Epidemiological Correlates of Nutritional Anemia in Adolescent by ert634


									                                                       Indian Journal of Community Medicine Vol. 31, No. 4, October-December, 2006

                        Epidemiological Correlates of Nutritional Anemia in
                                Adolescent Girls of Rural Wardha
                                              S. Kaur, P.R. Deshmukh, B.S. Garg
Objectives: To study the epidemiological correlates of nutritional anemia among adolescent girls in rural Wardha. Methods:
A cross-sectional study was carried out in adolescent girls of four villages of Kasturba Rural Health Training Centre, Anji.
The relevant information was collected with anthropometric measurements and hemoglobin estimation. Univariate and
Multivariate Logistic Regression analysis was done using SPSS 10. Results: The prevalence of anemia was found to be
59.8%. In univariate analysis, low socioeconomic status, low iron intake, vegetarian diet, history of worm infestation and
history of excessive menstrual bleeding showed significant association with anemia. While Multivariate logistic regression
analysis suggested that strongest predictor of anemia was vegetarian diet (OR=5.83, CI=3.73-9.13) followed by history of
excessive menstrual bleeding (OR=5.65, CI=1.26-25.38), iron intake <14mg (OR=4.16, CI=2.08-8.31) followed by 14-20mg
(OR=2.07, CI=1.06-4.05) and history of worm infestation (OR=4.11, CI=1.70-9.93). However age, education, socioeconomic
status, BMI and status of menarche did not contribute significantly.
                  Key words: Vegetarian Diet, Iron deficiency, BMI, Menstrual Bleeding, Hemoglobin
Introduction                                                             namely, Anji (6000 population), Borgaon (1150 population),
                                                                         Pawnoor (1350 population) & Chaka-majra , (1500
World interest in adolescent health issues has grown
                                                                         population) of Kasturba Rural Health Training Centre, Anji
dramatically in the past decade beginning with the
                                                                         which is field practice area of Department of Community
International Year of Youth in 1985 and the World Health
                                                                         Medicine, Mahatma Gandhi Institute of Medical Sciences,
Assembly in 1989, when discussions were focused on the
                                                                         Sewagram from October 2000 to May 2002. All unmarried,
health of youth.1
                                                                         non-pregnant and non-lactating adolescent girls in the
Among adolescents, girls constitute a vulnerable group,                  age group 13-19 years in the study area were covered.
particularly in developing countries where they are                      Considering the prevalence of anemia in adolescent girls as
traditionally married at an early age and exposed to a greater           40%, with 10% error, the estimated sample size was 600. In
risk of reproductive morbidity and mortality. Adolescence                10,000 proposed population for the study, the census was
represents a real opportunity to make a difference in life-              carried out and all 630 eligible adolescent girls were included
long patterns.2                                                          in the study.
The prevalence of anemia is disproportionately high in                   A pre-tested and pre-designed proforma was used to collect
developing countries, due to poverty, inadequate diet, certain           the information on socio-demographic characteristics like
diseases, pregnancy/lactation and poor access to health                  age, educational status, family size, monthly family income;
services.                                                                medical history like age at menarche, history of worm
                                                                         infestation, excessive menstrual bleeding in the past 3
The nutritional anemia in this group attributes to high MMR,
                                                                         months and dietary history. Height, weight and hemoglobin
high incidence of low-birth weight babies, high perinatal
                                                                         were recorded. Hemoglobin estimation was done using
mortality and fetal wastage and consequent high fertility rates.
                                                                         cyanmethaemoglobin method3. For interpretation of anemia,
This phase of life is also important due to the ever-increasing
                                                                         cut-off point for hemoglobin level taken was < 12g/dl4.
evidence that control of anemia in pregnant women may
                                                                         The severity of anemia was graded as Mild (10-12gm/
be more easily achieved if satisfactory iron status can be
                                                                         dl), Moderate (7-10gm/dl) and Severe (<7gm/dl)5. Data
ensured during adolescence.2 To plan effective interventions,
                                                                         was entered and analyzed in SPSS 10.0. Univariate and
it is important to understand the epidemiology.
                                                                         multivariate analysis was carried out.
Hence, the present study was carried out to study the
epidemiological correlates of nutritional anemia among
adolescent girls in rural Wardha.                                        There were 630 subjects in the study population of whom
Material and Methods                                                     majority (68.7%) were early adolescents (13-16 years).
                                                                         Only 0.9% girls were illiterate while more than 50% girls
It was a cross-sectional study carried out in four villages;             had completed secondary level education. Majority girls
Department of Community Medicine, Mahatma Gandhi Institute of            belonged to families with income group in Grade III (Rs.
Medical Sciences, Sevagram - 442 102, Distt. Wardha (MS)                 300-499) followed by Grade IV (Rs.150-300). 85.9% girls
E-mail: prd_wda@sancharnet.in
Received : 8-2-05                                                                             Epidemiological Correlates of Nutritional Anemia

                                                                     Indian Journal of Community Medicine Vol. 31, No. 4, October-December, 2006

had attained menarche & only 6.6% girls had history of                              In the present study, the prevalence of anemia was found to
excessive menstrual bleeding. With regards to daily iron                            be 59.8% (Table 1). The prevalence of severe, moderate and
intake, 90% girls had daily iron intake <20mg; 58.6% girls                          mild anemia was 0.6%, 20.8% & 38.4% respectively (Table
were non-vegetarian. Worm infestation was present in 10.3%                          2). Overall mean hemoglobin levels was 11.35±1.67.
girls (Table 1).                                                                    Table II. Anemia in Adolescents.
Table I. Epidemiological Determinants of anemia: Univariate logistic
regression analysis.                                                                Hemoglobin (gm/dl)                        No. of girls (% )
Variables        Total (%)      No.       OR          C.I.     p- value             <7                                            4 (0.6)
                 (N=630)     Anemic                 for OR                          7-10                                         131(20.8)
                             girls (%)           (Lower-Upper)                      10-12                                        242(38.4)
Age                                                                                 >12                                          253(40.2)
Early            433(68.7)   251(58.0)    1         -            -      -
                                                                                    Total                                        630(100)
Late             197(31.3)   126(64.0)   1.29      0.91-1.82           0.16         In univariate analysis, girls with socioeconomic status Grade
                                                                                    V (OR=3.87, CI=1.08-13.85) were associated with increased
                                                                                    likelihood of anemia compared to girls with Grade I. Those
Graduate &        35(5.6)    21(60.0)     1         -            -      -
                                                                                    with iron intake 14-20mg were 2 times more likely to have
Higher           187(29.7)   122(65.2)   1.25      0.60-2.63           0.55         anemia (OR=2.07, CI=1.17-3.64) than girls with >20mg iron
secondary                                                                           intake, while those with <14mg were 5 times more likely to
Secondary        360(57.1)   203(56.4)   0.86      0.42-1.75           0.68         have anemia (OR=5.09, CI=2.84-9.11). Strongest predictor
Primary &         42(6.7)    27(64.3)    1.11      0.44-2.82           0.82         to anemia was history of excessive menstrual bleeding
middle                                                                              (OR=12.29, CI=2.92-51.69) & vegetarian diet (OR=8.54,
Illiterate         6(0.9)     4(66.7)    1.33      0.21-8.29           0.76         CI=5.7-12.8) followed by history of worm infestation
Socio-Economic status                                                               (OR=5.45, CI=2.55-11.62). Age, education, BMI & status
Grade I           12(1.9)     5(41.7)     1         -            -      -           of menarche did not show any significant association with
Grade II         116(18.4)   63(54.3)    1.66      0.50-5.55           0.41         anemia (Table 1).
Grade III        229(36.3)   126(55.0)   1.71      0.53-5.56           0.37
Grade IV         209(33.2)   136(65.1)   2.61      0.80-8.51           0.11         Multivariate logistic regression model suggested that
Grade V           64(10.2)   47(73.4)    3.87      1.08-13.85          0.04         vegetarian diet (OR=5.83, CI=3.73-9.13), history of excessive
Body Mass Index                                                                     menstrual bleeding (OR=5.65, CI=1.26-25.38), iron intake
>85th             95(15.1)   59(62.1)     1             -    -          -           <14mg (OR=4.16, CI=2.08-8.31) followed by 14-20mg
percentile                                                                          (OR=2.07, CI=1.06-4.05) and history of worm infestation
5-85th           502(79.7)   296(59.0)   0.88      0.56-1.38           0.57         (OR=4.11, CI=1.70-9.93) were important determinants
percentile                                                                          of anemia. Age, education, socioeconomic status, BMI
<5th              33(5.2)    22(66.7)    1.22      0.53-2.81           0.64         and status of menarche did not contribute significantly
                                                                                    (Table 3).
Status of Menarche
                                                                                    Table III. Multivariate logistic regression analysis by Backward
Attained         541(85.9)   327(60.4)    1          -   -               -          Conditional Method: Final model.
Not-attained     89(14.1)     50(56.2)   1.19      0.76-1.87           0.45
Dietary habits                                                                      Variables               OR            C.I. for OR             p-value
Non-             369(58.6)   153(41.5)    1          -           -      -                                               (Lower - Upper)
vegetarian                                                                          Dietary habits
Vegetarian       261(41.4)   224(85.8)   8.54      5.70-12.80          0.00         Vegetarian              5.83           3.73 - 9.13             0.00
Iron intake/day                                                                     Iron intake/day
20-27 mg          63(10.0)   22(34.9)     1              -   -          -           <14 mg                  4.16           2.08 - 8.31             0.00
14-20 mg         291(46.2)   153(52.6)   2.07      1.17-3.64           0.01         14-20 mg                2.07           1.06 - 4.05             0.03
<14 mg           276(43.8)   202(73.2)   5.09      2.84-9.11           0.00         History of worm infestation
History of worm infestation                                                         Present                 4.11           1.70 - 9.93             0.00
Absent           565(89.7)   320(56.6)    1              -   -          -           History of excessive menstrual bleeding
Present           65(10.3)   57(87.7)    5.45      2.55-11.62          0.00         Present                 5.65           1.26 - 25.38            0.02
History of excessive menstrual bleeding (89 girls had not attained
menarche)                                                                           Discussion
Absent           505(93.4)   293(58.0)    1             -    -          -
                                                                                    The Government of India has made the adolescent health
Present           36(6.6)    34(94.4)    12.29     2.92-51.69          0.00
                                                                                    as a part of RCH package since 1997. The anemia in
Overall          630(100)    377(59.8)     -         -           -      -           this age group has been identified as an important health
                                                                                                           Epidemiological Correlates of Nutritional Anemia

                                                      Indian Journal of Community Medicine Vol. 31, No. 4, October-December, 2006

problem by DeMaeyer and Adiels-Tegman6 followed by                      too can be a major cause of delayed menarche.18 Heath et al19
further reinforcement at the 1994 International Conference              in also found that high menstrual blood loss was associated
on Population and Development held at Cairo.                            with increase risk of anemia. This further reiterates and
                                                                        emphasizes the need for corrective measures for anemia
In the present study, the prevalence of anemia was found to             and iron deficiency in girls before they enter adolescence
be 59.8%. Rana et al 7 and Seshadri et al8 reported a similar           so as to compensate the additional requirements for growth
prevalence of 60% and 63% respectively. Chaturvedi et                   & development during puberty and combat the extra losses
al9, Kotecha et al10 and Agarwal11 reported a prevalence of             during menstruation.
73.7%, 74.7% and 47.6% respectively. These differences
in the prevalence of anemia may be due to difference in                 In the present study, age, education status, socio-economic
the study area. WHO / UNICEF12 has suggested that the                   status and BMI was not significantly related with anemia.
problem of anemia is of very high magnitude in a community              Mehta et al13 and Kotecha et al10 also reported that age is
when prevalence rate exceeds 40%. Considering that                      not a significant correlate of anemia. Educational and socio-
anemia development is a consequence occurred at a later                 economic status alone may not have any significant effect
stage of iron deficiency, the problem of iron deficiency in               on anemia.10,20
these adolescent girls with a prevalence of 59.8% should
                                                                        The study provides an indication to initiate the anemia
be considered serious & calls for an action. The mean
                                                                        prophylaxis measures for adolescent girls in India including
hemoglobin in the present study was 11.3 ±1.7gm/dl which
                                                                        nutrition education in schools.
was higher than that reported by Mehta et al13 (10.6±1.2gm/dl)
and lower than Kotecha et al10 reported as 11.8 ±1.4g/dl.               Reference
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                                                                                              Epidemiological Correlates of Nutritional Anemia

                                                            Indian Journal of Community Medicine Vol. 31, No. 4, October-December, 2006

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