A cross-sectional study about knowledge, attitude and practice regarding anemia among school going adolescent girls in Naila, Jaipur, Rajasthan

Introduction

Adolescence originates from the Latin word “Adolescere,” meaning to grow into adulthood. This life stage is defined by the World Health Organization as encompassing the ages from 10 to 19 years [1]. In the WHO South-East-Asia (SEAR) region, adolescents make up approximately 20 % of the population, translating to about 1.3 billion individuals [2]. Adolescence is categorized into three developmental stages according to physical, psychological, and social changes as described by WHO/UNICEF in 1995 [3]. Among the health issues affecting this group, anaemia, particularly iron deficiency anaemia (IDA), is prevalent. IDA is recognized as a significant nutritional challenge among young children and women of reproductive age, especially in developing countries [4].

A 2001 WHO report estimated that two billion people globally suffer from anaemia, with IDA accounting for half of these cases [5]. In adolescence, IDA can severely impact learning capabilities, intellectual development, and work performance [6]. The National Family Health Survey-5 reported a 59.4 % prevalence of anaemia among adolescent girls in Rajasthan [7]. It’s estimated that 56 % of Indian adolescent girls are at risk of anaemia, affecting approximately 64 million at any given time [7].

Addressing anaemia effectively requires acknowledgment and proactive engagement from both the public and governmental sectors. Interventions include enhancing iron supplementation and implementing health education programs in schools to raise awareness among adolescents – both male and female [8]. The World Health Organization defines IDA based on hemoglobin concentration levels alongside serum ferritin concentrations.

Adolescents are particularly susceptible to IDA due to increased iron requirements, inadequate dietary iron, frequent infections, and societal issues such as early marriage and adolescent pregnancy [9]. The consequences of anaemia in adolescent girls extend into adulthood, contributing to high rates of maternal mortality, perinatal mortality, low birth-weight infants, and fetal loss [9], 10].

Additionally, there is a noticeable deficiency in proper nutritional knowledge and attitudes among adolescents, leading to unhealthy eating behaviors [11], [12], [13]. Programs like the Rastriya Kishore Swasthya Karykram (RKSK), Ujala Clinic, and Adult Family Health Clinic (AFHC) are essential for providing counseling related to the physiological, social, and mental changes occurring during adolescence [11]. Due to paucity of published literature regarding knowledge, attitude and practice regarding anaemia among school going adolescent girls in Jaipur, this study was planned with aims to evaluate the Knowledge, Attitude, and Practice (KAP) concerning anaemia among adolescent school girls within the RHTC, Naila area in Jaipur.

Subjects and methods

A community based cross-sectional descriptive study was conducted among 300 adolescent schoolgirls in the age group of 1019 years in Jaipur from November 2021 to July 2022. The aim of the study was to assess the level of knowledge, attitude, and practice regarding anaemia. After approval of research protocol from Institutional Research Review Board, Clinical Trial Screening Committee, Institutional Ethical Committee and permission from principal of the school as well as written consent from the parents, students were interviewed by using a predesigned, pretested, semi-structured questionnaire.

Sample size was calculated at 95 % confidence level, alpha error of 0.05 and at a relative error of 4 %, assuming prevalence of 91 % girls knowing about anaemia (as per seed article) [12]. The required sample size was 245 subjects which was further rounded off to 300 as final sample size to accommodate attrition. Study universe for study were adolescent girls residing in village Naila, Jaipur i.e., field practice area of Rural Health Training Centre (RHTC), Jaipur attached to Department of Community Medicine, SMS Medical College, Jaipur (Rajasthan) India. From this identified universe, subjects were selected as per following inclusion criteria by following sampling technique for females. Every eligible girl student belonging to class 8th to 12th who were studying in Government schools of field practice area of RHTC Naila were included in study. The response was analyzed using percentage analysis. Data analysis was completed by SPSS software version 17.0 (SPSS Inc., Chicago, USA).

Inclusion criteria:

1. Adolescent girls (age group 10 to 19-year-old).

2. Adolescent girls who were present during the data collection.

3. Those who have given informed consent or their parents have given consent.

Exclusion criteria:

1. Non-cooperative adolescent girl.

2. Psychiatric disorder affected students.

Results

The present study observed that maximum proportion of the study participants were in the age group of 17–19 years 173 (57.7 %), followed by 14–16 years 113 (37.7 %), and 10–13 years of age group were 14 (4.6 %) from Table 1 (knowledge level of adolescent girls regarding Anaemia). Maximum proportion of the study participants were from General Category 135 (45 %), followed by OBC Category 83 (27.7 %), and SC/ST Category 82 (27.3 %). Majority of the fathers of study participants were literate (approx. 85 %). Illiteracy was present only in 46 (15.33 %), education level up to primary was 101 (33.67 %), middle 56 (18.67 %), secondary 43 (14.33 %), Sr. Sec. and graduates were both 54 (9 %). Majority of the mother of study participants were primary educated. Primary 173 (57.67 %), illiterate 56 (18.67 %), middle 37 (12.33) Secondary 27 (9.00 %), senior secondary 6 (2 %) and least 1 (0.33 %) were graduate. Mostly (92 %) participants had heard about anaemia (82 %) knew the reasons of anaemia (22 %) participants had heard about haemoglobin.

Table 2 shows detailed knowledge regarding Anaemia among adolescent girls, based on multiple choice questions. 246 (82 %) participants knew iron deficiency to be the reason of anaemia, 66 (22 %) knew that haemoglobin level decreases in anaemia, 159 (53 %) participants knew that weakness is a symptom of anaemia, 180 (60 %) participants knew that iron and folic acid tablet is used to prevent anaemia, 156 (52 %) participants knew about the distribution of IFA Tablets at school and AWC, 24 (8 %) participants knew about the distribution of both IFA Tablets and Poshahar at school and AWC as prophylaxis program. 120 (40 %) participants considered poor diet is the cause of anaemia. 27 (9 %) participants considered reduced work capacity as the only effect of anaemia, 3 (1 %) participants considered the impact on physical growth as the only effect while 16 (5.3 %) participants considered both as the effect of anaemia. 180 (60 %) participants knew that green leafy vegetables are iron rich food.

Table 3 shows that only 12 (4 %) participants agreed that haemoglobin level should be checked once a year. All participants agreed that hands should be washed after defecation.

All the participants (100 %) washed their hands with soap after defecation. Only one third (38 %) of participants washed their hands with soap before consuming food, about two third (62 %) did not practise hand washing before consuming food. Fruits and vegetables were washed by only two fifths (40 %) before consuming, about two third (60 %) did not wash fruits and vegetables before consuming. About two third (61 %) of the participants do not consume iron rich food 4–5 times a week.

Figure 1 shows Primary educated mothers had 28.9 , 42.2 and 28.9 % association with good, fair, and poor attitude respectively. Middle educated mothers had 94.6 , 0, and 5.4 % association with good, fair, and poor attitude respectively. Secondary educated mothers had 100 % association with good attitude. Senior secondary educated mothers had 100 % association with good attitude. Graduate mothers had 100 % association with good attitude. Illiterate mothers had 42.8 , 3.6 and 53.6 % association with good, fair, and poor attitude respectively. Level of attitude is significantly associate with the mother education level of participants. This is evident from the chi-square test perform and the P- value (<0.05) showed significant difference in between proportions of mother education level.

Figure 1:

Association of attitude regarding anemia with education status of mothers of study participants.

All the participants (100 % washed their hands with soap after defecation. Only 38 % washed hands with soap before consuming food, 62 % do not practise hand washing before consuming food. Fruits and vegetables were washed by only 40 % before consuming, 60 % do not wash fruits and vegetables before consuming. 61 % of the participants do not consume iron rich food 4–5 times a week,

Discussion

This study was done to evaluate the knowledge, attitude and practice regarding anaemia among school going adolescent girls in field practice area of rural health training centre, Naila under SMS medical college, Jaipur. 60–90 % prevalence rate of anaemia among adolescent girls in India.

In the present study, 276 participants out of 300 (92 %) had heard about anaemia but only 246 (82 %) knew about the reasons for anaemia. Only 22.0 % of the participants had heard about haemoglobin and only 24 % said that anaemia could be diagnosed by blood test. 57.0 % participants knew that anaemia is a health problem but symptoms of anaemia were known to only 53 % of the participants. 62 % of the participants said that anaemia could be prevented while only 60.0 % of the participants knew that prophylaxis for anaemia can be taken. Iron deficiency being the cause of anaemia was correctly stated by 82 % of the cases while 8 % stated iodine deficiency as the cause of anaemia. 78 % participants did not know whether the haemoglobin level increases or decreases in anaemia and 22 % said that haemoglobin level decreases in anaemia. Angadi (2015) [12], in his study reported that 91 % of adolescent girls had heard of anaemia, 73 % knew that anaemia is a health problem, 36 % subjects answered correctly that haemoglobin decreases in anaemia and 40 % adolescent girls said that anaemia is due to deficiency of iron. The mean age of the study participants was found to be 16.3 years. Similar age grouping was observed in study by Pareek (2015) [14] found that 85 % of the subjects were in the age range of 14–16 years.

Conclusions

Rural adolescent girls are prone to anemia. There was adequate knowledge but moderate attitude and inadequate practice. Moderate attitude and inadequate practice were due to lack of proper information regarding haemoglobin level, deworming tablets, food-consuming habits and iron-rich diet. The education level of participants, mother’s education level, socio economic status had a major influence on the knowledge, attitude and practice regarding anaemia. Participants whose mothers were educated and participants with higher education level have adequate knowledge, attitude and practice regarding anaemia.