|Year : 2014 | Volume
| Issue : 1 | Page : 22-25
Nutritional status of adolescent girls residing in rural area: A community-based cross-sectional study
Sulakshana S Baliga, Vijaya A Naik, Maheshwar D Mallapur
Department of Community Medicine, Jawaharlal Nehru Medical College, Nehru Nagar, Belgaum, Karnataka, India
|Date of Web Publication||7-Feb-2014|
Sulakshana S Baliga
Department of Community Medicine, Jawaharlal Nehru Medical College, Nehru Nagar, Belgaum - 590 010, Karnataka
Source of Support: None, Conflict of Interest: None
Background: Adolescence is a period of transition between childhood and adulthood. Nutritional requirements during this period increase tremendously compared to preceding years of growth. The nutritional status of adolescent girls, the future mothers, contributes significantly to the nutritional status of the community. The present study was aimed to assess the current nutritional status of the adolescent girls. Materials and Methods: This one-year community-based, cross-sectional study was undertaken at a village Peeranwadi of District Belgaum, Karnataka among 400 adolescent girls of 10 to 19 years. Information on socio-demographic variables was collected by an interview using pre-designed and pre-tested questionnaire. A 24-hour recall method was used to assess nutrient intake. The nutrient intake was calculated using tables of nutritive value of Indian foods. For the comparison of anthropometric data, National Center for Health Statistics and National Health and Nutrition Examination Survey standards were used. Results: The mean age among the study population was 12.9 ± 2.06 years. Majorities (73.5%) of them were Hindus, 98.5% were literate, and 90% were currently studying. Adolescent girls between 10 and 14 years were more stunted (63.82%) as compared to 15 to 19 years (40.84%) (P = 0.0003) and thin (60.79% vs. 39.43%; P = 0.0009). Overall, the mean calorie intake was observed to be 1272.20 ± 133.28 kcal/day, protein intake was 40.99 ± 3.32 gm, and iron intake was 14.42 ± 2.58 mg. Conclusion: Overall, majority of girls were having dietary intake less than 50% of RDA, and almost three fourth of girls were anemic.
Keywords: Anthropometry, adolescent girls, calorie, dietary recall, nutritional status
|How to cite this article:|
Baliga SS, Naik VA, Mallapur MD. Nutritional status of adolescent girls residing in rural area: A community-based cross-sectional study. J Sci Soc 2014;41:22-5
|How to cite this URL:|
Baliga SS, Naik VA, Mallapur MD. Nutritional status of adolescent girls residing in rural area: A community-based cross-sectional study. J Sci Soc [serial online] 2014 [cited 2017 Apr 28];41:22-5. Available from: http://www.jscisociety.com/text.asp?2014/41/1/22/126712
| Introduction|| |
Adolescence is a crucial period when major physical, psychological, and behavioral changes take place.  This group constitutes about 22% of the Indian population.  Malnutrition is associated with significant morbidity, mortality, and affects the reproductive outcome in adolescent girls. , Owing to sudden growth taking place in this phase, nutritional requirements in them also increase compared to preceding years of growth. However, there is very little information about diet and nutritional status of adolescents, particularly from rural areas in India. In view of the above facts, an attempt was made to assess the current nutritional status of the adolescent girls.
| Materials and Methods|| |
This one-year community-based, cross-sectional study was undertaken at village Peeranwadi of District Belgaum, Karnataka.
The study was approved by Institutional Ethics Committee, Jawaharlal Nehru Medical College, Belgaum. Four hundred (400) adolescent girls of 10 to 19 years were selected for the study, by systematic random sampling method. After obtaining a written informed consent, the interview was conducted at the residence of the girls using pre-designed and pre-tested questionnaire. It included the information on socio-demographic variables. A 24-hour recall method was used to assess nutrient intake. The nutrient intake was calculated using tables of nutritive value of Indian foods.  For the purpose of analysis, adolescent girls were categorized into early and late adolescents.  For the comparison of anthropometric data, National Center for Health Statistics and National Health and Nutrition Examination Survey standards were used. , The hemoglobin estimation was done using cyanomathaemoglobin method.
The statistical analysis was done using SPSS statistical software applying chi-square test and student 't' test.
| Results|| |
The mean age among the study population was 12.9 ± 2.06 years [Table 1]. Majority (73.5%) of them were Hindus, and 394 (98.5%) were literate [Table 1]. In the present study, 360 (90%) were currently studying, 11 (2.8%) were housewives, and 29 (7.2%) were doing domestic work. Six (6%) were illiterate, and 34 (8.5%) were school dropouts.
Among 400 girls, 385 (96.25%) were unmarried and 15 (3.75%) were married. With regard to socio-economic status, 8 (2%) belonged to class II, 50 (12.5%) belonged to class III, 92 (23%) belonged to class IV, and 250 (62.5%) belonged to class V [Table 1]. Fifty-one percent had attained menarche, and 51% of them attained menarche by age of 11 years. The mean age of menarche was 13.00 ± 2.15 years. Of the 15 (3.75%) married girls, nine (60%) were pregnant, and all nine pregnant women were registered for antenatal care (ANC), either in government or private hospital. In the present study, out of 300 adolescent girls with anemia, 85 (21.25%) adolescent girls were taking vegetarian diet and 315 (78.75%) had mixed diet.
In the present study, 317 (79.2%) fathers and 270 (67.5%) mothers of adolescent girls were literates. One hundred and fifteen (28.8%) fathers were educated up to primary level, 137 (34.2%) up to high school, and 65 (16.2%) up to college, while 151 (37.8%) mothers were educated up to primary school, 103 (25.8%) up to high school, and 16 (4%) up to college.
The overall mean weight of the study population was 29.5 ± 8.08 kgs with range being 15 kgs to 55 kgs, and mean height was 138.60 ± 29.54 cms with range minimum being 102.50 cms to maximum 165 cms. Adolescent girls between the age 10 and 14 years were more stunted (63.82%) as compared to 15 to 19 years (40.84%) based on less than third percentile of NCHS standards (P = 0.0003) [Table 2]. Adolescent girls between the age 10 and 14 years were more thin (60.79%) as compared to 15 to 19 years (39.43%) based on less than fifth percentile of NHANES standards (P = 0.0009). In the present study, mean height, weight, and BMI were less among the adolescent girls aged between 10 and 14 years compared to 15 to 19 years (P = 0.000) [Table 2].
Overall, the mean calorie intake was observed to be 1272.20 ± 133.28 kcal/day, protein deficit was 40.99 ± 3.32 gm/day, and iron deficit was 14.42 ± 2.58 mg/day. The age-wise mean calorie, protein, and iron requirements, intake, and deficits are as shown in [Table 3], [Table 4], [Table 5] respectively.
|Table 3: Age-wise requirement, intake, and deficits of calories (kcal/day) |
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| Discussion|| |
Nearly one fourth of India's population comprises of adolescents representing a vibrant human resource. Nutritional status during adolescence is an important determinant of health outcomes. Hence, it is of utmost importance to improve nutritional status during adolescence.
A recent UNICEF's "State of the World's Children 2011" report says that more than half (56%) of adolescent girls in India are suffering from anemia. The appalling nutritional figures for adolescents put India in the company of least developed nations such as Congo, Burkina Faso, and Guinea. India, in fact, beats even sub-Saharan Africa with the highest underweight adolescent girl population of 47% in age group of 15 to 19 years. 
The most common causes among the school dropouts in this study have been domestic work (38.23%), opposition by parents (41.17%), and marriage (8.82%). According to NFHS-2,  the most common causes for not attending school have been education not considered necessary (13.17%), not interested in studies (15.8%), involvement in domestic work (24.5%), and did not afford fee (24.5%). UNICEF Report 2011 has also showed that for girls, school attendance has dropped sharply from primary to secondary school that is 83% to 59%. 
In the present study, 15 (3.75%) were married. Among them, four (1%) married before 18 years of age, and 11 (2.75%) married after 18 years of age. Among the married adolescents, more than half of them were pregnant. According to UNICEF Report 2011, 43% of girls were married off before the age of 18, and more than half of them gave birth before they turned adults, and 6000 adolescent mothers die every year. 
In this study, majority of adolescent girls were anemic (75%), and of them, 46.75% had mild anemia, 20.75% had moderate, and 4.5% had severe anemia. Study  from Rural Medak reported prevalence of anemia as 81% (mild 63.2%, moderate 12.5%, and severe 5.3%). Other studies  conducted in Bangladesh, Indonesia, Nepal, Mynamar, Srilanka report prevalence of anemia as 43%, 25.8%, 42%, 26.4%, and 40%, respectively. Whereas study  conducted in Tamilnadu reported 30% prevalence of anemia. According to UNICEF Report 2011, India's appalling figures include: 56% girls are anemic, on par with Congo, Burkina Faso, and Guinea.  High prevalence of anemia in this study could be due to lower socio-economic status and nutritional deficiency among adolescent girls.
Various studies , have reported significant association of socio-demographic parameters like age, religion, socio-economic status, diet, menarcheal status, literacy status of parents with anemia. However, in the present study, these socio-demographic parameters have not shown any statistically significant association with anemia (P > 0.05). In both the age groups, percentage of girls with severe anemia has been more in class V socio-economic group indicating nutritional deficiency; ignorance could be the reasons for severe anemia. Hemoglobin status of moderately and severely anemic girls in both age groups, if not corrected, may expose them to high-risk pregnancy in future.
The average calorie intake was 1272.2 ± 133.38 kcal/day, and calorie intake was deficient by 35%. A study done in Wardha reported that calorie intake was deficient by 39%. A study  done in Rajasthan reported that calorie intake was deficient by 36%, 34%, and 26% in the age group 10 to 12 years, 13 to 15 years, and 16 to 18 years, respectively.  Another study  done in Bihar reported that calorie deficiency among adolescents was 29%.
The average protein intake was 40.99 ± 3.32 gm/day, and the protein intake was deficient by 32%. A study  done in Wardha reported that average protein intake was 39.5 ± 7 gm/day, and protein intake was deficient by 36%. A study  done in Rajasthan reported that protein intake was deficient by 29%, 32%, and 23% in the age group 10 to 12 years, 13 to 15 years, and 16 to 18 years, respectively.
The average iron intake was 14.42 ± 2.58 mg/day and was deficient by 37%. A study  done in slums of Bombay on adolescent girls found that mean iron intake was 7.0 ± 3.1 mg in the age group of 14 to 16 years in low socio-economic status, while in upper socio-economic status, it was 18.5 ± 5.2 mg, and it was also found that in the age group of 17 to 18 years, the mean iron intake was 10.1 ± 3.1 mg in lower socio-economic status, and in upper socio-economic status, it was 24.1 ± 3.7 mg. Various studies , have reported similar findings. Several surveys ,, on adolescent girls have shown that diets are inadequate in nutrients including iron, proteins, calcium, and calories.
Adolescent girls constitute an important segment of the population. Their health status influences their reproductive functioning, pregnancy outcomes, birth weight, pregnancy wastage etc. In the present study, almost three-fourth of girls were anemic. Their status of anemia is likely to worsen during pregnancy, leading to complications including post-partum hemorrhage. Iron supplementation programs specially meant for adolescent girls need to be introduced for both school-going and non-school-going girls. As majority of girls were having dietary intake less than 50% of RDA by ICMR, whatever cooked in home, one extra meal should be advised. Further, emphasis on improvement of nutritional status of adolescent girls through counseling and health education is needed.
| Acknowledgements|| |
Dr. V. D. Patil, Principal, Jawaharlal Nehru Medical College, Belgaum for the permission to conduct this study, Staff of Department of Community Medicine, Staff of PHC, Kinaye PHC and all study subjects who participated in the study for their cooperation in data collection.
| References|| |
|1.||Mala V, Kumar D, Dwiwedi S, Dabral SB. Psychological behavioural pattern of unmarried adolescent girls in urban area of Allahabad, Uttar Pradesh. Indian J Community Med 2007;32:7-9. |
|2.||Mathur JS. Preventive and Social medicine - A Comprehensive Textbook. 1 st ed. New Delhi: CBS Publishers and Distributors; 2008. p. 405. |
|3.||World Health Organisation: Physical Status. The use and interpretation of Anthropometry. Technical Report Series No. 854. Geneva: WHO: 1995. p. 6. |
|4.||Kurz KM. Adolescent nutritional status in developing countries. Proc Nutr Soc 1996;55:321-31. |
|5.||Indian Council of Medical Research. Nutrient requirements and recommended dietary allowances for Indians. Hyderabad: National Institute of Nutrition, Indian Council of Medical Research; 2000. p. 43-9. |
|6.||World Population Prospects. The 2004 revision and World Urbanization Prospects: Population division of the Department of Economic and Social Affairs of the United Nations Secretariat. UNICEF; 2004. |
|7.||WHO. Measuring change in nutritional status. Geneva: World Health Organization; 1983. |
|8.||Over 50% adolescent girls in India anaemic. UNICEF. Available from: http://southasia.oneworld.net/todaysheadlines/over-50-adolescent-girls-in-india-anaemic-unicef [Last accessed on 2011]. |
|9.||Gupta SD. Adolescent Reproductive Health in India: Status, Policies, Programs, and Issues, POLICY Project. Available from: http://www.policyproject.com/pubs/countryreports/ARH_India.pdf. [Last accessed on 2003]. |
|10.||Prevention and control of anaemia in rural adolescent girls through school system, Andhra Pradesh Indian Institute of health and family welfare, annual report 2001-2002. Hyderabad, India: Andhra Pradesh Indian Institute of health and family welfare; 2003. |
|11.||World Health Organization. Adolescent Nutrition - A review of the situation in selected South East Asian Countries. No. SEA/NUT/163. New Delhi: Regional Office for South East Asia; 2006. |
|12.||Joseph GA, Bhattacharji S, Joseph A, Rao PS. General and reproductive health of adolescent girls in rural south India. Indian Pediatr 1997;34:242-5. |
|13.||Rawat CM, Garg SK, Singh JV, Bhatnagar M, Chopra H, Bajpai SK. Sociodemographic correlates of anaemia among adolescent girls in rural area of district Meerut. Indian J Community Med 2001;26:173. |
|14.||Chondhary S, Mishra CP, Shukla KP. Nutritional status of adolescent girls in rural area of Varanasi. Indian J Prev Soc Med 2003;34:53-61. |
|15.||Maliye CH, Deshmukh PR, Gupta SS, Kaur S, Mehendale AM, Garg BS. Nutrient intake amongst rural adolescent girls of Wardha. Indian J Community Med 2010;35:400-2. |
|16.||Chaturvedi S, Kapil U, Gnanasekaran N, Sachdev HP, Pandey RM, Bhanti T. Nuttrient intake amongst adolescent girls belonging to poor socioeconomic group of rural area of Rajasthan. Indian Pediatr 1996;33:197-201. |
|17.||Yadav RJ, Singh P. Nutritional status and dietary intake in tribal children of Bihar. Indian Pediatr 1999;36:37-42. |
|18.||Chakraborty N. Health and nutritional status of adolescent girls in a selected slum of Bombay. Dissertation. Bombay: SNDT University; 1992. |
|19.||Reddy V, Rao PN, Satry G, Kashinath K. Nutrient trends in India Hyderabad: National Institution of Nutrition. Indian Council of Medical Research; 1993. p. 33. |
|20.||Vasanthi G, Pawashe AB, Susie H, Sujatha T, Raman L. Iron nutritional status of adolescent girls from rural area and urban slum. Indian Pediatr 1994;31:127-32. |
|21.||Pushpamma P, Geervani P, Devi NL. Food intake, nutrient adequacy and anthropometry of adolescents in Andhra Pradesh. Indian J Med Res 1982;75:61-7. |
|22.||Thimmayamma BV, Rau P, Rao KV. Socioeconomic status, diet and nutrient adequacies of different population groups in urban and rural Hyderabad. Indian J Nutr Diet 1982;19:173-83. |
|23.||Kapil U, Manocha S, Bhasin S. Dietary intake amongst 'well to do' adolescent boys and girls in Delhi. Indian Pediatr 1993;30:1017-9. |
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]