Comparison Of Nutritional Status and Knowledge

for Prevention of Anemia Between The Receiver &

Non-receiver Of Iron & Folic acid Supplement
Among School Going Adolescent Girls In Jamalpur
District.

Soptonwita Saha
Roll No: 22024
Session: 2022-2023
MPH (Community Nutrition)
Department Of Nutrition and Biochemistry

National Institute Of Preventive and Social Medicine

(NIPSOM)
 Introduction
Adolescents, according to World Health Organization (WHO), are of
the age between 10-19 years.
Early adolescence after the first year of life is the second critical
period of rapid physical growth and changes in body composition,
physiology, and the endocrine system.
Rapid growth and changes heighten their nutritional requirements
and risks of undernutrition.
During adolescent period nutritional requirements increase
significantly, especially iron & folic acid. Anemia due to nutritional
deficiency disorder, is an important public health problem among
adolescent in our country caused by iron deficiency. It is a major
constraint for national human development & economic growth.
Anemia affects 19.1% of children aged 6-11 years and 17% of
children aged 12-14 years (Nutritional Micronutrient Survey 2011-
2012). It is important to recognize that at least one in every three
school going children is still anaemic.( Institute of Public Health
Nutrition, 2015).
World Health Organization (WHO) recommends weekly Iron & Folic
acid as a strategy to prevent iron deficiency anemia, improve
pregnancy iron reserve & improve folate status in adolescent girls.
In Bangladesh, The National Guidelines for the prevention &
treatment of IDA recommended weekly two tablets each having
60mg elemental iron & 400 microgram folic acid for adolescent girls
(Institute of Public Health Nutrition, 2015).
 Justification
The number of school children (6-15 years) forms 1/3rd of the
population, they are the future citizens, future leaders, as well as future
parents. The progress, welfare and development of a country depends
upon the school going children so they should be in a state of optimal
health. In Bangladesh, low family income, education, and periodic food-
shortage are associated with inadequate dietary intake, which might
lead to undernutrition.

Adolescents are considered as a high-risk group for anemia & iron

deficiency as they have high requirement of iron , poor dietary intake
of iron , high rate of infection. Additionally the social norm of early
marriage among adolescent girls and subsequent pregnancy could
worsen their health condition. If not treated , anemia could cause
delayed physical & psychomotor development, decreased physical
capacity for physical exercise & productivity , & significant damage to
central nervous system & girls are disproportionately affected with
deficit in intelligence, impaired coordination of language & motor skill,
poor attentiveness, lower school achievement.

It is therefore crucial to evaluate the knowledge of adolescent girls

regarding the prevention of iron deficiency anemia.
 Research Question
What is the nutritional status & knowledge for prevention of anemia
between the receivers & non-receivers of iron & folic acid supplement
among school going adolescent girls in Jamalpur district?

General Objective
To determine the comparison of the nutritional status & knowledge of
prevention of anemia between the receivers & non-receivers of iron &
folic acid (IFA) supplement among school going adolescent girls in
Jamalpur district.

Specific Objectives
(1) To determine the socio-demographic characteristics of school going
adolescent girls.
(2) To determine the nutritional status among school going adolescent
girls who receive IFA supplements in Jamalpur district.
(3) To determine the nutritional status among school going adolescent
girls who do not receive IFA supplements in Jamalpur district.
(4) To determine the knowledge for prevention of anemia among the
school going adolescent girls.
 Operational Definition
Adolescence : According to World Health Organization ( WHO)
adolescence is the phase of life between childhood & adulthood from
ages 10-19.

Anemia: Anemia is a condition in which the number of red

blood cells or the haemoglobin concentration within them is
lower than normal. This results in symptoms such as fatigue,
weakness, dizziness and shortness of breath, among others.
The most common causes of anemia include nutritional
deficiencies, particularly iron deficiency and deficiencies in
folate.(World Health Organization)

Nutritional Status: It is the current body status of a person or a

population, related to their state of nourishment, which is
manifested by their height, weight, BMI, physical activity &
disease.
 List of Variables
Dependent Variable:
Nutritional status of adolescent girls

Independent Variable:
(A) Variables related to socio-demographic characteristics :
•Age
•Family size
•Education of mother
•Occupation of father
•Monthly family income
•Religion
•Variables related to positive factors for WIFS program:
•Motivation by parents
•Motivation by teachers
(B) Variables related to negative factors for WIFS program :
• Discouragement by family members & friends
• Nausea
• Vomiting
(C) Variables related to knowledge about anemia. (Agustina,
R et al.,2021)
o Heard about anemia
o Symptoms of anemia
o Causes & effects of anemia
o Prevention of anemia
o Heard about IFA supplementation program
 (D) Variables related to anthropometric measurement
o Height-for-age
o Weight-for-age
o BMI

Conceptual Framework

Variables related
to Variables related
anthropometric to knowledge of
measurement anemia
Height-for-age Heard about anemia
Weight-for-age Nutritional Symptoms of anemia
status of school
BMI Cause & effects of
going anemia
adolescent girl

Variables related to
Variables related to negative factors for WIFS
positive factors for WIFS programe
programe Variables related Discouragement by
family members &
Motivation by parents to socio-
friends
Motivation by teachers demographic
Nausea
characteristic
Vomiting
Age
Family members
 Methodology

Study place: The study will be conducted in the selected high

schools of Jamalpur district.

Study period: 1st January 2023 to 31st December 2023

Study population: School going adolescent girls (10-16 years) who
receive & do not receive iron & folic acid supplement from the selected
schools.

Selection criteria:
* Inclusion criteria
. School going adolescent girls (10-16 years) who receive iron & folic
acid supplement from selected school.
. School going adolescent girls (10-16 years) who do not receive iron &
folic acid supplement from selected school.
. Students who are willing to participate & give consent.

*Exclusion criteria

. Severely ill & mentally unstable students

Sample size determination: Sample size will be calculated by
using this formula: n= n=z²pq/d²
Here,
n= assumed/ desired sample size
z= the standard normal distribution; usually set at 1.96 at confidence
level.
P=Prevalence of malnutrition is 50% = 0. 5 (Hossen K, Rahman F,
Mashreky SR, 2013)
q = 1- p = 1-0.5 = 0.5
d = Degree of error (5%) = 0. 05
According to the formula,
Sample size n = (1.96)2 × (0.5×0.5)/(0.05)2 = 384.16
Considering 10% of non- response rate, the total sample size will be
n = 384.16/ 0.9 = 426.84 ≈ 427

Sampling technique:
A convenience sampling technique selected from the school going
adolescent girl.

Data collection instrument:

Data can be collected by using semi- structured questionnaires.

Data collection technique

Face to face interview
Pre-testing
The developed questionnaire will be first pre-tested & modification will
be done accordingly & the questionnaire will be finalized.

Data management plan:

. Initially data will be checked for completeness & correctness in order
to exclude missing or inconsistent data.
. Then data will be entered into the computer using Statistical Package
for Social Science (SPSS).
Descriptive data will be analyzed by simple frequency distribution
(mean, standard deviation, percentage)
Data will be presented using frequency table, graph & chart.

Ethical Issues
• The protocol will be approved by protocol approval committee of
NIPSOM.
• Ethical clearance of the study will be obtained from the
Institutional Review Board (IRB) of NIPSOM.
• Permission of concerned authority of the mentioned hospital will
be taken.
• Informed written consent will be taken from each and every
participant.
• Privacy and confidentiality will be maintained strictly.
• Participants will have all rights to withdraw from the study.
• They will be assured that there would be no harm to them during
study as there is no invasive procedure will be applied.
Reference
Agustina, R et al.(2021). Associations of Knowledge, Attitude, and
Practices toward Anemia with Anemia Prevalence and Height-for-Age
Z-score among Indonesian Adolescent Girls. Food and Nutrition
Bulletin. Vol. 42,No.1,pp.92-108.
Hossen, K., Rahman, F., Mashreky, SR. (2016). Nutritional Status of
Adolescent girls in Bangladesh: findings of a community based survey.
South East Asia Journal of Public Health.Vol.6,No.1,pp.3-7
Institute of Public Health Nutrition.(2015). National Strategy on
Prevention and Control of Micronutrient deficiencies, Bangladesh
(2015-2024). Dhaka : Ministry of Health and Family Welfare