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Indian Journal of Community Medicine

Effect of Health Education on Knowlege, Attitude and Practices About Anaemia Among Rural Women in Chandigarh

Author(s): Manmeet Kaur, Kamaljit Singh

Vol. 26, No. 3 (2001-07 - 2001-09)

Abstract:

Research question: Is health education effective in changing the knowledge, attitude and practices (KAP) of women for anaemia prevention?

Objective: To assess the effect of health education on the KAP of women for prevention of anaemia in a village of Chandigarh.

Study design: Quasi-experimental.

Setting: A village of Chandigarh (U.T.). Participants: Sixty currently married women in reproductive age group were selected using systematic random sampling technique.

Methods: Interpersonal and group communication approaches were used to communicate messages on anaemia to a group of 30 women in four sessions over one month period (intervention group). Three months after health education their KAP were compared with 30 women of the same village who were not selected for health education programme (control group).

Statistical analysis: Chi-square test.

Results: Socio-economic and demographic characteristics of both the intervention and control groups were similar. All women in the intervention group could specify at least one correct cause of anaemia and identified a sign or symptom of anaemia, whereas, 73.3% and 46.6% women in the control group did not know the cause and signs and symptoms of anaemia respectively (p<0.001). The knowledge about methods of anaemia prevention was significantly higher in intervention group compared to control group (p<0.001). In intervention group, 93% women were in favour of including green leafy vegetables in their diet compared to 67% in control group (p<0.01). Higher proportions of women in intervention group were taking green leafy vegetables and iron tablets than control group but the differences were not statistically significant.

Conclusions: There was significant change in the knowledge and attitude of women who received health education. A co-ordinated communication strategy is required to improve anaemia prevention practices in the community.

Keywords: Anaemia, Women, Health education, Nutrition

Introduction:

Anaemia is one of the most widespread nutritional deficiency diseases. It affects all age groups and both sexes in most states of India. Profoundly affected groups are adolescent girls (74% to 98%), pregnant women (82% to 98%) and women in childbearing age (74% to 99%). Male population also has high rate of anaemia especially among elderly (>60 years age group)1.

Women are more vulnerable to anaemia because their needs of iron are greater than those of adult men. Women having closely spaced pregnancies are particularly at risk2.

National nutritional anaemia prophylaxis programme has been in operation for a number of years3. The programme aims at provision of iron and folic acid supplements to the `high risk' groups, identification and treatment of severely anaemic cases and promotion of the consumption of iron rich food. Change in dietary pattern is a long-term strategy for prevention of anaemia.

Indian women generally cook food keeping in mind the taste and preference of family members. They can introduce iron rich foods to family diet if they know that anaemia is an important health problem and can be prevented by increasing the intake of iron rich foods. Therefore, a study was carried out in a village to evaluate the effect of health education on the knowledge, attitude and practices of women related to anaemia.

Material and Methods:

This study was carried out in a peri-urban village of Chandigarh. All the 60 married women in the age group of 20 to 45 years were selected for the study. Thirty of them residing in northern part of the village were selected for health education intervention and 30 women living in the southern part served as control. A semi-structured interview schedule was developed and pre-tested to collect information on knowledge, attitude and practices about anaemia. Interview schedule had questions on the causes, signs and symptoms, complications, methods of prevention and role of dietary practices related to anaemia.

Health educator initially established a contact with the women individually at home and talked about causes, symptoms and prevention of anaemia. Then women were motivated to participate in health education sessions to be conducted in their locality. The purpose and importance of the health education activity was explained to them. On a fixed day of the week, a lecture cum discussion session was organized for these women in groups comprising of 10-12 women at a time. A total of 4 sessions were organized to cover all aspects of anaemia. Medical professionals facilitated two sessions out of the four.

Group discussion and a role-play followed the lectures. Picture posters were displayed in the lecture room. A film `Kuposhan Ke Parbhav' (effects of malnutrition) on iron deficiency was also shown to them in one of the sessions. Messages around two major themes i.e. effects of anaemia and requirement of iron and folic acid were the focus of health education.

Anaemia can lead to impairment in motor development and co-ordination, lack of efficiency/ decreased physical activity, impaired language and scholastic achievement in children, it specially affects the women in the reproductive age; daily iron requirement of an adult woman is twice that of an adult man; iron requirement during pregnancy increases many-fold, extra demand of iron during pregnancy cannot be met by adequate diet alone; supplement with iron and folic acid tablets is necessary.

Significant differences in the socio-economic and demographic characteristics, knowledge, attitudes and practices of women in the intervention and control group were tested three months after the last health education session using chi-square test.

Results:

Table I: Socio-demographic profile of women in intervention and control groups.

Characteristic Intervention n=30 No.(%) Control n=30 No.(%) x*2, df, p
Age group (years)
20-25 12(40.0) 16(53.3)
26-30 11(36.7) 10(33.3)
31+ 7(23.3) 4(13.3) 1.44, 2, 0.4
Education
Primary or less 13(43.4) 12(40.0)
Middle 7(23.3) 4(13.3)
Matric 10(33.3) 14(46.7) 1.52, 2, 0.4
Family income (Rs.)
<1000 2(6.7) 4(13.3)
1000-1400 11(36.7) 12(40.0)
1500-1900 13(43.3) 10(33.3)
2000+ 4(13.3) 4(13.3) 1.10, 3, 0.7

Forty percent women in the intervention group and 53.3% in the control group were in the age group of 20-25 years. The differences in the age, education and income level in the intervention and control group were not statistically significant (Table I).

Table II: Effect of health education on knowledge, attitude and practices of rural women about anaemia.

Characteristic Intervention
n=30 No.
(%) Control
n=30 No.
(%) x*2, df, p
Anaemia is a health Problem
Yes 30 (100.0) 14 (46.7)
No 0   16 (53.3) 19.18, 1, <0.001
Causes of anaemia
Pregnancies 2 (6.7) 0  
Poor nutrition 10 (33.3) 6 (20.0)
Excessive bleeding 16 (53.3) 2 (6.7)
All of the above 2 (6.7) 0  
Don't know 0   22 (73.3) 37.89, 4, <0.001
Signs and symptoms
Pallor 22 (73.3) 14 (46.6)
Weakness 8 (26.6) 2 (6.7)
Don't know 0   14 (46.6) 19.38, 2, <0.001
Anaemia prevention methods
Green leafy vegetables 16 (53.3) 30 (100.0)
De-worming 4 (13.3) 0  
Iron tablets 4 (13.3) 0  
All of above three 6 (20.0) 0   18.26, 3, <0.001
Will visit to health centre if suspects anaemia
Agree 28 (93.3) 23 (76.7)
Disagree 2 (6.7) 7 (23.3) 2.09, 1, 0.14
Intake of green leafy vegetables
Agree 28 (93.3) 20 (66.7)
Disagree 2 (6.7) 10 (33.3) 6.67, 1, 0.001
Intake of iron tablets
Agree 26 (86.6) 22 (73.3)
Disagree 2 (6.7) 8 (26.7)
Neutral 2 (6.7) 0   5.93, 2, 0.05
Knew her anaemic status
Yes 14 (46.6) 6 (20.0)
No 13 (43.3) 10 (33.3)
Don't know 3 (10.0) 14 (46.6) 8.94, 2, 0.01
Recognized anaemia by
Feeling of weakness 8 (26.7) 8 (26.7)
Blood test 17 (56.7) 6 (20.0)
Doctor told 2 (6.7) 2 (6.7)
Don't know 3 (10.0) 14 (46.6) 12.38, 3.0, 0.006
Intake of iron rich diet
Yes 22 (73.3) 18 (60.0)
No 8 (26.6) 12 (40.0) 0.68, 1, 0.41
Intake of iron tablets
Yes 12 (40.0) 8 (26.6)
No 18 (60.0) 22 (73.3) 0.68, 1, 0.41

The knowledge, attitude and practices are presented in Table II, `Anaemia is a health problem', was known to all the 30 women in the intervention group compared to 14(46.7%) women in the control group (p<0.001). All women (100%) in the intervention group could specify at least one correct cause of anaemia and could identify a sign or symptom of anaemia, whereas, 73.3% and 46.6% women in the control group did not know the cause and signs and symptoms of anaemia respectively (p<0.001). The knowledge about methods of anaemia prevention was significantly higher in intervention group compared to control group (p<0.001).

There were significant changes in the attitude of intervention group. In intervention group, 93% women were in favour of including green leafy vegetables in their diet compared to 67% in control group (p<0.001). Forty seven percent women in the intervention group knew their anaemia status compared to 20% women in the control group. Intake of iron rich diet and iron tablets was higher in intervention group compared to control group but the difference was not statistically significant.

Discussion:

Malnutrition results from three key factors: inadequate food intake, illness and deleterious caring factors. Integrated child development services scheme has been designed to take care of all the three factors. In addition, micronutrient supplementation schemes for iron have also been implemented. However, these efforts have not succeeded in solving the problem of micronutrient malnutrition4 because little attention has been paid to nutrition education.

Most rural women of control group in our study had poor knowledge about anaemia despite the fact that all the women had undergone pregnancy and had been the beneficiaries of the anaemia prophylaxis programme. Whereas, those who were exposed to nutrition education had much better understanding about causes, symptoms and the means of prevention of anaemia. Therefore, the programme should educate individuals and families about the means to prevent nutritional deficiencies along with the distribution of supplements. A structured advocacy programme is required at governmental level after developing a common frame of reference for understanding malnutrition and how to deal with it5.

Better outcome in the present study suggests that a health education strategy based on gentle persuasion is likely to be more successful. Our experience indicated that involving only women in the nutrition education may not solve the problem as due to their subordinate position in the family their suggestions may not be accepted by other family members. In our study, despite nutrition education, two women did not agree to include green leafy vegetables in the family diet due to opposition by the family. Therefore, to bring change in the practices, all the family members both men and women need to participate in the nutrition education activity.

It was realized while conducting the nutrition education sessions in our study that educator should use the language and terms used by the community. Participatory activities such as role-play allow the women to express many difficult situations that they encounter in their families. It not only helps in problem identification but the group can also find a suitable context specific solution. Social marketing and education is vital strategy to bring about desired change in feeding behaviour. Improved production, availability and access to foods at affordable prices is another important component5.

Acknowledgements:

I acknowledge the help rendered by Mrs. Surjeet Kaur, LHV and Mrs. Amarjeet Kaur, ANM of Palsora subcenter in planning and organization of field work. I am grateful to Dr. Rajesh Kumar for his technical comments which helped me in improving the paper and Dr. H.M. Swami for granting permission to use audio-visual aids of the department of Community Medicine, Government Medical College, Chandigarh.

References:

  1. Chakravarty I. Control of micronutrient malnutrition at grass root level through the involvement of existing infrastructure and manpower. National conference on opportunities and challenges for preventing micronutrient malnutrition through ICDS. Conference Programme. Department of Women and Child Development, GOI and United Nations World Food Programme, India 2000: 43-4.
  2. Levin HE et al. Micronutrient deficiency disorders. Draft monograph, World Bank Health Sector Priority Review, Washington D.C., 1990.
  3. ICMR Tast Force. Evaluation of the National Nutritional Anaemia Prophylaxis Programme-A study. ICMR Bulletin, 1994.
  4. Dodd NS. Micronutrient Malnutrition: Preventing the "Hidden Hunger". National Conference on opportunities and challenges for preventing micronutrient malnutrition through ICDS. Conference Programme. Department of Women and Child Development, GOI and United Nation's World Food Programme, India 2000. p46-57.
  5. National strategy to reduce childhood malnutrition. Hyderabad; Administrative Staff College of India, 1997.

Manmeet Kaur, Kamaljit Singh
Deptt. of Community Medicine,
Post Graduate Institute of Medical Education and Research, Chandigarh 160012

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