INTRODUCTION



RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCE

BANGALURU, KARNATAKA

PERFORMA FOR REGISTRATION OF SUBJECT FOR

DISSERTATION

|1 |NAME OF THE |Ms. Kavitha. R |

| |CANDIDATE AND |1ST Year .M. sc (N) |

| |ADDRESS |E.T.C.M. College nursing, |

| | |Kolar-563101, Karnataka. |

|2 |NAME OF THE |E.T.C.M. College nursing, |

| |INSTITUTION |Kolar-563101. |

|3 |COURSE OF |Master degree of nursing |

| |STUDY |Medical surgical nursing |

| |& SUBJECT | |

|4 |DATE OF |01-06-2009 |

| |ADMISSION TO | |

| |COURSE | |

|5 |TITLE OF THE |“A study to assess the effectiveness of structured teaching programme |

| |TOPIC |regarding causes and management of iron deficiency anemia in adults on |

| | |knowledge of nursing students in a selected colleges at Kolar.” |

BRIEF RESUME OF THE INTENDED WORK

6. INTRODUCTION:

Achieving health and remaining healthy is an active process. There are four general determinants of health including human biology, environment, and lifestyle and health care services. Health is maintained and improved not only through the advancement and application of health science, but also through the efforts and intelligent lifestyle choices of the individual and society. But people can become ill due to many factors such as lack of nutritional diet, and lack of activity, which leads to many blood related disorders. One such condition is iron deficiency anemia.1

The term anemia is derived from ancient Greek for “Blood less ness ’’Anemia affects all age groups and both sex in most states of India. Most profoundly affected groups are adolescent girls 74-98% women 82%-98 and woman in child bearing age 74% to 99% women are more vulnerable to anemia because their needs for iron is greater than those of adult men. Women having frequent pregnancies are particularly at risk. Iron deficiency anemia is the most common nutritional disorder in the world affecting over a billion people. It is estimated that 90% of anemic people reside in the developing countries with highest prevalence in south Asia including India.2

Several strategies have been developed which include fortification of food with iron, oral medicinal iron and slow release iron preparations. Poor effectiveness of these strategies in developing countries has been attributed to various factors, which include inefficient dose, time of supplementation and poor adherence. There is a concept that medium to long term weekly ingestion of iron supplements has proven efficacious if it is properly supervised)

The prevalence of IDA among pregnant women and pre-school children in South East Asia is between 50-70%. According to National Health survey of Pakistan report, about 43 to 47% of rural and 35 to 41% of urban women between 15 to 44 years are anemic. Similarly among boys and girls aged 5 to 14 years, 44% of urban girls and 46% of rural boys are anemic.

Iron, being an integral component of hemoglobin, myo-globin, cytochromes and iron containing enzymes essential for intermediary metabolism, is considered as a main culprit for IDA development. It may be due to higher requirements in children as compared to elderly people, low socioeconomic status, low bioavailability of dietary iron and mal absorptive diseases, which contribute, to development of IDA. Children are at a higher risk of becoming iron deficient due to rapid growth spurt, worm infestations and in teen-age girls due to menstrual loss. Iron deficiency manifests itself as decreased physical performance, altered cognitive functioning, delayed mental development, poor pregnancy outcomes, and slow growth in young children. The social, health and economic costs of IDA are not insignificant and in the broad context of public health concerns it should always be considered along with clinical implications. The general measures to control iron deficiency practiced at present include, modification of diet and life style aimed at increasing iron intake bioavailability. These practices include breast feeding, adequate amount and varieties of foods in meals including heme iron, changes in cooking practices to reduce phytates and other polyphenols, which inhibit iron absorption. Iron fortification programs to alter the basal consumption of iron and targeted interventions to decrease the intake of known inhibitors of iron absorption are viable alternatives to supplementation programs in some cases and need to be carefully considered.

In a study conducted in Indonesia in 1995, Schultink used a randomized, double blind trial of daily supplementation compared with twice weekly ferrous sulphate (30mg) given for two months to 2-5 years old children with iron deficiency anemia. The results of this therapeutic trial showed that daily and twice weekly iron supplements worked equally well, regardless of the severity of anemia.

A study was carried out in Berkley, California in which daily vs. weekly supplementation therapy trial was done on women of reproductive age group (18-45 years). Group one received daily iron for three months, group two, weekly iron for seven months and group three was control group. Both iron supplemented groups were equally effective in bringing hemoglobin levels above 12.0 to 12.5 g/dl in three months. 25 Another weekly supplementation therapy conducted in Indonesian female adolescents (14-18 years). They were divided into three groups. One group received 60 mg elemental iron daily, other the same dose weekly and third group received double dose (120 mg) weekly. After two months, groups that received daily and double dose weekly showed significant improvement in hemoglobin and ferritin levels, while the group that was on single weekly dose showed less increase in ferritin levels. 26 Similar studies were carried out in Lima Peru in adolescent girls aged 12-18 years, to assess the efficacy and acceptability of daily and intermittent iron supplementation. Result of this study concluded that daily supplementation led to greater increase in hemoglobin than intermittent iron supplementation but serum ferritin and free erythrocyte protoporphyrin were similar in two groups.3

These can be achieved by creating awareness among the nursing students regarding Iron deficiency anemia and ways to prevent it. So, its necessary as a member of health care team the student nurses should take initiative to create awareness among the public.

6.1 Need for Study

The importance of anemia as a major public health problem throughout the world and it is widely recognized. Globally anemia is estimated to effect 3.5 billions individuals in the developing world or well over 2 persons out of 3. More than 320 millions people in India suffer from iron deficiency anemia with the highest prevalence among woman and children, 40-80% expectants woman, 60-70% children and 50% adolescent girls.4

Anemia dietetic association says that, Iron deficiency anemia is one of the most common chronic hematologic disorder, is found in up to 30% of the world population. In the United States, it occurs in about 5% to 10% of people over 45. In addition, those most susceptible to iron deficiency anemia are the very young, those on poor diets, and women in their reproductive years. Normally, 1 mg of iron is lost daily through faeces, Sweat and urine in the adult male and 1.5mg / day in normal menstruating women. The median total iron loss with pregnancy is about 500mg or almost 2 mg /day over the 280 days of gestation.5

A cross sectional study was conducted in Zimbabwe to determine the prevalence of iron deficiency and iron deficiency anemia (IDA) in selected population groups. The design of the study was a cross sectional, household prevalence survey. A structured questionnaire was used to interview study participants to elicit information on risk factors associated with iron status and IDA. Blood samples were collected for quantitative measurement of ferritin in serum and hemoglobin estimation as part of a full blood count. Setting of the study was conducted in four administrative provinces of the country, Mashonaland Central, Midlands, Matabeleland South and Matabeleland North covering three of the five agroecologocial regions of the country. Thirty clusters were randomly selected from 28 enumeration districts. Subjects: The multistage sampling technique was applied. The total sample consisted of 3.15 study participants made up of 746 pregnant women, 800 lactating women, 811 adult males and 799 pre-school children. The results of this study were the overall prevalence of IDA was 24.1% of the total study sample. Of the preschool children surveyed 17.7% had IDA. 33.0% of pregnant women, 29.6% lactating women and 16.5% of adult males had IDA. Of the populating 9.1% surveyed had evidence of iron depletion on the basis of serum ferritin levels. More of the pregnant women had iron depletion, 14.8%, compared to adult males with 2.2%. The conclusion of this study was iron deficiency anemia (IDA) is a problem of public health significance in Zimbabwe and is associated with areas of food insecurity. 6

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.

A special symposium entitled improving Adolescent Iron Status before Child bearing was convened in Washington DC. The conclusions 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 second or third trimester. Thus they concluded that emphasis needs to be placed on pre-pregnancy programs to increase body iron stores.7

Iron deficiency anemia develops from a low red blood cell count or hemoglobin level caused by too little iron in the body; it occurs when iron intake cannot keep pace with iron loss. Iron is a crucial part of the hemoglobin, a molecule in the red blood cells that carries oxygen to cells throughout the body. When the body does not have enough iron stored, too little hemoglobin is made to fill the red blood cells, causing a decrease in the size and number of red blood cells. This in turn cuts down on the body’s ability to carry oxygen to the tissues, resulting in extreme fatigue with no evident cause.8

A statistical report indicates that the incidence of iron deficiency anemia is increasing and more in developing countries in India. This could be due to lack of knowledge and attitude regarding anemia and the ways to prevent it.

The investigators also came across with various nutritional problems like iron deficiency anemia among the patients and observe that there was lack of nutritional awareness among the people.

Based on researchers experience it is felt that education among nursing students is important to improve iron in the body and management of its deficiency and take care of them selves and to disseminate the knowledge in bringing the awareness of the public. As teaching enhance the knowledge of the researcher designed structured teaching programme to find out its effectiveness on iron deficiency anemia and its management.

6.2 REVIEW OF LITERATURE

Review of literature is the task of reviewing literature, which involves the identification, selection critical analysis, and reporting of existing information on the topic of interest. it provides the bases to locate the data, new ideas that need to be included in the present study it helps the researcher to find the accurate data that could be used for supporting the present finding and drawing conclusion

This chapter deals with a review of published and unpublished research studies and related material for the present study the review helped the researcher to develop on insight into the problem area and helped to build the foundation of the study

The Review of literature is presented under the following broad heading

6.2.1. Review related to causes of iron deficiency anemia in adults

6.2.2. Review related to management of Iron deficiency anemia in adults

6.2.3. Review related to structured teaching programme on Iron deficiency anemia.

6.2.1. Review related to causes of iron deficiency anemia in adults

The study was conducted in an urban area of Pakistan the background of this study was anemia affects almost two-thirds pregnant women in developing countries and contributes to maternal morbidity and mortality and to low birth weight. The objective of this study to determine the prevalence of anemia and the dietary and socioeconomic factors associated with anemia in pregnant women living in an urban community setting in Hyderabad, Pakistan. The method of this study was a prospective, observational study of 1,369 pregnant women enrolled at 20 to 26 weeks of gestation and followed to 6 weeks postpartum. A blood sample was obtained at enrollment to determine hemoglobin levels. Information on nutritional knowledge, attitudes and practice and dietary history regarding usual food intake before and during pregnancy were obtained by trained interviewed within 1 week of enrollment. The result of this study was the prevalence of anemia (defined by the WHO was hemoglobin ................
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