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Effects on Honey dates Amla mix on level of Fatigue on Iron Deficiency Anaemia
among Adolescent Girls at Selected Setting

Article  in  Research Journal of Pharmacy and Technology · January 2018

DOI: 10.5958/0974-360X.2018.00613.3

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 Research J. Pharm. and Tech. 11(8): August 2018

ISSN 0974-3618 (Print) www.rjptonline.org

0974-360X (Online)

RESEARCH ARTICLE

Effects on Honey dates Amla mix on level of Fatigue on Iron Deficiency

Anaemia among Adolescent Girls at Selected Setting
Mrs. Bhuvaneswari G1., Dr. Hepshibha Kerubhamani2 and Dr. Mangala Gowri, P.3
1
Associate Professor, Saveetha College of Nursing, SIMATS, Thandalam.
2
Professor, Saveetha Medical College and Hospital, SIMATS,Thandalam.
3
Principal, Professor, Department of Community Health Nursing, Saveetha College of Nursing, SIMATS
*Corresponding Author E-mail: chnpublication@gmail.com

ABSTRACT:
Background: Iron deficiency anemia is a common type of anemia is a condition in which blood lacks adequate
healthy red blood cells. Research involving anemic adolescence girls has found an increase in hemoglobin is
associated with an improvement in fatigue, which in turn is associated with improvements in health related
quality of life (HRQL). Objectives: To assess the effectiveness of honey dates amla mix on level of fatigue
among adolescent girls with iron deficiency anaemia. Method: An true experimental design with pre-test and
post-test was used for the study. Subjects were randomized to the control and experimental group. The
intervention was administered to the experimental group. The FACIT fatigue severity scale was used to assess
the fatigue level. Results: There was significant difference observed in the pre-test and post test level of fatigue
in the experimental group. In the experimental group there was a rise in mean values for fatigue Conclusion:
Combining the three extract led to the enhancing level of haemoglobin which further improves the quality of life
and improvement of fatigue, there by sense of satisfaction is good & hence can be routinely given to adolescent
girls even in rural area.

KEYWORDS: Iron deficiency anemia;adolescent girls; FACIT fatigue severity scale

INTRODUCTION: Adolescents are vulnerable to iron deficiency because of

Iron deficiency anemia is a common type of anemia — a
condition in which blood lacks adequate healthy red
blood cells. Red blood cells carry oxygen to the body's
tissues.1 According to the third National Health and
Nutrition Examination Survey (NHANES III) data, iron
deficiency, defined by two or more abnormal
measurements (serum ferritin, transferrin saturation
and/or erythrocyte protoporphyrin), continues to be
relatively prevalent in U.S. females, affecting. million
adolescents and women of childbearing age.2 Iron
deficiency anemia, a more severe stage of iron
deficiency (defined as a low hemoglobin in combination
with iron deficiency), was found in 3.3 million females3.
increased iron requirements related to rapid growth. Iron
needs are highest in males during peak pubertal
development because of a greater increase in blood
volume, muscle mass and myoglobin.4 After menarche,
iron needs continue to remain high in females because of
menstrual blood loss, which averages about 20 mg of
iron per month, but may be as high as 58 mg in some
individuals.5 Menorrhagia is heavy menstrual bleeding
which causes anemia due to heavy blood loss i.e., more
than 80 ml.19 Oral contraceptives decrease menstrual
losses, while some intrauterine devices may increase
losses. The most common symptom of all types of
anemia is fatigue (tiredness).5

Fatigue is a burdensome symptom in iron deficiency

anemia (IDA).6 Iron deficiency anemia (IDA), caused by
Received on 09.02.2018 Modified on 25.04.2018 various underlying conditions such as abnormal uterine
Accepted on 11.05.2018 © RJPT All right reserved bleeding (AUB), and gastro-intestinal (GI) disorders, is
Research J. Pharm. and Tech 2018; 11(8): 3337-3340. the leading cause of anemia worldwide; estimates
DOI: 10.5958/0974-360X.2018.00613.3
suggest that approximately five million people have IDA

3337
 Research J. Pharm. and Tech. 11(8): August 2018
in the United States.7 Fatigue occurs due to body doesn't
have enough red blood cells to carry oxygen to its many
parts. Also, the red blood cells your body makes have
less hemoglobin than normal. Hemoglobin is an iron-
rich protein in red blood cells. It helps red blood cells
carry oxygen from the lungs to the rest of the
body.Anemia also can cause shortness of breath,
dizziness, headache8.
Common symptoms of IDA include fatigue and
exercise-associated dyspnea, poor mental performance
and cold intolerance.9 Research involving anemic
adolescence girls has found an increase in hemoglobin is
associated with an improvement in fatigue, which in turn
is associated with improvements in health related quality
of life (HRQL) [8, 9]. There is also evidence that
decreases in hemoglobin are related to increases in
fatigue duration10.
Need for study:
Although the government has taken initiatives to combat
the situation by supplementation of iron and folic acid
tablets to adolescent girls still not much improvement
has been identified in their status. Numerous barriers
play an active role like they feel that it leads to gastric
disturbances, constipation, odour, and dark colour stools
etc. They discontinue taking the supplementation given
to improve their health status. Therefore it was most
important that the younger generation should be made
aware about anaemia and equips themselves with
alternative theory for girls to increase their consumption
of iron-rich foods such as dates, amla which is cheaper
and easily digestible and increase the iron level in the
blood and to treat anaemia. The various studies report
that goose berry and dates with honey can significantly
improve the haemoglobin level without any side effects.
Hence this was undertaken to assess the effectiveness of
alternative herbal therapy and improves the faticability.
So there are times when an iron deficiency is obvious,
but other times it isn’t obvious. When an iron deficiency
is detected then the short term solution is usually to
supplement with iron. However, one also needs to look
at the relationship of the other minerals when looking at
an iron deficiency.12 In other words, sometimes to
correct an iron deficiency one needs to balance out the
other minerals. And of course one’s diet is very
important as well, as some people don’t eat enough iron
rich foods. The best food sources that are high in iron
include honey dates amla mix. Also, keep in mind that a
copper deficiency can also lead to fatigue. So someone
can have strong adrenal glands, normal iron levels, but
have a deficiency in copper which is causing their
fatigue.13 Date fruits are also rich in minerals
like calcium, manganese, copper, and magnesium.
Calcium is an important mineral that is an essential
constituent of bone and teeth and required by the body
3338
for muscle contraction, blood clotting, and nerve
impulse conduction. The human body uses manganese
as a co-factor for the antioxidant enzyme, superoxide
dismutase. Copper required for the production of red
blood cells.14Those who are vegetarians need to make
sure they eat some foods rich in iron on a daily basis of
honey dates amla mix.
MATERIALS AND METHODS:
Participants:
Adolescents in the age agroup of 10-19 years, girls
residing in an institutionalised setting who arewilling to
participate in the study were included in the study.
Informed consent was obtained from the institutional
authorities and an assent was obtained from the
adolescent girls for their participation in the study. The
study was approved by the institutional Human Ethics
Committee of Saveetha University
(008/04/2015/IEC/SU).
Inclusion and exclusion criteria:
The study includes the adolescent from the residential
home who are having the age group of 13-18 years ,
hemoglobin level less than 12gm, attained menarche
interested to participate. The study excluded the
adloescent girls with other diseases like profile of
bleeding disorder, if they take long term medication,
systemic disease (associated and illness).
Phase I:
Both the care takers and adolescent girls were instructed
to administration of honey dates amla mix for
experimental group and clarified doubts before the
study. Weely once iron and folic acid was administered
to the control group.
Phase II:
Based on the inclusion criteria adolescent girls were
asked to assemble in the hall. After completing the
demographic data, pre test questionary on FACIT
fatigue severity scale were administered by the
researcher for both groups.
Phase III:
Alternative supplementation was prepared from honey,
dates, and amla. It was administered by the researcher
and caregiver to the adolescent girls in early morning
and before the breakfast daily for 90 days. For Control
group weekly once 100mg of elemental iron and
500mcg of folic acid given to the adolescent girls. Daily
telephone remembrance was given for checking
continuations and follow up of taking honey dates amla
mix.
 Research J. Pharm. and Tech. 11(8): August 2018
Phase IV:
After three months of intervention the the post test
questionary on FACIT fatigue severity scale were
administered by the researcher from the adolescent girls
whogave informed consent after screened the
haemoglobin level selecting randomly with the
demographic variables.
TOOL FOR DATA COLLECTION:
Level of fatigue was assessed to the control and
experimental groups by using FACIT Fatigue Scale,
(Webster et al., 2012). The test comprised of 13 -item,
easy to administer tool that measures an individual’s
level of fatigue during their usual daily activities over
the past week. The level of fatigue is measured on a four
point Likert scale (4 = not at all fatigued to 0 = very
much fatigued.) Score range 0-52. A score of less than
TABLE 5.3 : Level of fatigue in control (conventional) and experimental (herbal) groups in pre test and post test (n= 85 each)
S. No Parameter Group Median
(percentage)
(75%)
1. Fatigue Control 29±31%
Pre test
Control 36±38%
Post test
Experimental 31± 34%
Pre test
Experimental 40± 42%
Post test
Correlation of haemoglobin with level of fatigue:
In pre-test control group the haemoglobin was showed
significantly negative correlated with fatigue (r=-0.098,
P<0.371) In control post-test was positively significant
correlation in (r=-0.351, P<0.001), were as experimental
pre and post test. Correlation of haemoglobin and level
of fatigue showed positively significant
correlation.(r=0.33, P<0.001) (Fig.5). The present study
showed that the haemoglobin level was higher means
the level of fatigue was decreased (quality of life was
increase) and there is significant reduction of clinical
symptoms of iron deficiency anaemia among adolescent
girls. So alternative nutritional herbal supplementation
would reduce the iron deficiency.
CONCLUSION :
In conclusion, this study revealed that level of fatigue
was assessed among adolescent girls. A honey dates
amla mix has significant role in improving quality of
life.Similarly it has the beneficial effects in positively
changing the fatigue level among adolescent girls.
Overall the study resulted in highly significant
improvement in all the parameters than other
conventional treatment in reducing the anaemia among
adolescent girls residing in rural orphanage.
30 indicates severe fatigue. The higher the score, the
better the quality of life.
RESULTS AND DISCUSSION:
The data was analysed using non parametric test as
fatigue score is a discrete variable. Wilcoxon signed
rank test within experimental protest and post-test
showed significant difference in level of fatigue
(p<0.001). In control group there is no significant
difference (P<0.001) for the level of fatigue. After
intervention post test score of control and experimental
group were compared by Mann Whitney test was highly
significant (P<0.001). These results proved that herbal
(honey dates amla mix) therapy was very effective to
reduce the fatigue level on iron deficiency anaemia
among adolescent girls.
Mann Whitney Rank sum test Wilcoxon signed rank test
Con-Exp Pre test Con-Exp Post Control pre- Exp pre-post
test post
T=5931 T=4987 W= 34.13 W= 3543
P=0.001 P=<0.001 P=<0.001 P=<0.001
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