Brief Reports

Indian Pediatrics 2000;37:532-536

Reprint requests: Dr. Rajaratnam Abel, Head, RUHSA Department, Christian Medical College and Hospital, RUHSA Campus P.O., 632 209, Vellore District, Tamil Nadu, South India.

Manuscript received: August 10, 1999;
Initial review completed: September 27, 1999;
Revision accepted: October 28, 1999

Adolescence is a significant period of human growth and maturation, unique changes occur and many adult patterns are estaliblished. Following early childhood (<2 yr), during the adolescent growth spurt, the risk of iron deficiency and anemia reappears for both boys and girls(1), after which it subsides for boys but remains for girls because of menstrual blood loss. Iron deficiency affects the ability of adolescents to read, write and learn also. The USAID/OMNI/PCD consultation concluded that "iron supplementation resulted in significant improvement in school measure-ments of verbal and other measurable skills among primary school children and adoles-cents"(2). The existing prevalence studies(3-7) were carried out mostly in northern states of India and the only study in Tamilnadu was among affluent girls of Coimbatore. Data on the prevalence of anemia among rural adolescents is scarce, particularly in a rural community based setup. The present study was carried out as part of the baseline survey embedded in a larger study to prevent and control anemia among pregnant women.

As part of a community trial carried out by RUHSA Department of Christian Medical College and Hospital (CMC&H), a baseline survey was carried out in its project area in Vellore District, Tamilnadu, South India by selecting 155 and 161 adolescent girls in the age groups of 13 to 19 years from K.V. Kuppam block and Gudiyatham block. A multistage sample was used to select these girls by choosing 20 panchayats from each block randomly from 39 and 42 panchayats of the two blocks respectively at the first stage. Then a systematic sample of one in 7 girls from each panchayat was selected at the second stage.

The socio economic status of these girls was identified by their community, type of roof, number of rooms they have in their homes, the availability of latrine, the family type, the family size, girls’, mothers’, and fathers’ education and ownership of land. The demographic variables were age and age at menarche. Blood was drawn from 141 and 147 girls from K.V. Kuppam block and Gudiyatham block, respectively. The hemoglobin (Hb) concentration was assesed by measuring anticoagulated venous blood and using the cyanmethemoglobin method. Hb test was done in RUHSA Laboratory and a 5% sample was sent to CMC&H for validating the test done at RUHSA. Nutritional status of the adolescent girls was obtained by measuring height, weight and mid upper arm circumference using standard techniques.

Univariate analysis was done to estimate the mean, standard deviation and range of hemoglobin concentration in different ages, in different socio demographic and economic groups and also with different nutritional status, according to height, weight, and arm circum-ference. Correlation analysis was used to determine the variables that are correlated with Hb among adolescents. Multivariate analysis was done to identify the predictors for anemia among adolescent girls in this rural area.

The age of the girls ranged from 13-19 years with the mean and SD of 15.64 yrs (SD 1.65), 15.7 yrs (SD 1.76) and 15.67 yrs (SD 1.71) for K.V. Kuppam block, Gudiyatham block and both pooled together, respectively. Of these, 29 girls did not attain puberty. The mean and SD of age at menarche was 13.59 yrs (SD 1.03) ranging from 10-18 years.

The prevalence of anemia was 44.8% with severe anemia being 2.1%, moderate 6.3% and mild anemia 36.5%. There was a decrease in the prevalence as the age increased, however the difference was not statistically significant. The prevalence of anemia was 40.7% in premenarcheal girls as compared to 45.2% in post menarcheal girls.

There was reduction in the mean Hb as the age increased. A similar decreasing trend was observed with increasing age at menarche of the girls and also earlier the age at menarche, the higher was mean Hb. The mean Hb of premenarcheal girls was 11.63 g/dl (SD 1.5) and that of post menarcheal girls was 11.52 g/dl (SD 1.54).

A significant association was found between the hemoglobin concentration and the girls’s education and her mother’s educational status (Table I). There were marginal differ-ences in prevalence of anemia and mean Hb in relation to anthropometry which were not statistically significant (Table II). In the multiple regression analysis also girl’s education, mother’s education and the family type were identified as independent predictors for hemoglobin concentration. None of the other socio economic variables and nutritional status were picked up as independent significant predictors.

Table I: Prevalence of Anemia Among Adolescent Girls According to Their Socio-Demographic Groups.

Table II: Prevalence of Anemia Among Adolescent Girls of Various Nutritional Status Groups.

Based on the limited data available at that time on anemia during adolescence, DeMaeyer and Tegman(8) had earlier estimated the mean prevalence in developing countries at 27% with no gender differences. In a multicountry study(9) on the nutritional status of adolescents carried out by the International Center for Research on Women, anemia was found to be the most widespread nutritional problem and prevalences ranged from 32-55%. Nelson et al.(10) documented a 10.5% anemia prevalence among white adolescent girls aged between 12-14 years in a South West London suburb. Nelson et al.(11) also recorded that 20% of 111 girls (11-14 years) had Hb <12 g/dl in Wembley. Leshan et al.(12) documented a 50% prevalence of anemia among 169 African - American urban adolescents, with a mean hemoglobin level of 11.5 g/dl (SD 1.5 g/dl). Agha et al.(13) investigated 270 adolescent girls and found 18% girls had Hb <12g/dl and 54% girls were iron depleted.

Agarwal(3) had documented that the prevalence of anemia was 46.6% in premenarcheal girls as compared to 48.4% in post menarcheal girls in the urban slums of North East Delhi. Vasanthi et al.(14) observed a prevalence of 27% and 22% in the rural and urban premenarcheal girls and 24.2% and 27.8% in the rural and urban post menarcheal girls in the age group 11-16 years, respectively in Hyderabad. In the present study this was 40.7% and 45.2%, respectively.

A study conducted in 1994 in rural Rajasthan among 941 adolescent girls in the age group 10-18 years(4) recorded a 73.7% prevalence of anemia. Mehta(5) found out an anemia prevalence of 63.8% in urban slums of Bombay among 10-18 years adolescent girls. Seshadri(6) recorded anemia prevalence in the same age group of girls in Bharuch district of Gujarat as 63%, 54% and 63% in villages covered by 3 Government PHCs, respectively. Agarwal(3) documented in the urban slums of North East Delhi, an anemia prevalence of 47.6% among adolescent girls of age group 10-19 years. All the above three studies were sponsored by UNICEF and initiated in 1996. In the study sponsored by Mother Care project, USAID, Raina et al.(7) documented a prevalence of 85.3% (Hb <11 g/dl) in rural Haryana. In this present study the baseline prevalence in K.V. Kuppam block was 35.5%, in Guidyatham Block it was 53.7% with a total prevalence of 44.8%.

Raina et al.(7) documented a prevalence of severe anemia (Hb <8 g/dl) as 37% in rural Haryana. Mehta(5) found 4.8% severe anemia, 22.4% moderate and 36.6% mild anemia among adolescent girls of the same age group in the urban slums of Bombay. In the present study the prevalence of mild anemia of 36.5% is the same as that of Bombay urban slum girls and severe anemia was only 2.1%.

This study has demonstrated that anemia among rural girls of Tamilnadu is also high as in other parts of the country. This indicates the importance of including adolescents in the risk group to improve their iron status and the need for planning intervention programs that would increase the hemoglobin levels among adolescent girls through prophylaxis treatment, dietary modification and helminth control. Increasing the educational level of rural girls would also ensure safe motherhood.

The authors would like to thank Dr. V. Sampathkumar for his role in the data collection for this study. This publication was made possible through support provided by the Office of Health and Nutrition, United States Agency for International Development (USAID), under the terms of contract No. HRN-C-00-9300038-00 and John Snow, Incorporated (JSI). The contents and opinions expressed herein are those of the authors and do not necessarily reflect the views of USAID and JSI.

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