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

¹Associate Professor, Saveetha College of Nursing, SIMATS, Thandalam.

²Professor, Saveetha Medical College and Hospital, SIMATS,Thandalam.

³Principal, Professor, Department of Community Health Nursing, Saveetha College of Nursing, SIMATS

 

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.

 

 

 

INTRODUCTION:

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.

 

Adolescents are vulnerable to iron deficiency because of 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 various underlying conditions such as abnormal uterine bleeding (AUB), and gastro-intestinal (GI) disorders, is the leading cause of anemia worldwide; estimates suggest that approximately five million people have IDA 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 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.

 

 

 

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 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.

 

 

 

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%)	Mann Whitney Rank sum test		Wilcoxon signed rank test
				Con-Exp Pre test	Con-Exp Post test	Control pre-post	Exp pre-post
1.	Fatigue	Control Pre test	29±31%	T=5931 P=0.001	T=4987 P=<0.001	W= 34.13 P=<0.001	W= 3543 P=<0.001
		Control Post test	36±38%
		Experimental Pre test	31± 34%
		Experimental Post test	40± 42%

 

 

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.

REFERENCES:

1.     Ekwagwu AEA and Madukuce E: The role of micronutrients in child health African Journal of Biotechnology 2008; 7(21): 3804-3810.

2.     Gaja DR et al.: Juice Diet for Perfect Health, First Edition Nayneet publications 2011; 75-76.

3.     WHO: Global prevalence of anemia 2011.

4.     Singh E, Jain PK and Sharma S: Effect of food-based iron supplementation on the physical work performance of adolescent girls in Banasthali campus: A case study International Journal of Green Pharmacy 2013.

5.     Chauhan U, Golhar S and Dahake P: Correlation between Iron Deficiency Anemia and Cognitive Achievement in School Aged Children. Annals of International medical and Dental Research 2016; 2(4). 6. Pavod et al.: British Committee for Standards in Haematology. UK guidelines on the management of iron deficiency in pregnancy 2011.

6.     Nelson M, Bakaliou F, Trivedi A.(1994) Iron-deficiency anaemia and physical performance in adolescent girls from different ethnic backgrounds. Brit J Nutr; 72:427-33

7.     WHO: Global prevalence of anaemia 2011.

8.     Singh E, Jain PK and Sharma S: Effect of food-based iron supplementation on the physical work performance of adolescent girls in Banasthali campus: A case study International Journal of Green Pharmacy 2013.

9.     Chauhan U, Golhar S and Dahake P: Correlation between Iron Deficiency Anaemia and Cognitive Achievement in School Aged Children. Annals of International medical and Dental Research 2016; 2(4).

10.   Shanti Devi, Vidya (2015 )prevalence of anaemia among adolescent girls: a school based study International Journal of Basic and Applied Medical Sciences, Vol. 5 (1) January-April, pp. 95-98.

11.   Maheshwari RS: Natural antioxidants and their intrinsic worth for well being. Global Journal of Medical research 2013: 1-13.

12.   Kour S: Effect of Iron supplementation along with Vitamin C and nutrition counseling on anemic status of adolescent girls. International Journal of Health Science and Research 2016; 6(5): 279-287

13.   Mathur: A comparative study of impact of leaf concentrate and Iron and Folic acid supplementation on Blood profile of Anemic Adolescent girls 2005.

14.   Sen A and kannai SJ: Deleterious functional impact of anaemia on young adolescent school girls. Indian paediatrics 2006; 43(3): 219-26.

15.   UNICEF Malawi (2005) Report on the pilot survey on orphans and other vulnerable children in Blantyre, Malawi.

16.   Mathur B, Ramani SV and Bertin K: From studies on adolescent girls-An analytical review. Published by national Institute of public cooperation and child development Delhi 2008. Nirisha Sriram

17.   K .V Shyamala, V.Ravichandra, N .K. Subbalakshmi, R. Sheila Pai, K. Raghuveera. Iron Status Indicators of Neonates of Mild to Moderate Anaemic Mothers. Research J. Pharm. and Tech. 5(2): Feb. 2012; Page 203-206.

18.   Ajit Singh, Hashir Kareem, Tom Devasia, Prasad N Shetty, Sheetal Chauhan, Yeswanth Rao K. Graded Exercise Therapy and Six Minute Walk Test: The Modern Care of Peripheral Vascular Disease. Research J. Pharm. and Tech 2017; 10(11): 4099-4101.

19.   K. Sai Girisha, Mohan Ram. A Prospective Study on Efficacy of Mircera for Treating Anemia Associated with Chronic Kidney Disease. Research J. Pharm. and Tech 2017; 10(11): 3807-3809.

20.   Effectiveness of Poshan Modakam in Increasing HB % among Anaemic Students of, Smita Jha, Anju Bodalkar, Eashwari Thakur, Harsh Priya, Indu, Divya Sahu, Shashikala. Selected. College of Nursing, Jagdalpur, C.G. (2016). Int. J. Nur. Edu. and Research. 2017; 5(2): 191-194.

21.   V. Indra. A Study to Assess the Knowledge of Antenatal Mothers on Prevention of Nutritional Anaemia in Selected Hospital, Thrissur with a View to Develop a Self Instructional Module. Int. J. Nur. Edu. and Research 3(2): April-June, 2015; Page 209-217

22.   Shristi Nadar, Vijaykumar M, Gheena R. Prevalence of Anemia in Urban Children Attending A Pediatric Hospital of A Metro City in South India . Research J. Pharm. and Tech 2016; 9(10):1571-1574.

23.   T. S. Shanmuga Rajan, S. Yeswanthi. A Prospective Study on Quality of Life in Menorrhagia Patients with Anemia. Research J. Pharm. and Tech. 2017; 10(7): 2233-2235.

24.   K. Sai Girisha, Mohan Ram. A Prospective Study on Efficacy of Mircera for Treating Anemia Associated with Chronic Kidney Disease. Research J. Pharm. and Tech 2017; 10(11): 3807-3809.

25.   Therese P, S. Revathi. A Study to Assess thePrevalence of Maternal Anemia and Factors Associated with Anemia among Pregnant Women in Trichy District, Tamilnadu, India. Int. J. Adv. Nur. Management 2(4): Oct. - Dec., 2014; Page 231-234.

26.   Sumy. P. J, Jayasankari. S, Rebecca Samson, Kiruba Prasanna, Leena L. Raju, Bridgitte Akila. A Study to assess The effectiveness of Nutrition Supplement with Beetroot, Jaggery and Lemon on Mild Anemia among Nursing Students in A Selected College of Nursing at Puducherry. Int. J. Adv. Nur. Management. 2017; 5(4):305-310.

 

 

 

 

 

 

Accepted on 11.05.2018        © RJPT All right reserved

Research J. Pharm. and Tech 2018; 11(8): 3337-3340.