INTRODUCTION
"The doctor of the future will no longer treat the human frame with drugs, but rather will cure and prevent disease with nutrition".
Thomas Edison.
The adolescent term means "to emerge or achieve identity" It is derived from Latin word adosecere meaning to grow to maturity.
As per the estimation of World Health Organization (WHO, 2010) there are nearly 1.2 billion adolescent in the world. In India, about 21% of the population is in the age group of 10-19 years.
There are about 1.2 billion adolescent in the world equal to 5th of world's population and their numbers are increasing and out of 5 million adolescent are living in developing countries. India has reached one billion, out of which 21% are adolescents. Adolescent are no more children but not yet adults. They have different needs according to their development and their personal circumstances some are vulnerable and others are hard to reach. (J.S.Mathur, 2011)
Adolescence has been defined by the World Health Organization as the period of life spanning the ages between 10 to 19 years. This is the formative period of life when the maximum amount of physical and behavioural changes takes place. This is a vulnerable period in the human life cycle for the development of nutritional anemia which has been constantly neglected by public health programs. Girls are more likely to be a victim due to various reasons. In a family with limited resources the female child is more likely to be neglected. She is deprived of good food and education, and is utilized as an extra working hand to carry out the household works and also menstrual blood losses, normal or abnormal, precipitates the crises too often.
During adolescence, rapid growth leads to expansion of blood volume. In post menorrheal girls, the menstrual loss adds to the iron requirement. Iron is required for building hemoglobin. It is also necessary for oxidation of carbohydrate and in the synthesis of some hormones and neurotransmitters (Anne Waugh, 2005).
Adolescence is a significant period of human growth and maturation, unique changes occur and many adult patterns are established. During the adolescent growth spurt, the risk of iron deficiency and anemia occur for both boys and girls after which it subsides for boys but remains for girls after menarche. Iron deficiency affects the ability of adolescents to read, write and learn also. The United States Agency for International Development consultation concluded that "iron supplementation resulted in significant improvement in school measurements of verbal and other measurable skills among primary school children and adolescents". (J.S.Asoken, 2004)
The 'growth spurt' result in a 50% increase in calcium and 15% in iron requirements. Adolescent girls are at particularly high risk of anemia and malnutrition. Inspite of taking adequate nutrition, girls during adolescence can have serious consequences throughout the reproductive years and beyond. Iron deficiency anemia is one of the major nutritional problems affecting adolescent girls. Anemia in adolescence puts a young woman and her future child at risk of premature birth, low birth weight, increased perinatal mortality and maternal mortality. Iron deficiency anemia also impairs cognitive development and behavioral change resulting children in reduced school performance and also it reduces physical performance resulting in reduced work capacity and productivity and thus has economic implications. (Pyuish Gupta, 2010)
Iron is absorbed in ferrous form, passes through intestinal mucosa cells, delivered to transferrin in the plasma. This transferrin transfers to all body sites especially bone morrow. It helps in the formation of hemoglobin, combines with protein to form hemoglobin, which carries oxygen in blood, increases resistance to infection, functions as a part of enzymes involved in tissue respiration. It also takes part in synthesis of vitamins, purines and antibodies. (B.T.Basavanthappa, 2008)
Beetroot is anti-anemic as it contains iron and vitamin C and also rich in potassium, magnesium, and calcium. (Darshan Sohi,2009)
Jaggery also called as" medicinal sugar". It contains up to 50% sucrose, up to 20% invert sugars, moisture content up to 20% and the remainder is made up of other insoluble matter such as, proteins and fibers and also it contains all the constituents for the body like minerals and vitamins. Each 100gms jaggery contains 11.1mg of iron. (Swaminathan, 2010)
Need for the study
The healthy existence of children is essential to build up a challenging Nation. Adolescence is a cross road in life when choices and decisions made become crucial for the future of an individual. Adolescents learn and adopt new knowledge and practices more easily and generally these are long lasting with impact on next generation.
Adolescent is a crucial developmental period when nutritional requirement increases due to growth spurt. Iron requirements are especially high in pregnant women, infants, young children and adolescents who run a higher risk of being iron-deficient. In developing countries, the main cause of iron deficiency is the low bioavailability of the diet. The consequences of iron deficiency are many and it's not only affecting the individual's health but also the development of societies and countries. The prevention and control of iron deficiency anemia to all groups of population with different iron requirements imply to coordinate different interventions. (Akramipour R, 2008)
Iron deficiency anemia is a serious and widespread public health concern in both developing and developed countries. It affects 20-50% of the world's population and is common in young children. The prevalence of iron deficiency anemia is high due to poverty, inadequate diet and high incidence of communicable diseases, pregnancy/lactation and low immunity. In India, adolescent girls constitute a vulnerable group of iron deficiency anemia resulting in a reduced physical work capacity and cognitive function, behavioural disturbances, morbidity, delay in the onset of menarche which leads to cephalo pelvic disproportion. Measuring hemoglobin concentration is relatively easy and inexpensive and this measurement is frequently used as a proxy indicator of iron deficiency anemia. (Shilpa , 2008)
WHO reports global burden of diseases reports identified iron deficiency as the 12th most important risk for all mortality and the 9th most important risk factors for the Global burden of diseases. In India 50-60% of pregnant women suffer from anemia in which about 65-70% of antenatal mothers are anemic in Tamilnadu.
Adolescent girls 58% were anemic in developing countries. In India 62% of girls in the age group of 10-19 years were found to be anemic. A higher prevalence of anemia(43%) was observed in vegetarian girls and their hemoglobin level was less than 12gm/dl where as 28% of non-vegetarian girls and their hemoglobin level was less than 12gm/dl.(Devadas,2001)
Iron is important in human nutrition. It is necessary for many functions in the body including formation of hemoglobin, brain development and function, regulation of body temperature, muscle activity and catecholamine metabolism. The central function of iron is "Oxygen transport" and cell respiration. Iron absorption is mostly from the whole of the gastro-intestinal tract, a large amount is absorbed from the upper part of small intestine particularly from the duodenum. (Chatterjee, 2002)
India has the world's highest prevalence of iron deficiency anemia among women with 60 to 70 percent of the adolescent girls being anemic. The pre-pregnancy nutritional status of young girls is important as it impacts on the course and the outcome of their pregnancy. Hence, the health status of adolescent girls demands special attention. (Shilpa , 2012)
Anemia is a serious problem in adolescence girls. The investigator had a special interest to conduct an interventional study to manage the problem of anemia in adolescent girls. During adolescent period adolescent girls require adequate knowledge regarding anemia and iron supplementation. This helps to prevent them from complications during their pregnancies in the Fourth coming years and there by maternal and child mortality rate of our country can be reduced.
The investigator had selected two food items (Beet root and Jaggery) which are rich in iron content. Drinking fresh beetroot pulp daily is a great choice for those who have anemia or menstruating or who have just given blood. Beetroot was selected with the view of its local availability and also acceptable by all groups of people in the community. Mixing beetroot with some sweetened agent would be liked by all adolescents. It was found that there is difference in composition of iron between sugar and jaggery. Sugar is made up of only sucrose while jaggery is made up of predominantly sucrose, mineral salt, iron and fiber. Consumption of jaggery is recommended in iron deficiency anemia. Hence, the investigator selected jaggery to be mixed with beetroot pulp to prepare delicious pulp.
Statement of the Problem
A Study to Assess the Effectiveness of Beetroot Pulp on Anemia among Adolescent Girls at Selected Schools, Salem.
Objectives
To assess anemia among adolescent girls in experimental group and control group.
To determine the effectiveness of beetroot pulp on anemia among adolescent girls in experimental group.
To associate the pre-test scores on anemia among adolescent girls and their selected background variables in experimental and control group.
Operational Definitions
Effectiveness:
It refers to increase in the hemoglobin level after administration of beetroot pulp among adolescent girls. It is measured by using Sahlis Hemoglobinometer
Beetroot pulp:
It is prepared by cutting a fresh beet root in to small pieces which are blended well. 50ml of pulp is diluted in 50ml of jaggery water.
Anemia
Anemia is a deficiency in the number of erythrocytes, the quantity of hemoglobin and or the volume of packed RBC's (Lewis, 2011).In this study, it refers to a condition in which hemoglobin level is less than 11 gm /dl.
Adolescent girls:
Young girls between the age group of 14 and 15 years.
Assumptions
Adolescent girls may be anemic.
Adolescent girls may have knowledge regarding anemia.
Nutritional intervention may have effect on hemoglobin
Hypotheses
H1: There will be significant difference between the posttest scores on anemia among adolescent girls after administration of beet root pulp in experimental and control group at p<0.05 level.
H2: There will be significant association between the pretest scores on anemia among adolescent girls with their selected background variables in experimental and control group at p<0.05 level.
Delimitation
The study was limited to only adolescent girls with anemia.
The period of data collection was limited to 4 weeks.
The study was limited to selected schools, Salem
Projected Outcome
This study would assess the effectiveness of beetroot pulp on anemia among adolescent girls. Findings of this study would help the adolescent girls to practice the intake of beetroot pulp to prevent anemia.
Conceptual Framework
The investigator has adopted Imogene King's goal attainment theory (1981) based on the personal and interpersonal system including perception, judgment, action, reaction, interaction and transaction.
The investigator adopted goal attainment as a basic theory for conceptual framework, which is aimed to find out the effectiveness of Beetroot pulp on anemia among adolescent girls. This involves interaction between the investigator and the adolescent girls.
Six major concepts describes this phenomena
Perception:
It refers to people's representation of reality. It is not observable but it can be inferred. Here the investigator and the adolescent girls perceived the need for beetroot pulp on anemia.
Judgment:
Judgment is the decision which is made. Here the investigator decides to provide beetroot pulp for adolescent girls and to improve their hemoglobin level. The adolescent girls decide to participate in the research study.
Action:
This refers to the changes that have to be achieved. The investigator action is to administer beetroot pulp among adolescent girls with anemia thereby to increase hemoglobin level. The adolescent girls are ready to receive the intervention.
Reaction:
Reaction helps in setting a mutual goal. In this study the investigator and adolescent girls reaction is to set mutual goal which is to increase the hemoglobin level.
Interaction:
It refers to the verbal and non-verbal behavior between one individual and environment or two or more individuals who involved in goal directed perception and communication. Here the investigator interacts with the adolescent girls by giving pretest to both groups and beetroot pulp only to the study group.
Transaction:
This is the achievement of goal. In this stage, the investigator reassesses the hemoglobin level among adolescent girls by conducting posttest to both groups.
