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.
 Introduction
• 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 anemic.( 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.
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 assess 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
• To determine the socio-demographic characteristics of school
going adolescent girls.
• To determine the nutritional status among school going adolescent
girls who receive WIFA supplements in Jamalpur district.
• To determine the nutritional status among school going adolescent
girls who do not receive WIFA supplements in Jamalpur district.
• To determine the knowledge for prevention of anemia among the
school going adolescent girls.
Operational Definition

• Adolescent: 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 Variables:
A. Variables related to socio-demographic
characteristics :
• Age
• Family size
• Education of mother
• Occupation of father
• Monthly family income
• Religion
 Variables Continue…

B. Variables related to positive factors for WIFS

program:

• Motivation by parents
• Motivation by teachers
Variables….Continued

C. Variables related to negative factors for WIFS

program :

• Discouragement by family members & friends

• Nausea
• Vomiting
 Variables continue…
D. Variables related to knowledge about anemia.
(Agustina, R et al.,2021)

• Heard about anemia

• Symptoms of anemia
• Causes & effects of anemia
• Prevention of anemia
• Heard about IFA supplementation program
Conceptual Framework Variables
related to
knowledge of
Variables related anemia
to Heard about
anthropometric anemia
measurement Nutritional
status of school Symptoms of
Height-for-age anemia
Weight-for-age going adolescent
girl Cause & effects
BMI of anemia

Variable related
to socio-
demographic Variables related
characteristics to negative
Age factors for WIFS
Variables related to
Family members programe
positive factors for
Education of Discouragement
WIFS programe
mother by family
Motivation by
Occupation of members &
parents
father friends
Motivation by
Monthly family Nausea
teachers
income Vomiting
Housing status
Methodology
• Study place: The study will be conducted in the selected high
schools.

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

• Study population: School going adolescent girls (10-16

years) who receive &never receive iron & folic acid
supplement from the selected schools.
Methodology Continue..
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 never receive
iron & folic acid supplement from selected school.
• Students who are willing to participate & give consent.

Exclusion criteria
• Severely ill & mentally unstable students
 Methodology Continue..
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 nutritional status of adolescent girls (height ≤145cm)
is 31% = 0.31 (SECOND NATIONAL PLAN OF ACTION FOR
NUTRITION 2018-2019)
q = 1- p = 1-0.31 = 0.69
d = Degree of error (5%) = 0. 05
According to the formula,
Sample size n = (1.96)2 × (0.31×0.69)/(0.05)2 = 328.69
Considering 10% of non- response rate, the total sample size will be
n = 328.69/ 0.9 = 365.20 ≈ 366
Methodology Continue..

Sampling technique:
• Convenience sampling technique.
Data collection instrument:
• Data can be collected by using pre-tested semi-
structured questionnaire.
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
Methodology Continue..
Data Management Plan:
• Initially data will be checked for completeness and correctness
in order to exclude missing or inconsistent data.
• Then data will be entered into the computer using Statistical
Package for Social Science(SPSS).
Data Analysis Plan:
• Then data will be analyzed by using the 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 and 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.
References

1. 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.
2. 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
3. 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
Thank you