RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES



RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA.

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

|1 |NAME OF THE CANDIDATE AND ADDRESS |Ms. RINCY.P.RAJAN |

| | |1st YEAR MSc. NURSING STUDENT, |

| | |N.D.R.K. COLLEGE OF NURSING |

| | |B.M. ROAD HASSAN, KARNATAKA. |

|2 |NAME OF THE INSTITUTION |N.D.R.K. COLLEGE OF NURSING, B.M. ROAD, HASSAN, KARNATAKA. |

|3 |COURSE OF STUDY AND SUBJECT |MASTER OF SCIENCE IN NURSING |

| | |(MEDICAL AND SURGICAL NURSING) |

|4 |DATE OF ADMISSION TO THE COURSE |15.06.2010 |

|5 |TITLE OF THE TOPIC |“EFFECTIVENESS OF PLANNED TEACHING PROGRAMME (PTP) ON KNOWLEDGE REGARDING PREVENTION AND MANEGEMENT |

| | |OF IRON DEFICENCY ANEAMIA AMONG ADOLESCENT GIRLS OF SELECTED PRE-UNIVERSITY COLLEGE, HASSAN, |

| | |KARNATAKA” |

|5.1 |STATEMENT OF THE PROBLEM |“A STUDY TO EVALUATE THE EFFECTIVENESS OF PLANNED TEACHING PROGRAMME (PTP) ON KNOWLEDGE REGARDING |

| | |PREVENTION AND MANAGEMENT OF IRON DEFICENCY ANEAMIA AMONG ADOLESCENT GIRLS OF SELECTED |

| | |PRE-UNIVERSITY COLLEGE, HASSAN, KARNATAKA” |

6. BRIEF RESUME OF THE INTENDED WORK

6.1 INTRODUCTION

“This offers improved convenience for the patients and less injection related burden for the patients and health care professionals compared to weekly anemia treatment.”

Willard Dere

Anemia is a condition in which the number of red blood cells or the amount of hemoglobin is low. Red blood cells contain hemoglobin protein that it enables them to carry oxygen from the lungs and deliver it to all parts of the body. When the number of red blood cells is reduced or the amount of hemoglobin in them is low, the blood cannot carry an adequate supply of oxygen. An inadequate supply of oxygen in the tissues produces the symptoms of anemia.1

Even there are many blood disorders; Iron deficiency anemia is most prevalent nutritional disorders in the world today. Iron is a necessary mineral for body function and good health. Every red blood cell in the body contains iron in its hemoglobin, the pigment that carries oxygen to the tissues from the lungs. But a lack of iron in the blood can lead to iron-deficiency anemia, which is a very common nutritional deficiency in children& adolescents1

The statistical data of anemia in worldwide affects 1.62 billion people (95% CI: 1.50–1.74 billion), which corresponds to 24.8% of the population (95% CI: 22.9–26.7%) The highest prevalence is in preschool-age children (47.4%, 95% CI: 45.7–49.1), and the lowest prevalence is in men (12.7%, 95% CI: 8.6–16.9%). However, the population group within the greatest number of individuals affected is non pregnant women (468.4is Iron deficiency anemia is most prevalent among females with the age group of 15-22yrs. Surveys from a decade ago report 40% of pregnant women (a severe level) and 20% of non-pregnant women (a moderate level) are anemic due to iron deficiency in ability.2

Iron-deficiency anemia doesn't develop immediately. Instead, a person progresses through stages of iron deficiency, beginning with iron depletion, in which the amount of iron in the body is reduced while the iron in RBCs remains constant. If iron depletion isn't corrected, it progresses to iron deficiency, eventually leading to Iron deficiency anemia.3

Symptoms of Iron deficiency anemia include fatigue, weakness, shortness of breath, and the inability to concentrate. Iron-deficiency anemia can be the consequence of several factors, including, insufficient iron in the diet, poor absorption of iron by the body ongoing blood loss, most commonly from menstruation or from gradual blood loss in the intestinal tract, periods of rapid growth. Iron deficiency anemia may result from: inadequate dietary intake of iron (less than 1 to 2 mg/day), during rapid growth in adolescents. Iron malabsorption, such as in chronic diarrhea, partial or total gastrectomy, chronic diverticulitis, and malabsorption syndromes, such as celiac disease and pernicious anemia. Blood loss secondary to drug-induced GI bleeding (from anticoagulants, aspirin, and steroids) or due to heavy menses, hemorrhage from trauma, GI ulcers, esophageal varices, or cancer, intravascular hemolysis-induced hemoglobinuria or paroxysmal nocturnal hemoglobinuria. Mechanical erythrocyte trauma caused by a prosthetic heart valve or vena cava filters. It occurs most commonly in pre menopausal women, and adolescents (especially girls). Persons who are at increased risk for iron deficiency include those of low socioeconomic status who don’t get a well-balanced diet that includes iron-rich foods. Poverty is a contributing factor to Iron deficiency anemia because families. Iron continues to remain the most neglected micronutrient inspite of its greater burden on health.3

Mild iron deficiency anemia usually doesn't cause complications. However, untreated, iron deficiency anemia can become severe and lead to health problems. Iron deficiency anemia may lead to a rapid or irregular heartbeat. Your heart must pump more blood to compensate for the lack of oxygen carried in your blood when you're anemic. In people with coronary artery disease — narrowing of the arteries that supply the heart — unchecked anemia can lead to angina. Angina is chest pain caused by decreased oxygen and blood flow to the heart muscle is called Growth problems. In children’s, severe iron deficiency can lead to anemia as well as delayed growth. Untreated iron deficiency anemia can cause physical and mental delays in infants and children in areas such as walking and talking. Additionally, iron deficiency anemia is associated with a greater incidence of lead poisoning and an increased susceptibility to infections.4

Fortification of suitable food vehicles with absorbable forms of iron is a highly desirable approach to controlling iron deficiency. Another approach is to fortify a widely consumed condiment. Fish sauce, curry powder, salt, and sugar have all been successfully fortified with iron. The amount of iron absorbed from the diet is highly dependent on the composition of the diet, namely, the quantities of substances that enhance or inhibit dietary iron absorption successfully fortified with iron. Tea and coffee inhibit iron absorption when consumed with a meal or shortly after a meal. Heme food sources, predominately red meats, contain highly absorbable iron and promote the absorption of iron from other less bioavailable food sources5

To avoid being the part of this statistics the best solution is the appropriate preventive measures. There are three possible interventions for the prevention of anemia. These include dietary diversification, food fortification and individual supplementation. Dietary diversification involves promotion of a diet with a wider variety of iron containing food. Encouraging families with deficient iron intake to eat meat, fish, or poultry; whole or enriched grain; and foods high in ascorbic acid6.

To prevent this iron deficiency anemia is to diagnose and correct the underlying cause of anemia and treat the iron deficit through diet and supplemental iron preparation. Supplemental iron is usually administered to increase iron available in the blood. The medications of choice are ferrous sulphate, 0.325gm orally three times a day with meal. Ferrous gluconate 0.3gm orally twice a day, and iron dextran 100-250mg intramuscularly. Iron dextran is the parenteral drug of choice. The client typically feels more energetic and has an increased appetite within 48hrs.peak reticulocytosis occur about day 10. Red blood cells indices and hemoglobin content gradually returns to normal. Because of the high risk of allergic reaction, if iron is to be given I.V, the physician usually administers the first dose.  Teaching the basics of a nutritionally balanced diet — red meats, green vegetables, eggs, whole wheat products, and iron-fortified measures goes hand in hand with properly planned management such as life style modification, dietary management as well as medical management.7

6.2. NEED FOR THE STUDY

“Prevention is better than cure”

We found iron deficiency anemia prevalence of adolescent girl’s is 69.4% in the rural and 61.4% in the urban setting of Karnataka. Ninety seven (30.7%) of the women receiving oral iron showed an increase in Hb as against 64 of the 69 women (92.8%) receiving iron-sucrose, mean rise in Hb of 1.31gm/dl (sd0.77). 8

According to WHO the adolescent period is from the age of 10 years to 19 years that is second decade of life. It can be distinguished as early adolescence, age 10-13 years; middle adolescence, ages 14-16 years, late adolescence, age 17-20 years. The period of youth is from 15 through 24 years. The adolescents and youth together are phased as young people (10-24 years). The world’s adolescent population (age 10–19 years) is estimated to stand at more than 1 billion, yet adolescents remain a largely neglected, difficult-to-measure, and hard-to-reach population in which the needs of adolescent girls, in particular, are often ignored. This area of adolescent health has been difficult to study, and there are many unknown factors and consequences for iron deficiency during adolescence in terms of standards, measurement indicators and health consequences. According to the population bureau in 1996, 30 % of the total populations were that of adolescents (284.02 million). The adolescence is the period of relatively good health inspite of the storms and stresses of rapid physical growth, physiological changes, sexual and emotion growth and development9

The iron needs are high in adolescent girls because of the increased requirements for expansion of blood volume associated with the adolescent growth spurt and the onset of menstruation. When pregnancy is interposed during this time, problems of iron balance are compounded. Over half the world’s population is under 25 years old, and more than 80% of the world’s youth live in developing countries. Iron deficits induced by poor diet and disease, along with difficult logistics associated with supplementation programs in developing countries; compound the problem of studying the iron needs during pregnancy in much of the world’s population. For these reasons, we felt it important to study a population with adequate diets and normal pre-pregnancy iron stores. We investigated the response to supplemental iron in adolescents and adults throughout the course of normal pregnancies. Menstruating girls and young children also vulnerable to iron deficiency. Iron deficiency anemia also occurs with chronic blood loss.10

The adolescent require well balance nutrition diet to have normal growth and to keep fit. The adolescent should learn to relax and eat properly at meal time. They avoid taking junk food. They should take whole some snacks preferably made from ground nut, parched chana e.t.c. Inadequate diet leads to malnutrition and result in various deficiencies example anemia due to lack of iron especially in girls. Dietary deficiency may be due to ignorance, food facts, illiteracy, size of the family, cultural factors, gender discrimination, poverty e.t.c. it is therefore very important to educate adolescents, about nutrition needs of adolescents for planning and preparing nutritious diet using inexpensive food. Besides being nutritious food which is consumed by adolescent should be clean and safe. The food should be well cooked under clean and safe environment following all the principles of cooking .Food should be consumed as quickly as possible. Unconsumed food should be store in properly in the refrigerator below 10OC. Hands must be thoroughly washed with clean water before consuming or preparing the food. The adolescent need to be educated regarding such practice to prevent any kind of infection through food moreover to prevent iron deficiency. 10

In many populations, the amount of iron absorbed from the diet is not sufficient to meet many individuals’ requirements. If the amount of absorbable iron in the diet cannot be immediately improved, iron supplementation will be a necessary component of programs to control iron deficiency anemia. The dosage for iron supplementation in mass programs is unchanged from previous recommendations, except that the pregnancy dose has been reduced to 60 mg/day. Because the efficiency of absorption of iron increases as iron deficiency anemia becomes more severe, this dose should provide adequate supplemental iron to women who do not have clinically severe anemia if it is given for an adequate duration. if iron supplements containing 400 µg folic acid are available, their use in supplementation programs is recommended. If such supplements are not available, the currently available iron supplement containing 250 µg folic acid should be used until higher folate formulations can be obtained.11

The Healthcare and Research Association for Adolescents, Noida and the Nutrition Foundation of India, New Delhi studied women in the same districts and villages studied in NFHS-II and concluded that the prevalence and severity of anemia in rural adolescent girls was much higher than that reflected in NFHS-II: 84 % prevalence, of which 9.2 % fell into the severe anemia category15.The Indian Council for Medical Research (ICMR)’s district nutrition survey data also reported similar anemia prevalence of 84.2 %, with 13.1 % being in the severe anemia category16.12

The diet of common man in Maldives is not optimal; resulting in poor growth of adolescents’ .Anemia is wide spread especially in adolescent girls. Studies of “nutritional status and child feeding practice” and “iodine deficiency disorders “have been carried out recently. Results of the survey of iron deficiency disorders demonstrated the existence of iron deficiency anemia as a public health problem in Maldives.13

The researcher, who is in clinical area, met with a case an adolescent girl she was suffering from severe anemic. Because her stressful life style, she doesn’t had the proper food habits and she also had the obsession to thin. So that she stops eating. She does not believe that she is thin. Finally this girl develops amenorrhea and respiratory arrest which leads to death. Hence education regarding prevention and management of Iron deficiency anemia is most important among adolescent girls.14 .

Hence the investigator selected the adolescent girls and wants to assess and pour the knowledge regarding prevention and management of iron deficiency anemia. So the investigator suggested that, this study has to improve the knowledge of pre –university students regarding early detection, dietary management, pharmacological management, the prevention and management of iron deficiency anemia and follow up care14.

6.3. STATEMENT OF PROBLEM

“A study to Evaluate The Effectiveness of Planned Teaching Programme (PTP) on Knowledge Regarding Prevention and Management of Iron Deficiency Anemia among Adolescent Girls of selected Pre-university college, Hassan, Karnataka.”

6.4 OBJECTIVES OF THE STUDY

1. To assess the knowledge of adolescent girls in selected Pre-university college regarding prevention and management of iron deficiency anemia before the administration of planned teaching programme.

2. To Develop and administer planned teaching programme regarding prevention and management of iron deficiency anemia among adolescent girls in the selected pre-university college students.

3. To assess the knowledge of adolescent girls in selected pre-university college students regarding prevention and management of iron deficiency anemia after the administration of planned teaching programme.

4. To evaluate the effectiveness of planned teaching programme by comparing pre – test and post – test knowledge scores regarding the prevention and management iron deficiency anemia.

5. To associate the pre and post test knowledge scores of adolescent girls of selected pre-university college students with selected socio – demographic variables.

6.5. HYPOTHESIS

NULL HYPOTHESIS

H0: There will not be any significant difference and association between pre test and post test knowledge scores of adolescent girls in selected PUC who have received the planned teaching programme on prevention and management of iron deficiency anemia.

RESEARCH HYPOTHESIS

H1: There will be a significant difference between pre test and post test knowledge scores of adolescent girls in selected PUC who have received the planned teaching programme on prevention and manegement of iron deficiency anemia.

H2: There will be a significant association between selected socio- demographic variables and knowledge of adolescent girls in selected PUC students of prevention and management of iron deficiency anemia.

6.6. ASSUMPTIONS:

This study will

1. Improve the knowledge of PUC students regarding prevention and management measures of Iron deficiency anemia.

2. Improve the knowledge of adolescent girls in selected pre university college regarding iron deficiency anemia such as early detection, dietry modification, pharmacological management and follow up care.

6.7. OPERATIONAL DEFINITIONS

1. EVALUATE: To judge or determine the significant worth or quality of structured teaching program regarding prevention and management of iron deficiency anemia in adolescent girls in selected pre university college ,Hassan ,Karnataka.

2. EFFECTIVENESS: It refers to the quality or capacity of being able to bring about an effective structured teaching programme on prevention and management on iron deficiency anemia in adolescent girls.

3. PLANNED TEACHING PROGRAMME: It refers to the lecture given by the researcher to provide adequate information regarding prevention and management of iron deficiency anemia in adolescent girls

4. KNOWLEDGE: It refers to the understanding of information regarding prevention and management of iron deficiency anemia in adolescent girls.

5. IRON DEFICIENCY ANEMIA: it is the deficiency of iron in the blood.

6. PREVENTION: It refers to hindering the fact from happening

7. ADOLESCENT GIRL: Teenager girl at the age group of 16- 18yrs

8. SELECTED PRE-UNIVERSITY COLLEGE: Krishna Pre –University College Hassan Karnataka.

6.8 CRITERIA FOR SAMPLE SELECTION

INCLUSION CRITERIA

1. Adolescent girls who are studying in 1st year and 2nd year, in selected Pre-university College, at Hassan, Karnataka

2. Adolescent girls who are studying in 1st year and 2nd year in selected Pre-university College those who are present at the time of study.

EXCLUSION CRITERIA

1. Adolescent boys who are studying 1st year and second year in selected Pre-University College are excluded from the study

2. Adolescent girls who are absent at the time of study.

6.9 LIMINATION OF STUDY:

This study is delimited to,

1.60 adolescent girls in selected pre University College studying in Hassan Karnataka

2. Data will be collected in a period of 4to6 weeks

6.9 SIGNIFICANCE OF THE STUDY

1. Increase the knowledge of adolescent girls in selected pre-university college students regarding prevention and management of iron deficiency anemia.

2. Paves the way for pre-university college students to gain knowledge regarding preventive measures of iron deficiency anemia Such as screening, dietary management, pharmacological management and follow up care.

6.10 CONCEPTUAL FRAME WORK

Based on Betty Neuman Theory

6.11 REVIEW OF LITERATURE

Review of literature is a key step in research process. Review of literature refers to an extensive, exhaustive and systematic examination of publications relevant to the research project .Before any research can be started whether it is a single study or an extended project, literature reviews of previous studies and experiences related to proposed investigations should be done. One of the most satisfying aspects of the literature review is the contribution it makes to the new knowledge, insight and general scholarship of the researcher.

Review of literature is divided in to three parts; the literature related to,

6.11.1 Literature related to knowledge on prevalence of iron deficiency anemia among adolescent girls.

6.11.2 Literature related to Knowledge on prevention and management of iron deficiency anemia in adolescent girls.

6.11.3 Literature related to the effectiveness of planned teaching programme

6.11.1 Literature related to knowledge on prevalence of iron deficiency anemia

A study was conducted with the aim of identifying prevalence of iron deficiency anemia among adolescent girls, using cluster sampling techniques. At baseline, the overall prevalence of anemia was found to be 65.3%.it was highest among the tribal girls (68.9%) followed by 64.2%among urban slum girls and least (62.8%) among rural girls. The study was concluded, there may be highest prevalence among tribal girls comparing to urban and rural girls.15

The study was conducted in Punjab, with the aim of identifying prevalence and knowledge of iron deficiency anemia .data has been collected from 265 schedule caste girls to check whether they are having anemia. The doubtful cases excluded from the present sample. Anemia was diagnosed according to WHO out of 265 girls studied, only 29.43% were normal and 70.50%were affected with various grades of anemia.i.e.30.57%midly anemic,27.17% moderately anemic and 12.83% severely anemic. The study was concluded that an adolescent girl of there was a high prevalence in economically weaker sections. 16

6.11.2 Literature related to knowledge on prevention of iron deficiency anemia in adolescent girls

The study was carried out in Nasik district of Maharashtra state, India. the ‘Adolescent Nutritional Anemia Project’ for unmarried, non-pregnant, adolescent girls, aged 14–18 years. The Project covered 498,793 people from four tribal, four rural blocks of Nasik district, and all the urban slums of Nasik city. These girls were given weekly supplementation with iron folic acid tablets (100-mg iron and 0.5-mg folic acid) and were trained in life-skill training sessions for three hours every day for three days. Anganwadi Workers of the Integrated Child Development Services Scheme carried out these activities in their areas. The distribution of iron folic acid tablets was facility-based, i.e. Anganwadi. The supplies were replenished during their monthly review meetings at the Primary Health Centre. The study revealed that this project improved the knowledge of adolescent girls regarding prevention and management of iron deficiency anemia.17

The study was conducted to see the effectiveness of weekly supplementation of iron folic acid in rural and urban areas. Alternative modalities, such as peer educators, school-based approach, or house-to-house approach to improve the compliance may be worked out. Public health approach, consisting of a once weekly iron supplementation through schools and welfare centers, may turn out to be better strategy to combat anemia in adolescent girls. The study concluded that weekly supplementation of iron to adolescent girls should be universally started in rural and urban areas to correct the iron stores of women prior to becoming pregnant. The study also suggested in urban slums, programme need to improved17.

To study the differences in iron nutrition status among racial and ethnic subgroups, nutrition surveys should include larger numbers of individuals from ethnic subgroups in survey samples. For example, the sample used in NHANES III for the ''Hispanic'' population covers only Mexican Americans. Larger samples of Hispanic and other ethnic groups could be added to future survey samples (e.g., Cubans, Puerto Ricans, and those from the Caribbean). By expanding the representation of ethnic subgroups in national nutrition surveys, more data would be available to correlate dietary beliefs and practices with health status measurements18

In 1999, a special symposium entitled “improving adolescent iron status before child bearing” was convened in Washington DC. The conclusion of this group were that many girls are already anemic by the time they become pregnant (16-55%) and that pregnancy is too short a period of time in which to reduce pre-existing anemia, especially when many women do not seek prenatal care until the second or third trimester .thus they concluded that, emphasis needs to be placed on pre-pregnancy programs to increase body iron stores18.

A study was conducted to assess the knowledge on prevention and management of iron deficiency anemia. Surveys from a decade ago report 40% of pregnant women (a severe level) and 20% non pregnant women (a moderate level)are anemic due to iron deficiency in FSM,with prevalence being highest in Pohnpei state(WHO,2000;yamamura,2001)despite this, no health interventions have been to reduce the rates of this chronic condition. Symptoms of iron deficiency anemia include fatigue, weakness, shortness of breath, and the inability to concentrate.Haas and Brownlie”s review of 29 report a found a strong casual relationship between IDA and impaired aerobic capacity, endurance, energy efficiency and work productivity. Research concluded that iron-sufficient females perform better on cognitive tasks and complete them faster than females with IDA, but these results are reversible when healthy iron levels return (Murray-Kolb and Beard, 2007).19

6.11.3 Literature related to the effectiveness of planned teaching programme

A Study was conducted to evaluate the effectiveness of planned teaching programme in improving the knowledge of pre- university students sample of 30 pre-university students was selected by lottery system (simple random sampling technique).a structured questionnaire and observational check list were found to be suitable for the study to assess the knowledge of a group of pre –university students. The finding of this study indicate that the planned teaching programme enhance the knowledge and developed the ability of pre-university students. The planned teaching programme is a suitable method of instruction for educating pre-university students for disseminating health information20.

A study was conducted to measure the impact of teaching programme on their level of knowledge of pre-university students. All 60 pre-university students offered a planned teaching programme about prevention of iron deficiency anemia in adolescent girls and it contains prevention and manegemt, complication of iron deficiency anemia .a multiple choice questionnaire was used to assess their level of knowledge at the end of a 6-month period over which teaching sessions took place. Attendance at and satisfaction with the programme were high. There was a significant improvement in the level of knowledge at the end of the programme, with the greatest improvement in those attended most sessions. The low scores recorded recorded for questionnaire administered before the teaching programme suggest that there is critical need for improved education in palliative care amongst health workers20.

7. MATERIAL AND METHODS OF STUDY

7.1 SOURCES OF DATA

The data will be collected from adolescent girls in selected PUC college studying at, Hassan, Karnataka.

7.2 METHOD OF DATA COLLECTION

1. Research design: - Quasi experimental design-single group pre-test post –test design

Schematic plan of the study:-

|Group |Pretest |Intervention |Post-test |

|A group of 60 adolescent girls in selected PUC |O1 |X |O2 |

|studying at Hassan | | | |

|(single group) | | | |

Key:-

O1= Pretest knowledge of adolescent girls in selected PUC regarding prevention of iron deficiency anemia.

X = planned teaching programme on prevention of iron deficiency anemia.

O2 = Post test knowledge of adolescent girls in selected PUC regarding prevention of iron deficiency anemia.

2. Research setting: -Selected Pre-university collage, Hassan, Karnataka.

3. Population: -Adolescent girls in selected PUC studying in Hassan, Karnataka

4. Sample: -Adolescent girls in selected PUC who are fulfilling the inclusion criteria.

5. Sample size- 60 Adolescent girls in selected PUC studying at Hassan, Karnataka

6. Sampling technique-Probability sampling method by Stratified random technique will be used for the study.

7. Collection of data-Data will be collected by using structured questionnaires.

8 VARIABLES

INDEPENDENT VARIABLE

Planned teaching program for adolescent girls in selected PUC regarding prevention and management of iron deficiency anemia..

DEPENDENT VARIABLE

Knowledge of adolescent girls in selected PUC regarding prevention and management of iron deficiency anemia.

9. PLAN FOR DATA ANALYSIS

DESCRIPTIVE STATISTICS

Descriptive statistics include percentage, frequency, mean and standard deviation.

INFERENTIAL STATISTICS

It include independent ‘t’-test and paired ‘t-test’ with chi- square test and “ANOVA” “f” test for the assessment of knowledge and to associate the socio demographic variable is planned .

10. PILOT STUDY

10% of the population is planned for the pilot study.

11. ETHICAL CONSIDERATION

1. Does the study require any intervention to be conducted on PUC students?

Yes

2. Has ethical clearance been obtained from your institution?

Yes

3. Has the consent been taken from the PUC students?

Yes

12. LIST OF REFERENCES (VANCOUVER STYLE)

1.DeMaeyer EM, Dallman P, Gurney JM, et al (1989) Preventing and controlling iron deficiency anemia through primary health care: a guide for health administrators and programme managers. Geneva: World Health Organization.

2.Gillespie S, Kevany J, Mason J (1991) Controlling iron deficiency. ACC/SCN State of-the-Art Series Nutrition Policy Discussion Paper No. 9. United Nations.

3.Gillespie S (1998) Major issues in the control of iron deficiency. Micronutrient Initiative, UNICEF, in press.

4. International Nutritional Anemia Consultative Group (1989) Guidelines for the control of maternal nutritional anemia. INACG, Washington, DC

5. International Nutritional Anemia Consultative Group (1977) Guidelines for the eradication of iron deficiency anemia. INACG, Washington, DC

6. International Nutrition Anemia Consultative Group (1986) Combating iron deficiency in Chile: a case study. INACG, Washington, DC

7. International Nutrition Anemia Consultative Group (1990) Combating iron deficiency anemia through food fortification technology. INACG, Washington, DC

8. International Nutritional Anemia Consultative Group, UNICEF, (1996) Iron/multimicronutrient

supplements for young children. INACG, Washington, DC

9. Montresor A, Crompton DWT, Bundy DAP, et al (1998) Guidelines for the evaluation of soil-transmitted helminthiasis and schistosomiasis at community level. A guide for managers of control programmes. WHO/CTD/SIP/98.1.

10. World Health Organization, Geneva Morrow O (1990) Iron supplementation during pregnancy: why aren’t women complying? A review of available information. WHO/MCH/90.5. World Health Organization, Geneva

11. Nestel P (1993) Food fortification in developing countries. Vitamin A Field Support Project (VITAL), Washington, DC

12. PATH (1996) Anemia detection in health services. Guidelines for program managers.Program for Appropriate Technology in Health, Seattle

13. Pawlowski ZS, Schad GA, Stott GJ (1991) Hookworm infection and anaemia.

14. Approaches to prevention and control. World Health Organization, Geneva

15. UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR). WHO/UNICEF approach to integrated management of the sick child. TDR News No. 48, December 1995, pp1.8

16. Werner D, Bower B (1982) Helping health workers learn. The Hesperian Foundation,Palo Alto

17. WHO (1994) Report of the WHO informal consultation on hookworm infectionand anaemia in girls and women. WHO/CTD/SIP/96.1. World Health Organization,Geneva

18. WHO (1991) The control of schistosomiasis. Second report of the WHO Expert Committee TRS 830. WHO, Geneva

19. WHO, UNICEF, UNU (1998) IDA: Prevention, Assessment and Control. Report of a joint WHO/UNICEF/UNU consultation. World Health Organization,Geneva

20. World Bank (1994) Enriching lives. Overcoming vitamin A and mineral malnutrition in developing countries. World Bank, Washington, DC

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