EFFECTIVENESS OF DRUMSTICK LEAVES SYRUP AND SELF INSTRUCTIONAL MODULE UPON IRON DEFICIENCY ANEMIA IN ADOLESCENT GIRLS
BY
S.ALISON JENNIFER
A DISSERTATION SUBMITTED TO THE TAMILNADU DR.M.G.R MEDICAL UNIVERSITY, CHENNAI, IN PARTIAL FULFILLMENT OF THE
REQUIREMENT FOR THE DEGREE OF MASTER OF SCIENCE IN NURSING
EFFECTIVENESS OF DRUMSTICK LEAVES SYRUP AND SELF INSTRUCTIONAL MODULE UPON IRON DEFICIENCY ANEMIA IN ADOLESCENT GIRLS
Approved by the dissertation committee on :
Research guide :
Dr. Latha Venkatesan M.Sc (N)., M.Phil., Ph.D.,
Principal and professor in nursing, Apollo College of nursing,
Chennai – 600095
Clinical guide :
Mrs. Kanchana M.Sc (N)., M.SC(PSY), Associate Professor,
Medical surgical nursing, Apollo College of nursing, Chennai – 600095
Medical guide :
Dr. Jayakumar Reddy, MD, Consultant pediatrics,
Apollo Children’s Hospital, Chennai – 06
A DISSERTATION SUBMITTED TO THE TAMILNADU DR.M.G.R MEDICAL UNIVERSITY, CHENNAI, IN PARTIAL FULFILLMENT OF THE
REQUIREMENT FOR THE DEGREE OF MASTER
DECLARATION
I hereby declare that the present dissertation titled “Effectiveness of Drumstick Leaves Syrup and Self Instructional Module on Iron Deficiency Anemia among Adolescent Girls ’’ is the outcome of the original research work undertaken and carried out by me , under the guidance of Dr.Latha Venkatesan M.Sc(N)., M.Phil., Ph.D., Principal and Professor in Obstetric and Gynecological Nursing, Apollo College of nursing and Mrs. Kanchana M.Sc(N), Associate professor ., Medical and Surgical nursing , Apollo College of nursing , Chennai. I also declare that the material of this has not formed in anyway, the basis for the award of any degree or diploma in this university or any other universities.
ACKNOWLEDGEMENTS
Lord almighty is praised for uttering profusely his blessings and guidance on me throughout my endeavor and for sustaining me in hours of need.
I proudly and honestly express my sincere gratitude to Dr.Latha Venkatesan, M.Sc(N)., M.Phil., Ph.D., Principal Apollo College of nursing for her caring spirit , excellent guidance, support and valuable suggestions during the course of my work.
I take this opportunity to express my deep sense of gratitude to my guide Mrs.Kanchana M.Sc (N)., M.SC (PSY)., Associate Professor., Medical and Surgical nursing, for her constant encouragement, excellent guidance.
I express my sincere gratitude to Mrs.Nesa Sathya Satchi M.Sc (N)., Reader, Pediatric Nursing, Apollo College of Nursing for her constant encouragement, splendid guidance throughout my work.
I owe my profound gratitude to Dr.Jayakumar Reddy, M.D., (Consultant Pediatrician), Apollo Children’s Hospital, for his valuable suggestion and guidance.
I am thankful to The Director, CAM home for girls and Government girl’s hostel for their timely help to conduct this study.
I extend my earnest gratitude to Mrs. Lizy Sonia, M.sc (N)., Professor, Medical and Surgical Nursing, Apollo College of Nursing, for her elegant direction, and timely
I honestly express my gratitude to Prof.Vijayalakshmi, M.Sc (N)., Research coordinator, Apollo College of Nursing for her valuable suggestions and guidance.
I am immensely grateful to Ms.Kala, M.Sc (N)., Lecturer, Pediatric Nursing, Ms.Cecilia Mary, M.Sc( N)., Lecturer, pediatric Nursing for their kind support.
My sincere thanks to all the experts for validating the tools. I am thankful to the faculty of Apollo College of nursing for their support, guidance and encouragement. I extend my sincere thanks to the Librarians of Apollo College of Nursing for their help in getting the reference materials.
I honestly express my sincere gratitude to all the participants in this study and am greatly indebted to them for their participation.
I extend my heartful thanks to Mr.Kannan, Universe Computer center, for his valuable assistance and promptness in getting the printing works on time.
I am immensely grateful to my parents Mr. Samuel Osler and Mrs. Ruby for their love, patience, constant encouragement and support.
I would fail in my duties if I forget to thank a person behind the scene my fiancé Mr. Alfred Immanuel, for his constant support, encouragement, and sacrifice. The success of this work is credited to him.
Last but not least; I extend my warm thanks to all who helped me in shaping this study, directly or indirectly.
SYNOPSIS
An Experimental Study was Conducted to Assess the Effectiveness of Drumstick Leaves Syrup and Self Instructional Module upon Iron Deficiency Anemia in Adolescent Girls in Selected School Hostels at Arakonam.
The Objectives Of the Study were,
1. To assess the level of hemoglobin before and after administration of drumstick leaves syrup in control group and experimental group of adolescent girls .
2. To assess the effectiveness of self instructional module on knowledge of iron deficiency anemia in control and experimental group of adolescent girls.
3. To find out the effectiveness of drumstick leaves syrup by comparing the iron deficiency levels in control and experimental group of adolescent girls . 4. To find the level of satisfaction after administration of drumstick leaves syrup
among experimental group of adolescent girls.
5. To find the association between selected demographic variables and level of hemoglobin in control group and experimental group of adolescent girls.
6. To find the association between dietary practices and level of hemoglobin before administration of drumstick leaves syrup in control group and experimental group of adolescent girls.
check list to assess clinical signs and symptoms of iron deficiency anemia, interview schedule to assess the dietary practice, rating scale on level of satisfaction and interview schedule to assess the side effects.
An experimental research approach was used to achieve objectives of the study.
The present study was conducted in Catharine memorial home for girls and Government girls’ higher secondary school at Arakonam, with the sample size of 60, selected through simple random sampling technique.
The data collection of the main study was done using validated tools like demographic variable proforma, checklist to assess clinical signs and symptoms, dietary practice interview schedule, knowledge questionnaire regarding iron deficiency anemia, rating scale to assess level of satisfaction, checklist to assess side effects along with estimation of hemoglobin using sahli’s hemoglobin meter. The collected data was analyzed using descriptive and inferential statistics.
After collecting the data pretest was done for both control and experimental group. Experimental group was given a self instructional module on iron deficiency anemia and 15ml of drumstick leaves syrup which was prepared daily using 100GM of fresh drumstick leaves and 30GM of jaggery boiled with 50ml of water. The syrup was administered once daily in the morning after breakfast in the hostel.
The Major Findings of the Study were
¾ The study finding reveals that most of the adolescent girls belong to the age group of 13-14 years (46.6%, 90%) in the control and experimental group respectively. Majority of them belong to nuclear family (80%, 73.33%) in the control and experimental group respectively. Majority of the adolescent girls have family income less than 3000 per month (73.33%, 100%) in control and experimental group respectively. significant numbers of girls (67%, 57%) have regular menstrual cycle in the control and experimental group respectively.
¾ The results of the present study also revealed that the difference in the level of knowledge of adolescent girls in control group in the pretest (M=6.56, S.D=2.27) and posttest (M=6.66, S.D=2.27) did not have significant difference.
In experimental group the posttest level of knowledge was improved (M=17.3, S.D=1.82) when compared to the pretest level of knowledge (M=7.3, S.D=1.32).
It can be attributed to the effectiveness of self instructional module on iron deficiency anemia (p<0.005).
¾ The mean hemoglobin level in the control and experimental group during the pretest were 10.7, 10.95 respectively. The mean hemoglobin level in the control and experimental group during the posttest were 10.8, 12.69 respectively. The difference in the level of hemoglobin was significant at p<0.005
¾ It could be inferred from pretest results that majority of girls had fatigue (73.33%, 73.33%) in control and experimental group respectively, 73% of girls
group respectively. 77% of girls in control group and 83% of girls in experimental group had shortness of breath.
¾ It could be inferred from the posttest results that in experimental group of adolescent girls shortness of breath has reduced to 10% from 83.33%, headache has reduced to 7% from 80%, pale conjunctiva has reduced to 20% and only 7%
experienced loss of hair, and 100% of girls had improved appetite. No significant changes were observed in the control group.
¾ The data reveals that in control group there is association between the menstrual cycle, duration of menstrual flow, number of pads used per day, educational status, type of family, and monthly income of the family and there is no association between age and number of siblings hence null hypothesis was partially rejected.
¾ Data reveals that there is association between number of siblings, type of family and haemoglobin level in the experimental group and there is no association with the other selected demographic variables in the experimental group hence the null hypothesis Ho4 was partially rejected.
¾ Data shows that there is no significant association between the dietary practices and the level of haemoglobin in the control group and experimental group. Hence the null hypothesis Ho3 was retained.
¾ It could be inferred that no side effects of drumstick leaves syrup was observed in the posttest in the experimental group of adolescent girls.
¾ It reveals that majority of the adolescent girls were highly satisfied with the
therapy (100%). About 6.6% of the girls were satisfied with the administration of the syrup.
Recommendations
¾ The same study could be conducted on a large sample to generalize the findings.
¾ The study can be conducted in different settings with similar facilities.
¾ The study can be conducted to evaluate the effectiveness of drumstick leaves syrup in different age groups.
¾ A comparative study can be done using drumstick leaves syrup with jaggery and with sugar.
¾ The study can be conducted for a longer duration of time.
TABLE OF CONTENTS
CHAPTER CONTENTS PAGE NO.
I INTRODUCTION 1-16
Background of the Study 1
Need for the Study 6
Statement of the Problem 9
Objectives of the Study 9
Operational Definitions 10
Null Hypothesis 11
Assumption 12
Delimitations 12
Conceptual Frame Work 12
Projected Outcome of the Study 16
Summary 16
Organization of the Report 16
II REVIEW OF LITERATURE 17-25 Literature Related to Iron Deficiency Anemia among Adolescent Girls
17
Literature Related to Properties of Drumstick Leaves
21
Literature Related to Effectiveness of Drumstick leaves on Iron Deficiency Anemia
22
Literature Related to Effectiveness of Self Instructional Module
23
III RESEARCH METHODOLOGY 26-37
Research Approach 26
Population, Sample, Sampling Technique 29
Sampling Criteria 30
Selection and development of study instruments
31
Psychometric Properties of the Instruments
34
Pilot study 35
Protection of Human rights 35
Data Collection Procedure 36
Problems faced during Data Collection 37
Plan for Data Analysis 37
Summary 37
IV ANALYSIS AND INTERPRETATION 38-62
V DISCUSSION 63-72
VI SUMMARY, CONCLUSION, IMPLICATIONS,
RECOMMENDATIONS
73-81
VII REFERENCES 82-89
VIII APPENDICES xiv-x1vii
LIST OF TABLES
Table No. Description Page No
1 Frequency And Percentage Distribution Of Demographic Variables Of Experimental And Control Group Of Adolescent Girls.
40
2 Frequency and Percentage Distribution of Pretest Level of Haemoglobin in Control and Experimental Group of Adolescent Girls with Iron Deficiency Anemia.
45
3 Frequency and Percentage Distribution of Pretest and Posttest Level of Knowledge regarding Iron Deficiency Anemia in Control and Experimental Group of Adolescent Girls.
46
4 Frequency and Percentage Distribution of Pretest Clinical Signs &
Symptoms of Iron Deficiency Anemia in Control and Experimental Group Adolescent Girls
49
5 Frequency and Percentage Distribution of Posttest Clinical Signs and Symptoms in Control and Experimental Group of Adolescent Girls
50
6 Frequency and Percentage Distribution of Level of Satisfaction on Administration of Drumstick Leaves Syrup in Experimental Group of Adolescent Girls
51
7 Frequency and Percentage Distribution of Level of Satisfaction on various dimensions in Experimental Group of Adolescent Girls
52
8 Frequency and Percentage distribution of Level of Knowledge in according to various dimensions regarding Iron Deficiency Anemia in Control and Experimental group of Adolescent Girls.
53
9 Frequency and Percentage Distribution of Side Effects of Drumstick Leaves Syrup in the Experimental Group of Adolescent Girls.
54
10 Comparison of Mean and Standard Deviation of level of Hemoglobin in Pretest Between Control and Experimental Group and Posttest Level of Hemoglobin Between Control and Experimental Group of Adolescent
55
11 Comparison of Mean and Standard Deviation of level of Knowledge in Pretest Between Control and Experimental Group and Posttest Level of Knowledge Between Control and Experimental Group of Adolescent Girls.
56
12 Comparison of Mean and Standard Deviation of Pretest Level of Knowledge According to Various Dimensions in Control and Experimental Group and Posttest Level of Knowledge in Control and Experimental Group of Adolescent Girls.
57
13 Association Between Selected Demographic Variables and Pretest and Posttest Level of Haemoglobin in Experimental Group of Adolescent Girls.
58
14 Association Between Selected Demographic Variables and Pretest and Posttest Level of Haemoglobin in the Control Group of Adolescent Girls.
60
15 Association between Dietary Practice and Level of Haemoglobin in the Control and Experimental Group of Adolescent Girls before
administration of Drumstick Leaves Syrup.
61
LIST OF FIGURES
Fig. No Description Page No.
1 Conceptual framework for case management model (Little Rock, 2002).
15
2 Schematic representation of research design. 28
3 Percentage distribution of age in years in control and experimental group of adolescent girls
42
4 Percentage distribution education status in control and experimental group of adolescent girls.
43
5 Percentage distribution of menstrual cycle in control and experimental group of adolescent girls.
44
6 Percentage distribution of dietary practices in control and experimental group of adolescent girls
48
LIST OF APPENDICES
APPENDIX Description Page No.
I Letter Seeking Permission to Conduct the Study xiv
II Letter Granting Permission to Conduct the Study xv
III Ethical committee permission letter. xvi-xvii
IV Research participants consent form xviii
V Letter requesting opinions and suggestions of experts for establishing content validity of research tool
xix
VI Plagiarism report xx
VII List of experts for content validity of the tool xxi
VIII Certificate for content validity xxii
IX Certificate for English editing xxiii
X Demographic variable proforma of adolescent girls. xxiv-xxvi
XI Structured Interview schedule to assess dietary practices of adolescent girls.
xxviii- xxix XII Structured Checklist to assess clinical signs and symptoms of
anemia in adolescent girls.
xxxi-xxxii
XIII Structured questionnaire to assess the knowledge regarding iron deficiency anemia
xxxiv- xxxix XIV Rating scale to assess the level of satisfaction of drumstick leaves
syrup.
x1-x1i
XV Checklist to assess side effects of drumstick leaves syrup. x1iii-x1iv
XVI Data code sheet x1v
XVII Master code sheet x1vi-x1vii
APPENDIX –I
LETTER SEEKING PERMISSION TO CONDUCT THE STUDY
APPENDIX-II
LETTER GRANTING PERMISSION TO CONDUCT THE STUDY
APPENDIX III
ETHICAL COMMITEE LETTER
APPENDIX IV
RESEARCH PARTICIPANTS CONSENT FORM
Dear participants,
I am a M.Sc., Nursing Student of Apollo college of Nursing, Chennai. As a part of my study a research on Effectiveness of drumstick leaves syrup and self instructional module on iron deficiency anaemia is selected to be conducted.
The findings of the study will be helpful in improving the haemoglobin level of adolescent girls.
I hereby seek your consent and cooperation to participate in the study. Please be frank and honest in your response. The information collected will be kept confidential and anonymity will be maintained.
Signature of the Researcher
I ………., here by consent to participate and undergo the study.
Signature of the Participant
APPENDIX V
LETTER REQUESTING OPINIONS AND SUGGESTIONS OF EXPERTS FOR ESTABLISHING CONTENT VALIDITY OF RESEARCH TOOL
From
MS. S.Alison Jennifer
M.Sc., (Nursing) Second Year, Apollo College of Nursing, Chennai - 600095.
To
Forwarded Through:
Dr. Latha Venkatesan, Principal,
Apollo College of Nursing.
Sub: Requesting for opinions and suggestions of experts for establishing content validity for
Research tool.
Respected Madam,
I am a postgraduate student of the Apollo College of Nursing. I have selected the below mentioned topic for research project to be submitted to The Tamil Nadu Dr. M.G.R Medical University, Chennai as a partial fulfilment of Masters of Nursing Degree.
TITLE OF THE TOPIC:
An experimental study to assess the effectiveness of drumstick leaves syrup and self instructional module on iron deficiency anaemia among adolescent girls in selected school hostels at Arakonam.
With regards may I kindly request you to validate my tool for its appropriateness and relevancy. I am enclosing the Background, Need for the study, Statement of the problem, Objectives of the study, Demographic Variable Proforma, clinical signs and symptoms checklist, dietary practice assessment interview schedule, rating scale to assess level of satisfaction, checklist to assess side effects. I would be highly obliged and remain thankful for your great help if you could validate and send it as soon as possible.
P P 5
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APPENDIX VII
LIST OF EXPERTS FOR CONTENT VALIDITY OF THE TOOL
1. Dr. Latha Venkatesan, M.Sc., M.Phil., Ph.D., Principal,
Apollo College of Nursing, Chennai – 95.
2. Dr.Jayakumar Reddy M.D., M.R.C.P., Dch.,
Consultant Pediatrician Apollo Children’s Hospital,
Chennai – 10.
3. Prof. Mrs. Lizy Sonia, M.Sc (N)., Vice Principal,
Apollo College of Nursing, Chennai – 95.
4. Ms. Nesa Sathya Satchi M.Sc (N)., Reader,
Apollo College of Nursing, Chennai - 600095.
5. Ms. Abigayil Divya Lecturer,
Apollo College of Nursing, Chennai – 95.
6. Ms. Jamuna Rani, M.Sc (N)., Lecturer,
Apollo college of Nursing, Chennai – 95.
7. Ms. Jennifer, M.Sc (N)., Lecturer,
Apollo College of Nursing, Chennai – 95.
APPENDIX VIII
CERTIFICATE FOR CONTENT VALIDITY TO WHOM EVER IT MAY CONCERN
This is to certify that tools and content for the research study developed by
, II year M.Sc Nursing student of Apollo College of Nursing for her dissertation, “An experimental study to assess the effectiveness of drumstick leaves syrup and self instructional module upon iron deficiency anaemia among adolescent girls in selected school hostels at Arakonam” was validated for content validity.
Signature of the Expert
APPENDIX IX
APPENDIX X
DATA COLLECTION TOOLS
The tools are developed from the following areas concerned with iron deficiency anaemia,
1. General information regarding iron deficiency anaemia.
2. Causes of iron deficiency anaemia.
3. Signs & symptoms of iron deficiency anemia.
4. Prevention & treatment of iron deficiency anaemia.
DEMOGRAPHIC VARIABLES PROFORMA OF ADOLESCENT GIRLS WITH IRON DEFICIENCY ANEMIA
Purpose
This Proforma is used to collect demographic variables like age, educational status, type of family, religion, no: of siblings, family income, menstrual cycle, history of excessive bleeding, dietary habit.
Instructions:
The researcher will collect the information by interviewing the adolescent girls.
1. Sample number:
2. Age in years 2.113-14
3. Educational status 3.1 Middle
3.2 Secondary 3.3 Higher secondary
4. Type of family 4.1 Nuclear 4.2Joint 4.3Others
5. Religion 5.1 Hindu 5.2 Christian 5.3 Muslim 5.4 Others
6. No: of siblings 6.1 One
6.2 Two
6.3 Three or more
7. Monthly income of the family 7.1 <3000
8. Menstrual cycle 8.1Regular
8.2Irregular
9. No: of days of menstrual bleeding in each cycle 9.1 3-5 days
9.2 more than 5 days
10. Number of pads used per day 10.1 2-3
10.2 more than 3
BLUE PRINT FOR DIETARY PRACTICE INTERVIEW SCHEDULE
S.NO CRITERION ITEM NUMBER TOTAL NO: OF
ITEMS 1. Dietary sources & worm
infestation
1,2,3,4,5,7,9 7
2. Eating habits & cooking methods.
6,8,10 3
APPENDIX XI
STRUCTURED INTERVIEW SCHEDULE ON DIETARY PRACTICES OF ADOLESCENT GIRLS WITH IRON DEFICIENCY ANEMIA.
Purpose
This interview schedule is used to collect informations from adolescent girls like consumption of iron rich foods, cooking practices and hygienic practices to control worm infestations.
Instruction
The researcher will collect the information’s regarding the dietary practices by interviewing the adolescent girls.
S.NO DIETARY PRACTICE YES NO
1.
2.
3.
4.
5.
6.
7.
Do you take rich animal source of iron like liver, spleen and rich vegetable sources of iron like green leafy vegetables, beetroot etc?
Do you take other sources of iron like jaggery, ragi,dates, puffed rice etc?
Do you have the habit of consuming more pulses than cereals?
Do you have the habit of consuming tea or coffee with meals?
Do you get treated for worm infestation?
Do you have the habit of washing of hands with soap and water before eating?
Do you have the habit of habit of consuming fruits like guava, alma, oranges?
Scoring key:
YES carries 1 mark NO carries -0 marks
Score interpretation
<50% - Inadequate
>50% - Adequate 9
10
Do you have the habit of consuming dates, honey etc?
Do you have the habit of discarding the water used for cooking vegetable
BLUE PRINT FOR CHECKLIST FOR ASSESSING CLINICAL SIGNS AND SYMPTOMS OF IRON DEFICIENCY ANAEMIA.
S.NO CRITERION ITEM NUMBER
TOTAL NO:
OF ITEMS
1. General signs & symptoms 1,2,3,4,5,6 6
2. Systemic signs & symptoms 7,8,9,10,11,12,13,14,15 7
APPENDIX XII
CHECKLIST FOR ASSESSING CLINICAL SIGNS AND SYMPTOMS OF ANAEMIA AMONG ADOLESCENT GIRLS
Purpose
This checklist is used to assess the clinical signs and symptoms of iron deficiency anemia among adolescent girls.
Instructions
The researcher will assess the clinical signs and symptoms for each individual using the check list.
S.NO Observation Pretest Posttest
1. General signs & symptoms:
Fatigue Under weight Facial puffiness Decreased level of concentration
Reduced work performance Headache(frontal)
Present Absent Present Absent
2 Systemic signs & symptoms:
Flag sign Loss of hair Pale conjunctiva Pallor of the tongue Angular stomatitis Palpitation
Shortness of breath Spoon shaped nails Decreased appetite
Scoring key:
Present carries 1 mark Absent carries 0 marks
Score- interpretation
1-5 - severe anemia 6 – 10 - moderate anemia 11 – 15 - - mild anemia
BLUE PRINT FOR KNOWLEDGE QUESTIONNAIRE
S.NO CRITERION ITEM NUMBER
TOTAL NO:
OF ITEMS
1. General information about iron deficiency anaemia & causes of iron deficiency anaemia.
1,2,3,4,5,16 6
2. Signs & symptoms of iron deficiency anaemia.
6,7,8,15,17,18 6
3. Dietary sources of iron 11,12,13,19 4
4. Prevention & treatment of iron deficiency anaemia
9,10,14,20 4
APPENDIX XIII
STRUCTURED QUESTIONNAIRE TO ASSESS THE KNOWLEDGE REGARDING IRON DEFICIENCY ANAEMIA AMONG ADOLESCENT
GIRLS.
Purpose
This knowledge questionnaire is used to assess the level of knowledge of adolescent girls regarding iron deficiency anemia.
Instruction
Please place a tick mark in the space provided in the side of each item which you feel as appropriate. The responses will be kept confidential.
1. Iron deficiency anaemia means,
1.1. Decreased level of haemoglobin due to low iron intake
1.2. Decreased level of red blood cells 1.3. Decreased level of platelets 1.4. Decreased level of white blood cells
2. Function of haemoglobin in our body is,
2.1. To carry oxygen to all body tissues 2.2. To remove waste products 2.3. To provide immunity 2..4 to carry nutrients
3. Normal haemoglobin level of adolescent girl is,
3.1.8-10gm/dl 3.2.11-12gm/dl 3.3.13-15gm/dl 3.4.16-18gm/dl
4. Nutritional anaemia is caused due to,
4.1. Less intake of iodine 4.2. Less intake of sodium 4.3. Less intake of iron rich food 4.4. Less intake of calcium
5. Decreased absorption of iron is due to,
5.1. Intestinal infestations 5.2. High motility of intestines 5.3. Intake of spicy foods 5.4. Intake of high iodine content.
6. Eyes of anemic girls will be.
6.1. Reddish 6.2. Pale 6.3. Yellowish 6.4. Dry
7. Adolescent girls with severe anaemia will experience,
7.1. Abdominal pain 7.2. Tiredness 7.3. Palpitation 7.4. Muscle pain
8. The concentration level of anaemic girls will be,
8.1 High 8.2 Very high 8.3 Low 8.4 No changes
9. Iron deficiency anaemia can be diagnosed by,
9.1. Urine test 9.2. Blood test 9.3. Stool test 9.4 .X-ray 10. Oral intake of iron supplement can cause,
10.1. Vomiting 10.2 .Nausea 10.3. Black coloured stools 10.4. Abdominal pain
11. The vitamin which helps in iron absorption is,
11.1 vitamin B 11.2 vitamin E 11.3 vitamin C 11.4 vitamin D
12. An example of a fruit rich in iron are the following except,
12.1. Dates 12.2. Apple 12.3. Raisins 12.4. Banana
13. Green leafy vegetables are rich sources of,
13.1. Iodine 13.2. Iron 13.3. Calcium 13.4. Magnesium
14. Iron absorption can be inhibited by intake of,
14.1. Fruit juices along with food 14.2. Coffee and tea along with food 14.3. Cool drinks along with food 14.4. Milk along with food
15. Adolescent girls with anaemia will have,
15.1. Menstrual irregularities 15.2. Abdominal pain 15.3. Muscle pain 15.4. Neck pain 16. Adolescent girls are more prone for iron deficiency anaemia due to the following reason EXCEPT,
16.1. Growth spurts 16.2. Rapid weight gain 16.3. Blood volume expansion 16.4. Decreased appetite
17. The nails of anaemic girls will be,
17.1. Long and thin 17.2. Spoon shaped 17.3. Short 17.4. Curved 18. Adolescent girls with anaemia have a peculiar desire to eat,
18.1. Spicy foods 18.2. Unusual foods like chalk piece, brick 18.3. Bland foods 18.4. Less food
19. An example of iron rich vegetable is,
19.1. Brinjal 19.2. Drumstick 19.3. Cucumber 19.4. Tomato
20. Severe anaemia will require,
20.1. Balance diet 20.2. Antibiotics 20.3. Blood transfusion 20.4. Iron syrup
Scoring key
Each correct answer carries 1 mark Scoring interpretation
Less than 50% -inadequate knowledge 51-75% - moderate knowledge More than 75% - adequate knowledge
APPENDIX XIV
RATING SCALE ON THE SATISFACTION OF ADMINISTRATION OF DRUMSTICK LEAVES SYRUP
Purpose
The rating scale is designed to assess the level of satisfaction of the adolescent girls regarding drumstick leaves syrup.
Instruction:
Kindly read the items responses from highly satisfied to dissatisfied. Describe your satisfaction regarding drumstick leaves syrup. The responses will be kept confidentially.
S.no Items Highly
satisfied Satisfied Dissatisfied
1.
2.
3.
4.
Researcher
Explanation regarding drumstick leaves syrup
Approach of the researcher Time spent by the researcher Administration of drumstick leaves syrup
Duration of administration
6.
7.
8.
9.
10.
11.
12.
13
Comfortness after taking Drumstick leaves syrup Hygienic preparation of the drumstick leaves syrup Taste of the syrup
Method of preparation of syrup:
Easy availability of drumstick leaves
Ease of preparation of drumstick leaves syrup
Easy to follow
Effectiveness of therapy Improvement in the hemoglobin level
No complications
Score
Highly satisfied – 3
Score Interpretation:
<50% - Dissatisfied 51-75% - Satisfied
>75% - Highly satisfied
APPENDIX XV
CHECKLIST TO ASSESS SIDE EFFECTS OF DRUMSTICK LEAVES SYRUP Purpose
This side effects checklist is used to assess the various side effects that can arise due to consumption of drumstick leaves syrup
Instruction
The researcher will assess the side effects by interviewing the adolescent girls who consume the syrup
S.No Side effects yes No
No :of day of development of side
effect
1.
2.
3.
4.
Did you develop any Nausea after consumption of drumstick leaves syrup?
Did you have any vomiting after Consuming the syrup?
Have you had any Diarrheal episodes after taking the syrup?
Have you had any Heartburn
5.
6.
7.
8.
9.
10.
Was there any Skin rashes during the course of consuming the syrup?
Did you have constipation?
Was there any edema in your body?
Did you have Headache after taking the syrup?
Was there any Abdominal discomfort?
Did you develop Abdominal cramps after taking the syrup?
Scoring:
Yes – 0 Mark No - 1 Mark
APPENDIX XVI DATA CODE SHEET SN Sample number
AGE
EDU
TF
REL
NS
MI
MC
DMC Age 2.1.13-14 2.2.15-16 2.3.17-18
Educational status 3.1.Middle
3.2.Secondary 3.3.Higher secondary Type of family 4.1.Nuclear 4.2.Joint 4.3.Others Religion 5.1.Hindu 5.2.Christian 5.3.Muslim 5.4.Others
Number of siblings 6.1.One
6.2.Two
6.3.More than three
Monthly income of the family 7.1.<3000
7.2.3001-5000 7.3.>5000 Menstrual cycle 8.1. Regular 8.2. Irregular
Duration of menstrual cycle 9.1.3-5 days
9.2. More than 5 days
LOK Level of knowledge
LEVEL OF HB
CLINICAL S&S
DP
Upto 50%- Inadequate 51-75- Moderately adequate
>75% - Adequate Level of hemoglobin
Clinical signs and symptoms
1-5 – mild anaemia 6-10 – moderate anaemia
11-15 – severe anaemia
Dietary practice Upto 50% - Inadequate 51-75% - Moderately adequate
>75% - Adequate
MASTER CODE SHEET- CONTROL GROUP SN DEMOGRAPHIC VARIABLES LOK LEVEL OF HB CLINICAL S&S DP
AGE EDU TF REL NS MI MC DMC NP PRE POST PRE POST PRE POST
1 2.3 3.3 4.1 5.2 6.2 7.1 8.1 9.1 10.1 3 5 11.8 11.8 7 7 63 2 2.2 3.2 4.1 5.2 6.2 7.1 8.1 9.1 10.1 6 4 10 10.2 5 6 63 3 2.3 3.3 4.1 5.1 6.2 7.1 8.1 9.1 10.1 11 11 10.2 10 8 8 63 4 2.3 3.3 4.1 5.1 6.3 7.1 8.1 9.1 10.2 7 7 10.2 10.2 5 5 45 5 2.1 3.2 4.1 5.2 6.1 7.1 8.1 9.1 10.1 5 7 11 11 5 54 6 2.1 3.2 4.1 5.2 6.2 7.3 8.1 9.1 10.1 6 6 11.2 11.6 6 5 54 7 2.2 3.2 4.2 5.2 6.1 7.1 8.1 9.2 10.2 6 5 10.6 10.2 8 8 63 8 2.1 3.1 4.1 5.2 6.1 7.1 8.2 9.2 10.2 6 6 11.4 11.6 7 7 63 9 2.1 3.1 4.1 5.1 6.3 7.1 8.2 9.1 10.1 5 8 10 10 7 7 54 10 2.1 3.1 4.1 5.1 6.1 7.1 8.2 9.2 10.2 6 6 10.2 10.2 6 7 63 11 2.1 3.1 4.1 5.2 6.3 7.1 8.1 9.2 10.1 5 5 11.2 11.2 8 8 27 12 2.2 3.3 4.1 5.3 6.3 7.1 8.1 9.1 10.1 9 10 10.8 10.8 9 9 45 13 2.2 3.3 4.2 5.2 6.1 7.1 8.1 9.1 10.1 9 11 11 11 10 10 54 14 2.2 3.3 4.2 5.2 6.1 7.2 8.1 9.1 10.1 7 6 10 10.4 10 10 45 15 2.2 3.3 4.1 5.2 6.1 7.1 8.1 9.2 10.1 8 8 10.2 10.2 9 9 54 16 2.2 3.3 4.1 5.2 6.2 7.1 8.1 9.1 10.1 9 10 10.8 11 6 6 63 17 2.2 3.3 4.1 5.2 6.2 7.1 8.1 9.2 10.2 9 8 10.4 10.4 6 6 54 18 2.1 3.2 4.1 5.1 6.1 7.2 8.1 9.1 10.1 5 5 11 11 8 8 63 19 2.2 3.3 4.1 5.2 6.2 7.1 8.1 9.2 10.1 8 8 11 11 8 7 18 20 2.1 3.1 4.1 5.1 6.1 7.2 8.1 9.1 10.1 6 5 11 11 9 9 27 21 2.1 3.1 4.1 5.1 6.2 7.1 8.2 9.1 10.1 2 4 10.8 10.8 9 9 36 22 2.1 3.1 4.1 5.1 6.3 7.2 8.2 9.2 10.1 3 3 10.4 10.6 9 9 54 23 2.2 3.3 4.2 5.2 6.3 7.3 8.2 9.2 10.2 4 5 10.2 10.6 5 5 27 24 2.1 3.1 4.1 5.3 6.1 7.1 8.2 9.1 10.1 9 10 11.4 11.4 5 5 45 25 2.1 3.1 4.2 5.2 6.2 7.1 8.2 9.2 10.2 7 7 10.4 10.2 10 10 54 26 2.3 3.3 4.1 5.1 6.1 7.2 8.2 9.2 10.2 12 12 11.2 11.2 9 9 45
APPENDIX XVII MASTER CODE SHEET
MASTER CODE SHEET- EXPERIMENTAL GROUP SN DEMOGRAPHIC VARIABLES LOK LEVEL OF HB CLINICAL S&S DP
AGE EDU TF REL NS MI MC DMC NP PRE POST PRE POST PRE POST
1 2.1 3.2 4.1 5.2 6.1 7.1 8.1 9.1 10.2 8 18 10.4 12.2 8 3 45 2 2.1 3.2 4.1 5.2 6.2 7.1 8.1 9.2 10.2 9 17 11.8 12.2 10 5 54 3 2.1 3.2 4.1 5.2 6.3 7.1 8.2 9.2 10.2 8 20 11.6 12.6 5 2 45 4 2.1 3.2 4.2 5.2 6.1 7.1 8.2 9.1 10.2 6 20 11.6 12.8 8 3 63 5 2.1 3.2 4.1 5.2 6.1 7.1 8.1 9.2 10.1 7 16 11.4 12.4 10 3 54 6 2.1 3.2 4.2 5.2 6.3 7.1 8.2 9.2 10.2 7 15 10.9 13 6 3 54 7 2.1 3.2 4.1 5.2 6.1 7.1 8.2 9.1 10.1 8 17 10 12 9 5 54 8 2.1 3.2 4.1 5.2 6.2 7.1 8.2 9.1 10.1 7 17 12 13 8 3 54 9 2.1 3.2 4.1 5.2 6.2 7.1 8.1 9.1 10.1 9 16 10 12.8 5 1 36 10 2.1 3.2 4.2 5.2 6.3 7.1 8.2 9.2 10.1 8 15 10.5 12.6 8 2 54 11 2.1 3.2 4.2 5.2 6.2 7.1 8.1 9.2 10.2 8 15 10.4 12.4 8 3 54 12 2.1 3.2 4.1 5.2 6.3 7.1 8.2 9.2 10.1 6 19 10.2 12 9 3 54 13 2.1 3.2 4.1 5.2 6.3 7.1 8.1 9.1 10.1 4 19 10.8 12.2 7 1 72 14 2.1 3.2 4.1 5.2 6.2 7.1 8.1 9.1 10.1 10 18 10 12 8 3 54 15 2.1 3.2 4.1 5.2 6.2 7.1 8.1 9.1 10.1 7 15 11.2 12.5 10 2 54 16 2.1 3.2 4.2 5.2 6.2 7.1 8.2 9.1 10.2 6 19 11.8 13.5 10 5 45 17 2.1 3.2 4.1 5.2 6.2 7.1 8.2 9.2 10.2 8 20 10.6 13 9 6 36 18 2.1 3.2 4.1 5.2 6.2 7.1 8.1 9.1 10.2 6 18 12 12.4 9 6 63 19 2.1 3.2 4.2 5.2 6.2 7.1 8.1 9.2 10.2 7 18 11.8 12.6 7 6 54 20 2.1 3.2 4.1 5.2 6.2 7.1 8.1 9.2 10.1 9 13 11.2 13.5 7 1 45 21 2.2 3.2 4.1 5.2 6.2 7.1 8.1 9.1 10.2 8 18 11.2 12.5 6 3 54 22 2.1 3.2 4.1 5.2 6.3 7.1 8.2 9.1 10.2 5 18 10.2 13 9 4 36 23 2.1 3.2 4.2 5.2 6.2 7.1 8.2 9.2 10.2 6 15 10.9 13 10 5 63 24 2.1 3.2 4.2 5.2 6.3 7.1 8.1 9.2 10.2 8 16 11 12.6 7 5 54 25 2.1 3.2 4.1 5.2 6.2 7.1 8.1 9.1 10.1 9 15 10.4 12.8 5 1 45 26 2.1 3.2 4.1 5.2 6.1 7.1 8.1 9.1 10.2 6 19 11.6 13 7 4 45
CHAPTER I INTRODUCTION
Maturity is only a short break in adolescence.
- Jules Feiffer Background of the Study
Adolescence is a Latin word adolescence which means “to grow” or “maturity”.
Adolescence is a period of transition when the individual changes physically and psychologically from a child into adult. The period of adolescence is accomplished by its profound changes in growth rates, body composition and marked physiological and endocrinal changes. The dramatic physical changes of body include increase in height and weight, deposition and redistribution of fat, increased lean body mass and enlargement of many organs including the sexual components.
Adolescent girls are very important section of our society as they are our potential mothers and future homemakers. Adolescents aged between 10-19 years account for more than one fifth of the world’s population. In India this age group forms 21.4 per cent of total population (Saroja Prabhakaran, 2003).Unfortunately adolescent girls are a neglected sector of the population of our country. As a social custom and cultural practice, an adolescent girl enters married life and motherhood when she neither is matured enough to understand the meaning of motherhood nor is in good health to cope with the triple needs of growth, pregnancy and lactation.
is a period of growth beginning with puberty and ending at the beginning of adulthood; it is a transitional state between childhood and adulthood. The period has been likened to a bridge between childhood and adulthood over which individuals must pass before they can place them as grown adults.
Anemia is one of the problems of public health throughout the world, especially in developing countries. Iron deficiency anemia (IDA) is most prevalent and severe in pregnant women, young children and adolescent girls. Seventy per cent of the adolescent girls are anemic in India according to WHO studies. Iron deficiency anemia is a major threat to safe motherhood. It contributes to increased maternal mortality, increased fetal growth retardation, prenatal and perinatal mortality and low birth weight.
Proper nutrition including adequate iron intake plays an important part in the teen ager’s growth and development. During adolescence they acquire the knowledge and skills that will help them to become independent, successful young adults. Iron deficiency anemia can affect their learning and development. So ,parents, teachers and health professionals can teach them some easy ways to prevent iron deficiency anemia.
Nutritional megaloblastic anemia due to folic acid deficiency occurs at any age but more often affects adult women, infants and young children when compared to men.
Generally, this is manifested through pregnancy and is prevalent among Indian women.
If the problem is not addressed during the preconceptual period, it may cause irreversible fetal damage resulting in neural tube defects, as these defects occur only in early weeks of pregnancy. Therefore many of the unplanned adolescent pregnancies
Iron is vital for transporting oxygen in the bloodstream. A deficiency of iron causes anemia, which leads to fatigue, confusion, and weakness. With the onset of adolescence, the need for iron increases as direct consequence of rapid growth and the expansion of blood volume and muscle mass. As adolescents gain muscle mass, more iron is needed to help their new muscle cells obtain oxygen for energy. The onset of menstruation imposes additional iron needs for girls. The Recommended Dietary Allowance (RDA) for iron during Adolescence is 12-15 milligrams (mg) per day. Good sources of iron include beef, chicken, pork, legumes, enriched or whole grains, and leafy green vegetables.
Iron deficiency anemia is the most common type of anemia that can be easily treated that can occur when there is not enough iron in the body. A lack of iron can come from bleeding, not taking enough foods that contain iron or not absorbing enough iron from food that is consumed. In iron deficiency anemia, the body does not have enough iron to form hemoglobin, which means there no enough hemoglobin to carry oxygen to the whole body. The body gets its iron from food. A steady supply of iron is needed to form hemoglobin and healthy red blood cells.
Two billion people all over the world are affected by anemia (WHO, 2008). In India alone depending on age, sex, iron deficiency has been reported to range from 38-72%. Iron deficiency anemia prevalence rate increases in girls beyond the age of 6 years due to increased metabolic demands (Anshu sharma 2000). Of the
Anemia affects about 43 per cent of women of reproductive age in less developed countries. In India alone, depending on age and sex, Iron Deficiency Anemia has been reported to range between 38-72 per cent while majority of them are being women and children. According to NFHS the prevalence of anemia among married women in the age group of 15-49 years has risen from 51.8% in 1998-99 (NFHS-2) to 56.1 percent in 2005-06 and no less than 57.9 percent of pregnant women suffer from anemia.
Prevalence of anemia among adolescent girls in urban slums of Vellore was studied by Choudary (2006).Results of the study revealed 29% of them were anemic.
Most had mild anemia; severe anemia was not seen. Significant associations were observed between anemia and low economic status.
Green leafy vegetables are the rich sources of pro-vitamin A, vitamin C, folic acid and minerals like calcium, iron, phosphorus, sodium and potassium. It has been estimated that 100 g of tropical leafy vegetables can provide 60-140 mg of ascorbic acid, 100 μg of folic acid, 4-7 mg iron and 200 - 400 mg of calcium (Saxena, 1999).
Majority of the Indian population is vegetarian and daily intake of at least 100 g of fresh green leafy vegetable is recommended by the nutrition experts (Reddy, 1999).
The commonly consumed tropical green leafy vegetable in India is Amaranthus. In addition to this, a great variety of less familiar green leafy vegetables like Basella, Chekkur manis, Alternanthera, Drumstick etc., are also used locally in different parts of the country. So the cheap available sources can be used to treat iron deficiency anemia.
Green leafy vegetables are the cheapest of all the vegetables within the reach of poor man, being richest in their nutritional value. The problem of malnutrition is assuming seriousness in the vulnerable groups viz., adolescents, pregnancy, lactation and school children, not because of poverty but because of ignorance and illiteracy of the people. The lack of knowledge especially on the nutritive value of these green leafy vegetables among the public in general is the main drawback in their lower consumption.
Jaggery is also a good source of potassium and this along with low amounts of sodium helps to maintain blood pressure and reduces water retention. Not to forget, jaggery is very good for anemic people as it is a good source of iron that helps in increasing hemoglobin level in the body. It is also a very good source of manganese and selenium and thus acts as an antioxidant scavenging free radicals from the body. In addition, jaggery also possesses moderate amounts of calcium, phosphorus and zinc.
Jaggery thus helps to maintain optimum health and it also helps in the purification of blood, along with preventing rheumatic afflictions and disorders of bile.
Everything is costly and may require hospitalization except dietary management.
There are different forms of dietary sources of iron such as cereals, pulses, green leafy vegetables and animal sources such as liver, fish etc. Green leafy vegetables are the cheapest and are easily available sources of iron. For the under privileged which forms the majority of the population in India provision of all available nutritional diet is difficult. Nursing research which looks for cheapest sources of nutritional diet is a boon
jaggery which are easily available and cost effective can be used to correct iron deficiency.
Education is fundamental to anemia reduction projects because teenaged girls have poor knowledge about its cause and adverse effects. Health education regarding prevention and control of iron deficiency anemia is one of the strategies to create awareness and to take remedial measures in preventing anemia before pregnancy and thereby helps in preventing maternal deaths and promoting safe delivery. Hence the researcher decided both to administer drumstick leaves syrup and self instructional module on iron deficiency anemia and find the effectiveness of both the interventions upon iron deficiency anemia.
Need for the Study
Iron Deficiency by far is the most prevalent amongst micronutrient deficiencies in adolescent girls. They are at risk of developing iron deficiency because of the increased iron requirements for growth. Infectious diseases such as malaria, schistosomiasis, and hookworm affect both boys and girls, contributing to anemia by affecting the absorption or increasing the loss of iron. Following the end of their growth spurt, boys rapidly regain adequate iron status, whereas girls may continue to be or become more deficient because of the increased requirements for iron due to menstruation, pregnancy, and lactation.
By far the most frequent causes of nutritional anemia is iron deficiency.
elderly about 50%, school children about 40% and adolescents 30-55%. The nutritional anemia in adolescent girls attributes to high maternal mortality rate, high incidence of low birth weight babies, high perinatal mortality &fetal wastage and consequently leads to high fertility rate. Control of anemia in pregnant women may be more easily achieved if satisfactory iron stores can be endured during adolescence.
Iron deficiency anemia can cause reduced work capacity in adults and impair motor and mental development in children and adolescents. There is some evidence that iron deficiency without anemia affects cognition in adolescent girls and causes fatigue in adult women. IDA may affect visual and auditory functioning and is associated with poor cognitive development in children.
Globally, anemia affects 1.62 billion people (95%), which correspond to 24.8%
of the population. The highest prevalence is in preschool-age children (47.4%, 95%) and the lowest prevalence is in men (12.7%). However, the population group with the greatest number of individuals affected is non-pregnant women (95%). In a recent review of the prevalence of iron deficiency anemia in the United States, 9% of toddlers and upto 11% of adolescent girls were iron deficient .In women of childbearing age, the anemia prevalence is 30.2%; Overall, 468.4 million women of childbearing age are anemic. The highest prevalence is found in Africa (47.5%) and in South-East Asia (35.7%). It is 17.8% in the Americas (WHO Report, 2008)
Tamilnadu, Directorate of public health and preventive medicine conducted study on prevalence of anemia among adolescent girls. The study report shared that 65.6% in the rural and 85% in the urban were anemic. Directorate of public health stated that 3.44%
of school adolescents are anemic out of which 59% of them are receiving iron and folic acid tablets.
A review of Indian studies on anemia in adolescent girls revealed that >70% of adolescent girls in low income communities had Hb levels less than 11gm/dl. When WHO cut off of 12gm/dl was applied, the prevalence was even higher (80‐90%).
Anemia is an indicator of both poor health and poor nutrition. Interventions for anemic adolescent girls should raise their iron stores and sustain their haemoglobin at normal levels. This will not only improve their physical and mental capacity, but also subsequently help in reducing the incidence of low birth weight of infants and maternal mortality rates.
Rebecca. et al. (2006) says that iron deficiency anemia is most prevalent and severe in young children and women of reproductive age. For these reasons, this study was planned to highlight the problem of anemia in adolescent girls and to study socio- demographic factors related to anemia. Prevalence of anemia among adolescent girls who live in the urban slums of Vellore was 29% as studied by Choudhary (2006). The prevalence of anemia was higher among adolescent girls than boys in Kattankulathur, Tamilnadu 53.33% and there was a significant association between their socio- economic status and level of hemoglobin (Sugandhi 2008)
Anemia is a critical concern because it affects growth and energy levels. A much larger amount of iron is needed to meet the growth requirements of adolescence. Even a margin iron deficiency during this period of growth can precipitate overt anemia.
Though the Government of India has focused more on adolescent health through various national health programmes still anemia is prevalent among adolescent girls. There is a long gap between what we know to be effective, easily implemented in anemia management strategies and what we actually practice. Drumstick leaves syrup has significant effects on human and blood forming qualities due to higher iron content and proved to be an excellent remedy for anemia. Thus the researcher was interested to conduct an experimental study to know the effectiveness of drumstick leaves syrup and self instructional module in reducing iron deficiency anemia.
Statement of the Problem
An Experimental Study to Assess the Effectiveness of Drumstick Leaves Syrup and Self Instructional Module on Iron Deficiency Anemia in Adolescent Girls in a Selected School Hostels at Arakonam.
Objectives of the Study
1. To assess the level of hemoglobin before and after administration of drumstick leaves syrup in control group and experimental group of adolescent girls .
2. To assess the effectiveness of self instructional module on knowledge of iron
3. To find out the effectiveness of drumstick leaves syrup by comparing iron deficiency levels in control and experimental group of adolescent girls . 4. To find the level of satisfaction after administration of drumstick leaves syrup
among experimental group of adolescent girls.
5. To find the association between selected demographic variables and level of hemoglobin in the control and experimental group of adolescent girls.
6. To find the association between dietary practices of adolescent girls in control group and experimental group and level of hemoglobin before administration of drumstick leaves syrup
Operational Definitions Effectiveness
In this study it refers to the improvement of hemoglobin level after the oral administration of 15ml of drumstick leaves syrup once daily in the morning after breakfast for 4 weeks . It is measured by the estimation of hemoglobin level using sahli’s hemoglobin meter.
Drumstick leaves syrup
In this study it is a syrup prepared daily by the investigator by boiling 100 GM of fresh drumstick leaves with 50ml of water and straining the juice and adding 30GM of jaggery and reducing the mixture to syrup form.
Self instructional module on iron deficiency anemia
In this study it refers to an information booklet developed by the investigator on iron deficiency anemia. The booklet includes causes, signs and symptoms, treatment and preventive measures of iron deficiency anemia.
Iron deficiency Anemia
In this study it refers to a hemoglobin level between 10-12GM as established by WHO guidelines. It will be measured by the estimation of hemoglobin.
Adolescent girls
In this study it refers to the girls between the age of 13-18 yrs staying in selected school hostels.
Null Hypothesis
Ho1 There is no significant difference in the level of hemoglobin in control and experimental group before and after administration of drumstick leaves syrup.
Ho2 There is no significant difference in the level of knowledge in control and experimental group before and after administration of self instructional module.
Ho3 There is no significant association between the demographic variables and level of hemoglobin in the experimental group of adolescent girls before and after administration of drumstick leaves syrup.
Ho4 There is no significant association between incidence of iron deficiency anemia and dietary practices in control and experimental group of adolescent girls
Assumptions
¾ Adolescent girls are particularly susceptible for iron deficiency anemia because of the rapid period of growth.
¾ Iron deficiency anemia is mainly due to low bioavailability of iron in diet.
¾ Anemia in adolescent girls attributes to high maternal mortality rate.
¾ Drumstick leaves and jaggery are good sources of iron.
¾ Anemia is preventable and treatable.
Delimitations
¾ The study was conducted among adolescent girls who were residing in the selected hostels at Arakonam.
¾ The duration of the study was only four weeks.
¾ The study was limited to girls in the age group of 13-18 years.
¾ The girls who attained menarche.
Conceptual Framework
Concepts are the basic building blocks of the theory. A conceptual model broadly presents an understanding of the phenomena of interests and reflects the
serve as spring boards for generating research hypothesis. A frame work is the overall underpinning of the study (Polit and Beck).
The conceptual framework of the present study is based on modified case management model of (Little Rock, 2002). Case management society of America has defined case management as a collaborative process that assess , plans , implement, monitor and evaluate options and services to meet an individual’s health needs through communication and available resources to promote quality and cost effectiveness in health care.
Assessment
A Comprehensive assessment of client’s needs begins the process and its foundation. The investigator collected the information such as demographic variables, dietary practice, clinical signs and symptoms, level of knowledge regarding iron deficiency anemia, level of satisfaction and side effects of drumstick leaves syrup.
Planning
Following assessment the investigator analyzes the data by descriptive and inferential statistics and works independently to establish a plan of care. The client is the primary decision maker and investigator assists the client in decision making.
Interventions
of freshly prepared drumstick leaves syrup and self instructional module on iron deficiency anemia to the experimental group of adolescent girls.
Evaluation
Case management is a goal directed process that evaluates outcome. In this study the investigator evaluates level of hemoglobin and level of knowledge before and after administration of drumstick leaves syrup and self instructional module on iron deficiency anemia for the goal directed achievement in control and experimental group of adolescent girls.
Community
Adolescent girls staying in selected school hostels at Vellore District were considered as community.
Payer
Investigator is considered as payer for this study.
1 2 3 4 5
Payer
Asse 1. Demographi 2. Level of hem 3. Level of know 4. Level of satis 5. side effects
essment c variables moglobin
wledge sfaction
A lev an Adolescent gir
ssessment of vel of knowledge nd hemoglobin
Control Pla
Impleme Clien Comm rls (13-18yrs stay
e
Assess level of and he
Exper nning
entation nt
munity
ying in selected
ment of f knowledge emoglobin
imental school hostels)
1. Leve 2. Leve 3. Satis 4. Side
Evaluation el of Hb el of knowledge sfaction level e effects
Projected Outcome of the Study
The projected outcome of the study will be improvement in the hemoglobin level and level of knowledge in the experimental group.
Summary
This chapter dealt with the introduction which included background of the study, need for the study, statement of the problem, objectives of the study, assumptions, operational definitions, null hypothesis, delimitations and conceptual framework of the study.
Organization of the Report
Further aspects of the study are presented in the following chapters, In Chapter II - Review of literature
In Chapter III - Research methodology
In Chapter IV - Analysis and interpretation of the data In Chapter V - Discussion
In Chapter VI - Summary, conclusion, implication, and recommendation.
CHAPTER II
REVIEW OF LITERATURE
Review of literature is an essential component of the research process. It is critical examination of publication related to a topic of interest. Review of literature helps to plan and conduct the study in a systematic manner (Polit and Beck 2008).
This chapter deals with the review of published and unpublished research studies. The review helped the investigator to develop an insight into problem area. This helped the investigator in building the foundation of the study. Review of literature helps the researcher to build on the existing work he or she should understand what is already known in the topic (Polit and Hungler 2007).For the present study literature was reviewed and organized, under four broad headings.
¾ Literature related to Iron Deficiency Anemia among Adolescent Girls
¾ Literature related to Properties of Drumstick Leaves.
¾ Literature related to Effectiveness of Drumstick Leaves upon Iron Deficiency Anemia
¾ Literature related to Effectiveness of Self Instructional Module
Literature related to Iron Deficiency Anemia among Adolescent Girls.
Kahlon (2011) conducted a study on the effect of IDA on audio visual reaction time in adolescent girls aged between 17 – 19 years of age .The study was conducted in
