A STUDY TO ASSESS THE INCIDENCE AND KNOWLEDGE RELATED TO ANEMIA AMONG GIRLS OF NURSING COLLEGE OF LUDHIANA, PUNJAB WITH

A VIEW TO DEVELOP INFORMATION BOOKLET

Research Project submitted for the partial fulfillment of the requirement for the degree of POST BACHELOR OF SCIENCE IN NURSING
Of Baba Farid University of Health Science, Faridkot, Punjab

2013

Group B

Guru Hargobind college Of Nursing , Rakot (Punjab)

STUDY

TO

ASSESS

THE

INCIDENCE

AND

KNOWLEDGE RELATED TO ANEMIA AMONG GIRLS OF NURSING COLLEGE OF LUDHIANA, PUNJAB WITH A VIEW TO DEVELOP INFORMATAION BOOKLET

Research Project submitted for the partial fulfillment of the requirement for the degree of POST BACHELOR OF SCIENCE IN NURSING
Of Baba Farid University of Health Science, Faridkot, Punjab

2013

Group B

Name & Signature of Supervisor Mrs.Gursangeet kaur Assisstant professor M.Sc (N)

Name & Signature of Co-Supervisor Mrs .Mandeep kaur (Assisstant Professor M.Sc (N) Obstretric andGynaecology

Obstretric and Gynaecology

Guru Hargobind College Of Nursing, Raikot (Punjab)

Certificate of the Supervisor and Principal

This is to certify that Group B (Paramjeet kaur Dhaliwal,Parmjeet kaur Chahal,Ramandeep kaur grewal, Ramandeep kaur batth ,Ramandeep kaur grewal,Rashpinder kaur Dhindsa,Ravinder kaur Dhillon,Sandeep kaur Chahal,Veerpal kaur Mahli)has carried out the study titled , Astudy to assess the incidence and knowledge related to anemia among girls of nursing college Ludhiana,Punjab with a view to develop information booklet. It is the original work of the above said Group conducted under guidance and supervision.

Supervisor Mrs.Gursangeet kaur Assisstant professor Obstetrics and Gynaecology

Co- Supervisor Mrs.Mandeep kaur Asssisstant professor Obstetrics and Gynaecology

Principal Professor(Mrs) Shamim Sagar Guru Hargobind College of Nursing, Raikot, Ludhiana, Punjab.

Acknowledgement
Your Name, O Transcendent Lord, is Ambrosial Nectar; whoever meditates on it, lives. We praise and thank Lord Almighty for His love and care that He showered on us during our present study and we acknowledge that without which it would not have been a possibility. It is a sense of honor and pride for us to place on record, our sincere thanks to honorable Mrs. Shamim Sagar, Principal, INE, GHG COLLEGE OF

NURSING,RAIKOT, Ludhiana for her valuable guidance and inspiration to complete this research project We express our heartfelt gratitude to our Guide MRS Gursangeeet kaur, Assistant Professor, INE,and our Co-Guide GHG COLLEGE OF NURSING,RAIKOT, Mrs. Mandeep Kaur, Assistant Professor INE, GHG COLLEGE OF

NURSING,RAIKOT,, Ludhiana for their

, guidance, inspiration, support and

encouragement during the investigation and manuscript preparation throughout the course of our research project. We are also thankful to our beloved class teacher Mrs. Jaspreet kaur maan ,Clinical instructor and Miss. Chamandeep kaur, Clinical instructor, INE, GHG COLLEGE OF NURSING,RAIKOT, Ludhiana, for their guidance, inspiration, support and encouragement during the investigation and manuscript preparation throughout the course of our research project. It was not possible to complete the project without their endless efforts and sincere guidance. Words cannot express the gratitude and thanks we feel towards our research coordinator Mr. Narendra kumar sumeriya, Associate Professor, GHG COLLEGE OF NURSING,RAIKOT,, Ludhiana for this guidance, encouragement and for giving us an opportunity to undertake this research project. We are also our sincere thanks to honorable M.Sc experts Mrs. Asha Emanual(Professor), Mrs. V.Shantha laxmi (Associate Professor), Mrs.Charlotte Ranadive (Associate kaur Professor), (Assistant Mrs.Navneet Professor), kaur (Assistant Professor),

Mrs.kuldeep

Mrs.Manveerpal

kaur(Assistant

Professor)Mrs.Veena baksh(Assistant Professor), for their valuable suggestions and guidance.

Very deep appreciation for giving feedback valuable suggestions goes to faculty members of INE, , GHG COLLEGE OF NURSING,RAIKOT, Ludhiana. We also want to thank all our wonderful classmates, library staff and friends for their encouragement and motivation Word acknowledgment would remain incomplete if we do not express our sincere and deep sense of indebtedness to our parents and loved ones and also to the study subjects who helped us in gathering the data. Above all we bow our heart before almighty GOD and our gratitude to him for his abiding grace and for being the guiding for guiding for behind our task. All may not be mentioned, but none is forgotten from the heart. WITH BOUQUETS THANKS MISS.Paramjit kaur Dhaliwal MISS.Parmjeet kaur Chahal MISS Ramandeep kaur Grewal MISS.Ramandeep kaur Batth MISS .Ramandeep kaur Grewal MISS.Rashpinder kaur Dhindsa MRS.Ravinder kaur Dhillon MISS.Sandeep kaur Chahal MISS.Veerpal kaur Malhi

TABLE OF CONT

S.NO 1

CHAPTER

PAGE NO.

2 3

INTRODUCTION Introduction Need of the study Statement of problem Objectives Assumptions Limitation Operational definition Delimitations REVIEW OF LITERATURE METHODOLOG Resarch approach Research design Research Setting Population Method of data collection Sampling technique Sample size Criteria for selection of the sample Development and description of tools Validity of the tools Pilot study Reliability of the tools Data collection procedure

TABLE OF CONTENTS

S.NO CHAPTER

PAGE NO.

1 INTRODUCTION Introduction Need of the study Statement of problem Objectives Assumptions Limitation Operational definition Delimitations 2 REVIEW OF LITERATURE 3 METHODOLOG Research approach Research design Research Setting Population Method of data collection Sampling technique Sample size Criteria for selection of the sample Development and description of tools Validity of the tools Pilot study Reliability of the tools Data collection procedure Ethical consideration Plan of data analysis Summary

4 ANALYSIS AND INTERPRETATATION OF DATA Main Analysis and interpretation Major finding Discussion Summary 5 CONCLUSION , IMPLICATION AND SUMMARY 6 BIBLOGRAPHY 7 ANNEXURES

LIST OF TABLE

S.NO

TABLES

PAGE NO.

1 Frequency and Percentage distribution of Demographic data of girls. 2 Frequency and percentage distribution of knowledge Level regarding anemia among girls 3 Overall mean SD, mean percentage of knowledge Score of girls regarding anemia . 4 Association between knowledge regarding anemia. 5 Incidence regarding anemia among girls.

LIST OF FIGURES

S.NO

TITLE

PAGE NO.

1.1 1.2 2.1

Conceptual framework Research design Bar diagram showing the frequency distribution of subjects according to level of knowledge regarding anemia

4.1

Pia diagram showing the percentage distribution of knowledge according to girls age

4.2

Pia diagram showing the percentage distribution of knowledge according to area of parmenent residence

4. 3

Pia diagram showing the percentage distribution of knowledge according to type of family

4. 4

Pia diagram showing the percentage distribution of knowledge according to type of residence.

4.5

Pia diagram showing the percentage distribution of knowledge according to dietary habits

4.6

Pia diagram showing the percentage distribution of knowledge according to

monthly income. 4.7 Pia diagram showing the percentage distribution of knowledge according to source of information 5.1 bar diagram showing percentage distribution

according to incidence of anemia among girls

LIST OF ANNEXURE

S.NO

ANNEXURE

PAGE NO.

Experts opinion for content validity Of the tool.

2 3 4 5 6 7

Content validity certificate Letter requesting permission for pilot study. Letter requesting permission for final study List of experts Structured interview schedule List of formulas

CHAPTER 1 INTRODUCTION
Anemia is a world-wide problem with the highest prevalence of developing countries. It is found especially among child-bearing age and girls. In India the incidence of anemia is highest among women and young children. Anemia can be classified according to the causes i.e. Impaired production of RBCs and hemoglobin, Accelerated destruction of RBCs ,Blood loss and also classified morphologically.1 Iron deficiency can arise either due to inadequate intake or poor bioavailability of dietary iron or due to excessive losses of iron from the body. Although most habitual diets contain seemingly adequate amounts of iron only a small amount is absorbed. This poor bioavailability is considered to be a major reason for the widespread iron deficiency. Iron deficiency anemia (IDA) is a formidable health challenge in developing countries and remains persistently high despite national programs to control this deficiency. In the period of later school age and early adolescence nutrient requirements are high2. According to WORLD HEALTH ORGANISATION the hemoglobin level should be 12 gm/dl for girls . When the hemoglobin level less then 12 gm/dl is considered as iron deficiency anemia . WHO graded the Hb level 10 gm/dl is considered as moderate iron deficiency anemia and Hb less than 7 gm/dl is considered as severe iron deficiency anemia
3

The decreased dietary iron intake , poor absorption , warm infestation , increased body demand , menstruation are the major causes of iron deficiency anemia among adolescent girls.4 Iron deficiency anemia typically results when the intake of dietary iron is inadequate for hemoglobin synthesis. The body can store about one fourth to one third of its iron, and it is not until those stores are depleted that iron deficiency anemia actually begins to develop. Iron deficiency anemia is the most common type of anemia in all age groups, and it is the most common anemia in the world more than 500 million people are affected more commonly in underdeveloped countries where inadequate iron stores can result from inadequate intake of iron. Iron deficiency is also common in the United States5. Anemia is a sign, which can present at any age. It is important to investigate the cause of anemia exclude a serious under laying aliment. Anemia is present when the hemoglobin level in the blood is two standard deviations below the mean for the particular age and sex being evaluated. The physiologic definition of anemia is a condition in which tissue hypoxia occurs due to inadequate oxygen carrying capacity of blood6.

Iron deficiency anemia occurs when there is a decrease in total body iron content, severe enough to diminish erythropoietin and cause anemia. Diminished dietary iron absorption in the proximal small intestine or excessive loss of body iron can result in iron deficiency. Iron is essential for multiple metabolic processes, including oxygen transport, DNA synthesis and electron transport. In severe iron deficiency the iron containing enzymes are low and this can affect immune and tissue function7. Anemia in girls is one of the social health problems. Iron deficiency anemia leads to weakness, reduced exercise capacity, slower physical growth, impaired cognitive development, decreasing the ability to light infections, delayed wound healing, behavioral abnormalities and also . Anemia may compromise pubert. It may also reduce physical work capacity because the decrease in hemoglobin reduces the availability of oxygen to the tissues which in turn affects the cardiac output. Further in iron deficiency changes in brain iron content and distribution and in neurotransmitter function may affect cognition8. NEED OF THE STUDY Anemia is one of the most prevalent common nutritional deficiencies in the world especially among girls9. High prevalence of iron deficiency anemia reflects their poor status of nutrition because of their rapid growth combined with poor eating habits and menstruation10. In world health report of World Health Organization (WHO) states that the world wide morality rate of iron deficiency anemia is 60,404,000 in 200510. In Victoria 1996, the incidence rate of iron deficiency anemia was 1,87,979 cases among girls11. In USA, the incidence rate of iron deficiency anemia was 1 in 24 cases or 4.12% or 11.2 million people12. In Australia the incidence rate of iron deficiency anemia is 2,17,000 girls in 200413. National Family Health survey in 2006 showed that 56% of girls are anemic in India14. World health report of World Health Organization states that the mortality rate of iron deficiency anemia is 13,704,953 cases in India 200515. The study was conducted on Prevalence of iron deficiency anemia among girls in 16 districts of India in 2006. The survey showed that 90.1% of girls are having iron

deficiency anemia. In this 60.1% of girls were exposed to moderate iron deficiency anemia and 7.1% of girls were exposed to severe iron deficiency anemia16. The prevalence of iron deficiency anemia among girls are consistently high. Nowadays most of the girls are having an intension to maintain a slim structure. So they are eating

very less quantity of food. An influence of Jung foods and fast foods was reduce the intake of dietary iron rich foods17. Changes in the educational system and improvement in the standards of education was increase the workload of students. This was increase the stress among students. It was leads to meal skipping and gives a way to develop iron deficiency anemia. Due to iron deficiency the at girls may get impaired physical work, poor intelligent quotient, decreased motor and cognitive function. So all girls should know about iron rich foods, importance of iron intake and functions of iron in Human body18. If the iron deficiency is prolonged, the functions of heartis also affected gradually, because of an excessive oxygen demand. It was increase the extra workload of the heart, so it can produce myocardial infarction and angina in the later years. Complications of iron deficiency anemia should be prevented strictly, to create a healthy human being19 In order to tackle this public health problem a multi-prolonged 12 x 12 initiative has been launched by Family and Community Health Department in India. The initiative is targeted at all adolescents across the country with the aim for achieving hemoglobin level of 12 g/dl by the age of 12 years by 2012. The important elements of the initiative are as follows: Capacity building Health and nutrition education Increasing iron intake Weekly supplementation of iron tablets Parasite control through periodic de-worming Appropriate immunization This initiative has been launched with the support of Government of India, Indian Council of Medical Research, World Health Organization, UNICEF, Federation of Obstetrics and Gynecological Societies of India, Professional bodies and others20. All the above mentioned information suggests that it is mostly the girls who are affected with the iron deficiency anemia. In the journey of life the girls has various chances to experiment with the pleasures of life. In this situation as health professionals it is our responsibility to provide more awareness on this subject and prevent the coming generation from indulging in such deficiency. Based on these information the researcher feels that it is important to prevent the iron deficiency anemia among girls21

Statement of Problem
A study to assess the incidence and knowledge related to anemia among girls of selected college of ludhiana, Punjab with a view to develop information booklet.

Objectives:
To assess the knowledge related to anemia among girls . To assess the level of hemoglobin among girls of selected college. To find out the association of the knowledge related to anemia with the selected demographic variables. To develop information booklet related to anemia.

Assumptions:
Girls do have less Knowledge related to anemia Most of the girls going to colleges are anemic due to less knowledge.

Operational definition:
Knowledge: - it is defined as the information, understanding and skills that one gains through education and experience. In this knowledge refers to the level of information of girls related to anemia as evaluated through the structure knowledge questionnaire. Anemia: - Anemia is decrease in the number of red blood cell or hemoglobin resulting in lower ability for the blood to carry oxygen to body tissues. In the study anemia refers to the lower levels of hb component as assessed by the estimation of Hemoglobin.

Delimitations:
Studies limited to nursing students only. Studies limited to selected nursing college of Patiala The study was limited to sample of (60) girls

CONCEPTUAL FRAMEWORK
A conceptual framework represents a less formal attempt of organizing phenomena than theories.Conceptual models like theories,deal with abstractions that are assembled by virtue of their relevance to a common theme. (Denise f. Polit and Cheryl Beck,2006) In this study , it is conceptualized that are many factors which influence the knowledge regarding prevention of anemia.these factors include age, area of permanent residence, type of residence , type of family, monthly income, source of information .Knowledge was assessed regarding the prevention of anemia .Knowledge areas like excellent, good, average, below average. Thus, the investigator was conceptualized the interrelationship between knowledge and selected demographic variables of subjects levels are categorized as five

Chapter II Review of Literature

A review of literature is an essential aspect of study; it involves the systematic, identification, location, scrutiny and summary of written materials that contains information on a research problem. It broadens the view of the investigator regarding the problem under investigation, help in focusing on the issues specifically concerning the study. The investigator has made an attempt to explore studies, publications and reports related to the study21. The review of literature in this study was carried out under the following headings: Studies related to incidence and prevalence of anemia Studies related to knowledge of nursing student Studies related to prevention of anemia among girls Studies related to incidence and prevalence of anemia : Study was conducted to assess the Prevalence of anemia and determine serum The ferritin status among 1120 healthy adolescent (12-18 years) girls in a rural school at Chandigarh in India. The cross sectional study was conducted. The results were 23.9% of adolescent girls having a high prevalence of iron deficiency anemia22. The study was conducted on deleterious functional impact of anemia on young adolescent school girls, Gujarat, India. A standard method was used among 9-14 years of adolescent girls. The result was the prevalence of iron deficiency was 67%. It is a higher incidence rate23. The study was conducted on anemia among adolescent females in the urban area of Nagpur, Maharashtra in India. A cross sectional survey was

conducted among 296 girls (10-19 years). The results were the prevalence of anemia among adolescent females was found to be 35.1%. A higher prevalence was found17. The study was conducted on effectiveness of weekly supplementation of iron to control the iron deficiency anemia among adolescent girls of Nashik, Maharastra in India. The cluster sampling technique was followed in each stratum 30 clusters were identified. 10 adolescent girls from each cluster were identified. The prevalence of iron deficiency anemia came down significantly 54.3% from 65.3%24.

The study was conducted on risk factors for anemia in school children in Tanga region, Tanzania. A total of 845 school children were randomly selected in a cross sectional survey conducted. The prevalence of iron deficiency anemia was 79.6%25.

The study was conducted on prevalence of iron deficiency anemia among adolescent school girls from Kermanshah, West Iran. A cross sectional study was conducted to determine the prevalence of Iron deficiency anemia. The result was 47 girls 12.2% with iron deficiency anemia26. The study was conducted on excess adiposity and iron deficiency anemia in female adolescent. The cross section study was conducted to assess the iron status and excess adiposity, menarche, diet, physical activity and poverty status included in the National Health and Nutrition examination survey 2003-2004. The results were the heavier weight girls had an increased prevalence of iron deficiency anemia compare to those with normal weight27. The study was conducted on iron deficiency anemia among adolescent girls in Bangladesh. The sample size was 355 adolescent girls. The result was iron deficiency anemia has 24.8% of adolescent girls28. Choudary et al., (2008) conducted a cross sectional study to assess anemia among unmarried adolescent girls in South India, 100 adolescent girls, aged from 11 to 18 years were selected as samples by purposive sampling method. Blood samples were collected and haemoglobin test was done. The result showed that 29% of adolescent girls were affected with severe anemia, rest of them had mild anemia 71% (P<0.05). Anemia has a significant association with low socio economic status, religion and reporting of infrequent or non-consumption of meat. He concluded that the haemoglobin status of the adolescent girls need to be improved through dietary modification along with the iron supplements and nutritional education29. Dreyfuss et al., (2009) conducted an analytical study to assess the anemia among Indian adolescent girls under the project by Health and Family Welfare Bureau. Blood collection was done and serum ferritin, peripheral blood smear and Haemoglobin test were done and analysis was carried out. The result showed that in India severe anemia ranges from 1.6% to 11.7% among adolescent girls, moderate anemia seen in rural area were more (38%) than in urban (11.9%) area (P< 0.05). He concluded that the adolescent girls are

vulnerable to iron deficiency anemia, which interferes in their physical capacity and work performance. Adolescent period is the preparatory period for the physical development for the future mothers. The young reproductive age group women are more susceptible to anemia, because of their poor dietary intake30. Rohini et al., (2010) conducted are a retrospective study to assess the prevalence of anemia among adolescent girls in 16 slums at Pune. 1142 Adolescents were selected as samples. Data collection was done based on bio physiological measures, dietary history

morbidity history, anthropometric measures, mental history, frequency of lemon consumption with meals, consumption of locally available iron rich foods. The result showed that 1.3% of girls were severely anemic and 58% of girls were moderately anemic (P< 0.01) in the study population31. Sunitha et al., 2009conducted a descriptive study to assess the prevalence of anemia among adolescent girls in Jhirli. Random sampling technique was used and 105 school adolescents were selected as samples. Blood samples were collected and analyzed and a record of one-week dietary recall was maintained. The result showed that 82% of girls were anemic based on their dietary intake (P= 0.15). The report was concluded that anemia is an emerging problem among the world population, nearly 2000 million adolescent girls are suffering from this iron deficiency anemia32. Suman.k et.al (2008) conducted a cross sectional study to screen out the health pattern of the adolescent girls in the age group of 10-14 years. A total of 110 healthy adolescents were taken as samples by random sampling technique. Diet survey and serum

haemoglobin level were assessed. The result showed that less than 10% of the girls had 12gm/dl of haemoglobin and others were anemic with haemoglobin level in the range of 6 to 11.9 gm/dl (p<0.05). The report concluded that the daily food allowance for adolescent girls were inadequate for which the amount of iron and vitamins should be increased33. Sabita, 2009 conducted a descriptive study to assess the prevalence rate of anemia among school going adolescents at Jabalpur. A sample of 183 adolescents were taken from the age group of 12 to 18 years. The estimation of haemoglobin was done by

cyanmethaemoglobin method and serum Ferritin was estimated. The overall prevalence of anemia was significantly higher among the girls (23.9%) when compared to boys (3.75%). Anemia was observed more among rural (25.4%) adolescents than urban (14.2%) adolescents. There was a deficiency of 81.7% and 41.6% of serum Ferritin among adolescent girls and boys respectively34 Nandita, 2011conducted a descriptive study to assess the prevalence of anemia and impact of anemia control programme among adolescent girls for which 512 school going adolescent girls were selected. The result showed that the prevalence of anemia in

adolescent girls to be 80.6%. Dietary intake of the adolescent girls revealed that there was an inadequate intake of food. Almost 90.9% of adolescent girls were consuming less than 50% of required dietary allowance, the finding showed that there was a high prevalence of anemia among the study population ( P< 0.001) due to inadequate intake of food and there by a poor dietary intake of iron35.

Pawashe (2009) conducted a study regarding iron nutritional status of adolescent girls belonging to an urban slum and rural areas. Overall anemia was observed in 25% of the girls irrespective of their residence. A higher percentage of rural girls (37.5%) especially below the age of 12 years showed evidence of anemia. Thereafter, the prevalence was similar in both urban and rural girls who had not attained menarche. With increasing age, urban girls who had attained menarche showed an increase in the prevalence of anemia. The prevalence of iron deficiency (serum ferritin < 12 mcg /dl) showed a progressive increase from 28% to 60% over 12 years especially in the girls (P= 0.03). Findings suggested that distribution of iron and folate tablets to correct anemia to the vulnerable groups is essential36. Leenstra et al. (2008) conducted a cross sectional study by using multistage random sampling design with a total of 648 adolescent school girls aged 12-18 years were randomly selected. The prevalence of anemia (Hb <12gldl) was 21.1%. Only one girl had the haemoglobin less than 7gldl. The prevalence of anemia among adolescent girls were 19.8%, in which 30.4% of anemic was exclusively due to iron deficiency. Malaria and schistosomiasis were the main risk factor in other girls (14-18). Findings suggested that menstruating girls are at higher risk of developing anemia37. Sachdev et al., (2008) evaluated the effort of iron supplementation on the incidence of infections in children. Samples of 7892 children were selected for oral or parenteral iron supplementation or fortified formula milk or cereals. Incidence of all recorded infectious illnesses, such as respiratory tract infection, diarrhoea, malaria and other infection. The pooled estimate of the incidence rate ratio (iron v placebo) was 1.02; the incidence rate difference (iron minus placebo) for all recorded illnesses was 0.06 episodes per child per year. However, there was an increase in the risk of developing diarrhoea (incidence rate 1.11, 1.01 to1.23, P=0.04) but this would not have an overall importance on public health (incidence rate difference 0.05 episodes per child per year, 0.03 to 0.13; P=0.21). The occurrence of other illnesses and positive results on malaria smears were not significantly affected by iron administration. Findings revealed that iron supplementation has no apparent harmful effect on the overall incidence of infectious illnesses in children, though it slightly increased the risk of developing diarrhoea38. Parmar et al, (2011) conducted a study on prevalence of anemia at Chandigarh a sample of 1120 apparently healthy adolescent (12 to 18 years) was subjected to anthropometric examination and haemoglobin estimation. The estimation of haemoglobin was done by cyanmethaemoglobin method, for 183 students. The overall prevalence of anemia

calculated as pre WHO guidelines was significantly higher among girls (23.9%) as

compared to boys (p<0.01). Anemia was observed more in rural (25.4%) as compared to urban (14.2%) adolescents (p<0.01). Finding suggested that rural adolescent girls had higher prevalence of anemia. Dietary modification and consumption of meagre amounts of habitual food increase total iron consumption by 25 to 30%. Processes like germination (Sprouting of green grams) and consumption of green leafy vegetables would be an additional and a long term method for the prevention of Iron deficiency anemia (IAP)39. Manimaya et al., (2011) conducted a descriptive study to assess the prevalence of anemia among adolescent girls for which 630 school going adolescent girls were selected. The result showed that the prevalence of anemia in adolescent girls to be 80.6%. Dietary intake of the adolescent girls revealed that there was an inadequate intake of food. Almost 84.3% of adolescent girls were consuming less than forty percent of required dietary allowance and the finding showed that there was a high prevalence of anemia among the study population (p<0.001) due to inadequate intake of iron supplementation40. Muslimmanton et al., (2009) conducted a cross sectional study to identify the different nutritional and iron status characteristics of young adolescent girls (10-12 years) with iron deficiency anemia and anemia without iron deficiency in the rural coastal area of Indonesia. Anemic girls (N=133) were selected out of 1358 girls from 34 elementary schools. Haemoglobin, serum ferritin, serum transferrin receptor and zinc were measured for their nutritional status. Out of 133 anemic girls, 29 (21.8%) suffered from iron deficiency anemia, which is not significantly related to age and menarche. Further studies recommended to explore other factors associated with anemia and iron deficiency anemia, such as the thalassemia trait and vitamin A deficiency. girls41. Chandrakala, 2010 conducted a study to assess the nutritional status of rural adolescent girls, to measure their knowledge about maternal and nutritional needs, to measure their dietary intake, and to determine the socio-cultural aspects among 47 adolescent girls aged between 13-18 years who attended a workshop on health and development organized by the Center of Maternal and Child Health at Vellore, in India. The overall mean The current iron folate

supplementation programme for pregnant women should be expanded to adolescent

haemoglobin value was 10.0g/dl 73.5% of the subjects who had haemoglobin value below 12g/dl (WHO Standard) and hence classified as anemic. The mean haemoglobin level increased with increasing age with the lowest being 13years (9.8g/dl) and the highest at the age of 17 years (11.9gm /dl). The mean age of menarche was 14.3 years. The diet was predominantly rice. Consumption of vegetables, milk and meat were very low, which might have been the causes for prevalence of anemia among girls. The findings show that

rural adolescent girls have mild to moderate anemia. Thus, awareness must be created and nutritional supplements need to be provided42.

Chapter III METHODOLOGY

Research methods are the steps, procedures & strategies for gathering & analyzing the data in research investigations. The chapter includes: Research approach Research design Selection & description of setting Population Delimitations Sample & sampling technique Development & description of the tool Reliability Content validity Pilot study Plan of data analysis Summary

RESEARCH APPROACH:
Descriptive survey approach was used for this study.

Research design
A experimental research design was utilized to assess the knowledge regarding anemia among girls

RESEARCH SETTING:
The study will be conducted in a swift institute of nursing Patiala.

POPULATION:The population of present study compose of an

nursing college.

girls student of the

SAMPLING TECHNIQUE:
Purposive sampling technique.

SAMPLE & SAMPLE SIZE:

The sample size were 60 girls. INCLUSION CRITERIA: Age group between 17 to 23 years. Those who are willing to participate in this study. Girls who understand , read & write English .

EXCLUSION CRITERIA: Those who are sick at the time of data collection. Those who are not present at the time of data collection

DEVELOPMENT AND DESCRIPTION OF TOOL:

A questionnaire was developed after the review of literature to design the appropriate tool for collection of data . Review of literature from books , journals& internet , experts opinion and investigators own experience in the field area provided foundation for the construction of the tools . A proposed draft was prepared comprising of (08) questions related to demographic variables and (31) related to knowledge questions . The tools was given to 09 experts and deletion , addition , and modification were done according to experts opinion as follow : Number of item deleted = 2 in demographic variables and 10 in knowledge questionnaire Number of items added =4 in knowledge questionnaire Number of items modified= 02 After inclusion of experts opinion, tool consisted of item as follow : Part 1 : Demographic variables = 08 Part 2: Knowledge questionnaire = 31 Description of tools : To accomplish the objective of the study , a structured questionnaire was constructed to measure the knowledge respectively. The tool consisted of two parts : Part 1 : This part consisted (08) item related to demographic data of females related to their . Age of females , type of residence , type of family , dietery habit , monthly income , drug addiction and source of information. Part 2 : this part consisted of (31) structured multiple choice questions having one correct answer among the four option to assess the knowledge of females regarding anemia . The total score is = 31 For correct answer score is =1

For incorrect answer is= 0 Part 3 : Incidence of anemia through HB Estimation.

METHOD OF DATA COLLECTION:

The 31

structured

questionnaires wasused to assess the knowledge regarding the

prevention of anemia among girls in swift institute of nursing Patiala (Punjab) .The data was collected within two weeks.

Information booklet :
data collection.

information booklet was distribution and division after the

ETHICAL CLEARANCE:
Ethical clearance was obtained from the research committee of College of Nursing. The permission was obtained from Head of the Institution of swift institute of nursing and consent was obtained from the . girls during the data collection.

VALIDITY OF TOOL:
The content validity was established in consultation with experts from various nursing field.

PILOT STUDY: The pilot study was conducted in march to see the feasibility and
reliability of the study after obtaining the formal permission from the principal of swift institute of science and technology. Oral consent was obtained from the participants after explaining the purpose of the study. Females who met inclusion criteria were selected by using convenient sampling technique. The subject were asked to complete the

questionnaire followed by discussion to identify questions the respondent were likely to misinterpret . The time taken for the completion of questionnaire varied from 20-30 minutes . The purpose of the study was explained and the confidentiality of theirresponses was assured . Subject were satisfied with the questionnaire . It was found feasible and reliability to conduct main study. PLAN FOR ANALYSIS: The collected data will be planned and analyzed in the form of descriptive statistics and inferential statistics. The analyzed data will be presented in the form of tables and figures by using mean, percentage, standard deviation, X2 test . Does the study require any investigation or intervention to be collected on patients or other human or animals? If any please describe briefly.

SUMMARY:This chapter deal with the research approach, research design , research
setting, target population , sample , sample size, technique , development and description of tool, criterion measure , content validity , ethical consideration , pilot study , reliability of the tool, data collection procedure and plan of the data analysis.

Chapter-IV ANALYSIS & INTERPRETATION

The chapter deals with analysis and interpretation of the data collected from 60 girls regarding the knowledge of anemia. The data thus obtained was analysis and

interpretation in accordance with the objectives by using descriptive and inferential In descriptive statistics, mean, mean, mean percentage and degree of freedom, chi-square test was used for analyzing the distribution of knowledge and attitude of girls.

OBJECTIVES

1. To assess the knowledge related to anemia among girls. 2. To asses the level of hemoglobin among girls of selected college. 3. To find out the association of the knowledge related to anemia with the selected demographic variabls.

4. To develop information booklet related to anemia.

Section A: Distribution of demographic data of girls

Table -1 Frequency and percentage distribution of demographic data of girls.

Demographic data

1. Age of girls in year 17-18 year 19-20year 21-22year 23 above 3 25 25 7 5 42 42 11

2. Area of the permanent Residence Rural Urban Semi urban Semi rural 22 32 02 04 37 52 03 08

3. Type of residence Hostler Day scholar 13 47 13 78

4. Type of family Joint family Nuclear family Extended 15 45 00 27 73 00

5. Dietary habits Vegetarian Non vegetarian 51 09 85 15

6. Monthly income Rs <5000 Rs 5001-10000 Rs 10000-15000 Rs > 15000 26 03 15 16 44 05 25 26

7. Drug addiction None Smoking Alcohol Both alcohol & smoking Other drug (if any special) 60 00 00 00 00 100 00 00 00 00

8. source of information Print media Multi media Family member Health care worker 49 10 00 01 81 17 00 02

Table 1: reveal that (42%) of girls were 21-22 year and (42%) 19-20 year of age followed by (11%) 23 above ,(05%) 17-18 year respectively. Major no. girls (52%) were permanent residence urban area followed by (37%) rural area, (08%) semi rural ,(03%) semi urban area . Major no. of girls (78%) day scholar followed by (13%) hostler. Major (73%) no. of girls belonged to nuclear family followed by (27%)

joint family . Major (85%) no. of girls were vegetarian followed monthaly incone Rs >15000 and information from print media.by (15%) non vegetarian. Major (26%) no. girls belonged to monthly income Rs >15000 followed by (16%) girls from Rs 10000-15000 , (15%) girls from Rs 5001-10000 , and (03%) Rs <5000. Major (49%) no. of girls getting of information print media followed by (10%) multi media , (01%) health worker. Hence , it was concluded that major no.of girls were from age group 2122 year and 19-20 year,were permanent residenc urban area , day scholar .belong to nuclear family ,ditatry habits vegetarian ,

Section (b) Objective 1 :To assess the knowledge regarding anemia among girls. TABLE 2

Frequency and Percentage distribution of knowledge regarding anemia among girls

Knowledge score

Level of knowledge

score

Excellent Good Average Below average

<23 16-22 8-15 >7

12 36 1220 0

20 60

Table 1: illustrate that highest number 36(60%) of girls had good knowledge followed by 12(20% ) excellent knowledge and 12(20%) average knowledge score regarding anemia . Thus was deduced that girls had good knowledge regarding anemia.

40 35 30 25 20 36 15 10 5 0 excellent good frequency average 12 12 0 below average

Level of knowledge Fig 2.1: frequency distribution of subjects according to level of knowledge regarding prevention of anemia.

Table :3 Overall mean, sd and mean percentage of knowledge score of subjects regarding assess the knowledge among anemia.

Area

Maximum score

Knowledge score mean Standard deviation Mean persentage

Knowlegedge And incidence regarding anemia among girls 31 19.33 70.9 62.3

Table: 3 reveals that mean knowledge score obtained by subjects is 19.33 ,sd 70.9 which is 62.3 of total score . The shows that the subjects had average knowledge regarding prevention of anemia among girls.

Table :4
Association between knowledge regarding anemia among girls
Demograph ic variable Excelle-nt Good Average Age of year Area of Permanent residence Area residence Type family Dietary habit Monthly income Source Of information 08 44 08 4 8.98 9.48 10 40 10 6 9.9 12.59 Not significant Not significant 17 34 09 2 7.25 5.99 of 12 38 09 2 0.34 5.99 of 12 38 10 2 1.73 5.99 Not significant Not significant significant 14 37 09 6 7.82 12.59 12 37 10 6
value)

frequency

df

x2 (calculated

Table value

Level of significant

9.13

12.59

Not significant Not significant

Objective 3: To find out association between knowledge regarding anemia among girls and selected demographic variables i.e. age of girls area of present residence , type of family , monthly income , dietary habits , source of information regarding anemia .

Table -4 (a) Association between knowledge regarding anemia with age of girls(in year)

N=60 Knowledge level Age of Girls( In year) Excellent Good Average Total Df x2

f 17-18 19-20 21-22 Above 23 Total 0 3 8 1 12 14 05 38

f 01 18 2 4 3 1 10

f 03 25 25 07 60 = non significant 06 9.13

Table 3(a) delineate that highest (8) girls were with excellent knowledge about anemia in age group 21-22 year followed by (3) 19-20 year , (1) above 23 year respectively. Girls who had good knowledge belong to age group (18) 19-20 year, followed by (14) 21-22 year, (5) above 23 and(1) 17-18 year respectively. The average knowledge score was highest (4) 19-20 year followed by (3) 2122 year (2) 17-18 year and (1) above 23 year. The x2 value was found statistically non significant between age of girl (in year) and knowledge.

Age of girls
17-18 year 19-20 year 21-20 year 23 year above

12%

5%

41% 42%

Fig: 4.1 girls

percentage distribution of knowledge acorroding to age of of (in year)

Table 4(b) Association between knowledge regarding anemia with area of permanent residence N=60 Knowledge level Area of permanent Residence Excellent Good Average Total Df x2

f Rural Urban Semi urban Semi rural Total 8 6 0 0 14

f 09 22 02 04 37

f 5 4 0 0 9 22 32 02 04 60 06 7.82

= non significant Table 4(b) delineate that highest (8) girls were with excellent knowledge about anemia area of permanent residence in rural area followed by (6) in urban area.

Girls who had good knowledge belong about anemia (22) resides in urban are followed by (9) in rural are ,(4) semi rural and (2) in semi urban respectively. The average knowledge score was highest (5) in rural area and (4) urban area. The x2 value was found statistically non significant between area of permanent residence.

Area of permanent residence

Rural Urban Semi urban semi rural

5%

10%

5%

80%

Fig: 4.2 permanent

percentage distribution of knowledge according to area of

Table 4 (c) Association between knowledge regarding anemia with type of family

Knowledge level Type of family Excellent Good Average Total Df x2

f Joint Nuclear Total 05 07 12

f 07 32 39

f 3 6 9 15 45 60 02 3.4

non significant

Table 4(c) explicit that excellent knowledge was highest (7) among girls of nuclear family followed by (5) joint family Most of (32) girls have good knowledge were from nuclear family followed by (7) from joint family The average knowledge score was highest (45) in nuclear family followed by 15 joint family. The association between type of family and knowledge of girl was found non significant.

Type of family
joint family nuclear family 0% 25% extended

75%

Fig: 4.3percentage distribution of knowledge acorroding to type of family

Table 4 (d) Association between knowledge regarding anemia with type of residence

Knowledge level Type of Residence Excellent Good Average Total Df x2

f Hostler m Day scholar Total 01 11 12

f 09 29 38

f 3 7 10 13 47 60 02 1.73

non significant

Table 4(d) depicts that highest excellent knowledge is (11) in days scholar and (1) in hostler. And good knowledge (29) in days scholar. Average knowledge in highest (7) in days scholar and (3) in hostler. The x2 value was statistically non significant between type of residence.

Type of residence
hostler dayscholer

22%

78%

Fig: 4.4 residence

percentage distribution of knowledge acorroding to type of

Table 4(e) Association between knowledge regarding anemia with dietary habits

Knowledge level Diet habit Excellent Good Average Total Df x2

f Vegetarian 15

f 31 03 34 5 4 9

f 51 09 60 02 7.25

Non vegetarian 02 Total 17

non significant

Table 4(e) depict that excellent knowledge was highest(15) in vegetarian followed by(2) in non vegetarian. Good knowledge is highest (31) in vegetarian followed by (3) in non vegetarian. Average highest knowledge (5) in vegetarian followed by (4) in non vegetarian. The x2 value statistically significant between dietary habit and knowledge of girls.

Dietary habits
vegetarian non vegitarian

15%

85%

Fig:4.6 percentage distribution of knowledge acorroding to diet habits

Table -4(f)

Association between knowledge regarding anemia with monthly income

Knowledge level Monthly Income Excellent Good Average Total Df x2

f <5000 5000-10000 10000-15000 >15000 Total 1 3 2 4 10 2 9 8

f 0 3 6 1

f 3 15 16 26 60 6 9.9

21 40

10

non significant . Table 4(f) depicts that excellent knowledge was highest (4) among income group >15000 followed by (3) among income group 5000-10000, (2) income group 1000015000 And (1) among income group <5000. Good knowledge is highest (21) in income group >15000 followed by (9) income group 5000-10000 , (8) in income group 10000-15000 and (2) in income group <5000. Average knowledge is highest(6) in income group 10000-15000 followed by (3) in income group 5000-10000 , (1) in income group >15000. The x2 value statistically no significant between monthly income and knowledge of girls

monthly income
Rs<5000 Rs 5001-1000 Rs 10 000-15000 RS >15000

5% 43% 25%

27%

Fig: 4.7percentage distribution of knowledge according to monthly income

Table -4(g)

Association between knowledge regarding anemia with source of information

Knowledge level Source of Information Excellent Good Average Total Df x2

f Print media Multimedia Health care Worker Total 8 5 2 1

f 40 4 0 4 4 0

f 49 10 1

44

60

Not significant

Table 4(g) depict that excellent knowledge was highest(5) getting information regarding anemia from print media followed by (2) from multimedia and (1) from health care. Highest good knowledge (40) obtain information from print media followed by (4) obtain information from multimedia. Average knowledge obtain by girls is equal from print media and multimedia. The x2 value statistically no significant between source of information and knowledge of girls

source of information
print media multi media family member health care worker 0% 1% 17%

82%

Fig: 4.8

percentage distribution of knowledge according source of

information media

Table : 5 Incidence regarding anemia among girls

Objective 4: To anemia among girls.

determination

of frequency and percentage of

Hemoglobin level

Frequency

Percentage

Normal

04

7%

Anemic

32

53%

Moderate

23

38%

Severe

01

2%

Table 2 depict that out of 60 girls 32(53%) were anemic girls , 23(38%)has moderate level of hemoglobin 4(7%) girls have normal level of hemoglobin and 1(2%)girl has severe level of hemoglobin.

60 50 40 30 20 10 0 Normal Anemic Moderate Severe

Percantage

Fig :5.1Percentage distribution according to incidence of anemia among girls

CHAPTER 5
DISCUSSION, MAJOR FINDING, IMPLICATIONS

RECOMMENDATION
This chapter deal with a brief summary of the study undertaken , including discussion major finding , implication of the study and recommendation for future research.

Discussion :
A descriptive was used to collect data from 60 subject who studied in swift institute of nursing to assess their knowledge regarding anemia . The collected data was analyzed using descriptive and inferential statistics. In this section , the investigator interpretatively discuses the result of the study in the discussion ; the researcher ties together all the looses end of the study . The finding of the present study have been discussed in accordance with the objectives of the research and literature review.

LIST OF REFERENCE: REFERENCES Wongs , essential of pediatric nursing , 8th edition published by Mosby publishers , published in India 2009 , page no 915-917 WHO statistics for iron deficiency anemia 2005 from
www.pubmed.com

BT Basavanthappa , nursing research , published by JAYPEE BROTHERS , page no 49 www.WHO.com Dorothy , R.Morlow text book of pediatric , 6th edition

published by ELESEVIER PUBLISHER , published in new Delhi in 2007 page no 1133-1136 SundarLal, Text book of Community Medicine, published by CBS publisher, published in New Delhi 2007, Page No. 115130. Dorothy, R.Morlow Text book of Paediatrics, 6th edition, published by Elesevier publisher, published in New Delhi 2007, Page No. 1133-1136. K. Park, Text book of Preventive and Social Medicine, 18th Edition, published by Bhanot, published in Jabalpur 2007, Page No. 449-450. Wongs, Essentials of Paediatric Nursing, 8th Edition published by Mosby publisher, published in India 2009, Page No. 915-917. Dr. U.N.Panda, Hand book of Paediatrics, published by CBS publisher, published in New Delhi, 2007, Page No. 115-130.

IndianAcademy of Paediatrics, Text book of Paediatrics, 4th Edition, Volume 1, published by Jaypee brothers, published in New Delhi 2007, Page No. 101-103. Suraj Gupta, Text book of paediatrics, 11thedition, published by Jaypee brothers, published in New Delhi 2009, Page No. 212-214. Dr. M. Swaminathan, Advanced Text book on Food and Nutrition, Volume 1, published by Bappco Publisher, published in Bangalore2008, Page No. 392-394. World Health Organization (WHO) statistics for iron

deficiency anemia 2005, from www.pubmed.com. Dr. Huntleys Diagnosis checklist, Health statistics,

www.wrongdiagnosis.com Centers for disease control and Prevention, Anemia Statistics (Iron deficiency anemia) MMWR MORB MORTAL WKLYREP. 2002, Page No. 897-899. Jeteja G.S. Singh, Prevalence of Anemia among Adolescent Girls, Journal of Food and Nutrition bulletin 2006, December Page No. 311-315. Department of Family and Community Health, National Family Health Servey-3 (2005-2006), www.indiastat.com. BT, Basavanthappa, Nursing Research, published by Jaypee brothers, published in New Delhi 1998, Page No 49. SabithaBasu, Prevalence of Anemia among AdolescentSchool going Girls at Chandigarh in India, published in Journal

of Indian Paediatrics, Volume 42, June 17, 2005, Page No. 593-597. Sen A Deleterious Functional Impact of Anemia among Adolescent School Girls, published in the Journal of Indian Paediatrics, Volume 43, March 2006, Page No. 219226. Chaudhry SM, A study of Anemia among Adolescent Females in the urban area of Nagpur inIndia,published in the Journal of Community Medicine, Volume 33, October 2008, Page No. 243-245. Deshmuk P.R, Effectiveness of Weekly Supplementation of Iron to Control Anemia among Adolescent Girls, published in the Journal of Health Population and Nutrition, Volume 26, March 2008, Page No. 74-78. Tatala SR, Risk Factors for Anemia in School Children in Tanga region, Tanzania, published in the Tanzan Journal of Health Volume 10, October 2008, Page No. 189-202. A. Kramipour R, Prevalence of Iron Deficiency Anemia among Adolescent School Girls form Kermanshah, western Iran, published in the Journal of Haematology, Volume 13, December 2008, Page No. 352-355. Tussing-Humphreys LM, Excess Adiposity and Iron Deficiency Anemia in Female Adolescents,published in the Journal of American Dietary Association, Volume 109, February 2009, Page No. 297-302.

Other research

www.pubmed.com www.wrongdiagnosis.com www.indiastat.com www.WHO.com

Code no: _____ INSTRUCTIONS: The information is purely for research purpose. No information will be revealed or disclosed. Encircle in front of the right answer. SECTION A Demographic Profile

1. Age of girls in years:a) 17-18years b) 19-20years c) 21-22years d) 23 and above 2. Area of the permanent residence :a) Rural b) Urban c) Semi urban d) Semi rural 3. Type of residence:a) Hostler b) Day scholer 4. Type of the family :a) Joint family b) Nuclear family c) Extended family 5. Monthly income of family :a) Rs < 5000 b) Rs 5,001-10,000 c) Rs 10,001-15,000 d) Rs > 15,000 6. Dietary habits :a) Vegetarian b) Non-vegetarian 7. Drug addiction :a) None b) Smoking c) Alcohol d) Both alcohol and smoking e) Other drug (if any) specify 8. Sources of information regarding anemia :a) Print Media b) Multi media c) Family members d) Health care worker

SECTION B KNOWLEDGE QUESTIONNAIRE 1. Anemia is :a) Decreased Thrombocyte b) Increased Erythrocyte c) Decreased oxygen carrying capacity of blood d) Increased Leukocyte 2. Normal level of hemoglobin in females is :a) 8 - 10 mg/dl b) 10 12 mg/dl c) 12 14 mg/dl d) 12 16 mg/dl 3. The average life span of RBC s is :a) 120 days b) 140 days c) 160 days d) 180 days 4. Anemia may effect:a) Adolescent b) Older c) Children d) All of above 5. Hemoglobin level is measured with the instrument known as :a) Glucometer b) Thermometer c) Sphygmomanometer d) Hemoglobin meter 6. Sample required for Hb estimation is :a) Blood sample b) Urine sample c) Sputum sample d) Skin sample 7. The blood test done for anemia is :a) TLC b) DLC c) VDRL d) Hb Estimation 8. Risk factor for anemia is:a) Infection b) Continuous skipping of meal to lose weight c) Low iron diet d) All of above

9 .The main cause/causes of anemia among adolescent girls are/is :a) Excessive bleeding during menstruation b) Over eating c) Low diet d) All of above 10.Type/types of anemia is /are:a) Iron deficiency anemia b) Sickle cell anemia c) Pernicious anemia d) All of above 11.Most common type of anemia which occur in girls is :a) Iron deficiency anemia b) Sickle cell anemia c) Pernicious anemia d) Thalassemia 12.Sign and symptoms of anemia are :a) Headache, dizziness, weakness. b) Nausea, vomiting, diarrhoea c) Skin rashes and edema d) All of above 13.The color of the skin during anemia is :a) White b) Black c) Pale d) Pink 14.Shape of nails in severe anemia becomes :a) Spoon shaped nails b) Normal c) Round shaped d) Curved shaped 15.The color of sclera during anemia becomes :a) Red b) White c) Pink d) Pale 16.Diet to be added in anemic patient diet is :a) High cholesterol diet b) Green leafy vegetables c) Fast-food d) Vitamin D 17.The restricted food for anemic patient is/are:a) Greenleafy vegetables b) Fruits c) Fried and spicy food d) None of above 18.The source/sources of rich iron diet is/are :a) Beetroot and pomegranate b) Milk and cheese

c) Wheat and curd d) Milk and groundnuts 19.Anemia can be prevented by :a) Fatty and spicy food b) Iron rich diet c) Calcium rich diet d) Potassium rich diet 20.Vitamin is helpful in reducing the risk of anemia is :a) Vitamin A b) Vitamin B12 c) Vitamin C d) Vitamin d 21.The instruction/instructions to be followed during anemia is :a) Do not skip meal b) Nutritious diet c) Proper treatment and follow up d) All of above 22.In anemia following is avoided :a) Pulses b) Fruits c) Vegetables d) Alcohol and smoking 23. Combination of food to be avoided in anemia is :a) Spinach and cheese. b) Peas and potatoes c) Peas and mushroom d) None of above 24.Action to be taken in case of complication of anemia is :a) No action to be taken b) Take doctors advice c) Increased the dose of medicine d) All of above 25. Complication of anemia is :a) Hypovolemic and cardiogenic shock b) death c) weakness d) jaundice 26.Supplementary nutrition to be taken to prevent anemia are:a.Amoxicillin b. Calcium tablets c. Pantoprazole d. Iron and folic acid tablets 27. Supplementary iron therapy includes : a) Well balanced diet b) Tablets ferrous sulphate 200 mg with 1 mg folic acid c) Calcium d) All of above 28. Iron is best absorbed in the form of :a) In ferrous form b) In potassium form c) In folic acid form d) In calcium form

29.Folic acid is not absorbed with :a) Milk b) Lemon juice c) Water d) Orange juice 30.The best absorption of folic acid with :a) Sugarcane juice b) Milk c) Orange juice d) Water 31.The program is started by government of India to control the iron-deficiency anemia is:a) Mid-day meal program b) Iron supplementation program c) Vitamin A prophylaxis program d) Tuberculosis control program

Answer Key
S.NO 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. C C A D D A D D A D A A C A B D B C A B B D ANSWER

23. 24. 25. 26. 27. 28. 29. 30. 31. 32.

D A B A D B A A C B

APPENDIX-l EXPERT OPINION FOR CONTENT VALIDITY OF THE TOOL

From, GroupPost Basic Bsc(N)2nd year Guru Hargobind college of nursing, Raikot,Ludhiana,punjab

To,

Subject: expert opinion for content validity of tool Respected madam/sir, We, the member of group-B, student of Post Basic Bsc(N)2nd year, Guru Hargobind college of Nursing, Raikot ,Ludhiana,Punjab have undertaken a research study on the topic: A study to assess the incidence and knowledge related to anemia among gir ls of nursing college of ludhiana, Punjab with a view to develop information booklet Objective of the study are: 1) To assess the knowledge related to anemia among girls . 2) To assess the level of hemoglobin among girls of selected college.

3) To find out the association of the knowledge related to anemia with the selected demographic variables. 4) To develop information booklet related to anemia.

We request you to go through our tool and give your valuable suggestion regarding appropriateness of items in terms of content, language and accuracy. Kindly grant your expert opinion and suggestion for the same. Thanking You. Yours sincerely, GroupPost Basic B.Sc.(N)2ndyear

APPENDIX-Vl

LIST OF EXPERTS 1. Head of Administration Swift Group Of Colleges, Patiala 2. Principal, Swift Group Of Colleges, Patiala 3. Vice- Principal, Swift Group Of Colleges, Patiala 4. Associate Professor Community Health Nursing Swift Group Of Colleges, Patiala 5. Assisst. Professor Medical- surgical Nursing Swift Group Of Colleges, Patiala 6. Assisst. Professor Child Health Nursing

Swift Group Of Colleges, Patiala 7. Lecturer Community Health Nursing Swift Group Of Colleges, Patiala 8. Lecturer Midwifery & obstetrical Nursing Swift Group Of Colleges, Patiala 9. Lecturer Child Health nursing Swift Group Of Colleges, Patiala 10. Lecturer Child health Nursing Swift Group Of Colleges, Patiala 11. Lecturer Medical- Surgical Nursing Swift Group Of Colleges, Patiala 12. Lecturer Midwifery & obstetrical Nursing Swift Group Of Colleges, Patiala 13. Lecturer Medical Surgical Nursing Swift Group Of Colleges, Patiala 14. Lecturer Medical- Surgical Nursing Swift Group Of Colleges, Patiala

15.

Lecturer Mental Health Nursing Swift Group Of Colleges, Patiala

APPENDIX-V

LIST OF FORMULAE

Reliability

=xy-xy

{x2-(x)2/N}{ y2-(y)2/N}
Degree of freedom = ( C 1 ) =( r 1 )

Chi - square =

APPENDIX VII

TO WHOM IT MAY CONCERN

This is to certify that I have edited this thesis by for the partial fulfillment of requirement for the degree of Post bachelor of science in nursing of Baba Farid University of health Sciences Faridkot, Punjab. Topic:A study to assess the incidence and knowledge related to anemia among girls of nursing college of ludhiana, Punjab with a view to develop information booklet .

Date : .