Student Section

The Knowledge and Attitude towards Anaemia amongst

Adolescent Girls
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Dhivakar M1, Iswariya M1, Ponnambily Chandy Jobin2

1
III Year B.Sc. Nursing, Chettinad College of Nursing, Chettinad Academy of Research and Education, 2Assistant Professor, Chettinad Academy of Research and
Education, Kanchipuram, Tamil Nadu, India
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Abstract
General daily iron requirement expands 2–3 folds during adolescence because of high development spurt and the loss of 12.5–15 mg iron
every month during menstruation. Therefore, adolescent girls are vulnerable for iron deficiency anaemia if dietary intake is not sufficient to
meet the demands. Thus, the investigators wished to conduct a study to assess the knowledge and attitude towards anaemia amongst adolescent
girls in Kanchipuram district, Tamil Nadu. A descriptive research design was used. The population was adolescent girls in the age group of 18
and 19 years, and the sample size was 40. Simple random sampling was used to select the samples. A knowledge and attitude questionnaire
developed by the investigators was used to collect data. The study findings showed that the majority of the study participants had a high
level of knowledge regarding anaemia 37 (92.5%) and only 3 (7.5%) participants were having a moderate level of knowledge. However,
31 (77.5%) of the study participants expressed moderate level of attitude and none of them had a high level of attitude towards anaemia. All
participants (40 [100%]) stated that the inclusion of iron‑rich foods in the daily menu is essential to prevent anaemia. Study findings reveal
generally good knowledge and moderately acceptable level of attitude.

Keywords: Adolescence, adolescent girls, anaemia, attitude, knowledge

Introduction every month during menstruation. Iron deficiency during

‘Anaemia is a condition in which the number and size of red
blood cells (RBCs), or the haemoglobin (Hb) concentration,
falls below an established cut‑off value, consequently impairing
the capacity of the blood to transport oxygen around the
body’ (p. 1).[1] Anaemia is an indicator of both poor nutrition and
poor health. Anaemia is a condition where the quantity of red
platelets (RBCs) and their oxygen‑carrying capacity is lacking to
meet the body’s physiological needs. It is a condition when the
ordinary number of RBCs (<4.2 million/µl) or Hb level <12 g/dl)
in females and <13 in males goes below the expected levels
in blood.[2] Worldwide, it is the most widely recognised and
resolute nutrition issue influencing around 2 billion of the total
population having a significant effect on human well‑being and
social and monetary advancement, and more than 89% of this
burden is reported in low‑income nations.[3,4]
Even though anaemia can happen in all phases of life, it is
more common during the period of adolescence since the
general iron necessity expands 2–3 folds at this time due
to high development spurt and the loss of 12.5–15 mg iron
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puberty has irreversible negative consequences for their
reproductive development throughout their life and beyond.
Pregnancy during adolescence with anaemia increases the
maternal morbidity and mortality as well as the occurrence
of poor maternal birth results such as stillbirth, low birth
weight and prematurity and decreases the iron status of the
newborn baby.[5,6] The effect of anaemia amongst adolescent
girls is as yet a prevailing issue internationally, in spite of
the fact that there are explicit activities such as empowering
daily intake of iron‑rich foods through dietary change,
health‑related instructions, treatment and deworming and
iron supplementation to improve the iron status amongst
adolescent girls.[7]
Address for correspondence: Mrs. Ponnambily Chandy Jobin,
Chettinad College of Nursing, Chettinad Academy of Research and
Education, Kanchipuram, Tamil Nadu, India.
E‑mail: ponnambily.ponnu@gmail.com
Submitted: 10-May-2020 Revised: 18‑Jun‑2020
Accepted: 20-Jun-2020 Published: 14-Sep-2020
This is an open access journal, and articles are distributed under the terms of the Creative
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remix, tweak, and build upon the work non‑commercially, as long as appropriate credit
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DOI: How to cite this article: Dhivakar M, Iswariya M, Jobin PC. The knowledge
10.4103/IJCN.IJCN_30_20 and attitude towards anaemia amongst adolescent girls. Indian J Cont Nsg
Edn 2020;21:100-3.

100 © 2020 Indian Journal of Continuing Nursing Education | Published by Wolters Kluwer - Medknow
 Dhivakar, et al.: Knowledge and attitude towards anaemia amongst adolescent girls
Various researchers have conducted studies on anaemia
amongst adolescent girls from various settings of the world.
A study conducted in Thailand to determine the prevalence
and causes of anaemia amongst high school students showed
that 19 out of 227 participants (8.30%) had anaemia, and
iron deficiency was the main cause of anaemia.[8] Another
cross‑sectional study conducted in Ethiopia showed that
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the overall prevalence of anaemia amongst adolescent girls
was 25.50%, and dietary diversity score, household food
security status and living status of the adolescents were the
key determinants of anaemia amongst the study participants.[9]
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In South India, a cross‑sectional study conducted amongst
257 adolescent girls to estimate the prevalence of anaemia
and its associated factors showed that 21% of the study
participants had anaemia and the risk factors associated were
the presence of cysts in stool and menstruation. Hand washing
after toileting and before food intake, footwear usage and
jaggery consumption were identified as protective factors.[10]
Similarly, another cross‑sectional study conducted amongst
255 adolescent girls showed that the overall prevalence of
anaemia was found to be 48.63% and the same study reported
high prevalence amongst late adolescents and those belonging
to low socio‑economic status.[11]
The above‑mentioned studies reveal the existing prevalence
of anaemia amongst adolescent girls. The high prevalence
can be reduced through lifestyle modifications by instilling
knowledge and attitude towards anaemia amongst them.
A study conducted to assess the knowledge, attitude and
peer influences related to anaemia in South Africa showed
that only 43.9% of them had adequate knowledge, and there
was no significant relationship between knowledge and
attitude towards anaemia amongst them.[12] An experimental
study conducted amongst urban Tanzanian adolescent school
girls to observe the effect of a communication programme
on compliance with weekly iron supplementation showed
that the knowledge of anaemia increased significantly in all
schools after the intervention.[13] A study done in India on
the knowledge and attitude of rural adolescent girls revealed
that there was inadequate knowledge and neutral attitude
amongst adolescent girls regarding the prevention of iron
deficiency anaemia. There was a positive correlation between
the knowledge and attitude of adolescent girls regarding the
prevention of anaemia. The study concluded that adolescent
girls should be sensitised with the knowledge of prevention of
anaemia to enhance their understanding and to have a better
attitude.[14] An observational study in North India revealed that
55.9% of adolescents were found to be anaemic. Knowledge
and practices of personal hygiene were lower in anaemic
girls compared to non‑anaemic girls. The extent of deficit
of iron‑rich food consumption was low in both anaemic
and non‑anaemic girls. A study to assess the prevalence of
anaemia amongst adolescent girls in the selected Allied Health
Science College in 2019 showed that 56% of them had low Hb
levels (<12 g/dl).[15] As a follow‑up study, the investigators,
who were nursing students, wished to conduct a study to
Indian Journal of Continuing Nursing Education ¦ Volume 21 ¦ Issue 1 ¦ January-June 2020
assess the knowledge and attitude towards anaemia amongst
adolescent girls in Kanchipuram district, Tamil Nadu.
Objectives
• To assess the knowledge and attitude towards anaemia
amongst adolescent girls
• To find the association between knowledge on anaemia
with the selected demographic variables of adolescent
girls.
Methodology
A descriptive research design was used. Students from the Allied
Health Sciences College, in which a previous study revealed half
the proportion of students (56%) to have anaemia (<12 g/dl),[15]
were recruited for the study. A total of forty adolescent girls
between the age group of 18–19 years who did not have a
diagnosis of anaemia were randomly selected using a sampling
frame from sixty students in five batches, who were willing
to participate in the study. The data collection instrument was
developed by the investigators. The reliability and validity
of the tool was done with the help of nursing experts. It had
two sections such as (1) demographic data and (2) knowledge
and attitude questionnaire. The knowledge part included the
questions on definition, symptoms, management and prevention
of anaemia (15 questions) and attitude questionnaire included
the level of perception regarding danger of anaemia, importance
of implementing of healthy lifestyle to prevent anaemia and
education of anaemia amongst peer groups and family (ten
statements). The investigators applied the interquartile range
to score the data and divided into first (Q1), second (Q2)
and third quartiles (Q3). These quartiles were named as low,
medium and high level of knowledge/attitude, respectively.
The duration of the study was 7 days. Approvals from the
Undergraduate Committee and Human Ethics Committee were
obtained. Formal approval was also obtained from the principal
of the selected college. The investigator introduced the self to
the participants, and the purpose of the study was explained
to ensure better cooperation during the data collection period.
Descriptive statistics such as frequency distribution, percentage,
mean and standard deviation and inferential statistics such as
Chi‑square test were used to analyse the data.
Results and Discussion
Table 1 shows the frequency and percentage distribution of
demographic variables of adolescent girls.
In this study, older adolescent girls only were included in the
study. Majority of them were from urban (85%) and had more
than four members in the family (87.5%). Many (47.5%) had
a family income of more than Rs. 20,000/month, as these
participants were from urban areas of Chennai. Similarly,
a study on anaemia‑related knowledge amongst adolescent
females in South India showed that the majority of the study
participants belong to nuclear families (85%) and had a family
income of more than Rs. 20,000/month (42%).[16]
101
 Dhivakar, et al.: Knowledge and attitude towards anaemia amongst adolescent girls
Table 1: Distribution of adolescent girls based on their
demographic variables
Demographic variables Frequency, n (%)
Age (years)
18 14 (35)
19 26 (65)
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Residence
Rural 6 (15)
Urban 34 (85)
Types of family
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Nuclear 34 (85)
Joint 6 (15)
Total number of family members
<3 5 (12.5)
>4 35 (87.5)
Family monthly income (Rs.)
<20,000 13 (32.50
>20,000 19 (47.5)
Types of diet
Vegetarian 8 (20)
Mixed 32 (80)
The majority of the study participants had a high level of
knowledge regarding anaemia 37 (92.5%) and only 3 (7.5%)
were having a moderate level of knowledge. None of them
reported with a low level of knowledge on anaemia [Figure 1].
However, 31 (77.5%) of the study participants expressed a
moderate level of attitude and none of them had a high level
of attitude towards anaemia, which supported the findings of
the study on 56% prevalence of anaemia amongst adolescent
girls[15] in the same setting. Despite the good knowledge on
anaemia, the low‑to‑moderate level of attitude might be a
contributory factor of high prevalence of anaemia amongst the
adolescent girls[15] in the same study setting. On the contrary,
another study conducted in Tamil Nadu showed that the
majority of adolescent girls (57%) had inadequate knowledge,
only 43% had a moderate level of knowledge and none of
the adolescent girls had adequate knowledge regarding the
prevention and management of anaemia.[17]
In the present study, all the study participants (40 [100%])
correctly defined the anaemia as a state of condition with
decreased Hb, listed signs and symptoms and side effects
of anaemia in later stages of life. The majority of the
participants answered the types of iron‑rich foods (32 [80%])
and preventive measures of anaemia (25 [62.5%]) correctly.
However, study results from Ethiopia showed that more than
three‑fourths, 332 (78.5%) of the participants, had not heard
about anaemia. The majority (240 [56.7%]) of participants had
poor knowledge of anaemia. Around 43.30% of adolescent
girls had good knowledge of anaemia. Of all the study
participants, 162 (38.3%) had good knowledge on the causes
of anaemia, 178 (42%) on signs and symptoms of anaemia,
196 (46.3%) on the consequences of anaemia and 183 (38.5%)
on prevention of anaemia.[18] The high knowledge level in the
majority of participants in this study could be due to the fact
102 Indian Journal of Continuing Nursing Education ¦ Volume 21 ¦ Issue 1 ¦ January-June 2020
Figure 1: Distribution of adolescent girls according to the level of
knowledge and attitude
they are allied health professionals who have learnt about
anaemia.
All participants (40 [100%]) stated that the inclusion of
iron‑rich foods in the daily menu is essential to prevent
anaemia. The majority of them showed a favourable attitude
on the importance of iron tablets (31 [77.5%]), the role of
Vitamin C in iron absorption (28 [70.0%]) and the necessity
of prevention of anaemia (37 [92.5%]), which is a keystone
for achieving public health. Similarly, another study from
Karnataka showed that 160 (91%) participants had heard of
anaemia; 53 (33%) girls said that poor diet is the only cause
for anaemia; 49 (31%) told tiredness is the only feature of
anaemia; 20 (13%) answered anaemia impacts on physical
growth and learning process and decreases work capacity;
and 88 (55%) girls reported they will consult a doctor and
take iron tablets.[19] Even though the majority revealed a high
level of knowledge in this study, the prevalence of anaemia in
the same group reported in a previous study[15] suggests that
there may be other factors which may lead to anaemia. This
study shows the need for further study on practice related to
nutritional intake, dietary habits and other factors that may
affect the Hb levels in adolescent girls emphasising the fact that
transfer of knowledge into practice is important. The study did
not examine the practice related to the prevention of anaemia.
The present study showed a significant association between
the age in years, the socio‑economic background and level
of knowledge on anaemia amongst adolescent girls. On the
contrary, no significant associations were found between
selected demographic variables and the knowledge scores in
a study conducted amongst Pre‑University College for girls
in Mangaluru, India.[20]
Conclusion
Anaemia is seen as a major public health issue in society and
still prevalent amongst the adolescent girls. The present study
showed that adequate knowledge versus inadequate attitude
towards anaemia might be contributory factor of the same.
Based on the present study findings, the investigators gave
health education with an emphasis on determinants of and
 Dhivakar, et al.: Knowledge and attitude towards anaemia amongst adolescent girls
complications of anaemia in the later stages of reproductive life.
Despite the existing educational programmes and knowledge
levels, reiteration of good food habits, college‑based iron and
folic acid supplementation and regular nutritional screening
should be implemented to help adolescent girls who are in
danger of anaemia.
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Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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