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 Table of Contents  
ORIGINAL ARTICLE
Year : 2020  |  Volume : 15  |  Issue : 2  |  Page : 209-214

Sociodemographic determinants in prevalence of anemia in adolescents of rural area of Maharashtra


Department of Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Sawangi (Meghe), Wardha, Maharashtra, India

Date of Submission10-Jan-2020
Date of Decision18-Jan-2020
Date of Acceptance22-Jan-2020
Date of Web Publication21-Dec-2020

Correspondence Address:
Dr. Ashish Varma
Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Sawangi (M), Wardha - 442 004, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdmimsu.jdmimsu_179_20

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  Abstract 


Introduction: Anemia is one of the most important health problems throughout the world. The prevalence of anemia among adolescents is 27% in developing countries, and 6% in developed countries. Aim: This study aims to assess the prevalence of anemia among adolescents of the age group of 10–15 years in rural population. Objectives: The objective is to study the prevalence of anemia in adolescents in the age group of 10–15 years. To correlate anemia with the socioeconomic status (SES) of adolescents. Materials and Methods: The study was a cross-sectional study of the Department of Pediatrics, AVBRH, Sawangi (Meghe), Wardha, which is tertiary care rural hospital catering western zone of Maharashtra. A total number of 1010 adolescents from the age group of 10–15 years of both sexes were included in the study. Results: In our study, we found that 61.19% of the total individuals were found to be anemic. The prevalence of anemia was 53.79% in boys and 71.7% in girls. Anemia was very common in adolescents from lower classes of SES. Conclusion: Adolescent nutrition should be viewed more seriously with adequate improvement in the standards of living, supplementary programs and timely health education.

Keywords: Adolescent, anemia, hemoglobin


How to cite this article:
Varma A, Vagha J, Agrawal A, Meshram R, Damke S, Thakur S. Sociodemographic determinants in prevalence of anemia in adolescents of rural area of Maharashtra. J Datta Meghe Inst Med Sci Univ 2020;15:209-14

How to cite this URL:
Varma A, Vagha J, Agrawal A, Meshram R, Damke S, Thakur S. Sociodemographic determinants in prevalence of anemia in adolescents of rural area of Maharashtra. J Datta Meghe Inst Med Sci Univ [serial online] 2020 [cited 2021 Jan 26];15:209-14. Available from: http://www.journaldmims.com/text.asp?2020/15/2/209/304247




  Introduction Top


Nutrition plays important role for proper growth and maturation of functions. It is optimal intake helps us for better immunity and productivity. Since the ages, we have been working to improve the nutritional status of mankind by studying various aspects of diseases with respect to food and its proper utilization.

Adolescent is the junction of life when we should stand with them between losing out on the potential or nurturing them to transform society and build nation. As adolescents flourish, so do their communities, and all of us have a collective responsibility to ensure that adolescence is an age of opportunity.

Anemia is one of the most important health problems throughout the world.[1] The prevalence of anemia among adolescents is 27% in developing countries, and 6% in developed countries.[2]

In India, 40% of girls and 18% of boys are anemic. Anemia among adolescents adversely affects growth, resistance to infections, cognitive development, and work productivity.[3]

Adolescents, especially girls, are particularly vulnerable to iron deficiency due to onset of menses and growth spurt. The prevalence is highest between the ages of 12–15 years when requirements are at a peak.[4] Nutritional status during adolescence plays an important role in the human life cycle.[5] The diet of children and adolescent must fulfill demand of optimal and sometimes very rapid growth and development.[6] Twenty percent of the final adult height and 50% of adult weight occurs during this period: bone mass increase by 45%, dramatic bone remodeling and soft tissues, organs, red blood mass increase in size.[7]

Many of the studies have been done on adolescent age group especially vulnerable and more affected girl population of this age group. Through this study, we want to measure the magnitude of this issue in our area which can help us as clinicians to augment our efforts toward achieving desirable outcome.

Aim

1. To assess the prevalence of anemia among adolescents of the age group of 10–15 years in rural population.

Objectives

  1. To study the prevalence of anemia in adolescents in the age group of 10–15 years
  2. To correlate anemia with the socioeconomic status (SES) of adolescents.



  Materials and Methods Top


The study was a cross-sectional study that was conducted in the Department of Pediatrics, AVBRH, Sawangi (Meghe), Wardha. It is tertiary care rural hospital catering western zone of Maharashtra.

A total number of 1010 adolescents from the age group of 10–15 years of both sexes were included in the study.

The necessary approval was taken from institutional ethical committee.

Inclusion criteria

All patients of 10–15 years of age group admitted in pediatric wards including both males and females were included in the study.

Exclusion criteria

  • Outpatient department patients
  • Adolescents with congenital defects or diseases
  • Those adolescents who had chronic diseases.


All the relevant information was gathered in the predesigned pro formas. SES was determined using Modified Kuppuswami Scale.[8] Diagnosis of anemia was established when hemoglobin was <12 g/dl.[9]

All the data were analyzed using SPSS software (Chicago, Illinois, USA) and Chi-square test was used for calculating significance. The level of statistical significance was fixed at P < 0.05.

Ethical Approval

Ethical approval for this study (DMIMS(DU)/IEC/2019-20/7992) was provided by the Ethical Committee of Datta Meghe Institute of Medical Sciences (Deemed to be University) on 24/05/19.


  Results Top


Overall incidence of anemia was 61.19% (618) in our study [Figure 1].
Figure 1: Adolescent population with anemia

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In 10 years' age group, out of 213 adolescents 130 (61.03%) were anemic and 83 were normal.

In 11 years' age group, out of 168 adolescents 108 (64.29%) were anemic and 60 were normal.

In 12 years' age group, out of 200 adolescents 126 (63%) were anemic and 74 were normal.

In 13 years' age group, out of 209 adolescents 126 (60.29%) were anemic and 83 were normal.

In 14 years' age group, out of 177 adolescents 104 (58.76%) were anemic and 73 were normal.

In 15 years' age group, out of 43 adolescents 24 (55.81%) were anemic and 19 were normal.

In this study, out of 593 male adolescents 319 (53.79%) were anemic and 274 (46.2%) were normal [Figure 2].
Figure 2: Adolescent boys with anemia

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In 10 years age group, out of 123 male adolescents 69 (56.1%) were anemic and 54 (43.09%) were normal.

In 11 years of age group, out of 99 male adolescents 59 (59.6%) were anemic and 40 (40.40%) were normal.

In 12 years of age group, out of 122 male adolescents 69 (56.56%) were anemic and 53 (43.44%) were normal.

In 13 years of age group, out of 123 male adolescents 63 (51.22%) were anemic and 60 (48.78%) were normal.

In 14 years of age group, out of 99 male adolescents 48 (48.48%) were anemic and 51 (51.52%) were normal.

In 15 years of age group, out of 27 male adolescents 11 (40.74%) were malnourished and 16 (59.26%) were normal.

In this study, out of 417 females, adolescents 299 (71.7%) were anemic and 118 (28.3%) were normal [Figure 3].
Figure 3: Adolescent girls with anemia

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In 10 years of age group, out of 90 females, adolescents 61 (67.78%) were anemic and 29 (32.22%) were normal.

In 11 years of age group, out of 69 females, adolescents 49 (71.01%) were anemic and 20 (28.99%) were normal.

In 12 years of age group, out of 78 females, adolescents 57 (73.08%) were anemic and 21 (26.92%) were normal.

In 13 years of age group, out of 86 females, adolescent 63 (73.26%) were anemic and 23 (26.74%) were normal.

In 14 years of age group, out of 78 female, adolescents 56 (71.79%) were anemic and 22 (28.21%) were normal.

In 15 years age group, out of 16 females, adolescents 13 (81.25%) were anemic and 3 (18.75%) were normal.

A high prevalence of anemia is seen in all SES classes with an increasing trend with decreasing SES, i.e., the prevalence of anemia decreases with improving SES [Figure 4].
Figure 4: Distribution of adolescents with respect to socioeconomic status

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In this study, we found that out of 1010 adolescents 618 adolescents were anemic [Table 4]. Out of these 618 anemic adolescents 19 (45.23%) subjects belonged to Class-1, 75 (51%) subjects belonged to Class-2, 207 (58.97%) subjects belonged to Class-3, 190 (65.51%) subjects belonged to Class-4, and rest 127 (70.55%) belonged to Class-5.

In adolescents belonging to Class-1, 4 subjects belonged to 10 years' age group, 4 subjects belonged to 11 years' age group, 5 subjects belonged to 12 years' age group, 4 subjects belonged to 13 years' age group, 1 subject belonged to 14 years' age group, and 1 subject belonged to 15 years, age group.

In adolescents belonging to Class-2, 17 subjects belonged to 10 years of age group, 13 subjects belonged to 11 years of age group, 19 subjects belonged to 12 years' age group, 16 subjects belonged to 13 years' age group, 7 subjects belonged to 14 years' age group, and 3 subjects belonged to 15 years' age group.

In adolescents belonging to Class-3, 40 subjects belonged to 10 years' age group, 37 subjects belonged to 11 years' age group, 44 subjects belonged to 12 years' age group, 37 subjects belonged to 13 years' age group, 41 subjects belonged to 14 years' age group, and 8 subjects belonged to 15 years' age group.

In adolescents belonging to Class-4, 38 subjects belonged to 10 years' age group, 26 subjects belonged to 11 years' age group, 36 subjects belonged to 12 years' age group, 39 subjects belonged to 13 years' age group, 44 subjects belonged to 14 years' age group, and 7 subjects belonged to 15 years' age group.

In adolescents belonging to Class-5, 31 subjects belonged to 10 years' age group, 28 subjects belonged to 11 years' age group, 22 subjects belonged to 12 years' age group, 30 subjects belonged to 13 years' age group, 11 subjects belonged to 14 years' age group, and 5 subjects belonged to 15 years' age group.


  Discussion Top


In our study, we found that 61.19% [Table 1] of the total subjects were found to be anemic. The WHO defines anemia as Hb <12 g%. The prevalence of anemia was 53.79% [Table 2] in boys and 71.7% [Table 3] in girls. Girls had higher prevalence of anemia than boys.
Table 1: Age wise distribution of anemia in boys and girls of 10-15 years

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Table 2: Prevalence of anemia in boys

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Table 3: Prevalence of anemia in girls

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Table 4: Prevalence of anemia in the subjects of different socioeconomic class

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In a study in Wardha by Kaur et al.[10] the prevalence of anemia in adolescent girls was found to be 59.8%. Another study by Patil et al. from Maharashtra has prevalence of 85.4% in girls of adolescent age group.[11]

Another study from Gujrat by Aishwarya et al. concluded to have 37% of adolescent boys to have anemia.[12]

In study by Shivaramakrishna et al.[13] of nutritional status of adolescent girls of Kolar district the prevalence of anemia was found to be 34.8%. In another study of nutritional status of adolescent girls in rural area of Varanasi by Choudhary et al.[14] The prevalence of anemia was found to be 30.74%, whereas Swapna Chaturvedi et al.[15] in study of nutrient intake among adolescent girls belonging to poor socioeconomic group of rural area of Rajasthan found that 73.7% of girls suffered from anemia.

Studies conducted in different regions of India shown that the prevalence of anemia in girls was 52.5% in Madhya Pradesh,[16] 41.1% in Karnataka,[17] 21.4% in Shimla,[18] 55.6% and 57.9% in urban and rural Uttar Pradesh,[19] 50% in Bihar,[20] and 53.3% in Kerala.[21]

The prevalence of anemia in 10-16 years of age children was 51%, in that 64% of the samples in girls and 48% in boys in Tamil Nadu.[22]

The total prevalence of anemia among boys and girls was 30.7% and 45.7%, respectively, in Udupi, Karnataka.[23]

With international references, Murti found an overall prevalence of anemia in 14.0% (29 subjects), and 62.9% were males and 37.1% were females in age group median of 11 years in Indonesia. This is in contrast to more affected girls in our study.[24] The overall prevalence of anemia was 15.2% (n = 62). The prevalence was higher in female (19.3%) than male (9.4%) adolescents in southwest Ethiopia.[25] The prevalence of anemia in our study was much similar to studies conducted in Nepal by Baral and Onta (65%), and in Cote d'Ivoire by Atto et al. (53.1%).[26],[27]

If we study the age prevalence in boys and girls anemia was a common finding in boys in their early adolescence. If we take out the percentage of anemia in age group of 10, 11, 12 years, it was 57.27% (197/344) in age group of 13, 14, 15 years, it was 49% (122/249). The high incidence of Anemia in early adolescent year could be attributed to less attention toward eating and more towards the play, more energy expenditure, whereas the late adolescence the energy expenditure is less as they study in higher classes engaged in tuitions and become more conscious about eating habits. A study on nutritional status of adolescent school children in rural North India by Anand et al.[28] showed the prevalence of anemia was 27.8% in young boys (12 years–14 years) compared to 41.3% in older boys (15 years–18 years). Anemia was present in 51% of young girls compared to 38.5% in older girls.

The study showed the overall prevalence of Anemia in girls of 71.7% If the girls from age group of 10–15 years were divided in the groups – 10, 11, 12 years in one group and 13, 14, 15 years in the other, the prevalence of anemia in the first group was 167/237, i.e., 70.46% versus 132/180, i.e., 73.33. Although this was not statistically significant the prevalence was high in later adolescence, highest being in the age group of 15 years (81.25%). This could be attributed to dietary deficiency of iron, scarcity of food and periodic blood loss.

In study by Chandrakumari AS et al. increased prevalence of anemia was noted among girls age 14 years followed by 16 years of age. Increased prevalence of anemia was seen during the late adolescent age.[29] We also had observed prevalence of anemia according to SES class. Anemia was in 19/42 (45.23%), 75/147 (51%), 207/351 (58.97%), 190/290 (65.52%), and 127/180 (70.55%) in socioeconomic Class 1, 2, 3, 4, 5, respectively which clearly implies that, anemia is most common in lower class, the causes for which could be the same as depicted above. The prevalence of Anemia in adolescents together of Class 3, 4, 5 was very high (63.82%).

Adolescent girls belonging to lower socioeconomic groups (50.49% in Class IV and 70.59% in class V) showed high prevalence of anemia than the girls belonging to higher socioeconomic groups (34.48% in Class III), and this was statistically significant in study by Chandrakumari AS, et al. in Tamil Nadu.[29]

Basu et al., from study in Chandigarh showed 34.2% prevalence in lower and middle SES as compared to 23.9% in higher group.[30] These findings were concordant with other similar studies conducted to study anemia among girls belonging to Nagpur and Delhi, showing high prevalence rate among lower socioeconomic groups.[31],[32] A study by Kim et al., in Korea found that higher SES seems to have a protective effect on anemia.[33]


  Conclusions and Recommendations Top


Overall prevalence of anemia was very high (61.19%) and it was more common in girls (71.70%) compared to boys (53.79%). Anemia was very common in adolescents from lower classes of SES.

Adolescent nutrition should be viewed more seriously with adequate improvement in the standards of living and timely health education. Anemia is preventable disease with simple diagnostic test and can be avoided by modification and education of diet. Thus, imparting knowledge about disease and its prevention should be made a thrust area in fight against anemia in adolescent. The fortification of diet along with supplementation of iron and folic acid for adolescent should be included in specific program in India.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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