Assessment Of Effectiveness of Structured Educational Intervention on Knowledge and Attitude Regarding Anaemia in Female Adolescents

Mahenoor Fatima , Kanyakumari , Revan Siddappa C. Diggikar, Kalmesh jadhav , Shantveer Halcher ,

doi:10.5281/zenodo.17721179

Review Paper | Open Access
Volume 03 | Issue 11 | Article Id IJPS/250311501

Assessment Of Effectiveness of Structured Educational Intervention on Knowledge and Attitude Regarding Anaemia in Female Adolescents
Mahenoor Fatima * Kanyakumari Revan Siddappa C. Diggikar Kalmesh jadhav Shantveer Halcher
Rajiv Memorial Education Society’s College of Pharmacy, Kalaburagi - 585102, Karnataka.

Abstract

BACKGROUND: Anemia is one of the most widespread nutritional deficiency diseases. Adolescent girls are more vulnerable to anemia impacted by increased iron requirements related to their rapid growth, and menstrual blood loss etc. Knowledge about anemia, attitude, and practices are important to decrease the burden of anemia.AIM: To assess the knowledge and attitude of female adolescents towards anemia in Kalaburagi. OBJECTIVES: To know the knowledge regarding anemia among Female adolescents, to study the behavioural pattern of female adolescents towards anemia ,to improve the knowledge of female adolescents regarding anemia. MATERIAL AND METHODS:A educational interventional study was conducted among selected college students of adolescent age group using structured questionnaire and information leaflet ,pre-test was taken and after a gap of 15 days post-test was conducted, statistical data was analysed using SPSS 25.0 version software. RESULTS: Study observed that out of 1010 participants majority of 46.3%were in the age of 17 years, followed by 37.7% of participants were in the age of 16 years and 16.0% of participants were in the age of 18 years. The mean age of participants was 16.78 years.. The mean knowledge score in pre-test was 2.60 (32.5%).. The mean knowledge score in post-test was 5.97 (74.6%). Study reveals that there was statistically highly significant mean difference of knowledge score on knowledge of anemia between pre and post- test (P<0>0.05).

Keywords

Anemia ,adolescents, awareness, Knowledge, attitude, Questionnaire, information leaflet, Educational interventional study

Introduction

Anemia among adolescents is a global public health burden.¹Adolescent girls are considered to be more at risk of anemia as they have high nutritional demands to account for their growth acceleration, sexual maturation, and future pregnancy.²Increase in growing body tissue and red cell mass causes a double iron requirement. Even when the growth spurt has passed, the risk of anemia is still high due to menstruation.³Anemia-stunting coexistence is prevalent in many low- and middle-income countries (LMICs).^4,5 Shared factors, including poverty, limited education and access to knowledge, inadequate dietary and nutrient intake and infectious diseases, are suggested to contribute to anemia and stunting co-occurrence.^6.7Anemia is currently one of the most common and intractable nutritional problems globally that affects both developing and developed countries with major consequences on human health as well as social and economic development.The World Health Organization estimates the number of anemic people worldwide to be a staggering 2 billion, with approximately50% of all anemia attributable to iron deficiency.⁸The World Health Organization (WHO) defines adolescents as the population of 10 to 19 years of age.⁹Adolescents learn and adopt new knowledge and practices more easily and generally these are long lasting with impact on next generation. Anemia is one of the most prevalent conditions in the world and iron deficiency is the most common cause for it among all the others. According to WHO anemia is defined as if hemoglobin less than 11 g/dl for children below six years and less than 12 g/dl for children more than six years of age.¹⁰Adolescent period is the developmental period between the childhood and the adulthood, a time of rapid biological, cognitive and psycho-social maturation occurs.^11,12This period is characterized by rapid physical, psychological and cognitive development. This is a vulnerable period in the human life cycle for the development of nutritional anaemia. Adolescents make nearly one tenth of Indian population and form a crucial segment of the society.¹³Their current nutritional status will decide the well-being of the present as well as the future generations. As adolescent age is the formative years for development, anaemia at this stage of life has some long term consequences, such as stunted growth, poor school performance, reduced immunity, menstrual irregularities, later on poor pregnancy outcomes such as intrauterine growth restriction, low birth weight, increased perinatal morbidity and mortality.¹⁴The word Adolescence is derived from a Latin word “adolescent” which means “to grow”. The world is home to 1.2 billion individuals aged 10–19 years¹⁵and India has the largest national population of adolescents (243 million), followed by China (207 million), the United States (44 million), Indonesia, and Pakistan (both 41 million each).¹⁶World health organization also defines Adolescent as a transitional period phase of growth and development between childhood and adulthood.¹⁷ Adolescence is a crucial period in life of every individual, during which there is a transition from childhood to adulthood. This period is characterized by rapid physical, biological, and hormonal changes resulting in psycho-social, behavioral changes and sexual maturity in an individual. It is the second growth spurt of life, and both boys and girls undergo different experiences in this phase.^18,19Anemia is a condition characterized by reduction in the number of red blood cells and/or hemoglobin (Hb) concentration.²⁰ Anemia is a global public health problem affecting both developing and developed countries and has major consequences for human health as well as social and economic development. It affects 24.8% of the world population.²¹ The burden of anemia varies with a person’s age, sex, altitude, and pregnancy.²⁰The worldwide prevalence of anemia among adolescents is 15% (27% in developing countries and 6% in developed countries).²² Anemia in India primarily occurs due to iron deficiency and is the most widespread nutritional deficiency disorder in the country today. According to National Family Health Survey (NFHS)–III data, over 55% of both adolescent boys and girls are anemic. Adolescent girls in particular are more vulnerable to anemia due to rapid growth of the body and loss of blood during menstruation. According to NFHS-III, almost 56% of adolescent girls aged 15–19 years suffer from some form of anemia. More than 39% adolescent girls (15–19 years) are mildly anemic, while 15% and 2% suffer from moderate and severe anemia, respectively.²³In Karnataka, according to NFHS-III, the prevalence of anemia among adolescent girls,15–19 years, is 51.3% including 33.5% with mild anemia,16.5% moderate anemia, and 1.3% with severe anemia.²⁴Anemia is defined as a reduction in the red blood cell volume or hemoglobin concentration below the normal range of values occurring in the healthy population with respect to age and sex.²⁵ It is alternately defined as a reduced absolute number of circulating RBCs or a condition in which the number of RBCs (and subsequently their oxygen-carrying capacity) is insufficient to meet physiologic needs.²⁶ It is a medical condition in which the hemoglobin (Hb) concentration and red blood cells (RBCs) count are lower than the normal range.²⁷Anemia is not a disease but a condition in which the hemoglobin content of blood is lower than normal as a result of deficiency of one or more essential nutrients particularly iron, which is essential for the formation of haemoglobin. Anemia in any condition is characterized by an abnormal decrease in total blood red blood cell mass resulting, reduction in concentration of hemoglobin of blood on red blood cells mass. The lower haemoglobin level and insufficient number of red blood cells due to lack of iron reduces the oxygen carrying capacity to various tissue, impairs brain development, physical work capacity and regulation of body temperature.²⁸ It is defined as hemoglobin below two standard deviations of the mean for the age and gender of the patient. Iron is an essential component of the hemoglobin molecule.²⁹Anemia is a condition in which the number of red blood cells and consequently their oxygen-carrying capacity is insufficient to meet all the body’s physiologic needs which are vary with a person’s age, gender, altitude, smoking and different stages of pregnancy.³⁰WHO has classified anemia into three categories: mild (11.0 - 11.9 g/dl), moderate (8.0 - 10.9 g/dl) and severe (< 8 g/dl) anemia. UNICEF classified anemia to be mild in children, adolescent girls and pregnant women if the Hb level in blood is between 8.0 and 10.99 g/dl among children, 10.0 to 11.99 g/dl among adolescent girls and 8.0 - 10.99 g/dl Hb level among pregnant women. For severely anemic the Hb level should be below 5.0 g/dl among children, 8.0 g/dl among adolescent girls and 5.0 g/dl among pregnant women. Accordingly moderate anemia is denoted when the Hb level is between mild and severe anemia.²⁸

Classification of anaemia

Anemia can be classified from three points of view: pathogenesis, red cell morphology, and clinical presentation. All are important to guide the diagnosis. Pathogenic mechanisms involved in the production of anemia are very simple: inadequate production and loss of erythrocytes a result of bleeding or hemolysis. Based on these pathogenic mechanisms, anemia can be divided into two types. (1) Hypo-regenerative: when bone marrow production is decrease as a result of impaired function, decreased number of precursor cells, reduced bone marrow infiltration, or lack of nutrients; (2) Regenerative: when bone marrow responds appropriately to a low erythrocyte mass by increasing production of erythrocytes. In practice, classification based on basic parameters of red cell morphology such as mean corpuscular volume (MCV), allows for a quicker diagnostic approach. Anemia also can be classified according to the form of clinical presentation as acute (usually bleeding or hemolysis) or chronic. Anemia can be classified as microcytic, normocytic or macrocytic, depending on MCV. As stated above, it can be hypo-regenerative or regenerative, which depends on the number of reticulocytes. Using both, the list of possible diagnoses in the individual patient is reduced.³¹

Causes of anaemia:-The main causes of anemia are a decrease in RBCs, insufficient Hb synthesis or increased RBCs destruction, and the primary cause is an iron deficiency.²⁷ Iron deficiency anaemia is a major nutritional problem in India and other countries. The incidence of anaemia is the highest among women especially adolescent girls varying between 60% to 70%.³² The common causes of iron deficiency are incorrect dietary habits, infections, infestations and menstrual blood loss among girls. Anemia among school children can be prevented by deworming, iron supplementation, and proper diet.³³ Iron deficiency is thought to be the most common cause of anemia globally, but some other nutritional deficiencies (including folate, vitamin B12 and vitamin A), acute and chronic inflammation, parasitic infections, and inherited or acquired disorders can cause anemia.³⁰ Adolescent girls are at risk of iron deficiency and anaemia due to various factors including high requirements for iron, poor dietary intake of iron, high rates of infection and worm infestation, as well as pregnancy.³⁴ It may result from insufficient iron intake, decreased absorption, or blood loss. Iron-deficient anemia is most often from blood loss, especially in older patients. It may also be seen with low dietary intake, increased systemic requirements for iron such as in pregnancy, and decreased iron absorption such as in celiac disease.²⁹ Menstrual abnormalities and inadequate diet are two major cause of anemia among adolescent girls. It can result in development and cognitive function impairment, loss of productivity, and increase the susceptibility to infection, that would widely affect the economic burden.³⁵ Nutritional anemia's result when concentrations of hematopoietic nutrients those involved in RBC production or maintenance are insufficient to meet those demands. Causes of nutrient deficiency include inadequate dietary intake, increased nutrient losses (e.g., blood loss from parasites, hemorrhage associated with childbirth, or heavy menstrual losses), impaired absorption (e.g., lack of intrinsic factor to aid vitamin B12 absorption, high intake of phytate, or Helicobacter pylori infection that impair iron absorption), or altered nutrient metabolism (e.g., Vitamin A or riboflavin deficiency affecting mobilization of iron stores) [10]. A major cause of anaemia is contamination of drinking water with fluoride. It leaches out minerals in the earth’s crust and contaminates underground aquifers.³⁶

Factors associated with anaemia:-Factors such as nutrition deficiency with iron, infections like hookworm, schistosomiasis and malaria and hemoglobinopathy due to sickle cell disorder and thalessemia accelerates anemia. However anemia due to iron deficiency continues to remain the commonest cause of anemia. It is due to iron deficiency expedites adverse outcomes such as maternal and infant mortality, Intra Uterine Growth Restriction (IUGR) and heart failure.³⁷ In addition, the negative consequences of IDA on cognitive performance leading to a deficit of five to ten points in intelligence quotient (IQ). It also affects physical development, language skills, motor skills and coordination among infant and young children and physical development of children. It also impact the immune system and increases the chances of infections and inflammatory disease, leading to fatigue, weakness, lethargy, shortness of breath, Pain, discomfort, anxiety, depression and decreased concentration. All these contribute to reduced work capacity and overall performance in adults, bringing serious economic consequences and obstacles to national development.²⁸

Signs and Symptoms of anaemia^:-Symptoms and signs of chronic anemia are mostly due to decreased tissue oxygenation from the reduction of the oxygen-carrying capacity of the blood. Symptoms are worse when anemia is severe, with a rapid decrease in hemoglobin and hematocrit and with increased oxygen demands states like exercise. Common presenting symptoms includes Weakness, fatigue, dizziness, syncope, Exertional dyspnea (exercise intolerance) chest pain and palpitations anorexia cognitive impairment.³⁸ Psychological problems like depression, confusion, difficulty with memory or even dementia and Nervous problems like numbness, pins and needles, vision changes and unsteadiness. can develop. Prolonged or severe vitamin B12 deficiency may therefore cause permanent brain or nerve damage.³⁹

Diagnosis and Management of anaemia

Chronic anemia is managed predominantly in outpatient settings. They need hospitalization if

1.Patient is symptomatic

2.A significant drop in hemoglobin/HCT

3.Transfusion needed

4.Extensive investigations needed

5.If hemoglobin is less than 7 g/dl or if a patent is symptomatic, transfusion of packed red blood cells (PRBC) is indicated.

6.Transfusions should be done with caution in patients with volume overload status like end-stage renal disease (on hemodialysis) and Congestive Heart Failure (CHF). Other treatments include treating underlying conditions as below.

7.Iron deficiency anemia: Intravenous (IV) iron versus oral iron

8.Vitamin B12 and folic acid deficiency with B12 and folic acid supplementation

9.Treating underlying bone marrow disorders

10.EPO injections in chronic kidney disease patients

11.Synthroid in patients with hypothyroidism

12.Avoiding any culprit medications

13.Treatment of GI causes of blood loss (PPI for gastritis and PUD)

14.Regulation of menstrual cycles in patients with menorrhagia.³⁸

Increasing dietary iron consumption alone is insufficient to treat IDA and higher supplemental doses of iron are essential. However, increasing the iron intake and enhancing the absorption by minimizing the inhibitors and maximizing the enhancers may be valuable for secondary prevention of iron deficiency. Parenteral treatment may be used in patients who cannot absorb or tolerate oral iron, such as those who have undergone gastrectomy, bariatric surgery, gastrojejunostomy, or other small bowel surgeries.⁴⁰ Drinking orange juice when you take iron tablets can help with the absorption of iron,’ Ms Benton said. ‘Caffeinated drinks, drinks, such as (caffeinated fizzy drinks), tea or coffee can actually inhibit the absorption of iron, and therefore stops the medication working effectively.⁴¹The treatment of iron-deficient anemia includes treating the underlying cause, such as gastrointestinal bleeding, and oral iron supplementation. Iron supplementation should be taken without food to increase absorption. Low gastric pH facilitates iron absorption. A rapid response to treatment is often seen in 14 days. It is manifested by the rise in hemoglobin level. Iron supplementation is needed for at least three months to replenish tissue iron stores and should proceed for at least a month even after hemoglobin has returned to normal levels.²⁹ Treating anemia is a matter of how much food we eat that aid in hemoglobin synthesis. In general, to treat anemia, focus should be placed on foods that are good sources of iron, copper, zinc, folic acid, Vitamin B-12 and protein. The combination of iron and B-vitamins is especially good for treating anemia.³⁹The intervention strategies mainly involved provision of micro-nutrient supplementation such as calcium and zinc, in addition to the routine iron folic acid supplementation to adolescent mothers or engaging them in nutritional education sessions to enable them to improve nutritional intake.⁴² Especially for girls and women it is essential to educate this population because, today girls are future mothers. To strengthen any nation there is need of healthy mothers. Only healthy mothers can produce healthy citizens.⁴³ The beneficial interactions of deworming and vitamin A supplementation could have widespread implications for current preventive public health interventions.⁴⁴Shows in her study that the factors such as age, literacy status of mother, type of family, community, weight, diet, frequency of intake of green leafy vegetables and fruits, menstrual discharge, and deworming are the factors contributing to the prevalence of anemia.⁴⁵Studied that nutritional education includes gaining of knowledge and behaviour changes regarding food consumption and nutrition-related practices. He also explains that study conducted in India reported that nutrition education intervention was essential for female adolescents to create awareness of and to disseminate knowledge related to the control and prevention of anaemia.⁴⁶The associated factors of anemia among adolescent girls differ from study to study, like low dietary diversity score, living status of adolescents with either of the two parents, duration of menstruation, history of parasitic infestation, low socioeconomic status, household family size, inadequacy of dietary iron intake, drinking tea immediately after a meal, high consumption of whole wheat bread, and low consumption of vitamin C rich foods and molasses, parent’s level of education, parasite infections, low BMI, being stunted, and underweight.^47,48,49,50

Aim: To assess the knowledge and attitude of female adolescents towards anemia in Kalaburagi.

Objectives:

• 1. To know the knowledge regarding anemia among Female adolescents.

• 2. To study the behavioral pattern of female adolescents towards anemia.

• 3. To improve the knowledge of female adolescents regarding anemia.

METHODOLOGY

Study Duration: The study was carried out for a period of six month March 2024 – August 2024.

Study Design: Prospective educational interventional study.

Study Site: The study was carried out among the students of selected pre-university colleges of Kalaburagi city.

Source of Data: The data was collected by using data collection form.

1.Self structured questionnaire.

2. Information leaflet.

Study Criteria

Inclusion Criteria: 1) Female adolescents of selected pre-university college.

Exclusion Criteria: 1) Students who are not willing to participate in the study.

Sample size: 1010

Study Procedure: -The study was carried out after getting the approval from IRB. All the students were given informed consent form, which was duly filled by them after explanation of benefits of study. Relevant information like demographics was collected in self-structured data collection form. All the students were given a set of questionnaires which were self-prepared from the various article. The questionnaire was prepared in English and Kannada which comprises of knowledge, attitude and practice based questions. The study was conducted in two phases, one is “Pre-test” which is phase one and “Post-test” as second phase after a gap of 15 days. The questionnaire comprised of total 31 questions with 4 demographic details,8 knowledge based,6 attitude, ,4 dietary habits , 3 menstruation related and 6 practice based questions. After completion of pre-test all the students have been educated by the provided information leaflet, regarding anemia and asked to read and understand the information leaflet.

Post-test was conducted after 15 days, again the same questionnaire was provided to the same students. The questionnaire have been evaluated by providing marks that is for each correct answer mark one is given and for each wrong answer mark zero only for knowledge based questions. Comparison of responses of questions with pre and post intervention was done using suitable statistical test. All the data has been collected and entered in Microsoft excel sheet for data analysis. Further statistical data was analysed by IBM SPSS 25.0 version software.

RESULTS: -

Table No.1: Age wise distribution of participants (female adolescents)

Age in years	Number of participants	Percentage
16	381	37.7
17	468	46.3
18	161	16.0
Total	1010	100.0
Mean ± SD	16.78 ± 0.69

Bar diagram represents age wise distribution of participants (female adolescents)

Figure no. 1: Bar diagram represents age wise distribution of participants (female adolescents)

Table No.2: Mother’s occupation wise distribution of participants

Mother’s occupation	Number of participants	Percentage
House wife	691	68.4
Self employed	151	15.0
Government job	79	7.8
Private job	89	8.8
Total	1010	100.0

Pie diagram shows educational status wise distribution of female adolescent

Figure no. 2: Pie diagram shows educational status wise distribution of female adolescents

Table No.3: Father’s Occupation wise distribution of participants

Occupation	Number of participants	Percentage
Self-employed	410	40.6
Government job	231	22.9
Private job	269	26.6
Unemployed	100	9.9
Total	1010	100.0

Pie diagram represents father’s occupation wise distribution of participants

Figure no. 3: Pie diagram represents father’s occupation wise distribution of participants

Table No.4: Source of information wise distribution of participants

Source of information	Number of participants	Percentage
TV	286	28.3
School	218	21.6
News-paper & social media	264	26.1
Health care professional	242	24.0
Total	1010	100.0

Pie diagram represent source of information wise distribution of participants

Figure no.4 : Pie diagram represent source of information wise distribution of participants

Table No.5: Status of anemia wise distribution of participants

Status of anemia	Number of participants	Percentage
Present	106	10.5
Absent	904	89.5
Total	1010	100.0

Pie chart represents status of anemia wise distribution of participants

Figure no. 5 : Pie chart presents status of anemia wise distribution of participants

Table No.6: Pre-test knowledge score of participants

Pre-test knowledge scores	Categories	No. of participants	Percentage
<50%	Poor	844	83.5
50%--75%	Moderately Good	135	13.4
75%--100%	Good	31	3.1
Total	---	1010	100.0
Mean ± SD	2.60 ± 1.12 (32.5%)

Bar diagram represents pre-test knowledge score of participants

Figure no.6: Bar diagram represents pre-test knowledge score of participants

Table No.7: Post-test knowledge score of participants

Pre-test knowledge scores	Categories	No. of participants	Percentage
<50%	Poor	94	9.3
50%--75%	Moderately Good	260	25.8
75%--100%	Good	656	64.9
Total	---	1010	100.0
Mean ± SD	5.97 ± 1.12 (74.6%)

Bar diagram represents post-test knowledge score of participants

Figure no. 7 : Bar diagram represents post-test knowledge score of participants

Table No.8: Comparison of knowledge scores of awareness of anemia between Pre and Post-test

Knowledge scores	Categories	Pre-test		Post-test
Knowledge scores	Categories	No.	%	No	%
<50%	Poor	844	83.5	94	9.3
50%--75%	Moderately Good	135	13.4	260	25.8
75%--100%	Good	31	3.1	656	64.9
Total	---	1010	100.0	1010	100.0
Mean ± SD	----	2.60 ± 1.43		5.97 ± 0.72
Diff. of mean	---	3.37 (56.5%)
Paired t-test and p-value	t = 69.693, P = 0.0001, HS

NS= not significant, S=significant, HS=highly significant

Multiple bar diagram shows the comparison of knowledge score of anemia between Pre and Post-test

Figure no.8 : Multiple bar diagram shows the comparison of knowledge score of anemia between Pre and Post-test

Table No.9: Pre-test attitude questions based opinion of participants (female adolescents)

Statements	Options	No. of participants	Percentage
1. Awareness about iron deficiency anemia	a) Yes	392	38.8
1. Awareness about iron deficiency anemia	b) No	618	61.2
2. Do you think iron rich food should be a part of daily diet?	a) Yes	692	68.5
	b) No	318	31.5
3. Do you think adolescent girls are more prone to anemia?	a) Yes	565	55.9
3. Do you think adolescent girls are more prone to anemia?	b) No	445	44.1
4. Do you think IFA tablets prevents anemia	a) Yes	468	46.3
4. Do you think IFA tablets prevents anemia	b) No	542	53.7
5. Do you think iron needs of adolescents are different	a) Yes	482	47.7
5. Do you think iron needs of adolescents are different	b) No	528	52.3
6. Do you think anemia is a serious health issue?	a) Yes	647	64.1
6. Do you think anemia is a serious health issue?	b) No	363	35.9

Table No.10: Post-test attitude questions-based opinion of participants (female adolescents)

Statements	Options	No. of participants	Percentage
1. Awareness about iron deficiency anemia	a) Yes	906	89.7
1. Awareness about iron deficiency anemia	b) No	104	10.3
2. Do you think iron rich food should be a part of daily diet?	a) Yes	899	89.0
	b) No	111	11.0
3. Do you think adolescent girls are more prone to anemia?	a) Yes	791	78.3
3. Do you think adolescent girls are more prone to anemia?	b) No	219	21.7
4. Do you think IFA tablets prevents anemia	a) Yes	709	70.2
4. Do you think IFA tablets prevents anemia	b) No	301	29.8
5. Do you think iron needs of adolescents are different	a) Yes	724	71.7
5. Do you think iron needs of adolescents are different	b) No	286	28.3
6. Do you think anemia is a serious health issue?	a) Yes	864	85.5
6. Do you think anemia is a serious health issue?	b) No	146	14.5

Table No.11: Comparison of attitude of anemia between Pre and Post-test

Statements	Options	No. of participants		X²-test value, P-value & Sig
Statements	Options	Pre-Test	Post-Test	X²-test value, P-value & Sig
1. Awareness about iron deficiency anemia	a) Yes	392	906	X² = 569.46 P = 0.001, HS
1. Awareness about iron deficiency anemia	b) No	618	104
2. Do you think iron rich food should be a part of daily diet?	a) Yes	692	899	X² = 126.81 P = 0.001, HS
	b) No	318	111
3. Do you think adolescent girls are more prone to anemia?	a) Yes	565	791	X² = 569.46 P = 0.001, HS
3. Do you think adolescent girls are more prone to anemia?	b) No	445	219
4. Do you think IFA tablets prevents anemia	a) Yes	468	709	X² = 118.24 P = 0.001, HS
4. Do you think IFA tablets prevents anemia	b) No	542	301
5. Do you think iron needs of adolescents are different	a) Yes	482	724	X² = 120.50 P = 0.001, HS
5. Do you think iron needs of adolescents are different	b) No	528	286
6. Do you think anemia is a serious health issue?	a) Yes	647	864	X² = 123.67 P = 0.001, HS
6. Do you think anemia is a serious health issue?	b) No	363	146

Table No.12: Description of dietary habit wise distribution of participants

Statements	Options	No. of participants	Percentage
1. Menses status	Attained	949	94.0
1. Menses status	Not attained	61	6.0
2. Age at menarche	a) ≤ 14 years	577	57.1
2. Age at menarche	b) > 14 years	373	42.9
3.Length of blood flow in each menses	NR	60	6.0
	≤ 5 days	524	51.9
	> 5 days	426	42.1
	NR	60	6.0

Table No.13: Menstruation related characteristics of female adolescent’s wise distribution

Statements	Options	No. of participants	Percentage
1. Had checked haemoglobin before?	a) Yes	385	38.1
1. Had checked haemoglobin before?	b) No	625	61.9
2. Do you wash hands before food?	a) Yes	854	84.6
2. Do you wash hands before food?	b) No	156	15.4
3. Do you regularly you consume vitamin c rich fruits?	a) Yes	512	50.7
3. Do you regularly you consume vitamin c rich fruits?	b) No	498	49.3
4. Do you often consume iron rich foods in your diet	a) Yes	500	49.5
4. Do you often consume iron rich foods in your diet	b) No	510	50.5
5. Have you taken the deworming tablets in the recent past?	a) Yes	257	25.4
5. Have you taken the deworming tablets in the recent past?	b) No	753	74.6
6. frequency of Albendazole consumption	a) Once yearly	202	20.0
	b) Twice yearly	55	5.4
	c) Not answered	753	74.6

Table No.14: Practice based questions wise distribution of participants (female adolescents)

Statements	Options	No. of participants	Percentage
1. Had checked haemoglobin before?	a) Yes	385	38.1
1. Had checked haemoglobin before?	b) No	625	61.9
2. Do you wash hands before food?	a) Yes	854	84.6
2. Do you wash hands before food?	b) No	156	15.4
3. Do you regularly you consume vitamin c rich fruits?	a) Yes	512	50.7
3. Do you regularly you consume vitamin c rich fruits?	b) No	498	49.3
4. Do you often consume iron rich foods in your diet	a) Yes	500	49.5
4. Do you often consume iron rich foods in your diet	b) No	510	50.5
5. Have you taken the deworming tablets in the recent past?	a) Yes	257	25.4
5. Have you taken the deworming tablets in the recent past?	b) No	753	74.6
6. frequency of Albendazole consumption	a) Once yearly	202	20.0
	b) Twice yearly	55	5.4
	c) Not answered	753	74.6

Table No.15: Comparison of pre-test knowledge score with demographical profiles in female adolescents

Demographical profiles	Categories	No. of participants	Knowledge score	t-test value, P-value & sign.
Demographical profiles	Categories	No. of participants	Mean ± SD	t-test value, P-value & sign.
Age	16	381	2.63 ± 1.06	F = 0.415 P = 0.660, NS
	17	468	2.56 ± 1.14
	18	161	2.62 ± 1.20
Mother’s Occupation	House wife	691	2.53 ± 1.13	F = 1.724 P = 0.143, NS
	Self employed	151	2.42 ± 1.19
	Government job	79	2.53 ± 0.90
	Private job	89	2.58 ± 0.97
Father’s Occupation	Self-employed	410	2.61 ± 1.16	F = 1.208 P = 0.317, NS
	Government job	231	2.65 ± 1.07
	Private job	269	2.49 ± 1.12
	Unemployed	100	2.53 ± 0.99

DISCUSSION: - As pharmacist’s are accessible to community and have important role in promoting and encouraging adherence with lifestyle intervention, such as helping to understand who are at risk of developing anemia, causes, symptoms, diagnosis and treatment of anemia. These goals can be achieved by effective education of community.

The study aimed to assess the effectiveness of a standardized structured knowledge program on awareness of anemia among female adolescents. The majority of participants were in the age group of 17 years (46.3%), with a mean age of 16.78 ± 0.69 years, which is similar to study conducted by Verma SK et al.,2021 with mean age of 16.8±1 years. Most of the participants' mothers were homemakers (68.4%), while fathers were predominantly self-employed (40.6%).

The pre-test knowledge scores revealed that 83.5% of participants had poor knowledge, 13.4% had moderately good knowledge, and only 3.1% had good knowledge on anemia. The mean pre-test knowledge score was 2.60 ± 1.43 (32.5%). However, after the implementation of the structured teaching program, the post-test knowledge scores showed a significant improvement, with 64.9% of participants achieving good knowledge, 25.8% moderately good knowledge, and only 9.3% poor knowledge. The mean post-test knowledge score increased to 5.97 ± 0.72 (74.6%). The mean knowledge score on awareness of anemia in the post-test was observed significantly high as compare to pre-test mean score. The mean difference of knowledge score on awareness of anemia from pre-test to post-test was 56.5% that is 3.37 which is near similar to the study conducted by Salam SS et al.,2023 with mean knowledge score increased by 3.67 ± 0.17. Study reveals that; there was statistically highly significant mean difference of knowledge score on awareness or knowledge of anemia between pre and post- test (P<0.001) which is similar to the study conducted by Bandyopadhyay L et al.,2017 a quasi?experimental interventional study with the similar observation of post interventional score to be significantly improved with (P < 0.001).

The attitude of participants towards anemia also improved significantly after the intervention. Post intervention 88.01 % subjects in our study told that iron-rich food should be a part of daily diet and this result was near similar to the observation made in a study by Verma SK et al.,2021 which was 88.3% .The percentage of participants aware of iron deficiency anemia increased from 38.8% to 89.7%, those who believed iron-rich foods should be a part of the daily diet increased from 68.5% to 89.0%, and those who considered anemia a serious health issue increased from 64.1% to 85.5%. which is greater than the observation made in study conducted by Angadi N et al.,2015 which was around 73% . The observation of iron as the nutrient deficient in anemia preintervention was 36.7% which is near similar to the study conducted by Angadi N et al.,2015 . The attitude of subjects towards iron needs in adolescents are different was 70.1% posttest which is near similar to the observation made in the study conducted by Angadi N et al.,2015 which was 68% .The study subjects agreeing to adolescent girls being more prone to anemia was78.3% post intervention which is greater than the study conducted by Chaluvaraj TSI et al.,2018 with 69% observed value. The study also explored the participants' dietary habits and menstrual characteristics. It was found that 54.6% of participants consumed staple foods less than three times a day, 39.9% had irregular breakfast habits, and 45.4% regularly consumed vegetables and fruits. The breakfast habit of always with frequency of 31.7% is near similar to the study conducted by Utami A et al.,2022 with 37.7% frequency of having breakfast always.Vegetables and fruits consumption of frequency sometimes was 30.8% which is near similar to the study conducted by Utami A et al.,2022 with frequency of 29% The practice of not regularly consuming vitamin c rich fruits was 49.4% which was slightly greater than the study conducted by Gonete KA et al.,2017 . Regarding menstrual characteristics, 93.9% of participants had attained menarche, which is near similar to the study conducted by Gonete KA et al.,2017. In this study 57.1% is with experiencing menarche at or before 14 years of age. The length of blood flow during each menstrual cycle was ≤5 days for 51.9% of participants. The subjects who did not attain menstruation was 6.1% which is slightly less compared to the study conducted by Chaluvaraj TSI et al.,2018 which had 14% of subjects who did not attain menstruation yet . In terms of practices, only 38.1% of participants had their hemoglobin levels checked before, 84.6% washed their hands before meals, 50.7% regularly consumed vitamin C-rich fruits, and 49.5% often consumed iron-rich foods. However, only 25.4% of participants had taken deworming tablets in the recent past, with 20.0% consuming albendazole once yearly which is near similar to the study conducted by Angadi N et al.,2015 with 27% individuals consuming albendazole once yearly and 5.4% twice yearly, the limited use of deworming tablets, which could contribute to the prevalence of anemia. The study found no significant association between pre-test knowledge scores and demographic profiles such as age, mother's occupation, and father's occupation (p>0.05).

CONCLUSION: - The significant increase in knowledge scores from pre-test to post-test indicates that structured educational programs can effectively enhance awareness about anemia among adolescents. This suggests that similar interventions could be beneficial in other communities, particularly targeting young females who are at risk of nutritional deficiencies.

The standardized structured knowledge program was effective in improving the knowledge and attitude of female adolescents regarding anemia. However, there is still a need to focus on improving dietary habits, regular hemoglobin checkups, and deworming practices to reduce the prevalence of anemia among this population. The study's findings underscore the importance of age distribution in understanding anemia awareness and educational needs among female adolescents. The predominance of participants aged 16 to 17 years suggests a critical window for interventions aimed at improving knowledge and attitudes toward anemia.

In summary, this study demonstrates that targeted educational interventions can significantly improve knowledge and attitudes regarding anemia among female adolescents. By focusing on this vulnerable population and addressing their specific needs, we can foster healthier future generations equipped with the knowledge to make informed health choices.The findings of this study underscore the critical importance of educational interventions in improving the awareness and knowledge of anemia among female adolescents. The structured knowledge program implemented in this study led to significant improvements in the participants' understanding of anemia, as demonstrated by the statistically significant increase in post-test scores. This highlights the potential of well-designed educational programs to effectively address public health concerns such as anemia, which continues to be a major issue among adolescent population. However, the study also points to the need for more comprehensive and sustained interventions. While knowledge about anemia improved, gaps remain in the practical application of that knowledge, particularly in terms of nutrition and dietary habits. Addressing these gaps requires ongoing education efforts that extend beyond mere awareness. There is a need for practical, actionable advice on how to incorporate iron-rich foods and balanced diets into daily routines. Schools, healthcare professionals, and community organizations must work together to create environments that encourage healthy dietary practices. Another important finding from this study is the role of media in disseminating health information. While media channels such as TV and social media are useful in reaching large audiences, they may not always provide accurate or complete information. Therefore, it is crucial to involve healthcare professionals more actively in health education efforts to ensure that the information being conveyed is both accurate and effective. Schools should also be leveraged as platforms for health education, as they provide direct access to adolescents in a structured environment where consistent, reliable health information can be shared. This calls for policy-level interventions that include regular screening, early detection, and treatment of anemia in adolescents, along with education programs that focus on prevention through diet and lifestyle changes. By integrating education with practical health interventions, it is possible to make sustained progress in reducing the prevalence of anemia and improving overall adolescent health..The standardized structured knowledge program was effective in improving the knowledge and attitude of female adolescents regarding anemia. However, there is still a need to focus on improving dietary habits, regular hemoglobin checkups, and deworming practices to reduce the prevalence of anemia among this population. Healthcare professionals and policymakers should prioritize interventions targeting female adolescents to address this significant public health concern.

Suggestions: - Knowledge is a very important domain for action of someone. If the acceptance of new behaviour is based on knowledge, awareness and a positive attitude, then the behaviour will be lasting. Conversely, if not based on knowledge and then awareness won’t be immediate for long . Nutrition education intervention had an impact on improving knowledge, attitude of female adolescents post intervention. The nutrition program should be adopted and integrated into comprehensive intervention programs to target IDA among adolescents at various levels in the city .

Limitations: -The study was conducted in six selected colleges only so certainly it is not representative of the situation in all of the Kalaburgi district . While it was not among primary purpose of this study , a value measure of Hb level would be of great interest in determining the effect of KAP on prevalence of anemia among the study sample.

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