International Journal of Scientific Research and Engineering Studies (IJSRES)

Volume 1 Issue 3, September 2014

ISSN: 2349-8862

www.ijsres.com Page 21

The Burden Of Nutritional Anaemia Among Adolescent Girls In

Muzaffarpur District Of Bihar

Abstract: Objective: To study the socio- economic

factors, dietary pattern and nutritional status of adolescent

girls to estimate the prevalence of anaemia.

Methods: It was a cross sectional study carried out in

M.D.D.M government girl’s college of Muzaffarpur district,

Bihar. The study was designed to include all eligible aged

16-18 years non pregnant, unmarried college girls.

Information on socio-economic conditions, dietary intake,

food habit and knowledge about anaemia was obtained with

a pre-tested questionnaire. Food consumption of the subjects

was assessed using a 3-day 24-hour dietary recall method.

Hemoglobin was done using the Sahali’s hemoglobinometer

using standard procedure protocol.

Results: Study revealed that majority of the respondents 54%

belongs to middle cast. Maximum number of families 52%

had medium size, majority of the respondents 50% belonged

to income group earning from Rs. 15,000 – 20,000. A

detailed and relevant history of 167 study cases revealed that

58% girl students were vegetarian and 42% were non

vegetarians.Improper education and dearth of awareness

among mothers results in poor health of adolescents.The

overall prevalence of anaemia was was found to be 49.1%

.Of which 36.5%, 12%, 0.6% had mild, moderate and severe

anaemia.

Conclusions: Results indicate an overall poor nutritional

status of adolescent college girls in Muzaffarpur,District of

Bihar.This should be supported by programs for the

prevention of anemia among adolescent girls through

nutrition education and anemia prophylaxis.

Keywords: Anaemia, diet, iron, female, college.

I. INTRODUCTION

Nutritional anaemia may be defined as the condition that

results from the inability of the erythropoietic tissue to

maintain a normal haemoglobin concentration on account of

inadequate supply of one or more nutrients leading to

reduction in the total circulating haemoglobin. Nutritional

anaemia is caused by the absence of any dietary essential that

is involved in haemoglobin formation or by poor absorption of

these dietary essentials. Some anaemias are caused by lack

of either dietary iron or high quality protein, by lack of

pyridoxine (vitamine B 6) which catalyses the synthesis of

the haem portion of the haemoglobin molecule, by a lack

of vitamine C, which influences the rate of iron from transfer

into the tissues; or by a lack of vitamine E, which affects

the stability of the red blood cell membrane. Copper is not

part of the haemoglobin molecule but acids in its synthesis

by influencing the absorption of iron, its release from the

liver or its incorporation into haemoglobin molecule. A

vast majority of girls in India are suffering from either general

or specific morbidities (Balasubramaniam, 2005). As per

report published by International centre for research on

women (ICRW 2006), anemia is a very serious problem

among adolescent girls in India. Many Indian studies have

pointed out that iron requirement increase during adolescence,

especially in developing countries because of infections that

causes iron loss and because of low bioavailability of iron

from diets (Jain SP 1999).The iron needs are the highest in the

adolescent girls because of increased requirements for

expansion of blood volume associated with growth spurts and

onset of menstruation (Dallman PR,1992)(Beard JL,2000)

Thus growth spurts, menarche, poor diet and no added iron

supplementation puts them into the high risk category of iron

deficiency anemia. Adolescence is a time of intense physical,

psychological and cognitive development (Jill S et al, 2001).

When these adolescent girls after marriage subjected to the

added demands for iron during pregnancy, it may be too late

to address the problem of anemia during pregnancy. Therefore

adolescent girls who are potential mothers need to have better

status of hemoglobin.

Regulation of iron balance occurs mainly in the

gastrointestinal tract through absorption. (Beard J et al, 1996)

Iron in diet is present in heme and non heme forms. These two

forms are absorbed differently. Heme form is present in meat,

chicken and fish, and is absorbed two to three times faster than

the non heme form which is found in plant based foods and

iron fortified foods(Mangels R,2000)(Hallberg L,1981)

.Enhancers of iron absorption are heme iron and vitamin C;

Inhibitors of iron absorption include polyphenols, tannin,

phytates and calcium. (Siengenberg D et al, 1991). Anamia

can be due to iron deficiency or folic acid and Vitamine

B12 deficiency. The various causes of iron deficiency

anaemia can be clubbed under two main headings –

Dietary deficits and iron losses from the body.

Dietary deficit in the body can be due to two reasons -

low dietary intake of iron or reduced absorption of iron

in the body. In Bihar because of economic reasons many

Dr. Jayashree

Department of Clinical Nutrition & Dietetics M.D.D.M College

Muzaffarpur, Bihar, India

International Journal of Scientific Research and Engineering Studies (IJSRES)

Volume 1 Issue 3, September 2014

ISSN: 2349-8862

www.ijsres.com Page 22

communities largely consume vegetarian diets. The diets do

not contain sufficient absorbable iron due to the presence

of inhibitors. Animal foods from which iron is better

absorbed due to the presence of enhancers are expensive

and generally not consumed in most families in Bihar

due to religious and socio- economic reasons.

The second major cause of anaemia is increased loss

of iron from the body is increased loss of iron from the

body. In adult women loss of iron occurs every month due to

menstrual loss of blood. Apart from menstrual loss, loss of

iron occurs during pregnancy , delivery and lactation. Iron

lossess from the body are also more in case of people

suffering from hookworm and other worm infestations.

This is because worm residing in the small intestine of an

individual feed on his/ her blood. Heavy loss of iron from

the body in conditions of surgery or accident can also

lead to anaemia. Anaemia can also occur due to the deficiency

of folic acid and vitamine B12. Folic acid deficiency is

common among pregnant women who consume diets which

do not contain vegetables, fruits, milk or animal foods right

through their lives. Women and children are affected by folic

acid deficiency. Anaemia due to the deficiency of Vitamine

B12 is rather rare.

Anaemia is a major public health problem in India. The

prevalence of anaemia is 60-90% in different age groups

(Sethi et al., 2003). Under National Family Health Survey

2(NFHS, 2000) levels of anaemia in ever-married women, 15-

49 years of age were studied during 1998-99; the overall

prevalence of anaemia in 79662 women was 52%. The

percentage of mild, moderate and severe anaemia was

respectively 35, 5 and 2 %. ICMR , (2001) reported an

overall prevalence of anaemia in pregnant women from 16

districts as 84.9 %.The overall prevalence among 4,337 non-

pregnant adolescent girls from 16 districts was 90.1%; the

prevalence of mild (>10-11.9 g %) and moderate (7-10 g %)

was 32.1 and 50.9% respectively. Highest prevalence (24.3%

against the overall average of 7.1%) of severe anaemia was

observed in the adolescent girls of Bikaner.NFHS- 3 was

conducted in 29 states (2005-2006). A total of about 199,000

women aged 15-49 years were studied. Anaemia prevalence

among children (< 3 years) (Hb < 11g/dl), pregnant women

(Hb < 11g/dl), and women of reproductive age (Hb < 12g/dl)

was high at 79%, 59% and 56% respectively and appears to

have increased overall since the last survey (1998-1999),

though more so in rural than urban areas (Singh and Christian,

2008).

II. MATERIALS AND METHODS

It was a cross sectional study carried out in M.D.D.M

government girl’s college of Muzaffarpur district, Bihar. The

study was designed to include all eligible aged 16-18 years

non pregnant, unmarried college girls. Ethics approval was

received from the college officials, girls and the parents. 167

girls were selected randomly for the study. The study was

undertaken in the month of September 2013. The girls were

advised to increase the number of daily meals from two meals

to 3-4 meals or multiple meals at short duration daily and also

encouraged to consume vitamin C rich foods in combination

with iron rich foods.

Data Collection: Information on socio-economic

conditions, Dietary intake, food habits and knowledge about

anaemia was obtained with a pre-tested questionnaire. Food

consumption of the subject was assessed using a 3-day 24-

hour dietary recall method. A thorough knowledge of the local

measures the preparation and the method of preparation was

obtained for valid results. Formula used in dietary survey was:

Individual Raw intake - Raw quantity(g) of each preparation used by the family x individual intake

Total cooked amount (volume)of each preparation

Physiological Parameter: Hemoglobin was done using

the Sahali’s hemoglobinometer using standard procedure

protocol (Wintrobe MN 1975). The measured values were

tabulated and compared to the standard values of grading of

anemia according to WHO guidelines with < 12 gram % of

hemoglobin considered as anemic (WHO 1975).

Haemoglobin levels to diagnose anaemia (g/dl)

Age group No

Anae

mia

Mild

anaemia

Moderat

e

anaemia

Severe

anaemia

Children 6-59

months

≥11 10-10.9 7-9.9 <7

Children 5-11

years

≥11.5 11-11.4 8-10.9 <8

Children 12-14

years

≥12 11-11.9 8-10.9 <8

Non-pregnant

women (15 yrs of

age and above)

≥12 11-11.9 8-10.9 <8

Pregnant women ≥11 10-10.9 7-9.9 <7

Men ≥13 11-12.9 8-10.9 <8

Source: Haemoglobin concentration for the diagnosis of

anaemia and assessment of severity. WHO

III. RESULTS

Study revealed that majority of the respondents 54%

belongs to middle cast, 32% belongs to low cast and only 14%

were from high caste. Maximum number of families 52% had

medium size followed by 41% and 7% had large and small

size respectively. It is evident that majority of the respondents

50% belonged to income group earning from Rs. 15,000 –

20,000 , 23% having monthly income of Rs 20,001 -25,000

,18% respondents having monthly income 25,001- 30,000, the

remaining respondents 9% were from income group Rs30,001

and above.

A detailed and relevant history of 167 study cases

revealed that 58% girl students were vegetarian and 42% were

non vegetarians. Improper education and dearth of awareness

among mothers results in poor health of adolescents. Majority

of the subject 78% had unsatisfactory knowledge about the

iron rich food rich food, 17% had intermediate and only 5%

had satisfactory knowledge about the iron rich food. 71% had

unsatisfactory knowledge about Vitamine C rich food. The

intake of cereals and millets was 33.3% more than their

International Journal of Scientific Research and Engineering Studies (IJSRES)

Volume 1 Issue 3, September 2014

ISSN: 2349-8862

www.ijsres.com Page 23

respective RDA. Roots and tubers intake was double than their

respective RDA. Adolescent girls eat more fast foods which

are generally high in fat and the intake was 20% more than the

RDA. Adolescent girls take 50% less amounts of green leafy

vegetables. The intake of other vegetables and fruits was 5%

less than the RDA. A substantial proportion of the girls did not

take milk than their respective RDA. There was a mean deficit

of daily energy intake of 273 Kcal. The largest proportion of

energy 65% was obtained from carbohydrates, followed by fat

(20%) and protein (15%) Mean intake of iron was half of the

RDA. The intake of vitamine C was according to RDA

because most of the fruits consumed were guava,orange,lemon

etc. which are good sources of vitamine C. Out of 167

adolescent girls the overall prevalence of anaemia was was

found to be 49.1% .Of which 36.5%, 12%, 0.6% had mild,

moderate and severe anaemia.

IV. CONCLUSION

The burden of iron deficiency amongst adolescents is

rising. The overall prevalence of anaemia among adolescent

females was found to be 49.1%. CMS Rawat et al. found

35.1% prevalence of anemia among adolescent females in

Meerut. The National family Health Survey (NHFS-3)

conducted in 2005-2006 presents the statistics that 56% of

adolescents are anaemic. A recent study in adolescent girls of

rural Wardha, India (Kaur S et al, 2006) found prevalence of

anemia to be 59.8%. Toteja GS et al found 90.1% prevalence

of anaemia among adolescent girls from 16 districts of India,

with 7.1% having severe anaemia. It is seen that anemia

affects the overall nutritional status of adolescent females. The

awareness regarding anaemia and appropriate diet is very poor

in adolescent girls. In Bihar, adolescent girls face serious

health problems due to socioeconomic conditions, nutrition

and gender discrimination. The burden of anaemia is also due

to parent's educational status. This should be supported by

programs for the prevention of anemia among adolescent girls

through nutrition education and anemia prophylaxis.

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