A Quasi-Experimental Study to Evaluate the Effectiveness of Beet root Juice in The Level of Heamoglobin and Clinical Manifestations of Anemia among Adolescent Girls in selected Schools at Dharapuram

Ms. S. A. Helan¹, Mrs. P. Jasmine Sharmila², Mrs. Sheela Rani³, Mrs. Dr. Christy Mekala⁴

¹RN RM MSc. Nursing, Community Health Nursing, Bishop’s College of Nursing, C.S.I Mission Compound, Dharapuram - 638656.

²Associate Professor, Community Health Nursing, Bishop’s College of Nursing,

C.S.I Mission Compound, Dharapuram – 638656.

³Professor, Community Health Nursing, Bishop’s College of Nursing,

C.S.I Mission Compound, Dharapuram – 638656.

⁴Principal and Head of the Department, Community Health Nursing, Bishop’s College of Nursing,

C.S.I Mission Compound, Dharapuram – 638656.

*Corresponding Author E-mail: helansweety916@gmail.com

ABSTRACT:

Anemia is a condition in which you lack enough healthy red blood cells to carry adequate oxygen to your body’s tissues. Anemia is a public health problem that is increasing throughout the world especially in developing countries. This study was aimed to evaluate the effectiveness of beetroot juice on the level of heamoglobin and clinical manifestations of anemia among adolescent girls in selected schools at Dharapuram. The research approach used for the study was evaluative approach. The study was true experimental pretest post test only design was used. The conceptual frame work adopted for the present study was based on Pender’s health promotion model.(2002-Revised). Systemic random sampling technique was used to select the 100 samples for the study, 50 were in experimental group and 50 were in control group. The tool used for this study was cyanmethemoglobin method to determine the level of heamoglobin and score of clinical manifestations was checked by using modified structured observational checklist. The beetroot juice was given for 4 weeks in the mid- morning for experimental group. The collected data were analyzed using descriptive statistics and inferential statistics. The mean pretest level of heamoglobin 9.5(SD±1.00) was significantly higher than the mean post test level of heamoglobin 8.06(SD± 0.76) in the experimental group. The paired ‘t’ value for heamoglobin was 2.094 which was significant at P<0.05 level of significance. The mean pre test score of clinical manifestations 1.6(SD ± 0.79)was significantly lower than the mean post test score of clinical manifestations 2.1(SD ±1.0)in the experimental group. The paired ‘t’ value for score of clinical manifestation was 0.81 which was significant at p<0.05 level of significance. There were significant associations between heamoglobin and clinical manifestations with demographic variables except age of adolescents, types of food, religion, family income per month, types of family members. The study findings revealed that beetroot juice has significantly improved the level heamoglobin and reduced the score of clinical manifestations among adolescent girls in experimental group.

KEYWORDS: Anemia, Heamoglobin, Beetroot juice, Clinical manifestations, Adolescent girls.

INTRODUCTION:

Anemia is not a specific disease state but a sign of an underlying disorder. It is by far the most common hematologic condition. Anemia, a condition in which the heamoglobin concentration is lower than normal, reflects the presence of fewer than normal RBC_s within the circulation. As a result, the amount of oxygen delivered to body tissues is also diminished.¹ Adolescent has been defined by WHO as the period of life spanning the ages between 10-19. It is the formative period of life where maximum amount of physical and behavioral changes takes place. There are about 1.2 billion adolescents in the world, which is equal to1/5_th of the world’s population and their numbers are increasing, out of these 5 million adolescents are living in developing countries.² Anemia is a major health problem throughout the world with an annual prevalence of 400 million. The prevalence rates are higher in developing countries like India, especially affecting toddler, adolescents and early adult. It is one of the most prevalent health issues among adults within reproductive age group. WHO has estimated that prevalence of anemia among reproductive age group is 14% in developed and 51% in developing countries while it is 65-75% in India. The Indonesian National Household Health survey in 2001 showed that 30% od adolescent girls (10-19yrs) were anemic. This figure is similar to findings from other smaller studies showing an anemia prevalence between 22% and 44%, indicating that anemia is a health problem in Indonesia. According to WHO guidelines, anemia is considered a public health problem when the prevalence is higher than 15%.³ As per District Level health Survey (DLHS) (2002-04). Prevalence of anemia in adolescent girls is very high (72.6%) in India, with prevalence of severe anemia among them much higher (21.1%) than that in preschool children (2.1%) than that in preschool children (2.1%). In adolescent girls, educational or economic status does not seem to make much of a difference in terms of prevalence of anemia. Prevention, detection, or management of anemia in adolescent girls has till now not received much attention.⁴

MATERIALS AND METHODS:

Research Approach:

An Evaluative approach was adopted for this study.

Research Design:

The research design selected for the study was experimental basic research pre-test post- test only design.

Setting of the study:

The study was conducted in C.S.I girls higher secondary school and Ponnu girls higher secondary school at Dharapuram.

Population:

The populations for this study was adolescent girls.

Sample:

Adolescent girls between the age group of 12 to 16years.Who are all attained menarche.

Sample Size:

Sample size for the study is 100, 50 were in experimental group and 50 were in control group.

Sampling Technique:

Probability systematic random sampling technique was used to select the sample for the study.

Instrument and Scoring Procedure:

The instrument consists of 3 sections

Part I:

It consists of s demographic data such as age, religion, types of family, number of family members, family income per month, type of food, height, weight, BMI, history of menstrual cycle, when was the last deworming drugs taken, Source of health information.

PART II:

Assessment of heamoglobin level:

It includes assessing the Heamoglobin level of adolescent girls by using cyanmethemoglobin method.

According to WHO classification

PART III:

Structured observational checklist:

This is an observational checklist to assess the score of clinical manifestation of Anemia.

The clinical manifestations was scored as one (1) and the clinical manifestation absent was scored as zero (0). The total score is 10.

Cheklist Scoring for Clinical Manifestations of Anemia

SCORE	CATEGORY
Mild	1-3
Moderate	4-6
Severe	7-10

Validity:

The validity of the tool was obtained from 5 community to the suggestions and recommendations of the experts and research guide.

Reliability:

The reliability of the instrument was assessed by using interrator method (Karl Pearson’s formula) The value was found to be reliable (r =0.9). The reliability of the observational checklist was assessed by using interrator method (Karl Pearson’s formula). The value was (r=0.9).

Protection of Human Rights:

The research proposal was approved by the dissertation committee prior to conduct pilot study and main study. The verbal consent was obtained from the school students after explaining the purpose of the study.

Data Collection Procedure:

The study was conducted in CSI girls higher secondary school and Ponnu girls higher secondary school in Dharapuram. Before the study the investigator has obtained the written permission from the head mistress of the school. In CSI girls higher, secondary school between the age group from 12- 16 years were 201 students. On the first- and second-day screening procedure was done. Heamoglobin level was checked by using cyanmethemoglobin method, score of clinical manifestations was assessed by using modified structured observational check list. The samples who had mild and moderate anemia were selected as study participants. Third day the demographic variables were collected. And the level of anemia for 50 samples was assessed by checking the heamoglobin using cyanmethemoglobin method, and score of clinical manifestations of anemia was assessed by modified structured observational checklist, at last deworming tablet distributed. Instructed to take the tablet after dinner on the same day. For all the students heamoglobin level was checked and among them 101 students met the inclusion criteria. A name list was prepared and among those 101 students every 2^nd student was selected as study sample by using systematic random sampling 50 students were selected for experimental group. In Ponnu Girls Higher Secondary School 185 students were there, for all the students heamoglobin level was checked and score of clinical manifestations of anemia was assessed by using modified structured observational checklist. Among them 105 students met the inclusion criteria using systematic random sampling every 2^nd student was selected 50 students were selected for control group . From 3^rdday beetroot juice was prepared by following ingredients Beetroot 1_1/2k.g (460 calories), jaggery 1k. g (3620 calories), lemon -80ml (17 calories), ginger-50gram (40 calories), mint -10 leaf (6 calories), water -3.5 liter and it was measured in an ounce glass of 150 ml. And distributed to each student in the mid-morning once in a day for 4 weeks for the improvement in the level of heamoglobin among the adolescent girls. After the 4 weeks Post test was conducted for 2 days among the experimental group and control group, to check the level of heamoglobin and score of clinical manifestations of anemia. At last health education was given using the pamphlet regarding anemia.

RESULTS AND DISCUSSION:

Regarding age, 8(16%) belongs to 12 years, 16(32%) belongs to 13 years, 18(36%) belongs to 14 years, 7(14%) belongs to 15 years and 1(2%) belongs to 16 years in experimental group. In control group6 (12%) belongs to 12 years, 16(32%) belongs to 13 years, 22(44%) belongs to 14years 3(6%) 15years, 2(4%) belongs to 16 years. Regarding religion 41(82%) belongs to Hindu, and 9(18%) belongs to Christian in experimental group. In control group 31 (62%) belongs to hindu, 14(28%) belongs to muslim, 5(10%) belongs to Christian. Regarding type of family 37(74%) belongs to nuclear family, 10(20%) belongs to joint family, 3(6%) belongs to single parent family in experimental group. In control group 35(70%) belongs to nuclear family, 12(24%) belongs to joint family, 3(6%) belongs to single parent family. Regarding number of family members 6(12%) belongs to 3 members, 24(48%) belongs to 4 members 18(36%) belongs to 5 members, and 2(4%) belongs to above 5 members in experimental group. In control group 7(14%) belongs to 3 members, 19(38%) 4members, 13(26%) belongs to 5 members, 11(23%) belongs to above 5 members. Regarding family income per month 32 (64%) belongs to Rs 5001-10,000, 10(20%) belongs to Rs 10,001-15,000, and 8(16%) belongs 15,000 and above in experimental group. In control group 23(46%) belongs to Rs5001-10, 000, 16(32%) belongs to 10,000-15,000, 11(22%) Rs.15,001 and above. Regarding type of food 29(58%) were vegetarian, 21(42%) was non- vegetarian in experimental group. In control group 12(24%) belongs to vegetarian, 38(76%) belongs to control group. Regarding height, weight, body mass index 22(44%) belongs to below 18.5, 23(46%) belongs to normal 4(8%) belongs to preobesity, 1(2%) belongs to obesity class II in the experimental group. In control group 26(52%) belongs to below 18.5, 22(44%) belongs to normal, 1(2%) belongs to pre obesity 1(2%) obesity class II. Regarding history of menstrual cycle 8(16%) belongs to 28 days cycle, 26(52%) belongs to 30 days cycle 16(32%) belongs to irregular in the experimental group. In control group 29 (58%) belongs to 28 days cycle, 15(30%) belongs to 30 days cycle 6(12%) belongs to irregular menstrual cycle. Regarding deworming drugs 9(18%) belongs to before one month, 8(16%) belongs to before 3 months, 10 (20%) belongs to before 6month, 23(46%) belongs to not at all fore in the experimental group. In control group 3 (6%) belongs to before one month 45(90%) belongs to before 3 months, 2(4%) belongs to before 6 months. Regarding source of health information 9(18%) belongs to newspaper, 7(14%) belongs to radio/television, 11 (22%) belongs to peer groups, 23(46%) belongs to health professionals in the experimental group. In control group1 (2%) belongs to newspaper, 49(98%) belongs to radio/television.

Table 1: Comparison of mean score, standard deviation, mean difference, paired ‘t’ test and level of heamoglobin among adolescent girls in experimental group. n=50

Experimental group

Variables

Mean Difference

’t’ Value

Table Value

Level of

Heamoglobin

Pre-test

7.8

0.64

1.7

5.72

3.4

Post test

9.5

1.00

df=49 P<0.05

Table: 2 Comparison of mean score, standard deviation, mean difference paired ‘t’ value and clinical manifestations of anemia among adolescent girls in experimental group. n=50

Experimental Group	Variables	M	SD	Mean Difference	‘t‘ Value	Table Value
Score of clinical manifestations	Pre test	3.64	1.67	0.7	13.00	3.4
Score of clinical manifestations	Post test	1.66	0.7	0.7	13.00	3.4

df=49 p<0.05

Table: 3 Comparison of mean, mean difference, standard deviation and independent ‘t’ value level of heamoglobin of anemia in experimental group and control group. n₁50, n₂=50

Level of Heamoglobin	Pre test		Post test		‘t’ value	Table vale	Inference
	M	SD	M	SD
Experimental Group	7.8	0.6	9.5	1.0	8.82	1.98	Significant
Control Group	8.1	0.8	8.0	0.7

df =98 p<0.05

Table: 4 Comparison of mean, mean difference, standard deviation and independent ‘t’ value score of clinical manifestations of anemia in experimental group and control group. n₁=50, n₂=50

Score of Clinical Manifestation	Pre test		Post test		‘t’ value	Table vale	Inference
	M	SD	M	SD
Experimental Group	3.6	1.6	2	0.7	2.7	3.4	Significant
Control Group	2.0	1.1	2.1	1.0

p<0.05 df =98

Table 1: depicts that the mean pre-test level of heamoglobin in experimental group 9.5(SD ±1.00) and mean post-test level of heamoglobin in 9.5(SD±1.00). The paired ‘t’ value was 5.7 Which was significant at p<0.05 level. Which shows that beetroot juice was improving the heamoglobin level. Hence, the hypothesis H₁ that the mean post- test level of haemoglobin is significantly higher than the mean pre-test level of haemoglobin in experimental group was accepted.

Table 2: depicts that the mean pre-test and post test score of clinical manifestations anemia in experimental group 3.64(SD±1.67) and mean post-test score of clinical manifestations of anemia 1.66(SD±0.7). The paired ‘t’ value was 13.00 Which was significant at p<0.05 level, which shows that beetroot juice was decreasing the clinical manifestations. Hence the hypothesis H₂the mean post test score of clinical manifestations of anaemia is lower than the mean pre-test score of clinical manifestations of anemia in experimental group was accepted.

Table 3: depict that the mean pre test score of level of heamoglobin in experimental group 7.8(SD±0.6) and 8.1(SD±0.8) control group. The mean post test score of level of anemia in experimental group 9.5(±0.8) and 8.0(±0.7) control group. The independent ‘t’ value was 8.82 which was significant at p<0.05 level. Hence the H₃that the mean post test level of heamoglobin in experimental group is significantly higher than the mean pretest level of heamoglobin in control group was accepted.

Table 4: depicts that the mean pre test score of clinical manifestations of anemia in experimental group 3.6(SD ±1.6) and 2.0 (SD±1.1) control group. The mean post test score of clinical manifestations of anemia in experimental group 2.0(SD±1.1) and 2.1(SD±1.0) control group. The independent ‘t’ value was 2.7 Which was significant at p<0.05 level. Hence the hypothesis H₄ that the mean post test score of clinical manifestations of anemia in experimental group is significantly lower than the mean post-test clinical manifestations of anaemia in control group was accepted.

CONCLUSION:

The present study assessed the effectiveness of beetroot juice among adolescent girls with anemia. The study findings revealed that there was a significant difference in the pretest and posttest level of heamoglobin (‘t’ value 5.72) and score clinical manifestations of anemia (‘t’value 13.00). Therefore the investigator found out it is evident that the beetroot juice is effective in reducing anemia among adolescent girls

IMPLICATION FOR NURSING:

· Nurse can conduct screening programme in the community and organize school health programme in schools.

· Nurse can organize awareness programme on anemia and its management for adolescent girls.

· Nurse can provide nutritional counselling to the adolescent girls in order to modify their dietary behaviours.

Nursing education:

· The community health nurse can organize in service education for the VHN, ANM and anganwadi workers regarding early detection of anemia among adolescent girls.

· The nurse educator can make the students to organize and conduct workshop, cooking demonstrations, role play regarding iron rich diet and prevention of anemia.

Nursing administration:

· Mass health education using IEC package of anemia and its prevention can be given to adolescent girls and their family.

· The nurse administrator can organize awareness programme in the villages among the mothers of school children and adolescents regarding anemia and its preventive measures.

Nursing research:

· The findings of the study can be effectively utilized by the emerging researchers for their reference purposes.

· Students can do a mini project on other dietary intervention on anemia among adolescent girls with same age group.

RECOMMENDATIONS:

· Similar study can be conducted for a larger group.

· A health camp can be conducted among the same population after introducing a health education program.

· A comparative study can be conducted between the adolescence girls with anemia from selected schools.

· A study can be conducted to identify the factors influencing anemia school children.

LIMITATIONS:

It was time consuming for preparing beetroot juice.

Since the understanding level of adolescent girls was different the investigator faced problem in collecting blood samples.

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