During adolescence, more than 20% of the total growth in stature and upto 50% of adult bone mass are achieved. Adolescent girls need additional requirements of iron upto 15% to compensate the physiological blood loss during menstruation. Stunted and undernourished girls are more likely to have complications during pregnancy and give birth to low birth weight babies.
In view of the above, present study was carried out to find out the magnitude of anemia in adolescents in an urban community of Shimla and to ascertain the factors infl uencing anemia.
A school based cross-sectional study was conducted through a pretested, semi structured interview schedule in Boileaugang, an urban field practice area of Dept. of Community Medicine, Indira Gandhi Medical College, Shimla during June 2002 to January 2003. All (870) students of eleventh and twelfth class of four senior secondary schools aged 10-19 years were included in the study. The students were asked about their age, dietary habits, water and food hygiene, history of worm infestation, menstrual problems (in females), and symptoms of anemia viz. headache, fatigue, dyspnoea, blurring of vision, parasthesia, syncopal attacks. All the students were then clinically examined for the signs of anemia. Later 10% of students were selected by systematic random sampling technique and tested for anemia using Sahli’s hemoglobinorneter. WHO definition of anemia in adolescents was used (hemoglobin level below 12gm% in girls and 13gm% in boys1.
Clinical case definition for anemia used in the study was pallor in palpebral conjunctiva and hard palate(2). A group of five experts from field of medicine and pediatrics examined each student for pallor and diagnose a case as anemia after reaching consensus. For grading personal hygiene, a scoring system was devised based on regular bath, trimming of nails, cleaning of hairs, washing of hands before meals, cleanliness of clothes/footwear, presence of lice and skin diseases. For dietary history, the diet taken by adolescents during the last one week was ascertained. Inadequacy of green leafy vegetables, pulses and meat were calculated when the respondents had not taken either of these during the last one week. Chi square test was applied for the purpose of analysis. Informed consent of the head of the institution was taken.
A total of 870 adolescents (480 males and 390 females) participated in the study. Anemia was diagnosed clinically in 62 (12.9%) males and 52 (13.3%) females with an overall prevalence of 13.1 %. Mean age of adolescent boys suffering from anemia was 15.3 years while of girls was 15.1 years. The prevalence of anemia in both males and females were highest in 10-13 year age group and it decreased with increase in age. Almost equal prevalence of anemia was found in males. A total of 48 (77.4%) anemic males and 33 (63.5%) anemic females had poor personal hygiene. It was also observed that, 95 (23%) anemic males had history of worm infestation as compared to 378 (77%) non-anemic males (p<0.001).
Table 1: Relationship of Various Epidemiological Variables and Clinical Symptoms with Anemia
|Variables||Anemic group||Nonanemic group||P value|
|Age group (in years)|
|Present||95(23)||318(77)||P < 0.001|
| Green leafy
|77(10.1)||684(89.9)||P < 0.001|
|Pulses||97(11.9)||715(88.1)||P < 0.001|
|Meat||30(16.6)||150(83.4)||P > 0.05|
|Blurring of vision||8||33||P>0.05|
*Figure in parentheses denotes percentages
Among females, 44 (84.6%) anemic subjects had history of worm infestation as compared to 147(43.8%) non-anemic females (p<0.001). The relationship of poor diet (i.e. inadequacy of green leafy vegetables, pulses) with anemia was found to be statistically significant (p<0.001), although, the relationship of anemia with meat intake was found to be insignifi cant. It was also seen that, 30 (53.6%) anemic females had menstrual problems like menorrhagia, polymenorrhea, or irregular menstrual cycle cycles as compared to 22 (6.6%) non-anemic females (p<0.05). The signs and symptoms viz. Headache, fatigue, dyspnoea, parasthesia and syncopal attacks were significantly (p<0.05) more prevalent in anemic subjects in both males and females. Blurring of vision was not significantly associated (p=0.21) with anemia. (Table 1) Based on hemoglobin estimation by Sahli’s hemoglobinometer in 87 randomly selected adolescents, the prevalence of anemia was 14.9% (15.5% in males and 14.3% in females).
Various studies conducted in India3,4 and other developing countries5, have shown a high prevalence6 of anemia in adolescents i.e. between 25 to 88%. Agha eta16 conducted a study in adolescents residing in Islamabad showed a prevalence of anemia in 17% males and 18% females. Similarly, a low prevalence of 20% was observed in a study by Abalkhail etal in Saudi Arabia7. Low prevalence of anemia among adolescents is unique to this study.
Some studies3 reported higher prevalence of anemia in girls as compared to boys. Similar finding was observed in our study (14.3% males vs. 15.5% females by Sahli’s hemoglobinometer method). Few studies5 have shown that mean hemoglobin level among adolescents increased with increase in age and the prevalence of anemia decreases with age. Similar findings were observed in our study. In the study, worm infestation was significantly associated with anemia. Various studies10 have also shown that continued presence of worms in a population of adolescents with rapid growth needs, may contribute significantly to blood loss in intestine with resultant anemia.
Few studies3,7 have shown that menstruating girls were more at a risk of being anemic than non-menstruating girls. In our study, the prevalence of anemia was significantly higher in the group of females that had menstrual problems like menorrhgia, polymenorrhea and irregular menstrual cycles. In our study, anemia was significantly associated with lower intake of green-leafy vegetables, and, pulses. This is in conformity with other studies3. In the study, it was shown that, consumption of vegetables, milk and meat resulted in lower prevalence of anemia among adolescent girls and more vegetarians were anemic as compared to non-vegetarians.
The low prevalence of anemia among adolescents reported in our study needs further evaluation. This remains to be seen whether it was due to the higher altitude where chance of anemia are reported to be lesser9. However, NFHS II had reported a prevalence of 40.5% among women and 56% among adolescents in Himachal Pradesh10. So further comparative studies (hilly versus plain areas) on prevalence of anemia among adolescents may be planned.
(1)Deptt. of Community Medicine, Postgraduate Institute of Medical
Education and Research (PGIMER), Chandigarh-160012
(2)Deptt. of Community Medicine, I.G. Medical College, Shimla, H.P.