NUTRITIONAL STATUS OF ADOLESCENT GIRLS OF URBAN ...

Indian Journal of Community Medicine Vol. XXVII, No.4, Oct.-Dec., 2002

NUTRITIONAL STATUS OF ADOLESCENT GIRLS OF URBAN SLUMS AND THE IMPACT OF IEC ON THEIR NUTRITIONAL KNOWLEDGE AND PRACTICES A. Saibaba, M. Mohan Ram*, G.V. Ramana Rao**, Uma Devi, T.S. Syamala*** Deptt, of Communication, *Director, **Deptt. of Epidemiology, ***Deptt. of Demography, Indian Institute of Health and Family Welfare, Vengalrao Nagar, Hyderabad - 500 038 (A.P.) Abstract: Research question: What is the nutritional status of adolescent girls living in urban slums and methods to improve their nutritional knowledge and practices through Information, Education and Communication (IEC). Objective: To assess the nutritional status and dietary intake of adolescent girls and study the impact of IEC programme on their nutritional knowledge and practices. Study design: After collection of the baseline data, IEC intervention was carried out for six months and its impact was studied. Setting and participants: 2500 adolescent girls from urban registered slums located in twin cities of Hyderabad and Secunderabad, Andhra Pradesh, India. Statistical analysis: Proportions, Z test. Results: Though the pattern of growth in adolescent girls was similar to that of NCHS standards, their heights and weights at any given age were far below the standards and deficit increased with age. Iron deficiency anaemia was found to be the most common nutritional problem observed in them. After IEC intervention significant proportion of girls could correctly identify the foods rich in various important nutrients. A marked increase in the intake of finger millet or ‘Ragi’ was observed, which is a very rich source of calcium as well as iron. Conclusions: The IEC intervention resulted in improvement of nutritional knowledge of adolescent girls as well as behavioural pattern as envisaged by better cooking methods arid increase in the consumption of nutrient rich foods.

Key Words: Adolescent girls, Nutritional status, Nutrient intake, IEC intervention, Link volunteers

Introduction:

The period of adolescence comprises nearly half of the growing period. Besides the obvious changes in physical size and shape associated with adolescent growth and the onset of puberty, there are social and psychological changes that are equally transformative in magnitude. With the profound growth, comes increased demand for nutrients like proteins, energy, vitamins and minerals. Since majority of the adolescent girls especially representing the lower segments of society are undernourished with associated social maladies like son preference, incidence of early marriage and high rates of maternal mortality, a strong focus on improvement in nutritional status of adolescent girls through IEC is warranted. Several studies reported earlier also confirm the need for special attention to improve the health and nutritional status of the adolescents1-8. Material and Methods:

The study was conducted in the registered slums under India Population Project-VIII, MCH, located in twin cities of Hyderabad and Secunderabad, Andhra Pradesh - India. Girls between 10 and 19 years of age were covered in the 151

study. One hundred slums were selected based on criteria like availability of (a) an active NGO, (b) Urban heath post (UHP) (c) link volunteer scheme etc. These slums are being covered by 8 urban health posts and 3 NGOs. Link volunteer scheme is also in operation. Availability of adolescent girls was ascertained through household enumeration survey. In each of 100 slums, a quota of 25 adolescent girls or a total of 2500 respondents were covered, which accounts for 63% of all adolescent girls available in the study areas. A combination of anthropometry, biochemical, dietary assessment and interview schedule method was used for assessing the nutritional status and nutritional knowledge of adolescent girls. The study was conducted in three stages. In the first- stage, baseline data were collected using a specially designed pretested interview schedule. Four female trained investigators with home science background collected data/samples pertaining to KAP, nutritional status (height and weight), dietary intake (24 hours recall oral questionnaire method, using standard cups)9. Finger prick samples of blood (20 ul) were collected from subjects using standardized pipettes on ‘Whatman# 1 filter paper’. After


recording identification particulars on each filter paper, these wefe dried and placed in individual envelops. Haemoglobin levels were estimated at National Institute of Nutrition (NIN), Hyderabad by cyanmethaemoglobin method, within seven days10. The diet surveys were carried out on randomly selected sub-sample of 125 families from all UHP centres. In the second stage an intensive IEC intervention was carried out for a period of 6 months mainly through Inter Personal Communication (IPC) techniques. The IEC tools used included cooking demonstrations, posters, information booklet, innovative games and nutrition melas. Cooking demonstrations were held in all the intervention areas. They were organized in collaboration with Food and Nutrition Extension Board, Govt. of India. Adolescent girls were taught to prepare simple iron, calcium and energy rich recipes. They were also provided information on nutritive values of some commonly consumed food articles, right cooking methods and some tips to preserve nutrients while cooking. As a part of IEC intervention, some innovative participatory learning activities in the form of games were used. The approach used in these games is called ‘experiential learning’. It helped girls to learn from their own experiences, with facilitator-trainer as a guide. Situations and problems were presented, discussed and analyzed. Problem-solving is emphasized. The experimental games were conducted by the project investigators, with the help of facilitator's guide, which were intended to motivate young girls to change undesirable behaviours and adopt new behaviours, promote participation in the learning process. The informative booklet on adolescent health and nutrition, four multicoloured posters on education, nutrition, health and hygiene and age at marriage were used to evoke positive response among subjects. All the respondents were given information pertaining to their heights and weights, haemoglobin status etc. As a part of nutrition melas, poster exhibition on nutrition was also held. Services of Gynaecologist, Pediatrician, Public Health Specialist, Nutrition and Communication experts were utilized during the melas. Counselling sessions were held and many doubts with regard to nutrition, healthy cooking practices and

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menstruation were clarified by concerned specialists. Adolescent girls themselves presented some cultural items like songs, street plays etc. In the third stage, a repeat survey was conducted to find out the impact of IEC intervention in terms of improvement in knowledge scores. The data were computerized and analysis was done with SPSS package. Per cent frequency of each of the responses for various individual aspects/questions included in the schedule was calculated. The proportions Z test was applied to measure the impact of IEC intervention. Results:

The socio-economic profile: Table I: Socio-economic profile of respondents (n=2500). No. Age in years

Percent/ Mean±SD

14.3±3.4

Marital status Unmarried Married

2460 40 330

98.4

948 1105 117

37.9 44.2 4.7 7.0±2.7 7.1 32.8

Type of family

178 821 708 32 704 57 2070

Nuclear Joint

430

17.2

1430 195 875

57.2 7.8 35.0

Education (years of schooling)

1.6 13.2

Illiterate l-6th class 7-10th class >10th class Schooling in years Caste/Religion Hindu-Upper caste Hindu-Backward caste Hindu-Scheduled caste Hindu- Scheduled tribe Muslims Christians

Current status

Studying Working Helping in household activities

28.3 1.3 28.2 2.3 82.8

Saibaba A et al


The mean age of the adolescent girls was 14.3 years. Majority of respondents were unmarried (98.4%). The educational levels of the adolescent girls revealed that 13.2% of them were illiterates, around 38% of them had primary education and 44% of them had high school (7-10 years) education. Only a very small proportion of the girls studied upto 10th standard and above. The mean years of schooling among the sample population was 7 years. Distribution of the respondents according to religion showed that the majority of them were Hindus (69.5%) with greater proportion representing either backward castes (32.8%) or scheduled castes (28.3%). About one third of the subjects were Muslims. Majority of respondents (82.8%) belonged to nuclear family. Out of the total 2500 girls, 57.2% were studying, 7.8% of them were working and 35% were engaged in household activities (Table I).

observed in 49.0%, 31.3% and 7.9% of respondents respectively. Only 12.0% of respondents were found to be having normal haemoglobin levels of >12 g/dl.

Nutrient intake: Table II: Mean intake of nutrients (per day) by adolescent girls (10-17 years) - (n=163). Nutrient

Mean±SD

RDA

Proteins (gms)

39±17.28

57-63

Fat (gms) Energy (kcal) Calcium (gms) Phosphorous (mg) Iron (mg) Vitamin A (µg) Thiamin (mg)

20+13.33 1600±53U2 324±634.46 839±354.36 20±34.37 428±2176.87 07±0.41

22 1970-2060 600 500-600 19-30 600 1.0

Riboflavin (mg) Niacin (mg) Vitamin C (mg) Folic acid (u,g)

07±0.58 10±4.53 51±160.55 137±272.79

:

Nutritional status: The mean height of subjects was 147.1 cms and their mean weight was 38.7 kg. The pattern of growth was similar to that of NCHS standards. However, the heights and weights of study subjects at any given age were far below the NCHS standards and the deficit increased with age. The maximum increase in the height and weight was observed between 10 and 14 years of age and later it got stabilized. According to height for age SD classification of NCHS revealed that 7.2% were categorized as severely malnourished, 27.9% as moderately malnourished, 43% were mildly malnourished and 21.9% were classified as normal11,12. Iron deficiency anaemia was found to be the most common nutritional problem encountered by respondents. About 88% of subjects were anaemic using WHO classification13. Mild, moderate and severe anaemia was

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153

1.2 13-14 40 70-100

Barring the intake of vitamin C (51 mg), folic acid (137 ug) and to some extent fat (20 gms), recommended dietary allowances for adolescents as suggested by ICMR, in respect of major nutrients like proteins, energy, calcium, iron, vitamin A etc., were not met (Table II).

Impact of lEC intervention: Following IEC intervention, the knowledge about physical changes improved significantly. About 70% of the subjects for the first time received information on growth and development during IEC intervention. Though they were not aware earlier, after IEC intervention, 77.6% of girls could correctly identify the foods rich in iron, 55.2% could recall calcium rich foods and 62% could list the energy and protein rich recipes/food articles.

Saibaba A et al


Table III: Consumption of food items* - (n=2500). Pre IEC intervention*

Post IEC intervention*

Proportions Z value

Cereals

98.8

99.7

3.70**

Millets (Ragi)

3.5 63.5 92.7

97.9

66.80** 6.43** 6.12**

Pulses Fats/oils Oil-seeds Meat

Eggs Milk and milk products Vegetables Fruits Rice flakes Condiments/spices

8.7

72.0 96.6 9.2

27.3 12.7 24.5 73.6 30.6 1.6 9.7

27.0 16.5 19.6 82.8 36.0 2.8 10.5

0.62 0.23 3.81** 4.18** 7.88** 0.46 2.89** 0.94

*Precentage of study subjects consumed the food items on previous day; **Significant at p