International Journal of Scientific Research and Engineering Studies (IJSRES)

Volume 1 Issue 3, September 2014

ISSN: 2349-8862

The Burden Of Nutritional Anaemia Among Adolescent Girls In

Muzaffarpur District Of Bihar
Dr. Jayashree
Department of Clinical Nutrition & Dietetics M.D.D.M College
Muzaffarpur, Bihar, India

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 girls 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 Sahalis 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
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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
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International Journal of Scientific Research and Engineering Studies (IJSRES)

Volume 1 Issue 3, September 2014
ISSN: 2349-8862
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, 1549 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 nonpregnant 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 girls 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
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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 24hour 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 Sahalis 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
11

Mild
anaemia

Moderat
e
anaemia
7-9.9

Severe
anaemia

Children
6-59
10-10.9
<7
months
Children
5-11 11.5
11-11.4
8-10.9
<8
years
Children
12-14 12
11-11.9
8-10.9
<8
years
Non-pregnant
12
11-11.9
8-10.9
<8
women (15 yrs of
age and above)
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
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International Journal of Scientific Research and Engineering Studies (IJSRES)

Volume 1 Issue 3, September 2014
ISSN: 2349-8862
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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