Introduction: -

Anemia is a clinical condition that results from an insufficient supply of healthy red
blood cells to oxygenate the body’s tissue adequately; results in hypoxia. It is a deficiency in
the number of erythrocytes, the quantity of hemoglobin and or the volume of packed RBCs.
Iron deficiency anemia is a condition due to decreased hemoglobin synthesis. It typically results
when the intake of dietary iron is inadequate for hemoglobin synthesis.
Anemia is found in 30% of the world’s population. It is a widespread public health
problem with major consequences for human health as well as social and economic
development of the country. Iron deficiency anemia is the most prevalent nutritional disorder in
the world today; especially amongst women in developing countries. It is the most common
micronutrient deficiency which affects more than two billion populations worldwide, leading to
anemia in more than 40% of women of reproductive age in the developing world. Adolescents
aged between 13-19 years’ account for more than one fifth of the world’s population. Prevalence
of anemia among adolescents is more than 25% in developing countries and 7-12% in developed
countries. In India this age group forms 21.4 per cent of total population.
Iron-deficiency anemia doesn't develop immediately. Instead, a person progresses
through stages of iron deficiency, beginning with iron depletion, in which the amount of iron in
the body is reduced while the iron in RBCs remains constant. If iron depletion isn't corrected, it
progresses to iron deficiency, eventually leading to Iron deficiency anemia.
Symptoms of Iron deficiency anemia include fatigue, weakness, shortness of breath,
and the inability to concentrate. Iron-deficiency anemia can be the consequence of several
factors, including, insufficient iron in the diet, poor absorption of iron by the body ongoing
blood loss, most commonly from menstruation or from gradual blood loss in the intestinal tract,
periods of rapid growth. Iron deficiency anemia may result from: inadequate dietary intake of
iron (less than 1 to 2 mg/day), during rapid growth in adolescents. Iron malabsorption, such as
in chronic diarrhea, partial or total gastrectomy, chronic diverticulitis, and malabsorption
syndromes, such as celiac disease and pernicious anemia. Blood loss secondary to drug-induced
GI bleeding (from anticoagulants, aspirin, and steroids) or due to heavy menses, hemorrhage
from trauma, GI ulcers, esophageal varices, or cancer, intravascular hemolysis-induced
hemoglobinuria or paroxysmal nocturnal hemoglobinuria. Mechanical erythrocyte trauma
caused by a prosthetic heart valve or vena cava filters. It occurs most commonly in pre
menopausal women, and adolescents (especially girls). Persons who are at increased risk for

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iron deficiency include those of low socioeconomic status who don’t get a well-balanced diet
that includes iron-rich foods. Poverty is a contributing factor to Iron deficiency anemia because
families. Iron continues to remain the most neglected micronutrient inspite of its greater burden
on health.
Mild iron deficiency anemia usually doesn't cause complications. However,
untreated, iron deficiency anemia can become severe and lead to health problems. Iron
deficiency anemia may lead to a rapid or irregular heartbeat. Your heart must pump more blood
to compensate for the lack of oxygen carried in your blood when you're anemic. In people with
coronary artery disease — narrowing of the arteries that supply the heart — unchecked anemia
can lead to angina. Angina is chest pain caused by decreased oxygen and blood flow to the heart
muscle is called Growth problems. In children’s, severe iron deficiency can lead to anemia as
well as delayed growth. Untreated iron deficiency anemia can cause physical and mental delays
in infants and children in areas such as walking and talking. Additionally, iron deficiency
anemia is associated with a greater incidence of lead poisoning and an increased susceptibility
to infections.
Fortification of suitable food vehicles with absorbable forms of iron is a highly
desirable approach to controlling iron deficiency. Another approach is to fortify a widely
consumed condiment. Fish sauce, curry powder, salt, and sugar have all been successfully
fortified with iron. The amount of iron absorbed from the diet is highly dependent on the
composition of the diet, namely, the quantities of substances that enhance or inhibit dietary iron
absorption successfully fortified with iron. Tea and coffee inhibit iron absorption when
consumed with a meal or shortly after a meal. Heme food sources, predominately red meats,
contain highly absorbable iron and promote the absorption of iron from other less bioavailable
food sources.
To avoid being the part of this statistics the best solution is the appropriate preventive
measures. There are three possible interventions for the prevention of anemia. These include
dietary diversification, food fortification and individual supplementation. Dietary
diversification involves promotion of a diet with a wider variety of iron containing food.
Encouraging families with deficient iron intake to eat meat, fish, or poultry; whole or enriched
grain; and foods high in ascorbic acid.

To prevent this iron deficiency anemia is to diagnose and correct the underlying cause

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of anemia and treat the iron deficit through diet and supplemental iron preparation.
Supplemental iron is usually administered to increase iron available in the blood. The
medications of choice are ferrous sulphate, 0.325gm orally three times a day with meal. Ferrous
gluconate 0.3gm orally twice a day, and iron dextran 100-250mg intramuscularly. Iron dextran
is the parenteral drug of choice. The client typically feels more energetic and has an increased
appetite within 48hrs.peak reticulocytosis occur about day 10. Red blood cells indices and
hemoglobin content gradually returns to normal. Because of the high risk of allergic reaction, if
iron is to be given I.V, the physician usually administers the first dose. Teaching the basics of
a nutritionally balanced diet - red meats, green vegetables, eggs, whole wheat products, and
iron-fortified measures goes hand in hand with properly planned management such as life style
modification, dietary management as well as medical management.

BACKGROUND OF THE STUDY

World’s interest in adolescent health issues has grown dramatically in the past decade
beginning with the International Year of Youth in 1985 and the World Health in 1989, when
discussions were focused on the health of the youth.
Kaur S., (2005)
The term adolescence is derived from the Latin word ‘adolescence’ meaning, “to
grow, to mature”. Traditionally, adolescence is defined as the period from the onset of puberty
to the termination of physical growth and attainment of final adulthood and characteristic.
Adolescence constituted 22.8%of population in India as on 1st March 2000.
Ghai O.P.,(2004)
Adolescence is the period between child hood and adult- hood with accelerated
physical, bio chemical and emotional development. This period is characterized by the rapid
increase in height and weight, hormonal change resulting in sexual maturation and causing wide
swings of emotion. During the period of puberty, the body has increased need for calories
and key nutrients including protein, calcium, iron, folate and zinc. Iron and calcium are
particularly important nutrients for the body during adolescence. Increased physical activity,
combined with poor eating habits and onset of menstruation contribute to accentuating the
potential risk for adolescents of poor nutrition.
Yegammai C., (2004)
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Almost one sixth of India’s population comprises of adolescents. An adolescent boy or girl is
still a developing child. Among adolescents, girls constitute a vulnerable group, particularly in
developing countries where they are married at an early age and exposed to a greater of
reproductive morbidity and mortality.

Anemia is established if the hemoglobin is below the cut-off points of World

Health Organization. Most frequent cause of nutritional anemia is iron deficiency, and less
frequently folate or Vitamin B12. In India iron deficiency anemia is most wide spread micro
nutrient deficiency affecting all age groups irrespective of gender, caste, creed and religion.

As per district level health survey (2002-2004), prevalence of anemia in adolescent

girls is very high (72.6%). In India, with prevalence of severe anemia among them is much
higher (21.1%) than that in pre school children (2.1%).
Park K.,( 2009)

Iron is found not only in every cell of the human body but also in all living things,
both plants and animals. Iron forms a major component of the protein, hemoglobin in RBC
and myoglobin in muscle cells. The daily requirement of iron by a woman is twice as greater as
a man’s, but anyone who loses blood loses iron.
Card J.,(1994 )
Iron deficiency anemia, one of the most common chronic hemolytic disorders, is
found in 10% to 30% of the population in the United States. Regardless of economics or
geography, iron deficiency anemia is most common in infants, children, women who are pre-
menopausal or pregnant and older adults.
Iron deficiency anemia is the most widespread form of malnutrition. In Tamil Nadu
57% of women have some degree of anemia i.e. 37% of women are mildly anemic, 16% are
moderately anemic and 4% are severely anemic. Prevalence of anemia is slightly higher for
young women less than age 25 than for older women. It is higher for rural women (59%) than
for urban women (52%). The anemic levels for children age 3 to 35 months is 69% including
25% mild anemic, 40% moderately anemic and 7% severely anemic. Children aged 12 to 23
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months; children of higher order births, children in rural areas, and children of working women
and children with low standard of living have high levels of anemia.

Anemia is estimated to affect 3.5billion individuals in the developing world or over

two persons out of three. More than 320million people in India suffer from iron deficiency
anemia with the highest prevalence among women and children (40 to 80 percent expectant
women,60 to 70 percent children and 50 percent adolescent girls).
Yegammai C., (2004)

It is estimated that approximately 1.3 billion individuals in the world, suffer from
anemia making it one of the most important public issue on international agenda. In developing
countries, iron deficiency afflicts approximately 2 billion people and is the principle cause of
anemia.
Sharma K.K., (2000)

Daily iron requirements for female adolescents are 2.8mg. According to ICMR
recommended dietary intake of iron for 13-15years is 28mg and 16-18years is 30mg. And the
daily allowances of vitamin C for adolescents are 30-50mg.
Park k., (2009)
Lack of dietary iron is the world’s leading nutritional deficiency and the most
common cause of anemia. Other vitamins that are needed for the body to make red blood cells
include folate (folic acid) and Vitamin B12. A lack of these in the diet can also cause anemia.
Sharma A., (2008)

NEED OF STUDY

“Prevention is better than cure”

According to WHO the adolescent period is from the age of 10 years to 19
years that is second decade of life. It can be distinguished as early adolescence, age 10-13 years;
middle adolescence, ages 14-16 years, late adolescence, age 17-20 years. The period of youth
is from 15 through 24 years. The adolescents and youth together are phased as young people
(10-24 years). The world’s adolescent population (age 10–19 years) is estimated to stand at more

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than 1 billion, yet adolescents remain a largely neglected, difficult-to-measure, and hard-to-
reach population in which the needs of adolescent girls, in particular, are often ignored. This
area of adolescent health has been difficult to study, and there are many unknown factors and
consequences for iron deficiency during adolescence in terms of standards, measurement
indicators and health consequences. According to the population bureau in 1996, 30 % of the
total populations were that of adolescents (284.02 million). The adolescence is the period of
relatively good health inspite of the storms and stresses of rapid physical growth, physiological
changes, sexual and emotion growth and development.

The iron needs are high in adolescent girls because of the increased requirements
for expansion of blood volume associated with the adolescent growth spurt and the onset of
menstruation. When pregnancy is interposed during this time, problems of iron balance are
compounded. Over half the world’s population is under 25 years old, and more than 80% of the
world’s youth live in developing countries. Iron deficits induced by poor diet and disease, along
with difficult logistics associated with supplementation programs in developing countries;
compound the problem of studying the iron needs during pregnancy in much of the world’s
population. For these reasons, we felt it important to study a population with adequate diets and
normal pre-pregnancy iron stores. We investigated the response to supplemental iron in
adolescents and adults throughout the course of normal pregnancies. Menstruating girls and
young children also vulnerable to iron deficiency. Iron deficiency anemia also occurs with
chronic blood loss.

The adolescent require well balance nutrition diet to have normal

growth and to keep fit. The adolescent should learn to relax and eat properly at meal time. They
avoid taking junk food. They should take whole some snacks preferably made from ground nut,
parched chana e.t.c. Inadequate diet leads to malnutrition and result in various deficiencies
example anemia due to lack of iron especially in girls. Dietary deficiency may be due to
ignorance, food facts, illiteracy, size of the family, cultural factors, gender discrimination,
poverty e.t.c. it is therefore very important to educate adolescents, about nutrition needs of

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adolescents for planning and preparing nutritious diet using inexpensive food. Besides being
nutritious food which is consumed by adolescent should be clean and safe. The food should be
well cooked under clean and safe environment following all the principles of cooking .Food
should be consumed as quickly as possible. Unconsumed food should be store in properly in
the refrigerator below 10OC. Hands must be thoroughly washed with clean water before
consuming or preparing the food. The adolescent need to be educated regarding such practice
to prevent any kind of infection through food moreover to prevent iron deficiency.

In many populations, the amount of iron absorbed from the diet is not sufficient
to meet many individuals’ requirements. If the amount of absorbable iron in the diet cannot be
immediately improved, iron supplementation will be a necessary component of programs to
control iron deficiency anemia. The dosage for iron supplementation in mass programs is
unchanged from previous recommendations, except that the pregnancy dose has been reduced
to 60 mg/day. Because the efficiency of absorption of iron increases as iron deficiency anemia
becomes more severe, this dose should provide adequate supplemental iron to women who do
not have clinically severe anemia if it is given for an adequate duration. if iron supplements
containing 400 µg folic acid are available, their use in supplementation programs is
recommended. If such supplements are not available, the currently available iron supplement
containing 250 µg folic acid should be used until higher folate formulations can be obtained.
The Healthcare and Research Association for Adolescents, Noida and the
Nutrition Foundation of India, New Delhi studied women in the same districts and villages
studied in NFHS-II and concluded that the prevalence and severity of anemia in rural adolescent
girls was much higher than that reflected in NFHS-II: 84 % prevalence, of which 9.2 % fell into
the severe anemia category15.The Indian Council for Medical Research (ICMR)’s district
nutrition survey data also reported similar anemia prevalence of 84.2 %, with 13.1 % being in
the severe anemia category16.

The diet of common man in Maldives is not optimal; resulting in poor

growth of adolescents’. Anemia is wide spread especially in adolescent girls. Studies of
“nutritional status and child feeding practice” and “iodine deficiency disorders “have been

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carried out recently. Results of the survey of iron deficiency disorders demonstrated the
existence of iron deficiency anemia as a public health problem in Maldives.

The researcher, who is in clinical area, met with a case an adolescent girl
she was suffering from severe anemic. Because her stressful life style, she doesn’t had the proper
food habits and she also had the obsession to thin. So that she stops eating. She does not believe
that she is thin. Finally this girl develops amenorrhea and respiratory arrest which leads to death.
Hence education regarding prevention and management of Iron deficiency anemia is most
important among adolescent girls. .

Hence the investigator selected the adolescent girls and wants to assess
and pour the knowledge iron deficiency anemia. So the investigator suggested that, this study
has to improve the knowledge of pre–university students regarding early detection, dietary
management, pharmacological management, the prevention and management of iron deficiency
anemia and follow up care.

As per statistical rate in 2015-2016, the incidence rate of anemia among women aged
15-49 years in India is 53.3% and anemia among adolescent girl 56%. As per district level health
survey, prevalence of anemia in adolescent girls is very high (72.6%) in India, with prevalence
of severe anemia among them much higher (21.1%) than that in preschool children (2.1%). The
overall prevalence of anemia in India has increased from 74.2% (1998-99) to 79.2% (2005-06).
Nagaland had the lowest prevalence (44.3%), then Goa (49.3%) & Mizoram (51.7%). Bihar had
the highest prevalence (87.6%) followed closely by Rajasthan (85.1%), and Karnataka (82.7%)
and Gujarat 75% (2016-2017).

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STATEMENT PROBLEM:-

“A STUDY TO ASSESS THE EFFECTIVENESS OF PLANNED

TEACHING PROGRAM ON KNOWLEDGE REGARDING IRON DEFICIENCY
ANEMIA AMONG ADOLESCENT GIRLS IN SELECTED HIGHER SECONDARY
SCHOOL, AT VISNAGAR.”

OBJECTIVES OF THE STUDY: -

Objectives of the study are to:
1. To Assess the pre test knowledge adolescent girl in selected higher secondary school
regarding iron deficiency anemia.
2. To Evaluate the effectiveness of planned teaching program on iron deficiency anemia
by comparing the post test knowledge scores.
3. To Find out the association between pertest knowledge scores and selected
demographic variables.

HYPOTHESIS: -

NULL HYPOTHESIS

H0: There will not be any significant difference and association between pre test and post test
knowledge scores of adolescent girls in selected higher secondary school who have received the
planned teaching programme on iron deficiency anemia.

RESEARCH HYPOTHESIS

H1: There will be a significant difference between pre test and post test knowledge scores of
adolescent girls in selected higher secondary school who have received the planned teaching
programme on iron deficiency anemia.
H2: There will be a significant association between selected socio- demographic variables and
knowledge of adolescent girls in selected higher secondary school students of iron deficiency
anemia.
ASSUMPTIONS:

This study will

1. Improve the knowledge of higher secondary school students regarding Iron deficiency
anemia.
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 2. Improve the knowledge of adolescent girls in selected higher secondary school
regarding iron deficiency anemia such as early detection, dietry modification,
pharmacological management and follow up care.

OPERATIONAL DEFINITIONS: -

1. EVALUATE: To judge or determine the significant worth or quality of structured

teaching program regarding iron deficiency anemia in adolescent girls in selected higher
secondary school, at visnagar.

2. EFFECTIVENESS: It refers to the quality or capacity of being able to bring about an

effective structured teaching programme on iron deficiency anemia in adolescent girls.

3. PLANNED TEACHING PROGRAMME: It refers to the lecture given by the

researcher to provide adequate information regarding iron deficiency anemia in
adolescent girls.

4. KNOWLEDGE: It refers to the understanding of information regarding iron deficiency

anemia in adolescent girls.

5. IRON DEFICIENCY ANEMIA: it is the deficiency of iron in the blood.

6. ADOLESCENT GIRL: Teenager girl at the age group of 16- 18yrs

7. SELECTED HIGHER SECONDARY SCHOOL: - in selected higher secondary

school, at visnagar.

CRITERIA FOR SAMPLE SELECTION: -

INCLUSION CRITERIA
1. Adolescent girls who are studying in 11th and 12th, in selected higher secondary school,
at visnagar.

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 2. Adolescent girls who are studying in11th and 12th, in selected higher secondary school
those who are present at the time of study.

EXCLUSION CRITERIA
1. Adolescent boys who are studying in11 th and 12th, in selected higher secondary school
are excluded from the study.

2. Adolescent girls who are absent at the time of study.

LIMINATION OF STUDY:
This study is delimited to,
1. 60 adolescent girls in selected higher secondary school studying in visnagar.
2. Data will be collected in a period of 4to6 weeks.
SIGNIFICANCE OF THE STUDY: -
1. Increase the knowledge of adolescent girls in selected higher secondary school students
regarding iron deficiency anemia.
2. Paves the way for higher secondary school students to gain knowledge regarding iron
deficiency anemia Such as screening, dietary management, pharmacological
management and follow up care.

CONCEPTUAL FRAMEWORK OF THE STUDY:

The conceptual framework of the present study is based on Based on Revised Health Belief
Model of Rosenstoch (2003). It consists of three steps that are Associated factors, cues to action
health focus, likelihood of taking. Demographic variables include age, socio cultural belief,
educational status, total family income, Religion, Type food consumption, Source of health
information. Structural variables include knowledge about iron deficiency anemia. cues to
action health focus include Development of tool, Structured questionnaire to assess knowledge.
Determined reliability of the tool. Determined validity of the tools. Conduct pilot study.
Administered tool to assess knowledge. likelihood of taking includes development of planned
teaching program for improve knowledge regarding to iron deficiency anemia.

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