An epidemiological study on prevalence of anaemia among adolescents in Cherlapally village, Nalgonda district
Anaemia is defined as a condition in which the number of red blood cells, and consequently their oxygen-carrying capacity is insufficient to meet the body’s physiological needs. Specific physiological needs of an individual vary with age, gender, altitude, smoking behaviour, and pregnancy. Iron deficiency is the most common cause of anaemia globally, but other nutritional deficiencies (Folate, Vitamin B12, and Vitamin A), acute and chronic inflammation, parasitic infections, inherited and acquired disorders of haemoglobin synthesis, RBC’s production or RBC’s survival, can all cause anaemia.1 Although clinical evaluation of anaemia requires multiple laboratory tests to identify the severity, type and cause of anaemia, haemoglobin concentration is the most reliable indicator of anaemia at the population level. 2
Anaemia is an important public health problem globally. World Health Organization (WHO) estimates that 1.62 billion people globally (95% CI 1.50-1.74 billion) are affected with anaemia which corresponds to 24.8% of the world population.3 Public health significance of anaemia among populations in India needs no reiteration. National Family Health Survey-3 (2005-06) identified that 69.5% of children aged 6-59 months, 55.3% of women in reproductive age-group (15-49 years), and 24.7% of men during most productive period of their lives (15-54 years) were anaemic.4 In view of significant health implications of anaemia especially on maternal and child health, as well as huge social and economic loss, the government of India has initiated programmes to decrease the burden of anaemia among children, adolescent girls, non-pregnant women in reproductive age group and pregnant and lactating women through direct as well as indirect interventions.5,6,7 The present study was undertaken to study the prevalence of anemia among school attending adolescents of Cherlapally village of Nalgonda (Telangana), a village in the jurisdiction of Rural Health Training Centre, of Kamineni Institute Of Medical Sciences.
Materials and Methods
A cross sectional study was conducted during August 2015 in Government High School located in Cherlapally village under Rural Health Training Centre of a Medical College located in Nalgonda district of Telangana. A pilot study was conducted to refine the study instrument, standardize laboratory procedures and obtain approximate prevalence rate for calculation of sample size. A sample size of 150 was calculated based on prevalence of anaemia at 40% obtained after pilot study, level of significance 5% and allowable error of 20% of the estimated prevalence. Government High School, Cherlapally was selected for the study, based on understanding that the students would represent the rural adolescents, and convenience of the study. Sampling frame of the study included all students studying in 8th, 9th and 10th classes of the school. Simple random sampling was done to identify the study population. The socio-demographic and anthropometric data were recorded on a pre-tested questionnaire by trained undergraduate students. Knowledge of the study participants was classified as good, satisfactory and poor based on 13-questions scale with questions ranging from functions of haemoglobin, effects of anaemia on adolescents, and preventive measures. Haemoglobin estimation was done at the school by Sahli technique by laboratory technicians. WHO recommended levels for diagnosis and classification of anaemia1 were utilized to classify the cases as mild, moderate and severe anaemia. Data was compiled on Microsoft excel sheet and analyzed using statistical software SPSS version 19. Permissions of the District Education Officer and Head Master of the school were obtained. Students detected to have moderate and severe anemia were provided iron-folic acid tablets, and referred to the nearest health care unit. Health education of the students and teachers was conducted as a part of the survey.
A total of 150 students aged 11-19 years (mean 14.45 + 1.87 years) of both sexes (boys 71: girls 79) participated in the study. The study revealed that 83 (55.33%) adolescents were anaemic. The prevalence of anaemia among study population as per severity is shown in fig.1.
Table I depicts the prevalence of anaemia as per various socio-demographic variables. The analysis reveals that prevalence of anaemia in the study population was significantly higher among girls as compared to boys. No association was detected between prevalence of anaemia and age, religion, type of family, education and occupation of the head of the family, per capita income, and type of diet.
The examination of prevalence of anaemia in different age-groups in two genders revealed that the prevalence does not follow a time-trend, and the variation of prevalence in both sexes among adolescents of different age-groups was statistically insignificant (Fig 2).
Fig. 3 depicts the comparison of severity of anaemia between two sexes. It is seen that girls had, not only higher prevalence of anaemia, but mild, moderate and severe anaemia were also more prevalent among girls as compared to boys.
Table 2 reveals the knowledge of adolescents regarding anaemia. Statistical analysis showed that level of knowledge was not associated with the prevalence of anaemia.
Table 1: Distribution of Severity of Anaemia based of Socio-demographic Factors
|Characteristics / Variable||Group||Severity of Anaemia||Total||p value (Chi-square test)|
|Severe < 80*||Moderate 80-109*||Mild 109-119*||Normal > 120/130*@|
|Age||11-13||3||6||17||20||46||p > 0.05|
|Sex||Boys||2||3||25||41||71||p = 0.01|
|Type of Family||Nuclear||9||9||59||61||138||p > 0.05|
|Religion||Hindu||9||10||60||63||142||p > 0.05|
|Occupation of Head of Family||Labourer||8||6||38||38||90||p > 0.05|
|Education of Head of Family||Illiterate||3||5||22||12||42||p > 0.05|
|Secondary or higher||4||2||18||27||51|
|Per Capita Income (Rs/month)||< 2,000||7||7||24||18||56||p > 0.05|
|Type of diet||Non-veg||11||10||54||61||136||p > 0.05|
Note: * = grams per litre.
@ = Hb > 120 gm/l for girls in all age groups and boys aged <15, Hb > 130 gm/litre for boys > 15years of age
Table II: Knowledge of Adolescents regarding Anaemia
|Good||24||13||p > 0.05|
The study revealed that anaemia is a significant public health challenge among rural adolescent in Nalgonda district with prevalence rate of 55.33% (95% Confidence Interval (CI) 47.31-63.15%). The prevalence rate among boys was 39.86% (95 % CI 34.2-45.5%), while girls had a prevalence rate of 67.08% (95% CI 56.18-76.76%). Statistically higher prevalence of anaemia among adolescent girls was reported by NFHS-34 as well as by Basu et al in a study conducted in Chandigarh8, while Verma et al9 in a study conducted in Rohtak district of Haryana found higher prevalence of anaemia among adolescent boys (68.7%) as compared to girls (67%) which was not statistically significant. The study revealed that the anemia is significantly higher, both in quality and severity among girls than among boys. This is likely to be because of higher demand of micronutrients after menarche. Unsatisfactory knowledge of the adolescents regarding one of the most important health challenges in India is also a matter of concern. We, the Public health workers should also appreciate that knowledge in itself will not do, and much more is required of us to achieve positive attitudes, practices, results and impact.
As highlighted earlier, there is a lack of community based studies on prevalence of anaemia among adolescents in rural Telangana. The study reveals that anaemia among adolescents is an important public health problem. The authors recommend that anaemia among adolescents should be studied through larger studies e.g. NFHS-4, so that the public health importance of the disease can be quantified at state and national levels in this demographic group also. This will provide baseline data for planning and evaluating intervention strategies to improve health of adolescents. The authors also suggest that weekly iron should be provided to all boys also, as the disorder is not uncommon among male adolescents.
- WHO. Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. Vitamin and Mineral Nutrition Information System. Available from http://www.who.int/vmnis/indicators/haemoglobin.pdf. (last accessed on June 03, 2015)
- de Benoist B, Mclean Erin, Egli I, Cogswell. Worldwide prevalence of anaemia 1993-2005. WHO Global Database on Anaemia, World Health Organization 2008
- WHO. Global anaemia prevalence and number of individuals affected. Available from www.who.int/vmnis/anamia/ prevalence/summary/anaemia_data_status_t2/en/ (last accessed on May 31, 2015)
- International Institute for Population Studies (IIPS) and Macro International. 2007.National Family Health Survey (NFHS-3) 2005-06, India Volume 1. Mumbai: IIPS.
- Rashtriya Kishor Swasthya Karyakaram. Strategy handbook. Government of India, Ministry of Health and Family Welfare, New Delhi January 2014
- A Strategic Approach to Reproductive, Maternal, Newborn, Child and Adolescent Health (RMNCH+A) in India. Government of India, Ministry of Health and Family Welfare, New Delhi January 2013
- Deb S. Implementation of National Iron Plus Initiative for Child Health: Challenges ahead. Indian J of Public Health 2015; 59:1-2
- Basu S, Basu S, Hazarika R, Parmar V. Prevalence of anemia among school going adolescents of Chandigarh. Indian Pediatr 2005; 42(6):593-7
- Verma R, Kharb M, Yadav SP, Chaudhary V, Ruchi, Ajay. Prevalence of anaemia among adolescents under IBSY in rural block of a dist of northern India. Int J Social Sciences & Interdisciplinary Research 2013; 2:95-106