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Indian Journal of Community Medicine

Effect of De-worming on Response of Iron-Folic Acid Supplementation Among Adolescent School Girls of Lucknow

Author(s): S Tripathi, M.Z. Idris, J. Masood

Vol. 29, No. 4 (2004-10 - 2004-12)

Introduction

Adolescence the second decade of life (10-19) years) is a period of transition from childhood to adulthood1. Nutritional anaemia, particularly iron deficiency anaemia (IDA) is perhaps clinically the most wide-spread nutritional deficiency disorder in the world today2. The risk of iron deficiency is proportional to growth velocity and it increases during the adolescent growth spurt3,4. Following the growth spurt, the risk continues to remain high for girls because of menstrual blood loss, but subsides for boys. Significant impact of iron-folate, vitamin A and de-worming in reducing anaemia and improving iron status and growth of mid-day meal programme beneficiaries in western India has been clearly demonstrated5. In a study in India it was found that one third of adolescent girls had history of passing worms. The prevalence of anaemia was double in these girls (53.6%) compared to those who were not infected (25%)6. The present study was conducted to know whether de-worming together with iron-folic acid supplementation is more effective in improving haemoglobin status than iron-folic acid supplementation alone.

Material and Methods

The study was carried on 100 adolescent school girls (10-19 years) who had attained their menarche, attending schools of Lucknow city (from March 2001 to February 2002). It was a randomized controlled trial. Sampling technique adopted was two stages stratified random sampling. In 1st stage government and government aided girls Inter Colleges of Lucknow city were stratified into 6 regions, then one region was selected randomly and at second stage 2 girls Inter Colleges from the selected region were selected on random basis. 50 students each were selected from 1st and 2nd school on voluntary basis7. These 50 students drawn from first and second schools each were further randomly divided into 2 groups of 25 students each, out of which first 25 students were given iron folic acid (100mg of iron + 500mgm of folic acid) for three month+ single course of de-worming agent (400 mg of Albendazole) in the second month and next 25 students were given iron folic acid tablets (100mg of iron + 500mgm of folic acid) for three months and single dose of placebo tablets in place of de-worming agent.

Sahli's method was used for haemoglobin estimation. Haemoglobin cut-off level for determining anaemia as per WHO guidelines was taken as 12g/dl8 Information about biosocial characteristics and history of passing any kind of worm in last one year were gathered from the girls and recorded in a pre tested schedule, girls were followed up for the intervention period and haemoglobin was estimated within one week of completion of three months intervention.

Results

Table I shows history of passing worns and prevalence of anaemia.

Table I : Anaemia in Adolescent Girls in Relation to Passing Worms.

Girls Passing Worms Total Anaemic No. (%)
Yes 39 26 66.67
No 61 39 63.93
Total 100 65 65
RR=1.04, p=0.8

Table II shows that mean change in haemoglobin with and without de-worming was 1.74gm% and 1.62 gm% respectively (p=0.6) among the two groups and difference in mean increase in haemoglobin level after iron folic acid supplementation with and without de-worming was statistically not significant.

Table II: Effect of De-worming on Response of Iron Folic Acid Supplementation.

  Before Intervention After Intervention Mean Change
Mean Hb (gm%) level with De-Worming (n=50) 10.72±1.79 12.46±1.53 1.74
Mean Hb (gm%) level withouot De-Worming (n=50) 10.96±1.76 12.58±1.42 1.62
p value between with and without De-Worming = 0.6

Discussion

The results of study show that when de-worming was done response of iron folic acid supplementation on haemoglobin was not significantly different in the group receiving de-worming agent and the other group without de-worming agent. This may be because about 1/3rd (39%) girls had histroy of passing worms and no statistically significant relation of anaemia in girls passing worms was found in relation to those who were not passing worms (p=0.8), though very weak association of anaemia was found in relation to passing worm (RR=1.04) in adolescent girls. This finding was similar to the finding of Passi et al (Personal Communication).

Limitation of study

It is pertinent to mention here that results should be interpreted cautiously due to limitation of the study design. Response to therapy depends upon many factors and not only history of passage of worms. Secondly, usually de-worming is done first and then patient is put on iron preparation.

References

  1. Justice G Padmadan. Understanding adolescent II. Teens 2000; 1:8-10.
  2. Indicators for assessing iron deficiency and strategies for its prevention. A draft based on WHO/UNICEE/UNU Consultation, New York, 6-10 Dec. 1993.
  3. Beard J. Iron requirements in adolescent females. Journal of Nutrition 2000; 130:440S-442S.
  4. Dallman PR, Simes MA, Stekel A. Iron deficiency in infancy and chilhd. Am J Clin Nutr 1980; 33:86-118.
  5. Gopaldas T, Kanani SJ, Raghva RA, Cause for introducing nutrient inputs and deinfestation measures in the mid-day meal programme. Proceedings of Nutrition Society of India, 1983.
  6. Rawat CMS. An epidemiological study of anaemia in adolescent girls in the rural areas of Meerut. University, 2000.
  7. Sample size determination in health studies. Geneva: World Health Organization, 1991.
  8. Iron deficiency anaemia assessment, prevention and control, a guide for programe manager. Geneva: World Health Organization, 2001; Distribution No. WHO/NHO/01.3.

Deptt. of Community Medicine,
K.G. Medical College, Lucknow-226003

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