WORLD JOURNAL OF PHARMACY AND PHARMACEUTICAL SCIENCES

Koushik et al.

World Journal of Pharmacy and Pharmaceutical Sciences

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Volume 3, Issue 12, 827-836.

Research Article

ISSN 2278 4357

PREVALENCE OF ANAEMIA AMONG THE ADOLESCENT GIRLS: A

THREE MONTHS CROSS-SECTIONAL STUDY
Nalluri. Kranthi Koushik*, Mounica. Bollu, Nallani.Venkata Ramarao,
P.Sharmila Nirojini, Rama Rao. Nadendla.
Guntur, Andhra Pradesh, India.

Article Received on
28 September 2014,
Revised on 19 October 2014,
Accepted on 10 November
2014

ABSTRACT
Background: Anaemia is a common malady in the developing world
with wide spread prevalence especially among the adolescent girls.
India has the worlds highest prevalence of iron deficiency anaemia
among the women, with 60 to 70 % of the adolescent girls being

*Correspondence for

anaemic. Adolescence is considered as a nutritionally critical period of

Author

the life. However, the prevalence of anaemia in female adolescent age

Nalluri Kranthi Koushik

Guntur, Andhra Pradesh,
India.

group in association with diet is still an understudied subject.

Objectives: To assess the prevalence and the severity of the anaemia
among the adolescent girls. Results: The prevalence of anaemia was

77.33% (with that of severe anaemia being 12.06%, that of moderate anaemia being 50.86%
and that of mild anaemia being 37.06%.majority of the girls had the moderate anaemia. The
prevalence of anaemia was considerably high among the adolescent girls who belongs to the
lower socio-economic status. Conclusion: The present study revealed anaemia to be a major
public health problem among adolescents. A high prevalence of anaemia was found among
the adolescent girls, which was considerably high in the late adolescents. There was a
significant association of anaemia with the socio-economic status.
KEYWORDS: Adolescent girls, Anemia, highest prevalence.
INTRODUCTION
Anemia is one of the most important health problems throughout the world

[1]

. Anaemia is

defined as the condition in which there is either less than the normal number of red blood
cells (<4.2 millions/l) or less than the normal quantity of (<12 g/ml) haemoglobin in the
blood.

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The word adolescence is derived from the Latin word, adolescere; which means to grow,
to mature.[2]
The WHO has defined adolescence as the age period between 10 to 19 years of age for both
the sexes (married and unmarried). [3]
Adolescents are classified in to two groups they are the Early adolescence: 10-14 yrs and the
Late adolescence: 15-19 yrs. [4]
There are about 1.2 billion adolescents in the world, which is equal to 1/5th of the worlds
population and their numbers is increasing. Out of these, 5 million adolescents are living in
the developing countries. Indias population has reached the 1 billion mark, out of which 21%
are the adolescents. [5]
Anemia is a global public health problem affecting both the developing and developed
countries with major consequences for human health as well as the social and economic
development. Anemia affects mainly the women of child bearing age group, young children
and adolescent girls.

[6-9]

In females, adolescence marks the beginning of the menstrual cycle

or reproduction. Adolescents gain 30% of their adult weight and more than 20% of their adult
height between 10-19 years, which we call as the growth spurt. [10]
Adolescent girls are at a high risk for anaemia and malnutrition. Inadequate nutrition during
adolescence can have serious consequences throughout the reproductive years of life and
beyond. [2]
Very often, in India, girls get married and pregnant even before the growth period is over,
thus doubling the risk for anaemia. [11]
Normal haemoglobin range according to age: [12]
Age group
Newborn (< 1 week old)
6 months old
Children (1-15 yrs)
Adults
men
Women

Hb (Range in gm/dl)
14-22
11-14
11-15
14-16
12-16

According to the WHO criteria, the cut off level of the haemoglobin concentration in blood
for the diagnosis of anaemia is less than 11gm/dl for pregnant women and for children aged

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between 6 months and 6 years, less than 12 gm/dl for non-pregnant women and children who
are aged 6-14 years old, and less than 13 gm/dl for adult males.

[13]

Classification of the anaemia according to its severity[10]

Anaemia
Mild
Moderate
severe

Hb (range in gm/dl)
10-11.9
7-9.9
<7

As anemia is classified into three degree according to WHO: mild, moderate and severe. Hb
cut-off values of anemia were 10.0-11.9 g/dl (mild), 7.0-9.9 g/dl (moderate) and <7.0g/dl
(severe).
As Anaemia is a major public health concern in the pre-school childrens and pregnant
womens in the developing world. While many studies have examined these two at-risk
groups, but there is a lack of data on the anaemia among the adolescent groups who were
living in developing countries, in the complex ecologic context of poverty and malnutrition .
[14]

It is becoming increasingly evident that the control of anaemia in pregnant women can be
more easily achieved if a satisfactory iron status can be ensured in the adolescent females
prior to marriage. [15]
Adolescent is a transition from dependent childhood to independent and responsible
adulthood.
Nutritional anaemia due to iron and folic acid deficiency is a major global public health
problem. South Asia ranks among the regions, which have the highest prevalence of anaemia
in the world and India perhaps has the highest prevalence of anaemia among the South Asian
countries.
The very high prevalence of anaemia in South Asia, To a large extent is due to predominantly
vegetarian diet with high phytate and low iron content. Low dietary intake and poor iron and
folic acid intake are major factors responsible for high prevalence of anaemia in India. [16]
The reasons for the high incidence of anaemia among the adolescent girls are
Increased iron requirements because of growth.

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Menstrual loss
Discrepancy between the high iron need for haemoglobin formation and low intake of iron
containing foods
Erratic eating habits, dislike for foods which are rich in iron, like green leafy vegetables
Iron absorption inhibitors in food: phytates/tannins [17]
The following cutoff points which were suggested by the WHO were used to determine
whether iron deficiency anaemia was a major problem among the general population: [17]
Prevalence

Public health problem

<5%

Not a problem

5-14.9%

Low magnitude

15-33.9%

Moderate magnitude

40% and above

High magnitude

This study was designed with the objective to identify the prevalence of anemia among the
adolescent population.
MATERIALS AND METHODS
The present study was a cross-sectional study which was conducted for a period of 3 months
from June 2014 August 2014. A total 150 adolescent girls were included in this crosssectional study.
Age, Sex and Hb levels of study patients were collected from the hospital records that is case
sheets and analyzed for the anemia study. All the data collected was compiled ,analyzed and
tabulated .
Table:- 1 Distribution of study participants in relation to anemia
Anemia
Anemic
Non-anemic
total

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Study participants
Number
Percentage
116
77.33%
34
22.66%
150
100%

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Fig-1
[Table/Fig-2]: Distribution of study participants in relation to the severity of the anemia
Degree of anemia
Mild anaemia
Moderate anemia
Severe anaemia
Total

43
59
14
116

Study participants
Number percentage
37.06%
50.86%
12.06%
100%

Fig-2
DISCUSSION
In the present study among 150 paticipants,116 (77.33%) are found to have anemia and 34
(22.66%) are non-anemic ,these results are compared with the similar studies they include A
study which was conducted in the rural areas of Tamilnadu revealed that the prevalence of
anaemia among the adolescent girls was 44.8%. [18]

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Another study which was conducted among the girls who belonged to the low income
families in Vadodara, revealed that 67% of the adolescent girls were anaemic. [19]
Studies to estimate the prevalence of anaemia among adolescent girls, which were conducted
in rural Wardha and Lucknow found that the prevalence of anaemia in those areas was 59.8%
and 56% respectively. [20]
30% of the adolescent girls were found to be anaemic according to a study conducted in rural
South India. [21]
In another study by Premalatha T et al, The prevalence of anemia was found to be 78.75%
among the adolescent girls. [22]
Thus, the results of various studies which have been mentioned above, demonstrated that the
prevalence of anaemia in the adolscents group

was high. This indicated the importance of

including adolescents in the risk group to improve their iron status and the need for planning
interventional programs that would increase the haemoglobin levels among the adolescent
girls through prophylaxis treatment, dietary modification and helminth control.
In our study, the prevalence of severe anaemia was 12.06%, that of moderate anaemia was
50.86% and that of mild anaemia was 37.06%.but In a study which was conducted in rural
Tamilnadu, the prevalence of severe anaemia was found to be 2%, that of moderate anaemia
was 6.3% and that of mild anaemia was 36.5% . [18]
Similarly, in a study which was conducted in three districts of Orissa to assess the
haemoglobin status of non-school going adolescent girls revealed that 96.5% of the subjects
were anaemic, of which, 45.2%, 46.9% and 4.4% were found to have mild, moderate and
severe anaemia respectively. [23]
The prevalence of severe, moderate and mild anaemia in a study conducted in rural Wardha
was found to be 0.6%, 20.8% and 38.4% respectively. [24]
A study which was conducted among school going girls in Ahmedabad revealed that 55.2%
were mildly anaemic, 44.9% were moderately anaemic and that 0.6% were severely anaemic.
[25]

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The high prevalence of mild and moderate anemia demands due emphasis on iron and folic
acid supplementation and health education on the consumption of iron rich foods, so as to
bring down the total prevalence of anemia among the adolescents age group.
The prevalence rate of the anaemia was 96.8% and The majority of anaemic women were in
the category of mild (75.3 %) to moderate (16.9%) and severe Anaemia was 7.8% as per the
study conducted by mishra P et al. [26]
RECOMMENDATIONS [27]
Weekly Iron and Folic Acid Supplementation (WIFS) Programme for Adolescent Girls
and Boys (1019 Years) Supplementation through the Life Cycle For this target segment the
following interventions are proposed:
Administration of supervised weekly IFA supplementation (100 mg elemental iron and
500 mcg folic acid) throughout the calendar year, i.e., 52 weeks each year .
Albendazole (400 mg) tablets for biannual de-worming for helminthic control.
Screening of target groups for anaemia & referring these cases to an appropriate health
facility.
Information and counselling for improving dietary intake and for taking action for
prevention of the intestinal worm infestation
Implementation modalities for WIFS - The WIFS programme will be implemented in
urban and rural areas for adolescent boys and girls in school (1019 years) through the
platform of Government/Government aided/ municipal schools. WIFS will also reach out-ofschool girls in the age group 1019 years through the platform of Anganwadi Kendras.
This study reveals that anemia prevails irrespective of the socioeconomic status which
stresses the need to increase awareness of consequences of the anemia in all strata of the
society.
Periodic surveys should be done in schools on anemia for updating the prevalence.
Promoting awareness among the home makers will be helpful in overcoming this hurdle.
Health programs for housewives on utilization of easily available and affordable iron rich
diet and forming kitchen garden etc.
Educating the parents and children about the importance of deworming and emphasize
them to have dewormed once in six months.

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Parents as well as teachers should be sensitized on under nutrition, role of healthy diet
and consequences of the anemia.
There is need to include iron rich food in the diet of adolescents. Grams, maize, Mustard
leaf, powder milk and red meat has high iron component so at least once in a week, girls
should eat rich food to get recommended iron per day to gain normal body mass index.
Mustard leaf is affordable for adolescents so easily they can purchase and include twice
or thrice in a week. Students are taking food twice a day, they can increase food intake
thrice a day so from this at least adolescents will be able to get 18 mg/d iron. Thrice in a
day having food can help them to increase the iron content in their body. At the time of
preparing vegetables use of iron pot will also increase iron mineral in the body.
Counselling can be done to empower the adolescents to make understand the importance
of precaution measures to avoid anaemia in adulthood.
CONCLUSION
The present study revealed that the anaemia is a major health problem among the adolescent
girls .The high prevalence of mild and moderate anaemia demands due emphasis on iron and
folic acid supplementation and health education on the consumption of iron rich foods, so as
to bring down the total prevalence of anaemia among the adolescent girls. Health education
along with good quality of iron rich nutrition and anti-anaemic drugs can prevent the
prevalence of anaemia. mainly the increase in parity increases the prevalence of anemia.so,
its necessary to educate the adolescent girls on the importance of family spacing, literacy,
small family norms and the prevention of childhood marriages. Its the responsibility of the
pharmacist to counsel them inorder to bring the awareness regarding the anemia and to
further avoiding it by educating them.
REFERENCES
1. World Health Organization. Geneva: WHO; 1991. National Strategies for Overcoming
Micronutrient Malnutrition.
2. Nayar PD, Mehta R. Child Health. In: Gupta P, Ghai OP, Editors. Textbook of Preventive
and Social Medicine. 2nd ed. New Delhi: CBS Publishers and Distributors; 2007; 428-37.
3. WHO. Young Peoples Health. A Challenge for Society. WHO Technical Report Series
no 731, WHO, Geneva, Switzerland 1986.

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Koushik et al.

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4. Das P, Ray SK, Joardar GK, Dasgupta S. Nutritional profiles of the adolescents in a rural
community of the Hooghly district in West Bengal. Indian J Public Health, 2007; 51:12021.
5. Mathur JSS. Preventive and Social Medicine, A comprehensive text book.1st ed. New
Delhi: CBS Publishers and Distributors, 2007; 382-89.
6. WHO Groups of Experts on Nutritional Anemia. Technical Report Series. WHO, Geneva
1986.
7. Indian Council of Medical Research (ICMR). Evaluation of the National Nutritional
Anaemia Prophylaxis Programme-An ICMR Task Force Study. New Delhi:ICMR,1989
8. Dreyfuss ML, Stoltzfus RJ,Shrestha JB, Pradhan EK, LeClerq SC, Khatry SK, et al .
Hookworms, malaria and vitamin A deficiency contribute to anemia and iron deficiency
among pregnant women in the planes of Nepal. Journal of nutrition, 2000; 130:2527-36.
9. Atukorala TMS,de Silva LDR, Dechering WHJC, Dassenaeike TS. Evaluation of
effectiveness of iron-folate supplementation and anthelmintic therapy against anemia in
pregnancy-a study in the plantation sector of Sri Lanka. American Journal of Clinical
Nutrition, 1994; 60:286-92.
10. Lal S, Pankaj A. Editors. Textbook of Community Medicine (Preventive and Social
Medicine).1st ed. New Delhi: CBS Publishers and Distributors; 2007; 166-68.
11. Shobha S, Sharada D. Efficacy of twice weekly iron supplementation in anemic
adolescent girls. Indian Paediatr, 2003; 40: 1186-90.
12. Bell. A. Introduction to the Anemias: Approach to Diagnosis. In: Rodak BF. Editor.
Diagnostic Haematology. Philadelphia: W.B. Saunders Company; 1995;170-80.
13. Dhaar GM, Rabbani I. Editors. Foundations of Community Medicine. 2nd ed. New
Delhi:Elsevier India; 2008; 272-76.
14. Kara B, Cal S, Aydogan A, Sarper N. The prevalence of anaemia in adolescents: a study
from Turkey. J Paediatr Haematol Oncol, 2006; 28(5):316-21.
15. Shekhar A. The iron status of adolescents girls and its effect on their physical fitness.
Indian J Nutr Diet, 2005; 42(10):451-45.
16. Agarwal KN, Agarwal DK, Anshu S. Anaemia in Pregnancy- interstate differences.
Scientific Report 16 by Nutrition Foundation of India, 2005, 1-3.
17. Kishore J. Editor. National Health Programs of India. 6th ed. New Delhi: Century
Publications; 2006; 82-84.
18. Rajaratnam J, Abel R, Asokan JS, Jonathan P. Prevalence of anaemia among the
adolescent girls of rural Tamil Nadu. Indian Paediatr, 2000; 37:532-36.
www.wjpps.com

Vol 3, Issue 12, 2014.

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19. Sen A, Kanani SJ. Deleterious Functional impact of anaemia on young adolescent school
girls. Indian Paediatr, 2006; 43 (3): 219-26.
20. Singh J, Singh JV, Srivastava AK, Suryakant. Health status of the adolescent girls in the
slums of Lucknow. Indian J Community Med, 2006; 31(2): 102-03.
21. Joseph AG, Bhattacharji S, Joseph A, Rao PSS. General and reproductive health of
adolescent girls in rural south India. Indian Paediatr, 1997; 34:242-44.
22. Premalatha T, Valarmathi S, Srijayanth P, Sundar JS, Kalpana S (2012) Prevalence of
Anemia and its Associated Factors among Adolescent School Girls in Chennai, Tamil
Nadu, INDIA. Epidemiol 2:118.
23. Bulliyy G, Mallic G, Sethy GS, Kar SK. Hemoglobin status of non-school going
adolescent girls in three districts of Orissa, India. Int J Adolesc Med Health, 2007; 19:
395-406.
24. Kaur S, Deshmukh PR, Garg BS. Epidemiological correlates of nutritional anaemia in
adolescent girls of rural Wardha. Indian J Community Med, 2006; 31:255-58.
25. Verma A, Rawal VS, Kedia G, Kumar D, Chauhan J. Factors which influenced anaemia
among girls of the school going age (6-18 years) from the slum of Ahmedabad city.
Indian J Community Med, 2004; 29(1):25-26.
26. Mishra P, Ahluwalia SK, Garg PK, Kar R, Panda GK (2012) The Prevalence of Anaemia
among Reproductive Age Group (15-45 Yrs) Women in A PHC of Rural Field Practice
Area of MM Medical College, Ambala, India. J Womens Health Care 1:113.
doi:10.4172/2167-0420.1000113
27. Ramesh Verma,Minakshi Kharb,Shiv Parsad Yadav ,Vikas Chaudhary, Ruchi ,
ajay;prevalence of anaemia among adolescents under ibsy in rural block of a dist. of
northern india; ijssir, vol, 2013; 2 (9): 95-106

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