Effect of Health Education and Iron Supplementation on Haemoglobin levels in Adolescent Girls

 

Dinesh John Rajkumar¹, Manikandan. R¹, Mohammed Aboobacker Mathuf¹,

Koripella Sree Aakash¹, Dolly k Pajapath¹, T. R. Ashok Kumar¹, Sarumathy. S*¹, M Logaraj²

¹Department of Pharmacy Practice, SRM College of Pharmacy, SRM Institute of Science and Technology, Kattankulathur, Tamil Nadu, India-603203.

²Department of Community Medicine, SRM Institute of Science and Technology, Kattankulathur, Tamil Nadu, India-603203.

 

ABSTRACT:

Aim and Objective: The objective of the study is to assess the effect of health education and iron supplementation on haemoglobin (Hb) and haematocrit (Hct) levels in adolescent girls. Methods: Prospective observational study was conducted in adolescent girls (13-19 years) in the selected schools of kanchipuram district. Group A received iron with folic acid supplementation whereas group B subjects received health education along with iron and folic acid supplementation. Hb concentration and Hct values were estimated using digital haemoglobin testing system at baseline and follow up (3 months later). Results: On the comparative assessment of iron supplementation with health education and iron supplementation alone, the present study showed a statistical significant increase in Hb and Hct levels in group B compared to group A subjects. Conclusion: In conclusion, our findings suggest that health education and weekly iron folate supplementation can improve the Hb and Hct levels and also health education should be a part of our education system for the improving the health status of adolescent girls.

 

 

 

INTRODUCTION:

In most developing countries, iron deficiency anaemia is a serious health problem. The prevalence of anaemia among adolescent girls in India is 90%¹. Adolescent girls need higher iron requirements because of onset of menstruation and expansion of blood volume due to growth spurts^{2, 3}. Hence no added iron supplementation, poor diet, loss in menarche and growth put them in a greater risk of anaemia. After marriage these adolescent girls are subject to have high demand for iron during pregnancy ⁴. To combat iron deficiency anaemia, the idea of weekly iron supplementation was reached to stop the progress of anaemia in adolescent girls⁵.

 

 

In worldwide, iron deficiency anaemia is the third cause of loss of disability-adjusted life years (DALYs) among girls and women between the age group of 15-44 years⁶. In India 50 to 90 % of adolescents girls are anaemic^{7, 8}. To prevent iron deficiency anaemia during pregnancy and consequences, targeting adolescent girls is essential⁹. In adolescent girls, weekly iron and folic acid supplementation was effective in reducing the prevalence of anaemia in schools with greater compliance and supervision^{10, 11}. To prevent anaemia, weekly iron and folic acid supplementation is recommended which has fewer side effects^{12, 13}. Henceforth this study was designed to study the effect of health education and iron supplementation on Hb and Hct levels in adolescent school going girls of rural areas.

 

MATERIALS AND METHODS:

This prospective observational study comprising of 102 adolescent school going girls aged between 13 -19 years for the determination of Hb and Hct levels after health education along with iron supplementation and iron supplementation alone was carried out in two schools present in rural areas of kanchipuram district for a period of 3 months. Of the 102 subjects, two subjects dropped out during the study period. The institutional ethical committee approved the study and the informed consent was also obtained from their legal representatives. Subjects were selected based on the inclusion and exclusion criteria. The inclusion criteria of the study were adolescent girls aged between 13-19 years and willing to give written informed consent and parental consent form, subjects with recent malaria, chronic disease like tuberculosis, and diagnosed morbidities such as sickle cell anaemia. The exclusion criteria were subjects who were unwilling to participate in the study.

 

In Group I, 50 adolescent girls received oral ferrous ascorbate 100 mg + folic acid 1.5 mg once a day in a week and in Group II, 50 adolescent girls received health education through oral counselling and issue of patient counselling leaflet (regarding disease status, monitoring of Hb levels, dietary counselling and medication adherence) with oral ferrous ascorbate 100 mg + folic acid 1.5 mg once a day in a week for three months. A drop of blood will be collected for Hb and Hct values estimation at the beginning (baseline) and after 3 months of the study (follow up).

 

Hb concentration and Hct values were estimated by using digital haemoglobin testing system. Results will be analysed by using SPSS software. The data will be presented as mean and standard deviation (SD) changes. Chi-square test will be used for comparison between results at the start and end of the study groups and P values less than 0.05 will be considered statistically significant. Flow chart of study is shown in (Figure 1).

 

RESULTS:

The demographic details of the study population such as age wise distribution, dietary habits, history of passing worms in stools, sanitary hygiene, social economic status and body mass index (BMI) distribution were shown in (Table 1 and Table 2).

 

 

Figure 1. Flow chart of study

Table 1: Demographic details of the study population

PARAMETERS	GROUP A (n=50, %)	GROUP B (n=50, %)
Age wise distribution 11-14 years	43 (86)	21 (42)
15-17 years	7 (14)	29 (58)
Dietary habits Vegetarian	9(18)	3(6)
Non-vegetarian	41(82)	47(94)
Meat intake of subjects Weekly  Once	38 (76)	43(86)
Weekly Twice	1(2)	2(4)
Monthly Once	2(4)	2(4)
Nil	9(18)	3(6)
History of passing worms in stools Yes	3(6)	2(4)
No	47(94)	48(96)
Wearing Slippers Yes	49(98)	50(100)
No	1(2)	0(0)
Sanitary hygiene Present	39 (78)	36(72)
Absent	11(22)	14(28)
Socio Economic status Poor	17(34)	45(90)
Lower Class	10(20)	4(8)
Lower Middle Class	8(16)	0(0)
Middle Middle class	3(6)	0(0)
Upper Middle  class	0(0)	0(0)
Not known	12(24)	1(2)
BMI Underweight	25(50)	26(52)
Normal	15(30)	20(40)
Overweight	9(18)	4(8)
Obese	1(2)	0(0)

 

Table 2: Mean and SD Changes of various parameters

Parameters	Group A (n = 50)	Group B (n = 50)
Age	13.42+ 0.86307	14+0.81039
Height	147.3+ 9.03338	151.74+5.49883
Weight	40.5+11.92879	41.22+7.81231
BMI	17.858+2.98035	17.858+2.98035

 

Table 3 shows the Hb and Hct levels of study subjects for baseline and follow-up, respectively. The present study shows there is statistical difference between two groups.

 

Table 3: Haemoglobin and Hematocrit levels of the study population.

Parameters	Group A (n = 50)		P-Value	Group B (n = 50)		P-Value
	Baseline (n=50)	Follow-up (n=50)		Baseline (n=50)	Follow-up (n=50)
Hb	10.874±1.151	11.334±0.243	0.0068	10.992±1.116	11.548±0.311	0.0010
HCT	32.120±3.127	33.2±0.571	0.0182	32.340±3.267	34.24±0.770	0.0001

 

DISCUSSION:

Iron deficiency anaemia leads to poor pregnancy outcome, impaired school performance, decreased work productivity and other adverse outcomes. Targeting adolescent girls will prevent iron deficiency during pregnancy and its consequences. In our study the children from selected rural schools were belonging to poor socio-economic status confirming the earlier results by Goyal N et al.¹⁴ Growth spurts and menarche increases iron requirements with poor diet and no added iron supplementation puts them into high risk for iron deficiency¹⁵. Narendra kumar sharma et al concluded that school adolescent girls in slum areas are prone to anaemia due to lack of nutrition and health education, and menstrual loss which affects the ability to read, write and learn¹⁶. More number of the subjects were underweight, non-vegetarian but followed sanitary hygiene in both the study groups. On the comparison of iron supplementation and health education with iron supplementation alone, it was found that the haemoglobin levels are found to be increased in both the study population but there was a statistical significant raise in Hb and Hct levels in group B (11.548±0.311 and 34.24±0.770) compared to group A (11.334±0.243 and 33.2±0.571) adolescent girls, respectively. The results of Nguyen et al. also suggested for weekly IFA plus vitamin B-12 supplementation to women in reproductive age as efficacious as daily supplementation in improving the serum folate status¹⁷. Future studies are recommended for the confirmation of the results in larger group of study population and to assess the knowledge attitude and practice regarding anaemia in adolescent girls.

 

CONCLUSION:

On the comparative assessment of iron supplementation and health education with iron supplementation on Hb levels in adolescent girls after conducting a prospective observational study, the present study shows there is statistical difference between two groups. Our study concludes that iron deficiency anaemia is considered as major health problems in adolescent girls. Iron fortification in foods should be done and it should reach rural areas to combat anaemia in adolescent girls. Future study should to be carried out in large population for better results. Health education and awareness should be a part of education system to subside iron deficiency anaemia.

 

CONFLICTS OF INTEREST:

All Authors have none to declare

 

REFERENCES:

1.       Aloafe H, Zee J, Dossa R, O Brien HT.Education and improved iron intakes for treatment of mild iron deficiency anemia in adolescent girls in Southern Benin. Food and Nutrition bulletin.2009;30(1): 24-36.

2.       Dallman PR.Changing iron needs from birth through adolescence.Nutritional Anemias. Nestle Nutrition Workshop Series.1992;30(1) :29-38.

3.       Beard JL. Iron requirements in adolescent females. Journal of Nutrition.2000; 130(1): 440S-442S.

4.       Beard J, Davidson H , Pinero D.Iron metabolism a comprehensive review Nutrition review.1996;54(1):295-317.

5.       Viteri FE, Berger J. Importance of pre pregnancy and pregnancy iron status: can long term preventive iron and folic acid supplementation achieve desirable and safe status?. Nutritional Reviews.2005;63(2):S65-S76.

6.       Murray CD, Lopez AD. The global burden of disease. World Health Organization. Vol 1, Geneva .1996.

7.       Toteja GS, Singh P, Dhillon BS, Saxena BN, Ahmed FU,Singh RP, Prakash B, Vijayaraghavan K, Singh Y, Rauf A,Sarma UC, Gandhi S, Behl L, Mukherjee K, Swami SS,Meru V, Chandra P, Chandrawati, Mohan U. Prevalenceof anemia among pregnant women and adolescent girlsin 16 districts of India. Food Nutr Bull 2006;27:311–5.

8.       Dwivedi A, Schultink W. Reducing anaemia among Indian adolescent girls through once-weekly supplementation with iron and folic acid. SCN News 2006;31:19–23.

9.       Preventing iron deficiency in women and children:Technical consensus on key issues. A UNICEF/UNU/WHO/MI Technical workshop,UNICEF-NY,October 1998.

10.     Beaton G, McGabe G. Efficacy of intermittent iron supplementation in the control of iron deficiency anaemia in developing countries.Ottawa:Micronutrient Initiative.1999;1:1-10.

11.     Tee ES, Kandial M, Awin N, Chong SM, Satgunasingam N, Kamarudin L, Milani S, Dugdala AE, Viteri F. School administered weekly iron folate supplements improve haemoglobin and ferritin concentration in Malaysian adolescent girls. Am J Clin Nutr 1999;69:1249–56.

12.     Angeles-Agdeppa I, Schultink W, Sastramidjojo S, Grass R, Karyadi D. Weekly iron supplementation builds ironstores in female Indonesian adolescents. Am J Clin Nutr1997;66:177–83.

13.     Schultink W.Iron supplementation programmes: Compliance of target groups and frequency of tablet intake.Food Nutr Bull 1996;17:22-26.

14.     Goyal N, Rawat CMS, Jha SK. Prevalence of anaemia among school adolescent girls 2015;27(3):1–4.

15.     Kaur M, Bassi R, Sharma Impact of nutrition education in Iron deficiency anemia in Adolescents girls. Indian J of Fundamental and Applied Life Sciences.2011; 1(4):222-228.

16.     Sharma NK, Bhayal AS. Study on Effectiveness of Daily / Weekly Iron , folic Acid Supplementation With or Without Intensive Health Education among Adolescent Anemic School Girls of Varanasi ( Uttar Pradesh ). IJSR 2015;4(9):2021–3.

17.     Nguyen P, Grajeda R, Melgar P, Marcinkevage J, Flores R, Martorell R. Weekly May Be as Efficacious as Daily Folic Acid Supplementation in Improving Folate Status and Lowering Serum Homocysteine Concentrations in Guatemalan Women. J Nutr. 2008;138:1491–98.

 

Accepted on 14.05.2018        © RJPT All right reserved

Research J. Pharm. and Tech 2018; 11(7): 2761-2764.