CHAPTER I

INTRODUCTION: -
"It is health that is real wealth and not pieces of gold and silver
-Mahatma Gandhi

Life's major asset is cherishing good health. Nutrition is the essential part of the
mosaic factors that determine health Nutritional adequacy is one of the key
determinants of the quality of human resources everywhere, Iron deficiency
Anemia is a form of major micronutrients deficiency and it impacts lives of
million people in the world
Anemia is a global public health problem affecting both developing and
developed with major consequences for human health as well as social and
economic development. Total number of individuals affected is 1.62billion It
occurs at all stages of life cycle, but is more prevalent in non-pregnant women
(73.5%), pregnant women (69%), and young children (74%).
[WHO2008]
Anemia is one of the important public health problems not only in India but also
in most of the south east Asian countries it is the most common nutritional
problem in the world and mainly affects women of child bearing age globally
30% of the total world population is anemic and half of them are suffering from
iron deficiency anemia.
Hemoglobin estimation and study of peripheral smear is good indicator for
diagnosis of anemia the normal amount is least 13g/dl (13 grams of hemoglobin
per deciliter of blood) for men and 11g/dl for women anemia is often classified
mild degree (Hb %-9-11gms%) moderate (7-9gms%) severe (4-7gms5) and
very severe (less than 4gms%) Iron deficiency is a well-known form of
nutritional deficiency.
The world's adolescent population is facing a series of serious nutritional
challenges which are not only affecting their growth and development but also
their livelihood as adults. Yet, adolescents remain a largely neglected, difficult-
to- measure and hard-to-reach population, in which the needs of adulthood girls
in particular, are often ignored.
Adolescent girls and young adults are at a high risk for anaemia and
malnutrition. Inadequate nutrition during adolescence can have serious
consequences throughout the reproductive years of life and beyond. Very often,
in India, girls get married and pregnant even before the growth period is over,
thus doubling the risk for anaemia.
In India, adolescent girls and young adult, constitute a sizable segment of its
population, 20 to 40. % of maternal deaths are due to anaemia. Young people
are particularly susceptible because of their rapid growth and associated high
iron requirements. Anaemia is a critical health concern because it affects growth
and energy levels. Anaemia is the result of a wide variety of causes that can be
isolated, but more often coexist. The most significant contributor to the anaemia
is iron deficiency anaemia. It is generally assumed that 50% of the cases of
anaemia are due to iron deficiency. Iron deficiency is not life threatening but it
can have detrimental effect on work capacity. learning ability and resistance to
disease. Once anaemia results, there is also impairment in cognitive
performance and behavior.
The iron deficiency anemia signs and symptoms are pallor of the eyes,
irritability, fatigue, husky voice, loss of appetite, desire to have gnaw solid
substance (pica), ice (pagophagia) or clay (geophagia), nail's are dry, brittle
concave, angular stomatitis, irritation of the tongue, sore mouth, difficulty in
swallowing, breathing difficulty due to decreased oxygen carrying capacity of
the blood and it affects immune system also.
Some are malnourished due to lack of knowledge about dietary iron, poor socio-
economic status, low-income family which is common in rural areas and also in
menstrual period reproductive women used loose 45 ml of blood (i.e.) 22 mg of
iron. Iron deficiency anemia will be prevented by adequate dietary intake or
iron such as green leafy vegetables such as amaranth, spinach, coriander leaves,
drumstick leaves, radish leaves, vegetables such as beet root, drumstick, cereals
like Raggi, barley, cholam (Sorghum), rice (raw milled), legumes like Bengal
gram dhal, Black gram dhal, soya bean, Nuts and oil seeds like dates, cherry,
fruits such as chickoo, pomegranate and jaggery.
Education about low cost iron rich foods such as dates, jaggery, ragi, green
leaves to the rural areas, and avoiding the meal skipping to eat Jung foods and
fast foods will prevent the iron deficiency anemia. By giving 25 grams of
jaggery as a daily requirement, it regulates the deficiency of iron and also
purifies the blood very well; it improves the digestion, and reduces joint pains.
Regular hemoglobin screening tests will identify the iron deficiency anemia in
early stage. Iron supplementation should be given before meals because iron
will absorb easily in acidic nature or it may be given along with citrus juice like
lime or orange juice.
Anemia is the decreased ability of the red blood cells to provide adequate
oxygen to body tissues. It may be due to a decreased number of red blood cells,
a decreased amount of substance in red blood cells, which transports oxygen
different types of anemia, some due to a deficiency of either a single or several
(hemoglobin), or a decreased volume of red blood cells. There are over a dozen
essential nutrients and others from conditions that are not related to nutrition
such as infections.
Haemoglobin is the protein molecule in red blood cells that carries oxygen from
the lungs to the body’s tissues and returns carbon dioxide from the tissues back
to the lungs. Haemoglobin is made up of four protein molecules (globulin
chains) that are connected together. Low haemoglobin levels usually indicate
that a person has anemia.
People throughout the region suffer from non-nutritional anemia's (such as
sickle-cell anemia and thalassaemia, which are induced by genetic disorders),
but these are few in comparison to the number of people children, women and
men and especially young adults with nutritional anemia.
According to the World Health Organization (WHO), anemia is defined as
hemoglobin (Hb) levels <12.0 g/dL in women and <13.0 g/dL in men.
Mild: Hemoglobin 10.0 g/dL to lower limit of normal. Moderate: Hemoglobin
8.0 to 10.0 g/dL. Severe: Hemoglobin 6.5 to 7.9 g/dL[1] Life-threatening:
Hemoglobin less than 6.5 g/dL.
The bio availability of iron rich diet can be enhanced by positive dietary habits
& reduces the intake of inhibitors and enhanced iron absorption through vit-C,
vit-A rich fruits & vegetables. [Yegammal & Aswarnalatha, 2003]
Ragi is rich in iron, a vital component of hemoglobin, which carries oxygen in
the body. Eating iron-rich foods like ragi laddu can boost iron levels, leading to
increased hemoglobin production.

Ragi laddu contains ingredients like jaggery with vitamin C, which enhances
iron absorption from ragi. Combining ragi with vitamin C helps the body absorb
iron better, leading to improved hemoglobin levels.
Ragi is a good source of folate (vitamin B9), essential for the production and
maturation of red blood cells that carry hemoglobin. Including ragi in the diet
supports healthy hemoglobin levels.
 NEED FOR THE STUDY

“Time and health are two precious assets that we don’t recognize and
appreciate until they have been depleted”
Denis Waitley

Sadly it‘s surprising that youngsters diets are becoming increasingly unhealthy
and higher numbers are becoming overweight. This focus on weight could be
taking its toll on some of their vitamin and mineral intake, creating a nutritional
gap which could lead to its own health issues in the future.
In World 40% of population suffer from anaemia especially, adolescent 30-
55%. Iron deficiency is the most common micronutrient deficiency which
affects more than 2 billion of the population worldwide, leading to anaemia in
more than 40% of women of reproductive age in the developing world and 7- 12
percent in developed countries. Estimates suggest that over one third of the
world’s population suffers from anaemia, mostly iron deficiency anaemia
According to ICRW (International centre for research on women), India has the
highest prevalence of iron deficiency anaemia among women in the world,
including 60-70 percent if Indian young adult is anaemic. Prevalence of
anaemia in India is high because of low dietary intake, poor availability of iron
and chronic blood loss due to hook worm infestation and malaria. While
anaemia has well known adverse effects on physical and cognitive performance
of individuals, the true toll of iron deficiency anaemia lies in the ill-effects on
maternal and foetal health
In Tamil Nādu 1-10 per 100 adolescent girls are prone for anaemia (Government
of Tamil Nādu 2006).As per district level health survey (DLHS 2002-2004)
prevalence of anaemia in adolescent girls is very high ( 72.6%) in India with
prevalence of severe anaemia among them much higher (21.1%).
The National Family Health Survey (NHANES 3) conducted in 2005-06, 56%
of adolescent girls are anaemic. In another study, data from The National Family
Health Survey (NHANES III) were examined for an association between iron
deficiency and weight. The prevalence of iron deficiency increased as body
mass index increased from normal weight to >85th percentile for age and sex to
>95th percentile for age and sex (2.1 percent, 5.3 percent, and 5.5 percent,
respectively). Obesity was a risk factor for iron deficiency anaemia in both boys
and girls, but rates were approximately three times higher in girls. The etiologic
of anaemia in obese individuals is uncertain but may be related to low-quality
diets or increased needs relative to body weight.
The study was carried out by National Nutrition Monitoring Bureau in Andhra
Pradesh, Karnataka, Kerala, Madhya Pradesh, Maharashtra, Orissa, Tamil Nadu,
and West Bengal. Objectives of the study to estimate haemoglobin level among
preschool children, adolescent girls, young adults and pregnant and lactating
women.
A total of 75600 HHs from 633 villages were covered. 3291 preschool children,
6616 adolescent girls, 2983 pregnant women, and 3206 lactating mothers were
covered for haemoglobin estimation. The lowest mean haemoglobin level was
found among adolescence (9.9g/dl), followed by preschool children (10.3 g/dl),
lactating women (10.6 g/dl). There is an urgent need for improving the
implementation of national nutrition programmes and strengthening nutrition
education.
Iron needs are higher in adolescent girls after the onset of menstruation because
of monthly blood loss. An important risk factor for iron deficiency anaemia is
heavier than normal menstrual bleeding, adolescent females often do not get
enough iron to keep up with menstrual losses. They especially do not want to
talk about how heavy their periods are. They are often very sensitive about their
diet and their body image. Fewer than 2% of adolescents eat enough of all the
food groups, and almost 20% of females and 7% of males do not eat enough of
even one of the food groups. Frequent dieting or restricted eating, skipping
meals, vegetarian eating styles and others listed at left are all risk factors for
anaemia in adolescents and young adults.
HYDERABAD: More than 60% children in Hyderabad are anaemic indicating a
serious iron deficiency in their food intake, shows national family health survey
(NFHS-5) data released on November 24 by the Union health ministry
The report also points to a significant population of women-about 52% of those
surveyed in the city suffering from anaemic. The numbers are much the same at
the state-level.
Anaemia, caused primarily due to iron deficiency, is a condition which is
marked by low levels of haemoglobin in the blood. Over the last four years,
Telangana has seen a substantial increase in prevalence of anaemic cases among
children and adults, according to the NFHS-5 report for 2019-20.
Hence the researcher is interested to conduct the study in order to increase the
level of hemoglobin among nursing students and to reduce anaemic students.
Raagi is the common name of finger millet in southern part of India (and known
as Nachni in the Northen part of India). It is rich in calcium and protein and also
have good amount of iron and other minerals.

Benefits of ragi in our diet includes

1. Loaded with calcium: ragi flour is one of the best non-dairy sources of
calcium when compared to any other grains. According to the National Institute
of Nutrition in India, 100gms of ragi contains 344 mg calcium, calcium is
critical for healthy bones and teeth and prevention of osteoporosis- a disease
which weakens the bones.

2. Helps in controlling diabetes, 3. Reverts skin ageing, 4. ragi is an excellent

source of natural iron and thus a boon for anemic patients and also for those
with low haemoglobin levels. Once ragi is allowed to sprout, the vitamin C
levels tend to increase and lead to easy absorption of iron into the blood stream.
5. Relaxes the body: regular consumption of ragi highly beneficial in dealing
with conditions of anxiety, depression and insomnia. The presence of
antioxidants mainly tryptophan and amino acids, helps as they work as natural
relaxants. 6. Helps in weight loss. Ragi laddu is the combination of jaggaery and
ground nut. Jaggery

PROBLEM STATEMENT
A study to assess the effectiveness of Ragi laddu on hemoglobin levels among
Nursing Students with anemia in selected Nursing College, Hyderabad,
Telangana.

OBJECTIVES OF STUDY
• To assess the pre intervention haemoglobin levels of Nursing Students with
anemia.
• To determine the effectiveness of Ragi laddu among Nursing Students with
anemia.
• To find out the association between post intervention hemoglobin level with
selected demographic variables of Nursing Students.
Operational Definitions: -

Assess: To evaluate the level of anemia for nursing students

Effectiveness: Refers to the outcome of the ragi laddu on anemia among

nursing students by comparing pre-test & post-test haemoglobin values.

Ragi laddu: It is laddu prepared by researcher which contains of roasted raagi -

500gm roasted groundnuts- 250gm jaggery-250gm

The researcher will give total of 35gms of ragi laddu per day

Anaemia: Nursing students whose Haemoglobin is less than normal.

Mild: Hemoglobin 10.0 g/dL to lower limit of normal.

Moderate: Hemoglobin 8.0 to 10.0 g/dL.

Severe: Hemoglobin 6.5 to 7.9 g/dL

Nursing students: It refers to the students studying in BSc and GNM of

selected nursing college
VARIABLES UNDER STUDY

a) independent variable: Ragi laddu

b) Dependent variable: Nursing students with anaemia.

Assumption: -

 The level of anaemia varies from individual to individual.

 Consumption of ragi laddu will improve the hemoglobin level.

Delimitations: -

 The study will be delimited to the selected Nursing students

 The sample size is limited to only 60 subjects.
 Those who are diagnosed with anaemia.

Hypothesis: -

H1- There will be significant difference between pre-test & post-test level of
anemia among nursing students after providing ragi laddu.
H2: - There will be significant association between level anemia among nursing
students with demographic variables.

Conceptual framework

Conceptual frame work is inter relate of concept are abstractions that are
assembled together in some rational schemes by virtue of their relevance to a
common thing. The investigator adopted the weidembach's help in or of clinical
nursing theory (1964) as a basis for developing the conceptual frame work. The
art of clinical nursing requires individualized interpretation of behaviour in
meeting needs for help. In her theory, she described ideas about nursing art,
concept and philosophy

Emestime weidembach proposes that prescriptive theory has three factors which
are incorporated in the present study

1. Central purpose

2. Prescription

3. Realities

1. Central purpose: The central purpose in nursing is to motivate the individual

and or facilitate individual efforts to overcome the obstacles that may interfere
the ability to respond capably to the demands made of her by the realities in her
situation.

Theorist emphasized that the nurse’s goals are grounded in the nurse's
philosophy, that those believes and values that shape her attitude towards life
toward follow human beings and toward herself

The three concepts that emphasize the essence of reach philosophy are
according to present study.

Agent the agent is nurse supplying the nursing action. The agent has four basic
responsibilities

To reconceal assumption about realities

To specify the objectives

To practice nursing according to the objectives

To engage in related activities that contributes to self-realization and to
improvement of nursing

In the present study, agent who is the nurse is applying the nursing action by
checking the hemoglobin levels and providing them with ragi laddu.

Recipient: The recipient is vulnerable and is depend on other for help and risks
losing their individuality, dignity, worth and autonomy The recipient who is
receiving the action are no whose behalf the action is taken, In the present the
recipient are nursing students whose hemoglobin levels are less than 12 gm/dl

Goal: The goal or the end to the attained through nursing activity. The goal or
directed outcomes, the nurse wishes to achieve. Here the goal is to improve the
hemoglobin level.

Means: The means, the action and devices through which the nurse enables to
reach the goal. The activities that the nurse is empowered to achieve the goals,
here the mean Is to identify the nursing students whose hemoglobin levels are
less than 12gm/dl and provide iron rich ragi laddu

Framework: The frame works consists of human, environmental, professional

organizational facilities it comprises of situational factors that affect the nurses
ability to achieve nursing results, in the present study the frame work is selected
nursing college where girls are less hemoglobin percentage level 12mg/dl The
conceptualization of the nursing practice according to this theory consists of
three steps as follows

STEP1: Identifying the need for help:

Need for help is defined as any measure desired by the patient that as the
potential to restore or extend the ability to cope with various life situation that
health and wellness. Identification of the need of help involves:

Observing in consistencies and acquiring information about students.

Determining whether student can meet the need for help.

Determining the cause of discomfort or need for help.

Nursing primarily consists of identifying the student need for help. If the need
for help requires intervention, the nurse facilities the medical plan of care and
also creates and implements and nursing plan of care based on needs and desires
of students, Here the investigator identifies that nursing students need to
improve their hemoglobin levels.
STEP2: Ministering the need for help:

In Ministering the needed help to the student, the nurse may give advice or
information make referral, apply a comfort measure or carry out therapeutic
procedure, she makes adjustment in the plan of action if necessary.

STEP3: Validating the need for help:

After the help has been minister the nurse validates that action were indeed
helpful. Evidence must come from the patient that purpose of nursing action has
been fulfilled

Here the investigator evaluates the effectiveness of consumption of ragi laddu

on hemoglobin levels among nursing students.

The model adopted for this study is weidenbach is helping art of clinical nursing
theory researcher adopted this model and perceived art enabling to assess the
effectiveness of consumption of ragi laddu on hemoglobin level among nursing
students.
In present study the primary prevention focuses on asses the Iron deficiency
anaemia among nursing students (18 to 21 yr) it focuses on protecting the
normal life of flexible line defence. Secondary prevention focuses on screening
for anaemia by checklist, checking Haemoglobin levels & providing nutritional
supplements for 30 days.

EPILOGUE:

This chapter dealt Introduction, Need for the study, Problem statement,
operational definitions of terms, variables, conceptual frame work,
Assumptions, and Delimitations.
 Chapter-2
Review of literature

This chapter deals with selected studies related to the objectives of the proposed
study. A literature review is a compilation of scientific studies pertaining to the
present study. It is frequently found as a subsection of the published research
study. Reviews of literature are also published as free-standing explorations of a
body of knowledge. Review of literature is an essential part of every research
project. A literature review involves systematic identification, scrutiny and
summary of written materials that contain information on a research problem.

(Polit and Hungler. 2012) The Investigator made a thorough search of research
studies, reports and publications brought out in anemia among adolescent girls.
Computer search was also done for collecting the literature related to the present
study. Related literature for the present study has been collected and organized
under the following sections. The relevant studies are organized into the
following categories based on objectives.

A literature review is a body of text that aims to review the critical points of
current knowledge including substantive findings as well as theoretical and
methodological contributions to a particular topic. Literature reviews are
secondary sources, and as such, do not report any new or original experimental
work.

Most often associated with academic-oriented literature, such as these, a

literature review usually precedes a research proposal and results section. It's
ultimate goal is to bring the reader up to date with current literature on a topic
and forms the basis for another goal, such as future research that may be needed
in the area relevant references with consistent, appropriate referencing style;
proper use of terminology, and an unbiased and comprehensive view of the
previous research on the topic... Through the literature review, researcher
generates a picture of what is known about a particular situation and the
knowledge gap that exists between the problem statement and the research
subject problems and lays a foundation for the research plan.

The literature review was based on an extensive survey of journals, books, and
international nursing indicates
The relevant studies are organized into the following categories based on
objectives.

A) Review related to incidence of anaemia

B) Review related to effectiveness of Iron rich Nutritional ball.

(C) Review related to anaemia among adolescent girls. A) Review related to

incidence of anaemia

Ross (2011) An article on iron deficiency saying iron deficiency is a common

problem especially for women,5% of women between the ages of 20 and 49
years have iron deficiency with anaemia, also recommend that iron deficiency
can be improved by consuming more of iron rich diet like cereals, grape nuts,
baked potato, broccoli, kidney beans, meat etc.

Paul R Meier (2013) A study conducted on prevention of iron deficiency

anemia in adolescent and adult pregnancies, design was randomized double-
blind clinical trial with placebo control, conducted in multicentre clinic in
central Wisconsin, the participant of the study was women above 18 years. They
received iron supplementation 60mg day. He concluded that iron deficiency
anaemia substantially reduced with 60mg of elemental iron per day.

Al- Sharbatti ss, Ai-Ward N J,(2013) A study conducted in two distinct socio-
economic areas (SEAS) in Baghdad and to assess the importance of diet and
some other factors which could be relevant in the epidemiology of anemia in
adolescents. A random sample of 1051 adolescents were included in the present
study, 46% of them (487 adolescents) were from Al-Mansoor area for high
socio-economic area (HSEA) and 54% of them (564 adolescents) were from
AlHorya area for low socio-economic area (LSEA) in Baghdad, Iraq. Collection
of data was carried out during the period between November 2012 until the end
of April 2013. Haemoglobin concentration and packed cell volume levels were
determined. Dietary intake of iron, calories, protein and Vitamin C were
estimated. The conclusion of the study was the prevalence of anaemia among
adolescents in HSEA was 12.9% compared with 17.6% in LSEA. Haemoglobin
concentration in males was significantly correlated with age and dietary iron
intake while in females it was correlated significantly with years of education of
father and mother, number of pads and age at menarche. Anaemia among
adolescents was found to be a health problem of moderate severity
Ida Tidemann- Anderson, Hedwig Acham(2013) A recent study focused on
the iron and zinc content in selected foods and intake of the micronutrients iron
and zinc among adolescence in Kumi District, Uganda. Over a period of 4
weeks single 24-hour dietary recall interviews were carried out on a
convenience sample of178 adolescence (15- 18years old). Data from the dietary
recalls was used when selecting foods for chemical analysis. The data on food
intake collected in the 24-hour recall interviews was used as a basis to select
foods for iron and zinc analyses. Both dry foods and fresh foods that were
possible to sun-dry locally were included. This selection excluded certain foods
such as tomatoes, cucumber and cabbage because of lack of facilities for drying
or freezing the samples. Results from this study showed that the iron
concentrations varied were high in some cereals and vegetables. Data from the
24-hour dietary recall showed that the daily Recommended Nutrient Intake
(RNI) was met for iron but not for zinc. In this study it was found that
adolescence of Kumi district had a predominantly vegetable based diet. The iron
content in the selected foods was high and variable, and some vegetables and
cereal exceeded the iron concentrations in meats

Taru Agarwal, G. K Kochar. (2014) An experimental study was done to

identify the impact of iron supplementation on anaemia during adolescent girls.
Salty rice flakes preparation was prepared. Sixty volunteered girls, who were
studying in school, undergo experimental trial. Ten non anaemic girls were
included in control group. A questionnaire regarding general information was
filled up. All the subjects were showing symptoms of anaemia but signs were
not same. Majority (90 %) were showing paleness of eyes. Hb values of group
and C were more than the control group A and were found significant in
comparison with group A. Thus, iron supplementation in both forms (Tablet as
well as Food) is helpful in managing anemia The results concluded that there is
a significant difference in anaemic condition of group iron tablet supplemented
group (B) and iron Rich Food Supplemented group (C) as compared to control
group (A). More improvement in hemoglobin values of group C was also
noticed in comparison to group B but statistically the difference was found non
significant. It is recommended that both kind of supplementation of iron are
helpful in managing anemia among adolescence.

B) Review related to effectiveness of Iron rich ragi laddu.

Gloria Tsang (2013) published an article saying that iron deficiency anaemia in
women, a diet with iron rich foods along with iron supplements often
recommended. Absorption of iron from food is influenced by multiple factors.
One important factor being the form of the iron is Heme Iron, found in animal
sources (Meat fish/poultry), is highly available for absorption. Non-heme iron
on the other hand is found in vegetable sources (Broccoli, brussels sprouts,
tomato, potato, lemon and orange juice).

Nandita Kapadia(2014) has done a study on reducing iron deficiency anaemia

and changing dietary behaviours among adolescent girls in Maharashtra, India.
A census of 1142 adolescent girls in 16 slums in Pune was conducted. 811 were
surveyed for information on dietary and morbidity history, menstrual history,
consumption of locally available iron rich food, lemon is added up with meals
and workload of the women. Blood sample was taken with the help of
cyanmethaemoglobin method. He concluded that eating meals more than three
times, addition of lemon and the frequency of fruit intake increases the
hemoglobin level.

Hilary M.Creed (2012) conducted a study for improving dietary intake to

prevent anemia in adolescent girls through community kitchen in a urban
population of Lima, Peru. They used pre/post comparison between intervention
and communities with similar demographic and socio-demographic
characteristics. They randomly selected the community and adolescent girls.
They concluded that majority of the girls stated anemia was associated with a
poor diet, poor quality of diet, lack of vitamins, inadequate amount consumed
and not keeping meals.

C)) Review related to anemia among girls.

Neetu Gugta (2013) reported a study on pervasiveness of anemia in adolescent

girls of low socio-economic group of Haryana .He used Sahilis method to check
hemoglobin. Sample size used was 110 girls. He concluded that overall socio-
economic development, adequate nutrient intake and education will surely help
in reducing the prevalence of anemia in girls.

Patil.S.N (2014) conducted a study on health problem amongst girls in rural

area of Maharashtra, India. Cross sectional approach had adopted. Simple
random technique was used... Hemoglobin was measured. The study concluded
that majority of girls had clinically obvious nutritional deficiency disease. Two
third of the study subjects were undernourished.
Sanjeev M Chaudhary (2013) reported a study to estimate the prevalence of
anemin among adolescelent females and to study the socio-demographic factors
associated with anemia. A cross-sectional survey was conducted in an urban
area under Urban Health Training Center, at Nagpur. A total of 296 adolescent
females (10-19 years old) were included in this study. They concluded that
anemia affects the overall nutritional status of adolescent females.

S. Kaur, P.R.etat., (2014), Epidemiological Correlates of Nutritional Anemia in

Adolescent Girls of Rural Wardha. This study was a cross-sectional study
carried out in four villages population of the study was 10000 and sample size
was 630. All unmarried, non-pregnant and non-lactating adolescent girls in the
age group 13-19 years in the study area were covered. A pre-tested and pre-
designed Performa was used to collect he information. Later, they concluded
that the study population of whom majority (68.7%) were early adolescents (13-
16 years). Only 0.9% girls were illiterate while more than 50% girls had
completed secondary level education. Majority girls belonged to families with
income group in Grade III (Rs.300-499) followed by Grade IV anaemia.

Sabita Basu (2011) briefly reports the prevalence of anaemia and among school
going adolescents of Chandigarh. This study was conducted to assess the
prevalence of anaemia and determine serum ferritin status among 1120
apparently healthy adolescents (12 to 18 years) sampled from 11 city and rural
school in Chandigarh. The estimation of haemoglobin was estimated by
cyanmethemoglobin method. The overall prevalence of anaemia was calculated
as per WHO a guideline was significantly high among girls as compared to
boys.
 Chapter -3

Methodology

In the present study the investigator aims to study the Effectiveness of

Nutritional Ball on prevention of iron deficiency Anemia among Adolescent
girls at selected school Nizamabad, Telangana.

Research approach:-

In the Present study, the research approach adopted was qualitative approach
(quasi experimental approach ). The present investigator aims to study the
effectiveness of Nutritional Ball on prevention of iron deficiency Anemia
among Adolescent girls at Selected schools, Nizamabad, Telangana.

Research design:-

The Research design adopted for the present study was quasi experimental
design- one group pre-test and post-test design. In this design, the sample is
pretest with the help of demographic variables. After the pre-test the
independent variable is administered to the sample irrespective of their pretest
knowledge score and its effectiveness is assessed with the help of the post test

Schematic representation of the design:

Where 'Ol' is a pretest which includes assess the level of the iron deficiency
anemia among adolescent girls.

"X" is the proposed by the investigator which is selected experimental study on

effectiveness of nutrition ball on iron deficiency anemia among adolescent girls.

02' is the post-test which includes Assessing the Effectiveness of nutrition ball
on iron deficiency anemia among adolescent girls.
Z

E 01 X 02