty six percent of girls had attained menarche and of them 21% had history of excessive menstrual bleeding. Worm infestation was present in 20 % subjects while 23% girls gave history of malaria in past three months. .Majority of girls (64%) were non vegetarian in diet. Only 6% of subjects were married of whom 2% were pregnant. In present study, the prevalence of anemia was found to be 61%. Age, socio-economic status, religion, type of family, educational status and menarche did not show any significant association with anemia. Table -2: Hemoglobin level in adolescent girls History of excessive menstrual bleeding, worm infestation, malaria in past 3 months, vegetarian diet and marital status were significantly associated with anemia. The symptoms of headache and fatigue have no significant relation while dyspnoea is significantly associated with anemia. Severity of anemia Out of 61% anemic subjects 54% had mild anemia while 7% had moderate anemia. None of the subjects had severe anemia. Of 6 married subjects 2 were pregnant and both had mild anemia (Hb 10-11 gm %). Hemoglobin (gm/dL) <7 7-10 10-12 >12 Total No. of girls (%) 00 07 54 39 100

Table- 3: Results of peripheral smear examination Normocytic hypochromic anemia was seen in 39 subjects depicting early stages of iron deficiency anemia. It was found that 31% Normocytic normochromic Normocytic hypochromic Microcytic hypochromic Dimorphic anemic subjects had microcytic hypochromic picture while 13%had dimorphic picture showing iron along with folic acid and B12 deficiency. 19 08 00 00 Red cell Morphology Subjects with anemia (n=61) 02 32 Subjects without anemia (n=61) 32 07

DISCUSSION
In the present study prevalence of anemia was found to be 61%. Kaur et al5, Rana et al6 and Seshadri et al7 reported similar prevalence of 59.8%, 60%and 63% respectively. National Family Health Survey (NFHS) 3 estimates reveal the prevalence of anemia to be 65 -75 % in adolescent girls . WHO/ UNICEF has suggested that the problem of anemia is of very high magnitude in a community when prevalence rate exceeds 40% 8. This shows that the problem of iron deficiency in these girls with prevalence of 61% should be considered serious and action should be taken without delay.
2

Epidemiological correlates: In the present study the important correlates of anemia were found to be excessive
menstrual bleeding , worm infestation , history of malaria in past 3 months, vegetarian diet and marital status. Studies conducted by Kaur et al and Goel et al also show that anemia was significantly higher in group of girls that had excessive menstrual bleeding. Various studies5, 9 have also shown that presence of worms in adolescent population may contribute significantly to blood loss in intestine with resultant anemia and call for deworming campaign along with iron folic acid supplementation in anemia control programme.
5 9

Indian J. Prev. Soc. Med Vol. 40 No.3 & 4

145

July December, 2009

Rekha Dutt et al.

Prevalence of anemia in rural adolescent girls

Our study shows that anemia was significantly associated with history of malaria owing to destruction of red blood cells which is in conformity to other study . anemic which is confirmed by other studies
10

Our study reveals that compared to non vegetarians, more vegetarians were
5, 9

. In India poor bioavailability of dietary iron along with low intake of haem iron

from animal food is a major cause for anemia. Dietary modification such as promoting of iron absorption enhancers like haem iron and vitamin C rich food or on reducing ingestion of inhibitors (phytates, tannins and oxalates) are beneficial. Anemia is more common in married girls is a well known fact because of innumerable social factors like neglected diet, more work with responsibilities and obstetrical causes. In our study age, educational status, socioeconomic status, religion and family type are not significantly related to anemia which is in conformity with other studies deficiency anemia which is consistent with other studies providing nutrition education to the girls .
11, 12 5, 11

. The majority of

subjects had a normocytic hypochromic and microcytic hypochromic picture in peripheral blood smear suggestive of iron .Thirteen percent of anemic had dimorphic picture depicting deficiency of folic acid and B12 also. Therefore there is need to give supplementary iron , folic acid and vitamin B 12 and

CONCLUSION
Reorientation of primary health care functionaries to strengthen 12 by 12 initiative (by year 2012 every adolescent should have at least 12gm% Hb by 12 years of age) by providing iron folic acid and vitamin B12 supplementation, deworming, prevention and early diagnosis and treatment of malaria and emphasizing the need for nutrition education with the help of ICDS workers can control the anemia in rural adolescent girls.

REFERENCE
1. 2. 3. 4. 5. 6. 7. World Health Organization, Programming for adolescent health and development. WHO Tech Rep. 886; 2: 1996. Suryakantha AH .Community Medicine with Recent Advances, first edition pg188, 2009. A reappraisal of iron status indicators, ICMR Bulletin, Vol 27; 1: 1997. DeMaeyer EM. Preventing and controlling iron deficiency anemia through primary health care. A guide for health administrators, WHO; pg 26:1989. Kaur S, Deshmukh PR, Garg BS. Epidemiological correlates of nutritional anemia in Adolescent girls of rural Wardha, Indian J of Community Medicine, 31(4); 255-258: 2006. Rana T. Age at menarche Nutritional status and other associated factors in urban Hyderabad girls .PhD. Thesis . Submitted to National Institute of Nutrition, Hyderabad 1983. Seshadri S. A database for iron deficiency anemia. Prevalence, etiology, consequences and Strategies for control, Task force for micronutrients malnutrition control, Department of Women and Child development, Ministry of Human Resource Development, New Delhi, 1996. WHO/ UNICEF. Indicators for assessing iron deficiency and strategies for its prevention. Draft based on a WHO / UNICEF Consultation; WHO Geneva: 1996. Goel S, Gupta BP, Low anemia prevalence among adolescents of an urban hilly community, Indian J of Community Medicine, 32(1); 67-68: 2007. Sahu T, Sahani NC, Patnaik L.Childhood anemia-A study on tribal area of Mohana Block in Orissa, Indian J of Community Medicine, 32(1); 43-45: 2007. Gautam VP ,Bansal Y , Taneja DK ,Saha R. Prevalence of anemia amongst pregnant women and its sociodemographic associates in a rural area of Delhi, Indian J of Community Medicine, 27(4); 157-160: 2002. Chaudhary SM, Dhage VR . A study of anemia amongst adolescent females in urban area of Nagpur, Indian J of Community Medicine, 33(4); 243-245: 2008.

8. 9. 10. 11. 12.

-----

Indian J. Prev. Soc. Med Vol. 40 No.3 & 4

146

July December, 2009