Screening and management of anemia in adolescent girls in lower socioeconomic strata

INTRODUCTION: Adolescence is a time of intense physical, psychosocial and cognitive development. Increased nutritional need at this junction relate to the fact that the adolescents gain upto 50 % of their adult weight, more than 20 % of their adult height and 50% of their adult skeletal mass during this period. The iron needs are high in adolescent girls because of the increased requirements for expansion of blood volume associated with the adolescent growth spurts and the onset of menstruation.[Clinical medicine and Research] India has the highest prevalence of iron deficiency anemia among women in the world especially adolescent girls. 60-70% of Indian adolescent girls are anemic [International centre for research on women and the Institute of health management- pachod] The percentage of Indian adolescent girls who were anemic was reported as 73.7% by Chaturvedi et al, 61.9% in urban areas and 85.4% in rural areas. AIM OF THE STUDY: 1. To assess the Hb status of adolescent girls from lower socio economic strata of society. 2. To identify the attributable causes of anemia in these adolescent girls. 3. To counsel on the impact of anemia and to educate them and the importance of regular iron intake. 4. To appropriately treat anemia in whom it was deducted. 5. To reassess the Hb status at three months interval for 1 year. 6. To encourage the regular intake of iron. 7. To popularise adolescent girls about consuming locally available, economically affordable iron rich foods. MATERIALS AND METHODS: The study was conducted at Institute of Social Obstetrics and Govt. Kasthurba Gandhi Hospital (ISO and Govt. KGH), Triplicane, Chennai, Outpatient Department. period of study: From April 2007 to April 2008. Study Population: 500 Adolescent girls between 12-19 years of age belonging to lower socioeconomic strata were included in the study based on the inclusion and exclusion criteria. Inclusion Criteria: 1. Age between 12 and 19 years of age. 2. Belonging to lower socioeconomic strata. 3. No known hematological lesion. 4. Not pregnant at the time of intervention. 5. Not on IFA Supplementation. Exclusion Criteria: 1. Girls 19yeras of age. 2. Pregnant woman. 3. H/o bleeding tendency. 4. On long time medications which might produce hematological complications. 5. H/o menstrual disturbances. 6. H/o malarial fever in the recent past. 7. Not willing to consume IFA tablets. 8. Not sure about follow up visits. 9. Not willing for changing food habits. SUMMARY: This study conducted at ISO-KGH, Chennai is to screen the adolescent girls in lower socioeconomic status for anemia. Among 500 girls screened, 340 (68%) were found to be anemic under various degrees. All the girls showed significant improvement in Hb levels and reached normal level after IFA supplementation and deworming. Severely anemic girls needed a longer time of IFA supplementation. In this study, lower socioeconomic status, hookworm infestation, increasing age were found to be attributable causes of anemia. There is significant improvement in the knowledge about anemia after counseling. CONCLUSION: Adolescence is an oppurtune time for interventions to address anemia. In addition to growth needs, girls need to improve iron status before pregnancy. Preventing iron deficiency and increasing iron stores in adolescent girls can improve their iron status in preparation for pregnancy and benefit their current health and well being. Treating anemia in adolescent girls is a primordial prevention there by reducing anemia complicating pregnancies and hence maternal mortality and morbidity to a great extent. This study shows the prevalence of anemia in adolescent girls in lower socioeconomic strata. Hence there is an urgent need to improve their iron status by planning intervention programme that would increase the hemoglobin levels through prophylaxis treatment, dietary modification and helminthic control