a study on the neckshaftangle of femur

TO STUDY THE SOCIODEMOGRAPHIC PROFILE AND PREVALENCE OF ANAEMIA IN ADOLESCENT GIRLS IN RURAL

FIELD PRACTICE AREA OF B.L.D.E.A’S SHRI B.M.PATIL MEDICAL COLLEGE, BIJAPUR.

BY

DR. MANJULA S. PATIL

DISSERTATION SUBMITTED TO THE

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA,

BANGALORE

IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF

M.D.DEGREE

IN COMMUNITY MEDICINE

UNDER THE GUIDANCE OF

DR. M. M. ANGADI M. D.

Professor & Head

DEPARTMENT OF COMMUNITY MEDICINE B.L.D.E.A’S

SHRI B M PATIL MEDICAL COLLEGE HOSPITAL & RESEARCH CENTRE BIJAPUR

September 2006

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TO STUDY THE SOCIODEMOGRAPHIC PROFILE AND PREVALENCE OF ANAEMIA IN ADOLESCENT GIRLS IN RURAL

FIELD PRACTICE AREA OF B.L.D.E.A’S SHRI B.M.PATIL MEDICAL COLLEGE, BIJAPUR.

By

Dr. Manjula S. Patil

Dissertation submitted to the

Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore

In partial fulfillment of the requirements for the degree of

M.D. Degree

In Community Medicine

Under the guidance of

Dr. M. M. Angadi M. D.

Professor & Head

Department of Community Medicine BLDEA’S

Shri B M Patil Medical College Hospital & Research Centre Bijapur

September 2006

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Rajiv Gandhi University of Health Sciences, Bangalore, Karnataka

DECLARATION BY THE CANDIDATE

I hereby declare that this dissertation entitled “TO STUDY THE

SOCIODEMOGRAPHIC PROFILE AND PREVALENCE OF ANAEMIA IN

ADOLESCENT GIRLS IN RURAL FIELD PRACTICE AREA OF B.L.D.E.A’S

SHRI B.M.PATIL MEDICAL COLLEGE, BIJAPUR.” is a bonafide and genuine

research work carried out by me under the guidance of DR. M. M. ANGADI, M.D,

Professor And Head, Department of Community Medicine, B.L.D.E.A’S Shri. B.M. Patil

Medical College, Bijapur.

Date: Place: Bijapur Dr. Manjula S. Patil

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CERTIFICATE BY THE GUIDE

This is to certify that the dissertation entitled “TO STUDY THE



SHRI B.M.PATIL MEDICAL COLLEGE, BIJAPUR.” is a bonafide research work

done by Dr. Manjula S. Patil in partial fulfillment of the requirement for the degree of

M.D.Community Medicine.

DR. M. M. ANGADI M.D

Professor and Head Department of Community Medicine B.L.D.E.A’s Shri. B. M. Patil Medical College BIJAPUR

Date: Place: BIJAPUR

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ENDORSEMENT BY THE

HEAD OF THE DEPARTMENT AND PRINCIPAL

B. L. D. E. A’s Shri B. M. Patil Medical College,

Hospital And Research Centre,

Bijapur

This is to certify that the dissertation entitled “TO STUDY THE



SHRI B.M.PATIL MEDICAL COLLEGE, BIJAPUR.” is a bonafide research work

done by Dr. Manjula S. Patil under the guidance of Dr .M. M. Angadi, M.D, Professor

And Head, Department of Community Medicine, B. L. D. E. A’s Shri. B.M. Patil Medical

College, Bijapur

Head of Department of Community Medicine Principal Dr. M. M. Angadi Dr. R.C. Bidari

M. D M.D (Medicine) BLDEA’s Shri. B. M. Patil BLDEA’s Shri. B. M. Patil Medical College, Bijapur Medical College, Bijapur Date: Date:

Place: Bijapur Place: Bijapur

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COPYRIGHT

Declaration by the Candidate I hereby declare that the Rajiv Gandhi University of Health Sciences, Karnataka

shall have the rights to preserve, use and disseminate this dissertation in print or electronic

format for academic / research purpose.

Date: Place: Bijapur Dr. Manjula S. Patil

© Rajiv Gandhi University of Health Sciences, Karnataka

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ACKNOWLEDGEMENT

It gives me immense pleasure and honour to express my deep sense of gratitude to

Dr.M.M.Angadi Professor and Head, Department of Community Medicine, Shri. B.M.

Patil Medical College, Bijapur and I am highly indebted to him for his guidance, timely

advice, constant source of inspiration and encouragement.

I take this opportunity to express my deep sense of gratitude and sincere thanks to

Dr.P.B. Jagirdhar, Professor for his supervision and timely advice.

My sincere thanks to Dr. M.C. Yadavannavar Assistant Professor, DrRekha Udhgiri

Lecturer, Dr Prathiba Dabas Lecturer for valuable supervision and good wishes.

I am extremely thankful to Mrs. Vijaya Soraganvi, Statistician for her guidance in

statistical analysis.

My thanks to G.V.Kulkarni, Mrs.Veena Algur and Miss Vidya Ugran for their

support and good wishes.

I sincerely thank all the staff of Rural Health Training Centre, Shivangi for their

help during data collection and carrying out laboratory investigations.

I am very grateful to my colleagues for the kind co-operation. I thank all the non-

teaching staff of my department for their constant encouragement and moral support.

I also thank Mr. Shivu and Mr. Sharanu of Cyber Inn Computers Solapur road,

Bijapur for their efforts during typing and printing of this dissertation.

I am extremely grateful to my family members for their constant encouragement

and support.

Finally I acknowledge with gratitude, all adolescent girls and their parents for their

co-operation in this study.

Place: Bijapur

Date: Dr. Manjula S. Patil

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LIST OF ABBREVATIONS USED Cms: Centimeters.

CSO: Central Statistical Organisation

CPI: Consumer Price Index

df: Degree of freedom

Gm: Gram

GLV: Green leafy Vegetables

Hb: Hemoglobin

H&FW: Health and Family Welfare

ICMR: Indian Council of Medical Research.

ICDS: Integrated Child Development Services

Kg: Kilogram

MCH: Maternal and Child Health

NCHS: National Center for Health Statistics

NIN: National Institute of Nutrition

PUC: Pre- University College.

RCH: Reproductive and Child Health

RDA: Recommended Daily Allowances

SD: Standard Deviation

UNICEF: United Nations International Children’s Emergency Fund

WHO: World Health Organization

X2 : Chi-square

Yrs: Years

Z: Standard normal deviate

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ABSTRACT

Background:

Adolescence is a crucial period in woman’s life. Health and nutritional status during

this phase is critical for physical maturity, which in turn influence the health of offspring.

The adolescent girls of today are the mothers of tomorrow in whose hands lie the future of

her family, community and the nation.

Objectives:

1. To study socio-demographic profile of adolescent girls.

2. To study knowledge and practices regarding menstruation among adolescent girls.

3. To study prevalence of anaemia among adolescent girls.

Method:

Community based cross sectional study was done in rural field practice area of

Shivangi of BLDEA’S Shri B.M. Patil Medical College, Bijapur. The study subjects

include all adolescent girls who have attained menarche. Data was collected by

questionnaire method and analyzed.

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Results:

87.3% girls were illiterate, 15% girls were married with mean age of marriage being

13.9±2.29yrs.35.9% had knowledge about menstruation prior to attainment of menarche,

mean age of menarche is 13.45±0.95years.The mean calorie intake was about 65% of RDA

and protein intake was 45% of RDA leading to underweight and stunting. Prevalence of

anaemia was 67.1%.

Interpretation and conclusion:

A statistically significant association was found between marital status and education

of girls i.e. increased age at marriage was related to higher education status. A statistically

significant association was found between age at menarche and socio-economic status.

Prevalence of anaemia has statistically significant association with type of family, socio-

economic status and mother’s education.

Key words:

Adolescent, socio-economic status, menstruation and anaemia

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LIST OF CONTENTS

Sl.No CONTENTS Page No

1 INTRODUCTION 1

2 OBJECTIVES 4

3 REVIEW OF LITERATURE 5

4 METHODOLOGY 35

5 RESULTS AND DISCUSSION 44

6 SUMMARY 85

7 CONCLUSION 89

8 RECOMMENDATIONS 91

9 BIBLIOGRAPHY 94

10 ANNEXURES 103

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LIST OF TABLES

Sl.No Tables Page No

1 Distribution of adolescent girls according to their age 44

2 Religion wise distribution of adolescent girls 45

3 Distribution of adolescent girls according to type of their family 46

4 Distribution of adolescent girls according to their father’s education 47

5 Distribution of adolescent girls according to their father’s occupation 48

6 Distribution of adolescent girls according to their mother’s education 49

7 Distribution of adolescent girls according to their mother’s occupation 50

8 Distribution of adolescent girls according to their socioeconomic status 50

9 Distribution of adolescent girls according to their educational status 51

10 Distribution of adolescent girls according to their marital status 52

11 Distribution of adolescent girls according to age at marriage 53

12 Association between education status and marital status 54

13 Association of marital status and socioeconomic status 55

14 Distribution of adolescent girls according to their occupation 56

15 Distribution of adolescent girls according to their current status 57

of education

16 Distribution of adolescent girls according to the reason for not going 58

to school

17 Distribution of adolescent girls according to environmental hygiene 59

18 Distribution of adolescent girls according to their diet 59

19 Mean calorie and protein intake of adolescent girls and 60

percentage of RDA

20 Anthropometric measurements in adolescent girls 61

21 Distribution of adolescent girls according to their knowledge about 62

menstruation before attainment of menarche

22 Distribution of adolescent girls according to their knowledge 63

regarding normal age at menarche

23 Distribution of adolescent girls according to main source of 63

information about menstruation

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24 Distribution of adolescent girls who wants to abstain from 64

activities during menstruation

25 Distribution of adolescent girls according to their age at menarche 65

26 Association between religion and age at menarche 66

27 Association with age at menarche and socioeconomic status 66

28 Distribution of adolescent girls according to their reaction to 68

first period

29 Distribution of adolescent girls according to material used during 69

menstruation

30 Modes of disposal of menstrual pads/cloth after use 69

31 Distribution of adolescent girls with respect to their practices 70

during menstruation period

32 Distribution of adolescent girls according to regularity of 71

menstrual cycle

33 Distribution of adolescent girls according to inter- menstrual interval 71

34 Distribution of adolescent girls according to amount of blood flow 72

35 Distribution of adolescent girls according to days of blood flow 73

36 Distribution of adolescent girls according to their premenstrual 74

symptoms

37 Distribution of adolescent girls according to menstrual symptoms 75

38 Distribution of adolescent girls according to menstrual disorders 76

39 Distribution of early and late adolescent girls according to menstrual 77

disorder

40 Prevalence of intestinal parasites among adolescent girls 78

41 Distribution of adolescent girls according to hemoglobin status 79

42 The association of family composition and anaemic cases 80

43 The association of mother education with anaemic cases 81

44 The association of socioeconomic status with anaemic cases 82

45 Association between presence of intestinal parasitic infestations 83

and presence of anaemia

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LIST OF FIGURES

Sl.No Figures Page No

1 Religion wise distribution of adolescent girls 45

2 Distribution of adolescent girls according to type of their family 46

3 Distribution of adolescent girls according to their martial status 52

4 Association between education status and marital status 54

5 Distribution of adolescent girls according to menstrual disorders 76

6 The association of family composition and anaemic cases 80

7 The association of socio economic status with anaemic cases 82

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ANATOMY

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A STUDY ON THE NECK SHAFT ANGLE OF FEMUR IN 100 MACERATED

BONES




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B. L. D. E. A’s

SHRI B. M. PATIL MEDICAL COLLEGE HOSPITAL &

RESEARCH CENTRE, BIJAPUR

DEPARTMENT OF ANATOMY


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HOD, PRINCIPAL/HEAD OF THE INSTITUTION




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BLDEA’s Shri. B.M. Patil Medical College,

Hospital & Research Centre,

Bijapur


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NECK SHAFT ANGLE OF FEMUR IN 100 MACERATED BONES”




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RUDRAGOUDA S BULAGOUDA


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R


S .D. DESAI


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. Dr. S.D. Desai M.S


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Principal Professor & Head Dr. R.C. Bidari


BLDEA’s Shri


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CERTIFICATE BY THE CO-GUIDE


Date

Bijapur Dr. B. M. BANNUR M.S Professor Dept of ANATOMY BLDEA’s S. B. M. Medical College, Hospital And Research Centre. Bijapur.

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B. L. D. E. A’S SHRI B. M. PATIL MEDICAL COLLEGE,

HOSPITAL

AND RESEARCH CENTRE, BIJAPUR



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This is to certify that this dissertation entitle “STUDY ON THE NECK

SHAFT ANGLE OF FEMUR IN 100 MACERATED BONES” is the

bonafide work of Dr. RUDRAGOUDA. S. BULAGOUDA, a post

graduate student in ANATOMY and is done under my direct supervision

and guidance at BLDEA’S Shri B. M. Patil Medical College, Hospital and

Research Centre, Bjapur, in partial fulfillment of the regulations of Rajiv

Gandhi University of Health Sciences, Bangalore for the award of the degree

of “Doctor of Medicine in Anatomy”.

I have satisfied my self that his observations noted in this

dissertation are authentic and also that these confirm with the standards of

Rajiv Gandhi University of Health Sciences, Bangalore.

I have great pleasure in forwarding this dissertation to the

university.


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Rajiv Gandhi University of Health Sciences, Karnataka

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ACKNOWLEDGEMENT It gives me immense pleasure and honour to express my deep sense of gratitude to my beloved professor Dr. S.D. Desai M.S. Professor and Head Department of Anatomy B. L. D. E. A’s Shri. B.M. Patil Medical College, Bijapur and I am highly indebted to him for his guidance, timely advice constant source of inspiration and encouragement. I thank my professor with at most sincerity for the affection and kindness he has shown towards me and for the valuable support he has given to me while preparing dissertation. I also thank him for permitting me to use the materials in the department in preparing this dissertation. I take this opportunity to express my deep sense of gratitude towards my reverend teacher and co-guide Dr. B.M. Bannur Professor of Anatomy for his valuable guidance constant encouragement expert suggestions and prompt help even during his busy schedule to overcome the obstacles and difficulties and without whom this work would not have been completed. I thank Dr. R.C. Bidari Principal BLDEA’s Shri. B.M. Patil Medical Collage for permitting me to utilize the materials and his constant support to undergo this study in various department of the collage. My sincere thanks to Dr. A.K. Kazi, Dr.




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R. V. Talawad & Dr. S.S. Halasagi for their continuous encouragement and valuable guidance. I sincerely acknowledge Dr. D.G. Gannur Assistant Professor Forensic Medicine for his persevering concern, pleasant guidance, immutable motivation and positive feedback which has made it possible for me to expedite this dissertation. I remain grateful and infinitely obliged to Dr. Pramod B. Gai M.Sc. Ph.D Professor and head Department of Anthropology Karnataka University, Dharawad for having permitted me to use the instrument for this study. I am extremely thankful to Dr. S.B. Madagi M.Sc. Ph.D Statistician for his guidance


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in Statistical analysis. I express my deep indebtedness to my parents, brothers, sisters, wife and family members for their words of advice encouragement and moments of support during the course of this dissertation. I am very grateful to my colleagues Dr. Sumathi.


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S. and Dr. Smita. E. for the kind co-operation which was always voluntary with deep sense of gratitude I thank all the non teaching staff my department for their constant encouragement and moral support.

I also thank Mr. Shivu & Mr. Sharanu of CyberInn Computer Solapur road, Bijapur for the meticulous care taken during typing and composing of this dissertation. To all of those who contributed thank you very much.


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Dr. Rudragouda S. Bulagouda.

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ABSTRACT BACKGROUND & OBJECTIVES Neck of the femur is a mystery in terms of its position, blood supply, direction and function. It doesn’t lie in the same plane like that of femoral shaft and its co




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ndyles. The neck sustains an angle with the shaft and lies anterior to it in the


coronal plane – referred conventionally as femoral anteve


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rsion surprisingly in rare occasion neck lies posterior to the shaft calls as femoral retrove


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rsion. The present study is based on two elements. First, to determine the neck shaft angle of neck and shaft and secondly, its relation to sex. Exclusive of any deformity or features of fracture are


studied with 100 cadaveric adult femurs with the help of M


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INTRODUCTION

HEALTHY ADOLESCENT – WEALTHY NATION

The term adolescence comes from Latin word meaning" to grow to

maturity"1.WHO has defined adolescence as a period between 10-19 years2.This is

the period of transition form childhood to adulthood which are formative years when

maximum amount of physical, psychological and behavioural changes take place3.

In any country, adolescents represent a major potential human resource for the

overall development of nation. The proportion of the world adolescent population is

growing faster than of other age groups. Between 1960 and 1980, while the world

population increased by 46%, the population of adolescents increased by 66%.Today

84% of the world adolescents live in the developing world. In India 22.5% are

adolescents4.

Adolescence is a crucial and dynamic period for young people as they begin

to develop their capacity for empathy, abstract thinking and future time perspective.

In rural India most of the girls seem to jump straight from childhood to adulthood.

Many assume adult roles in the family even before the onset of puberty, taking

responsibilities for household and childcare tasks and in addition working in the

fields. These girls experience the joys and pains of growing up. These may vary

depending on geographic location, economic circumstances and most significantly,

the social and cultural environment in which they find themselves5.

1

Healthy development of adolescents depends on several complex factors viz

socio-economic circumstances, the environment in which they live and grow, the

quality of relationship with their families, communities, peer groups and the

opportunities for education and employment 2.

For girls, adolescence is a period of extreme stress and strain. Menarche and

menstruation are bound to elicit tremendous psychological response in them. In

conservative society like ours, where these matters are hardly discussed freely,

there bound to be some practices, customs and misbelieves which are detrimental

during adolescent period.

Since adolescence is a period of growth, higher nutrient intake is essential.

The nutritional needs of girls during this period are generally ignored leading to

stunting and poor health which pose many complications in their future life like

during pregnancy and child birth. WHO consultation on nutritional status of

adolescent girls reported 45% prevalence of stunting among girls and 20%among

boys 6.This difference is due to deep-rooted gender discrimination. Adolescent girls

do not acquire full height and weight potential because of dietary insufficiency.

During the period of adolescence, blood volume and muscle mass increase

and this in turn is found to increase the need for haemoglobin formation7. Lack of

proper nutritious diet leads to anaemia. In our country, the prevalence of anemia

2

amongst adolescent girls varies between 50%-82%8.Such a high prevalence of

anaemia among adolescent girls is a matter of great concern as these girls enter

reproductive life.

Like budding flower, the adolescent girl needs the love and affection from

parents at home, supported by friendly and sensitive health system to help her bloom

and mature into a healthy woman. It is a tragedy that in developing countries

including India some of these blossoms are nipped in the bud.

Realising the importance ,WHO had rightly chosen the theme for WHO Day

in 1985 “Healthy youth our best resources” in an endeavor to focus the attention of

all those concerned towards all round development of youth .Unfortunately in India

,this group of adolescents is almost neglected and out of focus of policy makers and

planners .There is inadequate information about the health of this group as most of

the focus and energy of health service is geared towards the health of preschool

children and pregnant women 9. Implementation of RCH programmes made the

beginning of initiating health programmes for adolescents. It is distressing to observe

that health team has not initiated any worthwhile activity on health education about

personal care, hygiene and diet and sex education.10

Bijapur being a backward district, studies on the health of adolescents are

rare. Because of the scarcity of information regarding the problems of adolescent

girls, particularly in rural area, the present study is undertaken to provide information

3

about the prevalence of anaemia and knowledge and practice regarding menstruation

among adolescent girls.

OBJECTIVES OF THE STUDY 1. To study the socio-demographic profile of adolescent girls.

2. To study the knowledge and practices regarding menstruation among

adolescent girls.

3. To study the prevalence of anaemia among adolescent girls.

4

REVIEW OF LITERATURE

The term adolescence is derived from the Latin word means “to

grow to maturity”1. This is the transition period between childhood to adulthood.

Period of adolescence is very crucial since these are formative years in the life of an

individual during which physical growth, sexual development and maturation,

psychological and social development takes place. It is also the period when opinion

and attitudes are formed.3

In the evolution of mankind, adulthood was made to start very early for taking

up full economic, social and familial responsibilities. Even in the present time in the

developing countries and societies, marriages are reported to be solemnized quite

often at puberty after the end of childhood and in such a situation there is no period of

transition from childhood to adulthood.11

The transition period of adolescence is a period of personal development

during which young person must establish a personal sense of individual identity and

feeling of self worth. It includes alteration of his or her body image, adaptation to

more mature intellectual abilities, adjustments to society’s demands for behavioral

maturity, internalizing a personal value system and preparation for adult roles.4

5

HISTORY

Sushrut samhita (500 B.C.) noted that Indian girls commenced to menstruate

at the age of 12 years.12

Jeevika and Kashyapa (300 B.C) were considered as world’s first

Pediatricians. Their manuscripts contained information on child and children

diseases.13

Indian civilization tried to divide female life into stages like Naganika, Kanya,

and Gauri. But in essence, the life of female child had an abrupt change from child to

woman marked by starting of menstruation i.e. menarche.14

From time immemorial, women in this land of ours were treated as a sort of

objects. Hindu Shastras mentioned that ‘The Women is the bond slave of her father

when she is young, to her husband when she is middle age and to her son when she is

a mother’. Her place in society was not at par with other human being. She has been

used just like a machine for procreation.15

Ancient Greeks, Hebrews, Romans, Christians and Indians knew menstruation.

They used to follow various myths and beliefs regarding menstruation. Hindus did

not allow menstruating women to enter kitchen or temple, while Koran forbids her to

pray or to enter a mosque.16

6

Count Philibert Gueneau De Monte Billared (1759-1777) compiled the first

description of adolescent growth spurt.17

The appointment of medical officer by School Association in Great Britain in

1884 is regarded as first indication of organization of separate clinic for

adolescents. 18

First step in organization of the separate clinics for adolescents began at the

end of 19th century and first scientific paper on adolescent growth and development

was published at the same time in USA. 18

In India during the First Development Plan (1951) priority was accorded to

MCH services. In these services, adequate care was given only to pregnant women

and mothers. Adolescents were neglected.19

Subsequent progress took place largely in USA where society for adolescent

medicine was formed in 1968. 18

In 1977 WHO expert committee published technical report series on health

needs of adolescents.

7

In 1980, the publication of Journal of Adolescent Health Care began in USA as

official voice of the society but inspite of this limited development took place. 18

In 1992 American Pediatrics Association issued their guidelines for adolescent

preventive services for adolescents aged 11 to 21 years.20

In 1993 health care policy makers and providers, in consultation with social

scientists, incorporated various strategies like health education and health protection

programmes in the concept of adolescent health promotion. 18

The adolescent health care has gained importance in our country only since

1997 as a component of RCH programme. But adolescent health care seems to be

merely a fringe activity and not a core activity in RCH .The on going school health

services as a means of delivery of adolescent health care are seemingly perfunctory

because school health itself lacks priority and credibility and services are nearly non-

existent and education of children especially girl child is not a priority in low socio-

economic status families, rural and tribal population.21

In year 2000 Indian Academy of Pediatrics published first volume of journal

“Teens” devoted for teenage care and premarital counseling.22

8

Indian academy of Pediatrics in 1999 accepted new action plans for

adolescent care like “To observe 1999 as a year for family education for adolescent”

and year 2000 for “Establishing teenage care clinics” etc. 22

Various programmes have been launched in our country to provide health care to

adolescents. They are

1. Factories act, 1948 prohibits employment of children below 14 years and

declares persons between 15-18 years as adolescents. 21

2. Reproductive and child health programme recognizes 10-19 years age group

as adolescents.4

3. Since 2000-01, adolescent health has been included into ICDS project, which

considers girls between 11 to 18 years as adolescents.23

Unfortunately, there is no defined age group for adolescents as evident from

the above programmes. Even the National youth policy 2003 considers the youth in

the age group of 13 to 19 years as adolescent age group.24 This lack of commitment to

define the age, fails to provide an universalized care.

9

Adolescence is divided into early (10-14 yrs), middle (15-17 yrs) and late

adolescence (18 to 19 years). 18

W. H. O. defines adolescence as the period between 10-19 yrs of age and

early adolescence as 10 to 14 yrs and late adolescence as 15 to 19 yrs.25

Demographic Trend:

Size of adolescent population differs from country to country.

Of the total adolescent population, 84% live in developing countries and

remaining 16% live in developed countries.4

India:

According to Census of 2001 adolescents belonging to age group of 10-19

years comprise 22.5 % of total population. 4

10

Literacy and Education:

The benefits of education for the individual and development of nation are

well known. The positive effect of women’s education in reducing indicators related

to fertility, child mortality and other social developments have been established.

Therefore education and literacy should be a prime concern for policy makers. The

literacy situation of Indian adolescents reveals a picture of steady progress from

26.5% (1961) to 67.5%(2001). 26

Significant proportions of young people remain illiterate and wide geographic

and gender disparities in enrollment persist, particularly middle and secondary school

enrollment. While 15% of young males aged 15-19 are illiterate, about twice its

percentage, 32% of females are illiterate. 26

Drop Out Rate (Percent) At Different Stages Of School Education 27

Year Primary

Girls Boys

Middle

Girls Boys

Secondary

Girls Boys

1980-81 62.50 56.20 79.40 68.00 86.60 79.80

1990-91 46.00 40.00 65.13 59.12 76.96 67.50

1999-2000 41.22 38.62 60.09 54.4 50.0 35.0

11

Above report points out that the dropout rates in girls are much higher than that of

boys. High dropout rates are not related to financial constraints alone, as they occur

despite huge subsidies by the state. Main reasons cited for dropouts apart from

financial aspects were child not interested in studies, parents not interested in

education and child participating in other economic activities. The most common

reason cited was inapt attitude of parents towards providing education to their

children.

Sai Baba A et al(2002) in their study among 2500 girls aged 10-19 years

from urban slum revealed that 13.2% of them were illiterates, around 38% of them

had primary education and 44% had high school education and only small proportion

of the girls studied up to 10th standards.28

Sharma A.K et al (2003) in their study at Delhi on pregnancy in adolescents,

found that 41.1% adolescents were illiterate, 43.8% were primary educated and only

15.1% had higher education.29

A study from ten villages in Punjab showed that at the threshold of 21st

century, 11.60% girls in the age group 9-19 years are never enrolled in schools and

57.30% girls dropped out from school because of their parents will. This high

proportion of girls dropping out of school reflects the negligence of our society

towards the education of the girls.30

12

Employment:

Studies have revealed that employment whether in strenuous jobs or non-

strenuous jobs definitely impairs the overall growth and development of adolescent

population. Working children are more likely to be of lower height and weight. This

is because of lack of opportunity for education, self-betterment, lack of physical

exercise (play) and entertainment and the nature of work, duration of work etc 26

Despite constitutional and legal provisions (Child labour Act 1986), children

are continued to be employed. Child labour constitutes a violation of children’s

rights. 31

SaiBaba A. et al (2002) in their study in Hyderabad observed that out of 2500

adolescent girls, 57.2% were studying, 7.8% working and 35% were engaged in

house hold activity.28

Qumorum Nahar (1999)in his study in Bangladesh observed that 59% of

adolescent boys and 39% of girls in urban slum worked for money. They worked as

housemaid or garment factory worker.32

13

Marriage

Early marriage leads to abuse of girl’s human rights. They are deprived of their

personal freedom, exploited for labour and discrimination of their educational

development. Furthermore they are subjected to life threatening damage to their

health due to pregnancy and childbirth before their bodies are sufficiently mature to

bear the burden .33

A large number of girls from poor families are pushed into early marriage

that is almost immediately after menarche. Of the 4.5 million marriages that take

place in India three million marriages involve girls in 15-19 years age group.26

Though Child Marriage Restraint Act (1976) has pegged the legal age of

marriage as 18 years for girls and 21 years for boys, it was observed that in 1996 an

average of 38%of girls in the age group of 15-19 were married.4

The levels of early marriage have decreased by 25.00% in India. Those who

have finished at least seven years of school in developing countries are more likely to

wait up to 18 yrs to marry .As the level of education increases, the early marriage will

decrease proportionately. 34

14

Married adolescents comprise 20 per 1000 population. Data (1992-1993)

reveal that 6% of the urban and 21% of rural women were married before the age of

15 years.35

In Karnataka 18.78% rural females in age group of 15 – 19 years are married.

Whereas in our neighbouring state Kerala, only 8.75% rural and 2.50% urban

adolescent girls are married in the same age group.36

Sharma AK(2003) in their study on pregnancy in adolescent girls observed

that mean age at marriage was 17 years and mean age at menarche 13 years.29

The mean age at marriage is steadily rising and the proportion of females

married in their teens is gradually decreasing.

Changes during Adolescence 2

A) Physical changes in girls.

In girls, physical changes may begin at 10 years or even earlier to that like

1. A general increase in growth rate of skeleton, muscles and viscera:

2. Gonadal growth and development:

3. Changes in body composition:

4. Sexual development in adolescent girls occurs in the following order:

a) Breast development:

b) Development of pubic hair:

15

c) Peak growth velocity (physical growth/growth spurt):

d) Further development of breast and pubic hair:

e) Menarche usually starts two years after the pubic hair start

appearing

(mean 12.5years)

f) Further development of breast and pubic hair:

5. Growth spurt: 37

Adolescents gain about 25% of adult height and 50% of adult weight during

puberty. With pubertal growth spurt, girls show fat deposition in characteristic

female distribution. Growth spurt occurs in 3 phases.

Phase 1- There is moderate increase in height velocity in prepubescent phase.

Phase 2-In the pubescent phase both height and weight increases rapidly.

Phase 3-In the post pubescent phase the velocity of growth decreases but the weight

gain continues even after the increase in height.

6. A general readjustment of the endocrine balance resulting in establishment

of menstruation and ovulation in girls:

Anthropometry is important during adolescence because it allows the monitoring

and evaluation of hormone-mediated changes in growth and maturation and is

sensitive to nutritional deficit. The data (height and weight) represents health status in

relation to heredity factors and environment.38

16

Satyavathi K (1981) studied 915 school going boys and girls from rural area of

Chittor district (A.P.) The increment of height ranged between 5-7 cm per year while

maximum annual weight gain was 3-4 kg per year. 39

Agarwal D.K. (1992) studied the growth parameters on 12899 boys and 9951

girls of affluent class from 8 states of the country. Indian adolescent girls of affluent

class are shorter and lighter as compared to those from developed countries. However

they are similar to their counterparts of Asian origin. 40

Sachar et al (1997) studied 698 adolescent girls aged 9 –19 years in rural

Punjab to study their growth parameters. This study revealed that almost 92% girls

achieved satisfactory weights and height.41

Anand K. et al (1999) studied 494 school going students of classes six to

twelve. The prevalence of stunting (low height for age as per NCHS reference) shows

a declining trend from 61.4% at 12 years to 27.3% at 17 years of age. The prevalence

of stunting in 12-18 year age group was 41%. 42

B. Puberty:

In girls physical changes begin at around 10 years. Menstruation is recognized

as onset of maturity and in some cultures it is celebrated by performing special rites

or rituals.

17

Menarche and menstrual cycle:

Menarche is the onset of first menstruation among girls. This is often

recognized as the onset of maturity in girls. There are variations in the age at which

menarche occurs.2

Good nutritional status will lower the age at menarche i.e. girls will attain

menarche earlier, while in malnourished girls menarche is delayed.

The ovaries in a healthy girls body begin to ovulate at around 11-14 years or

earlier, once in 28 days. The ovum produced by ovaries is released and the uterus

prepares itself for fertilization. Fertilization occurs when a female egg unites with

male sperm, which leads to pregnancy. If fertilization does not take place,

menstruation occurs.2

Menstruation occurs once a month as a regular rhythmic period. Menstrual

cycle is a continuous process. It remains as a normal physiological phenomenon

throughout the childbearing years of the women except during pregnancy and

lactation and stops permanently at menopause approximately between the ages of 45-

55 years.43

18

C. Physiological and behavioral changes: 2

1. Development of an integrated and internalized sense of identity.

2. There is gradual move from involvement with groups of the same sex to

mixed groups and sexual pairing may take place.

3. Begin to explore new interest and influences, which can mould their thinking,

their ideas and actions.

4. Behavioural changes during these years could range from exploring sexual

relationship to alcohol, tobacco and other substance abuse. Young people may

be tempted to emulate their role model characters on television often with

disastrous consequences. Peer pressure may also lead them to drive

dangerously, drop out of school , suffer eating disorders or practice

unprotected sex.

Menarche:

Bhaskar Rao (1969) mentioned that the word menstruation is derived from the

Latin word menses, meaning month, which as we all know, signifies the normal

physiological cycle common to all healthy adult females. 44

Frisch R. E (1972) mentioned that the term menstruation is of very ancient

vintage. It has been used a number of times, even in the Bible, many centuries before

19

the knowledge of evaluation of hormones. The old concept of menstruation was

manifestation of a local uterine process. 45

Agarwal. K.N. (1979) stated that the term menarche was introduced into

medical literature by Kishch (1910) to denote the period of life, in which as a sign of

puberty, menstruation first makes its appearance. 46

Mechanism of Menarche:

The exact mechanism, by which the onset of sexual maturation is initiated at a

particular time, is still to some extent uncertain. Growth and development follow such

a regular pattern that some built in coordinating mechanism seems almost

indispensable. Nicholson and Hamley (1953) extracted a general maturity factor and

suggested an endocrine and neuro- hormonal link to account for development.47

A general readjustment of endocrine balance has been described to occur

between childhood and adult life. While the anterior pituitary, the adrenal cortex and

gonads are the triad of endocrinal organs most directly concerned; others are involved

to greater or lesser extent. e.g. Thyroid. Thus the initiation of sexual maturation will

depend both on the production of necessary stimulus and also on the capacity of

gonads to respond. The production of gonadotrophic hormones is probably

dependent on the necessary stimulus being received from the hypothalamus. But

exactly why this stimulus is initiated or released at, say 11 years of age in one and 13

years in another is largely conjectural.47

20

Many girls do not menstruate according to an exact calendar and late starters

at 16 or 18 yrs of age rapidly develop a normal cycle and have normal fertility. 48

Knowledge of the age at menarche of our population is important for the study

of reproductive age group. It is also an essential factor in any study on growth. A

correct appraisal of the age at menarche of our girls is pressing need, without which

no social law, especially those related to marriage can be made. A shift in the age of

menarche signifies a concurrent change in the factors associated with it.49

Knowledge regarding menstruation before attainment of menarche:

Ram Rao A (1963) in his study found that 33.4% of girls had the awareness

about menarche, before the actual event though they belonged to high

socio – economic group.16

Hegade et al (1990) also found that only 8% of girls received instruction

about menstruation prior to the onset of menarche.50

The study from China on adolescent girls revealed that 67.80% adolescent

girls had no previous knowledge about puberty and 52.20% were puzzled and

disgusted with the onset of puberty .35

Age of menarche

21

Koshi E.P. (1970) at Almabagh, Lucknow studied 568 rural girls (aged 9 to 20

yrs). He found that age at menarche ranged from 8 – 17 yrs. The maximum

percentage (66.8%) being between the age of 13-15 yrs. The mean age at menarche

was 14.19 years with S.D. 1.6 years .51

Prasad B. G. et al (1972) carried out a cross sectional study in 192 girls (aged

18-25 yrs) of Lucknow to know the menstrual pattern among these girls. The age of

menarche ranged between 11 – 15 yrs .The mean age of menarche was 13.62 years.52

Gurmeet M.P.Singh (1989) at Ludhiana carried out cross sectional study in

517 girls(10 to 16 yrs), to know the onset of menarche among these girls. The mean

age at menarche was found to be 14.7 years.53

Agarwal. D. K. (1992) studied as 951, girls of affluent class from eight states.

He found that mean age at menarche was 12.6 years.40

Durge P. M. et al (1993) studied 200, rural school girls (aged 12 to 16 yrs)

from Kodhamendhi village of Nagpur District. In this cross sectional study, out of

200 girls 145 (72.5%) had attained menarche. The menarche age ranged between 12

to 16 years. Maximum girls attained menarche between 13 to 14 years. The mean

menarche age was 13.5 years.54

22

Wills Shiela (1993) carried out cross sectional study in 500 school girls (aged

14 – 17 years) at Chennai. The age at menarche ranged between 12.2 to 17 years.

The maximum girls attained menarche between 12.6 to 13.5 years. The mean age at

menarche was 13.6 years.55

Vaidya R. A et al (1998)carried out a study in three western sub -urban

schools of Mumbai in 782 girls (aged 10 – 17 yrs) belonging to upper middle class

families. Out of 782 girls 586 (74.93%) attained menarche. The average age at

menarche in this study was 12 years with a range of 8.2 to 15 years.56

Lal .M. M (1978) found that mean age at menarche ranges from 12 .39to 13

.93 years among adolescents.57

Source of information about menstruation:

Rama Rao A (1963) found that only 33.4% students from higher status of

society had awareness of menstruation before the actual events .The common

source of information in majority of cases has been mothers and sisters.16

Prasad B.G et al (1972) in the study of 192 girls at Lucknow found that

117(60.9%) girls had no knowledge about menarche and 75(39.1%) had prior

knowledge about menarche. Majority i.e.,56% among the latter had gained the

information from mothers,20.3% from sisters and remaining 23.7% from either by

friends or relatives or by books.184 (95.8%) had taken advice for care during periods

and the advice was given by mothers. Only 8(4.2%) girls did not seek any advice.52

23

Study from Palnagam showed that amongst 47% adolescent girls who had

information, mother was the main source of information and this was followed by

friends 26% and sister 11%. 58

The rural community based study from Baroda showed that, the knowledge

regarding menstruation was gained by most of the girls 84% through mothers, 12%

by friends and 4% by others.59

Reaction to first period

In study from rural Palnagam on adolescent girls about menstruation and other

reproductive health issues, it was found that almost 50% of the girls practiced some

religious rituals during menstruation. They reacted differently to first menstrual

period 25% felt shy, 20% reported sense of irritability, 10% felt acute feeling of

isolation and about 35% of girls said that they did not feel any difference.24% said

that they were not aware of the right age and 7.00% did not respond.58

Gurmeet MPS (1989) in a study of randomly selected government schoolgirls

in Ludhiana found that those who knew about menstruation prior to menarche, had

positive reaction to menarche, where as those who did not know, reacted with

surprise 4.5%, nervousness 38% and fear 27%. Lack of knowledge, stigma on talking

about menstruation and the very nature of the problem put young girls into many

embarrassing situation. As a result they became negatively oriented to this process.53

24

Srinivas D.K. (1977) having studied Pondichery School girls, writes that the

“coming of age” of girls is considered a very important event in the family and is

celebrated on a grand scale (81.5% Hindu &15.6% Christians). The celebration seems

to serve only as source of information to relatives and friends and does not help the

girls in acquiring any useful knowledge about menstruation. He also found that

86.2% girls were scared at the onset of menstruation. Other reactions were worry and

sadness. Only 15% felt calm.60

The study conducted at Ambajogai by P.S. Deo et al (2005) among

schoolgirls, reports that the reaction to first menstruation was 44.6% scared, 33.9%

indifferent, 4.05% discomfort, 4.05% disgusted, 5% guilty, and 6% sad.61

The rural community based study from Baroda showed that 34.60% of girls

had depression in response to menarche and 22.10% were indifferent to menarche. 59

Restriction of activities during menstruation:

Rama Rao (1963) in his study of 305 menstruation girls at Delhi found that

151 girls restricted their activities during bleeding or when they felt discomfort.

There were some girls who restricted their activities although they felt no discomfort

during period. Probably these girls belong to orthodox families where the system of

restricting all activities during menstruation was prevalent.143 girls were not

restricting their activities and 11 girls did not respond. 16

25

Elango Vasantha(1994) in her study in Bangalore reported that 63.5% slum

girls restricted their movement, 7% remained isolated, 14% had bath during

menstruation.62

Hygiene practiced during menstruation:

The rural community based study from Baroda showed that, 77.30%

menstruating adolescent girls used house made cloths and only 22.60% used

napkins 59

Elango Vasantha (1994) in her study in Bangalore observed that 96% slum

girls are used old cloth, 2.9% used commercially available pads and 1.1% did not use

anything during menstrual period.62

Srinivas D.K. (1977) found that 84% girls used cloth and only 4% used

commercially available pads, 3% used cotton and 9% girls did not use anything. In

the same study 67.7% girls took bath daily where as 32.3 % were allowed to take bath

only after 3 days.60

Pattern of menstruation:

A woman gets 13 menses in a year and around 400 menses in her reproductive

life. The menstrual cycle is usually of 28 days measured from the first day of the next

period with deviation of 2-3 days. The duration of bleeding is about 3-5 days and

26

estimated blood loss is between 50-200 ml. The menstrual cycle is often irregular

during few years after menarche. These are usually anovulatory cycles. But at the

age of 17-18 years, regular normal cycle becomes established. 63

Pattern of menstruation includes a) regularity of menstrual cycle b) Days of

menstrual bleeding c) Interval between cycle and d) Amount of blood flow.

Rama rao A (1963) studied 305 girls from Lady Harding Medical college,

New Delhi (age 18-20 years) 38.8% had irregular cycles at the onset of menstruation.

But at the time of interview only 11.3% had irregular menstrual cycles.16

Prasad B.G et al (1972) conducted study of menstrual pattern in 192 girls of

Lucknow.The range of days for menstrual bleeding was2-8 days. Maximum of 8 days

in 3 girls and minimum of 2 days in 1 girl. Majority of girls were menstruating for 4-

5 days. The average days of menstrual flow were 4.9days with a S.D of 1.35 days. He

found that143 (74.5%) girls were menstruating at interval of 26-30 days. In 19(9.9%)

the menstrual interval was less than 25 days. The mean inter-menstrual period was

28.21 days with S.D of 1.58 days.52

Premenstrual and menstrual symptoms:

Many adolescent girls experience premenstrual symptoms 7 to 10 days before

onset of bleeding. These include irritability, lassitude, malaise, headache,

gastrointestinal upset, feeling of fullness in breast.

27

In majority of females, apart from per vaginal bleeding there are no symptoms

during menstruation. Pain in abdomen during menstruation is one of the frequent

complaints. Complaints like leg pain, backache may also be associated with normal

menstrual cycle.64

Rama Rao.A (1963) in his study of 305 adolescent girls found that 78.4% had

associated discomforts with menstruation. The complaints reported were vomiting,

headache, giddiness, fainting and depression. Majority of girls had pain in legs and

backache. On an average the girls suffered from more than two complaints during

menstrual period.16

Prasad B.G.et al (1972) in his study of 192 adolescent girls found that 180

(93.8%) had premenstrual and menstrual complaints. These complaints were pain and

heaviness in lower abdomen, cramps in calf muscles, backache, headache, breast

changes.52

Desai P (1990) studied 600 adolescent girls aged 13 to 19 years at Baroda and

found that 40% girls had some form of premenstrual or menstrual complaint like

abdominal pain, cramps and aches. 59

Disorders of menstruation:

Anderson Bjorn et al(1982) studied the prevalence of dysmenorrhoea in 19yrs

old women of urban Swedish population. 72% of women had dysmenorrhoea. A

28

significant correlation was found between early menarche, amount of menstrual flow

and of dysmenorrhoea.65

Durge P. M et al (1993) in her study on 200 adolescent girls of Nagpur district

found that of 145 adolescent girls who attained menarche, 75% of the girls were free

of menstrual disorders. 20.4% of the girls had dysmenorrhoea while 4.6% had other

problems like scanty menses and menorrhagia.54

Hegade K. et al (1990) in a study of 600 school and college girls found that

39% adolescent girls had irregular cycles to begin with, of which 23% reverted back

to normal cycles within subsequent 6 cycles. They also observed that 95% of the girls

had duration of 3-7 days.50

Elango Vasantha (1994) in a study in Bangalore observed that 45.3% of slum

girls had dysmenorrhoea.62

Vaidya R.A (1998) found that out of 782 girls studied, 586 attained menarche

and among 586 girls, 12 reported to have menstruated only once. In this study the

prevalence of dysmenorrhoea was 55%, 8.2% had menorrhagia.56

NUTRITION AND HEALTH NEEDS IN ADOLESCENCE:

Nutritional needs of the adolescents are conspicuously increased due to

speedy growth during adolescence. The diet of adolescents should provide extra

29

energy, protein, and vitamins to meet the additional requirements for rapid weight

gain.37

BALANCED DIET FOR ADOLESCENT GIRLS

Food groups (gms) Age (Yrs) Age (Yrs)

10-12 13-19

• Cereals and millets 270 300

• Pulses 60 60

• Milk (ml) 500 600

• Roots and tubers 100 100

• GLV 100 100

• Other vegetables 100 100

• Fruits 100 100

• Sugars 30 30

• Fats/oils 25 25

Source; Dietary guidelines for Indians a manual, NIN &Indian Council of Medical

Research, Hyderabad, 1998.

30

ANAEMIA IN ADOLESCENT GIRLS:

Anaemia is a condition that results from lowering of hemoglobin levels

below what is considered to be normal for specific demographic groups.

The criteria for determining the presence of nutritional anaemia, as recommended by

WHO (De Maeyers, 1989) are given below.66

Hb<11gm/dl - pregnant women and preschool children below 5 years.

Hb<12gm/dl - school children, adult women including lactating women.

Hb<13gm/dl -- adult men.

Adolescence is a period of peak growth for boys and girls. Food and nutrition

needs are proportionately higher during the growth spurt.

Prevalence of anaemia is high in adolescent girls from low socio-economic

status families, joint families due to inadequate intake of diet by adolescent girls.

Prevalence of anaemia depends upon the literacy status of mother and is more

common in adolescent girls having illiterate mothers.67

Intestinal parasitic infestations are widely prevalent in many developing

countries including India. Most of the population chronically affected with intestinal

parasites live in the developing countries. Intestinal infestations are particularly

important in the adolescence as they cause or aggravate malnutrition including iron

31

deficiency anaemia. Parasites that cause anaemia / malnutrition include Ancylostoma,

Ascariasis, Hymenolepis among others. Malaria infection can be cause of anaemia in

some areas. Environmental factors like open air defecation, bare foot walking, poor

hygiene and sanitary facilities contributed to high prevalence of intestinal parasitic

infestations.68

All above factors contribute to high prevalence of anaemia in adolescent girls.

Inadequate iron stored during adolescence before conception, is major cause of iron

deficiency anaemia during pregnancy, which aggravates the risks during pregnancy.

Stunted and undernourished girls are more likely to have complications during

pregnancy and give birth to low -birth weight babies.43

Severe anaemia in pregnancy is associated with increased maternal deaths. A

report from India indicates 16% of all maternal deaths are attributed to anaemia

(WHO 1993). A six times higher maternal mortality has been reported in severely

anaemic pregnant mothers compared to normal. Anaemia is also associated with three

times increased risk of premature delivery and higher incidence of low birth weight

infants.69

In slum community study of Bombay by Naik V.A.et

al(1993),19.00%adolescent girls were anaemic.70

32

Koshi E.P (1970) studied hemoglobin level of adolescent school girls by

Sahli’s method found 171(40.6%) students had hemoglobin level between12 and

13gm % and in 123(29.3%) it was between 13 and 14gm %.51

Agha F. et al (1992) investigated 270 adolescent girls and found that 18%

girls had Hb <12gm/dl and 54% girls were iron depleted.71

Nelson M. et al (1993) documented 10.5% anaemia prevalence among white

adolescents girls aged between 12-14 years in southwest London suburb.72

Agarwal K. N (1998) had documented that the prevalence of anaemia was

46.6% in premenstrual girls as compared to 48.4% in post menarche girls in the urban

slums of North East Delhi and anaemia prevalence of 47.6%among adolescent girls

of the age group 10-19 yrs.73

Rawat C.M.S et al (2001) studied 504 rural adolescent girls of Meerut district

(U.P) 34.5% girls were found to be anaemic.67

Kotecha (2000) from Gujarat reported 74% anaemia in adolescent girls.74

Jondhale et al (1999) studied prevalence of anaemia among 300 selected

schools going adolescent girls of 13 to 15 yrs of age; anaemia was assessed by

determining hemoglobin content by haematocrit method. 265 adolescent girls were

found to have anaemia.7

33

A Saibaba et al (2002) conducted study in twin cities of Hyderabad and

Secunderabad among 10 – 19 years age girls. Among these 49% had mild anaemia,

31.3% had moderate and7.9% had severe anaemia 28

S. K. Ganguli (2003) conducted a study in school going girls between ages 13

to 15 yrs. The level of blood Hb was estimated for 230 girls. 45.7% showed Hb

below 12gm/dl and considered anaemia as per W. H. O. criteria.4

Dilip Kumar et al (2005) conducted a study in Amdanaga block of North 24

Paraganas District, West Bengal.The overall prevalence of anaemia was found to be

45%.75

Tiwari K et al (2000) studied the prevalence of anaemia among adolescent

girls of urban Kathmandu, Nepal. It was found that 60.5% girls were anaemic, out of

which 57.4% were mildly anaemic and 3.1% were moderately anaemic.76

34

MATERIAL AND METHODS

1) Study Design:

The present study is a community based descriptive cross-sectional study

undertaken to find out the socio demographic profile of adolescent girls, their

knowledge and practices regarding menstruation and prevalence of anaemia among

adolescent girls.

2) Study Area:

The present study was carried out in a rural area Shivangi, which is a rural

field practice area of Department of Community Medicine, B.L.D.E.A’s Shri B. M.

Patil Medical College, Bijapur.

3) Period of study:

The study conducted during a period of one year from November 2004 to

October 2005.

a. Pilot study (1 month): A pilot study was carried out in November 2004 at

Honnutagi, an adjoining rural area and based on that pre-tested

questionnaire was modified and used for the further study.

b. Data collection: December 2004 to August 2005. (Twice in a week)

c. Data analysis and write up of report: September and October 2005.

35

4) Selection of study subjects:

Adolescent girls who have attained menarche were included in this study.

Exclusion Criteria 1. Adolescent girls who did not give consent to the study.

2. Adolescent girls who have not attained menarche.

3. Adolescent girls who are not mentally sound.

5) Sample Size

As per national data, the adolescent population is about 22.5%4 and that the

population of boys and girls is almost equal27. The population of Shivanagi being

7750 according 2001census, the adolescent population accounts for 1743, in that the

adolescent girls population is 871. The number of adolescent girls who have attained

menarche is 470. In the present study 440 adolescent girls were studied, remaining 30

girls could not be contacted.

Methodology

House to house visit was done. All adolescent girls who have attained

menarche, their parents and community leaders were explained in detail about the

purpose and methodology of the study. Only after taking consent, they were

interviewed, examined and investigated. A pre-tested, pre-designed questionnaire was

used to record information.

It includes 1) socio-demographic variables,

36

2) Assessment of knowledge and practices regarding menstruation.

3) Nutritional intake by 3 days recall method.

4) Physical examination, hemoglobin estimation and stool

examination.

Instruments used

1. The primary tool of data collection was pre -designed and pre- tested

questionnaire.

2. Weighing machine – platform type.

3. Measuring tape.

4. Stethoscope.

5. Hemoglobinometer

6. Sterile bottle

7. Microscope

Operational Definition

Adolescent girls: Girls in the age group of 10-19 years were considered as

adolescent girls for the study.2

A. Education

Illiterate: A person who could not read or write. This category also included

those who could only sign or reproduce some writing mechanically without any

meaning.77

37

Education level: Primary school : class 1 – 4th Secondary school : class 5th -7th High school : class 8th to 10th College : PUC I & II Graduate : Those who have obtained Degree. Postgraduate : Those who have obtained Master Degree.

B. Type of family 31

1. Nuclear family: When family unit consist of husband, wife and children it is

called nuclear family.

2. Joint family: This consists of a number of married couples and their children

who lived together in the same household. All are either blood related or

matrimonially related.

38

C. Socioeconomic Status 13

Socioeconomic status as suggested by B.G. Prasad was adopted and modified

as per all India consumer price index of 2004.

Socioeconomic class

Per capita family income (Rs) Updated as per CPI (2004)

I 2500 and above

II 1250-2499

III 750-1249

IV 375-749

V 375

Note: The correction factor (CF) = The value of all India CPI X 4.93 100 All India CPI was 502 for 2004. Correction factor = 502 X 4.93 = 24.748=25 100 D) Caloric and protein requirement of adolescent girls78

Calorie- 10 to 12 years –1970Kcal/day

13 to 18 years- 2060Kcal/day

Protein - 10 to 12 years –57gms/day 13 to 15 years- 65gms/day 16 to 18 years- 63gms/day

39

Menarche: The onset of menstruation for first time.48

Menstruation: Menstruation is the monthly vaginal bleeding coming

usually at the interval of about 28 days from the

osterogen progesterone primed uterine endometrium.63

Regular menstrual cycle: The menstrual cycle coming at regular interval

irrespective of duration between two menses for last

three cycles is called regular cycle.

Irregular menstrual cycle: Any deviation from regular menstrual cycle is called

irregular cycle.48

Menstrual blood flow48 a. Scanty: The menstruation lasts for 1 to 2 days and amount of blood loss is very

small.

b. Moderate: The menstruation lasts for 3-4 days (2-7 days) and average blood loss

is 80 ml. (range 50-200ml)

c. Heavy: The passage of large clots during menstruation is called heavy blood

flow.

40

Pre menstrual symptoms: Behavioral symptoms occurring during the second half of

the menstrual cycle which may resolve with onset of

menses.63

Dysmenorrhoea: Painful cramping pain accompanying menstruation

lasting for about 12 to 24 hours.48

Menorrhagia: There is excessive menstrual bleeding either in duration

of flow or in amount of blood loss.48

Polymenorrhoea: It is the cyclic bleeding where the cycle is reduced to an

arbitrary limit of 21 days or less and remains constant

at that frequency.48

Taboos: Taboos are primary to practices that have been often

repeated by a multitude of generation, practices that

tend to be followed simply because that they have been

followed in the past.79

D) Anthropometry80

41

Height: Height in centimeters was marked on a wall with the help of a

measuring tape and height was measured against the wall. The girls

were asked to remove footwear and with heels together and head

positioned, so that the line of vision was perpendicular to the body. A

scale was brought down to the topmost point on the head. Height was

recorded to the nearest 1 cm.

Weight: Platform type of weighing machine was used, zero error was checked

for and weight was recorded to the nearest 500 gms.

E) Laboratory investigations Hemoglobin: Hemoglobin was estimated by Sahli’s method .Depending on

Hemoglobin level anemia is graded as below:

Anemia: 66 Mild: 10 -12 gm%Hb

Moderate: 7 -10 gm%Hb

Severe: < 7 gm%Hb

Cut off: 12gm% for non-pregnant adolescents and 11 gm% for pregnant adolescents Stool examination: 81

1) Naked eye examination

42

2) Unstained preparation: A drop of normal saline was taken on the

centre of the slide .The collected stool sample was thoroughly mixed with the stick in

the container and then a portion of it was picked up with stick and mixed with normal

saline on the slide. Cover slip was put and observed under low power microscope.

F) Data analysis: The collected data was tabulated and analyzed and tests of

significance were applied wherever necessary.

43

RESULTS AND DISCUSSION

TABLE – 1

Distribution of adolescent girls according to their age

Age in Years Number Percentage

12 04 0.9 13 50 11.36 14 106 24.1 15 98 22.3 16 90 20.5 17 42 9.6 18 38 8.6 19 12 2.7

TOTAL 440 100 The distribution of total 440 adolescent school girls according to age showed

that maximum number of girls i.e. 106 (24.1%) were of the age 14 years followed by

98 (22.3%) of 15 years, 90 (20.5%) of 16 years of age. Lowest number of girls were

of 12 years of age.i.e.4 (0.9%).

Among the study group160 (36.4%) adolescent girls were in early

adolescence (10-14 years) and 280(63.6 %) were in late adolescence (15 –19 years).

44

TABLE – 2

Religion wise distribution of adolescent girls

Religion Number Percentage

Hindu 320 72.7

Muslim 120 27.3

Total 440 100

Figure-1

27.30%

72.70%

HinduMuslim

Religion wise distribution of 440 study girls showed that 320 (72.7%) girls

belonged to Hindu religion and 120 (27.3%) girls belonged to Muslim religion.

45

TABLE – 3

Distribution of adolescent girls according to type of their family

Family Composition

Number Percentage

Nuclear 248 56.4

Joint 192 43.6

Total 440 100

Figure-2

43.60%56.40%

NuclearJoint

Out of 440 adolescent girls the maximum number of girls i.e. 248 (56.4%)

belonged to nuclear families.

Varid Mala et al (2005) studied 396 adolescent girls from Allahabad observed

that 67.2% belonged to nuclear family and 32.8% belonged to joint family. 82

Now a days after marriage, couples prefer to live separately, so number of

nuclear families are increasing.

46

TABLE – 4

Distribution of adolescent girls according to their father’s education (n=428)

Father’s

education Number Percentage

Illiterate 208 48.6 Primary 68 15.8 Secondary 46 10.7 High school 59 13.8 P. U. C 26 6.1 Graduate 21 5.00 Total 428 100

• 12 Girls had lost their fathers.

As seen in above figure, maximum i.e.208 (48.6%) fathers were illiterate.

Compared to Karnataka state literacy status, the observed literacy rate is

low.i.e.father’s literacy rate in this study is 51.4% against 76% of state male literacy

rate.

In a study conducted by S.Choudhary et al (2003) in rural area of Varanasi

observed that 34.35% fathers were illiterate, 27.9% were educated upto secondary

school, 24% high school 13.8% were educated upto graduation and above.19

47

TABLE – 5

Distribution of adolescent girls according to their father’s occupation (n=428)

Father’s occupation

Number Percentage

Labourer 198 46.2 Agriculture 122 28.6 Business 45 10.5 Service 34 7.9 Others 29 6.8 TOTAL 428 100

Labourers (agricultural and non agricultural labourer) accounted for

198(46.2%) followed by agriculture 122(28.6%). Others 29 (6.8%) included

unemployed, pensioner or retired persons.

In a study done by CMS Rawat et al (2001) in rural area of Meerut revealed

that most common occupation of father was agriculture 221(43.8%)followed by

labour 191(37.9%), service 56 (11.1%) and business 36(7.1%)67

48

TABLE – 6

Distribution of adolescent girls according to their mother’s education (n=434)

Mother’s education

Number Percentage

Illiterate 300 69.1 Primary 58 13.4 Secondary 29 6.7 High school 21 4.8 P. U. C 12 2.8 Graduate 14 3.2 TOTAL 434 100

*6 adolescent girls had lost their mothers.

Maximum i.e.300 (69.1%) mothers were illiterate, while134 (30.9 %) mothers

were literate. Mother’s literacy rate in the present study 30.9% is low as compared to

57% of Karnataka state female literacy rate.

In a study by CMS Rawat et al (2001) in rural area of Meerut revealed that

43.25% mothers were illiterate followed by middle secondary school 21.4%, primary

20.2%, highschool 9.5% and intermediate and above 5.5%.67

49

TABLE – 7

Distribution of adolescent girls according to their mother’s occupation (n=434)

Mother’s occupation

Number Percentage

House wife 257 59.2 Labourer 173 39.9 Service 04 0.9 TOTAL 434 100

Maximum number of mothers 257(59.2%) were housewives followed by

labourer (Agricultural and non agricultural labourer) 173(39.9%). Only 4(0.9%)

mothers were in service.

TABLE – 8

Distribution of adolescent girls according to their socio – economic status (n=440)

SES Number Percentage

Class I 08 1.8 Class II 47 10.7 Class III 72 16.4 Class IV 168 38.2 Class V 145 32.9 Total 440 100

Table no.9 shows distribution of adolescent girls as per the socio-economic

status of family. (B.G.Prasad’s modified classification)

50

Out of 440 adolescent girls, majority 313(71.1 %) were from lower socio

economic class (Class IV and Class V) followed by 72(16.4%) from middle socio

economic class (classIII), whereas only 55(12.5 %) from upper socio economic class

(Class I and Class II).

Koshi E.P(1970) studied 568 adolescent girls from Lucknow (1970) observed

that 75.4% came from families with social class IVandV (Prasad’s classification). 51

TABLE – 9

Distribution of adolescent girls according to their educational status (n=440)

Educational

status Number Percentage

Primary 58 13.2 Secondary 86 19.5 High school 214 48.6 P. U. C 26 5.9 Illiterate 56 12.7

TOTAL 440 100

In this study population of 440 adolescent girls,56 (12.7%) were illiterate and

384(87.3%) were literate. Study done in rural area of District Sirmaur, Himachal

Pradesh which showed that 14% girls were illiterates83.

51

Sharma A.K (2003) in his study at Delhi on pregnancy in adolescents, found

that 41.1% adolescents were illiterate, 43.8% were primary educated and only 15.1%

had higher education.29

Another study from the Integrated Child Development Service Project area in

Pondichery showed that 14% girls were illiterates. 84

TABLE – 10 Distribution of adolescent girls according to their martial status

(n=440)

Martial Status Number Percentage Unmarried 374 85 Married 66 15 Total 440 100

Figure - 3

15%

85%MarriedUnmarried

52

In the present study 374(85%) adolescent girls were unmarried and

66(15%)girls were married. The married percentage is less compared to Karnataka

state figures of 18.78% for rural females (15-19 years of age). Whereas in our

neighboring state Kerala, only 8.75% girls in rural area are married .34

TABLE – 11

Distribution of adolescent girls according to age at marriage (n=66)

Age at Marriage Number Percentage 7 Yr 2 3.1 10 3 4.5 11 5 7.6 12 4 6.0 13 9 13.6 14 12 18.8 15 13 19.6 16 10 15.1 17 8 12.1

Total 66 100

Mean age at marriage13.9 ± 2.29 years.

It is seen from the table that all 66(15%) girls were married before the legal

age of marriage (18 years). The mean age at marriage in this study is 13.9 ±

2.29years.It is shocking to note that 5(7.6%) of girls below 10yrs are married even

today. This may be due to the fact that more number of parents are illiterate and

belong to low socio-economic status.

53

According to Task Force H& FW, Government of Karnataka reports (2001)

6% urban and 21% rural woman aged 15-19 years are married before age of 15

years.35

Sharma (2003) in his study on pregnancy in adolescent girls observed that

mean age at marriage was 17 years and mean age at menarche 13 years.29

TABLE-12

Association between education status and marital status

Married Unmarried Total Education status Number Percentage Number Percentage Number Percentage

Illiterate 18 27.3 38 10.2 56 12.7

Primary 16 24.2 42 11.2 58 13.2

Secondary 12 18.2 74 19.8 86 19.5

High school 11 16.6 203 54.3 214 48.6

PUC 09 13.6 17 4.5 26 5.9

Total 66 100 374 100 440 100

X2 = 44, df=4, p<0.001

18 38 1642

12

74

11

203

9 17

0

50

100

150

200

250

No.

of A

dole

scen

t G

irls

illiterate

Primary

Secondary

HighSchool

PUC

MarriedUnmarried

Figure: 4

54

Among married adolescent girls, the percentage of girls getting married has

decreased with increase in the level of education.

So also among unmarried, as the level of education has increased, the

percentage of unmarried girls has increased

Thus as education level increases, the percentage of marriage decrease. This is

statistically significant.

Similarly, the study from Tulsiwadi slum area, Bombay showed that 36.60%

illiterate adolescent girls were married and among those educated upto primary level

22.00% of the girls were married.70

TABLE-13

Association of marital status and socioeconomic status

6 49 55

Marital status Married Unmarried

Total SES Class

Number % Number % Number % I 1 1.5 7 1.8 8 1.8

II 5 7.5 42 11.2 47 10.6

III 16 24.2 56 14.9 72 16.4

IV 20 30.3 148 39.6 168 38.2

V 24 36.4 121 32.4 145 33

Total 66 100 374 100 440 100%

Pooled X2 =5.16, df=3, p>0.05

55

Out of 66 married adolescent girls, 44(66.6%) belong to class IV and V.

While of 374 unmarried adolescent girls, 269(72%) belong to classIV and V.

However the difference is not statistically significant.

TABLE – 14

Distribution of adolescent girls according to their occupation (n=440)

Occupation Number Percentage Student 275 62.5 Labourer 88 20.00 Weaving 22 5.00 Household 55 12.50 Total 440 100

In our study majority 275 (62.5%) were studying followed by 88 (20%) were

doing labourer work(agricultural and nonagricultural labourer), 22 (5%) were

weavers and 55 (12.50%) were doing household activities.

Saibaba A. et al (2002) in their study in Hyderabad observed that out of 2500

adolescent girls, 57.2% were studying, 7.8% working and 35% were engaged in

house hold activity.28

56

Qumorum Nahar (l999) in his study in Bangladesh observed that 59% of

adolescent boys and 39% of girls in urban slum worked for money. They worked as

housemaid or garment factory worker.32

TABLE – 15

Distribution of adolescent girls according to their current status of education

Currently Studying Not Studying

Age in Years Number Percentage Number Percentage Total

12 - - 04 2.4 04 13 30 10.9 20 12.1 50 14 81 29.4 25 15.1 106 15 75 27.3 23 13.9 98 16 65 23.6 25 15.2 90 17 15 5.4 27 16.4 42 18 06 2.2 32 19.4 38 19 03 1.1 09 5.4 12

Total 275 100 165 100 440

Out of 440 adolescent girls, 275 (62.9%) girls were currently studying and

165 (37.5%) girls were not going to school or discontinued. In the girls who are

currently studying, 29.4% were of 14 yrs and it gradually decreases upto 16years of

age. After that there is drastic decrease in number of adolescent girls who are

currently studying. This may be due to the fact that there are cultural practices of not

giving higher education and there is belief that high education is of no use.

57

TABLE – 16

Distribution of adolescent girls according to the reason for not going to school (n=165)

Reason Number Percentage

Opposition by parents 75 45.5 Domestic Work 54 32.7 Financial constrains 37 22.5 Not Interested 25 15.2 Marriage 42 25.5

• Multiple answers

Our study revealed that165 (37.5%)of adolescent girls either discontinued the

studies or not attended school at all because of various reasons; out of them, parents

of 75 (45.5%)girls were not willing, 54 (32.7%) because of domestic work, 37

(22.5%) due to financial problems, 42 (25.5%) because of marriage and 25 (15.2%)

were not interested in education.

The study from Tulsiwadi slum community, Mumbai showed that for 13%

girls further education was refused merely because they were girls. At the same time

32.81% discontinued because of domestic work and 6.25% due to poverty. 70

58

TABLE-17

Distribution of adolescent girls according to environmental hygiene (n=440)

Environmental hygiene

No. of respondents Percentage

Good 12 2.7 Fair 320 72.7 Poor 108 24.5 Total 440 100

The environmental hygiene was assessed by scoring system and observed that

320(72.7%)girls had fair environmental hygiene, 108(24.5%)girls had poor and12

(2.7%)had good environmental hygiene.

TABLE – 18 Distribution of adolescent girls according to their diet (n=440)

Diet Number Percentage

Vegetarian 260 59.1

Mixed 180 40.9

Total 440 100

In the present study 260 (59.1%) girls were vegetarian and 180 (40.9%)

girls were taking mixed diet.

59

Gurmeet M.P (1989).studied 517 adolescent girls during 1986 from

Ludihiana aged 10 to 16 years. Maximum i.e., 284(54.94%) were non-vegetarian and

233(45.06%)were vegetarian.53

Adolescent is a crucial phase of rapid growth as it offers the second and last

chance for the catch up growth in the life cycle of girls. For the sake of both, future

mothers and their babies, it is vital to concentrate on nutrition of teen-age girls in

particular.

TABLE – 19

Mean Calorie and Protein intake of adolescent girls and percentage of RDA

Age No Calories Mean ±SD % RDA Protein mean ±SD %RDA

10 to 12 4 1335.5 ±88.51 67.79 25.5 ±6.13 44.73

13 to 15 254 1303.14±120.19 63.25 30.51±6.54 46.93

16 to 19 182 1306.84±113.80 63.43 30.18±6.67 47.90

As seen in above table, the mean caloric intake is about 65% of RDA while

protein intake is 45 % RDA. This could be due to inadequate and improper

knowledge regarding the quantity and quality of diet.

A study by A.K.Sharma et al (2005) among adolescent girls in Delhi revealed

that mean calorie intake was 1155.95±22.7 which is only 56% of recommended daily

caloric intake. The mean protein intake was 44.09±20.9 gms which is 30% less than

RDA.85

60

TABLE – 20

Anthropometric measurements in adolescent girls

Age in yrs Number Mean ht(cms)

Mean wt(kg)

ICMR Mean ht(cms)

ICMR Mean (wt)

12 4 139.3 ± 4.2 32.7 ± 4.1 150.3 42.6

13 50 142 ± 5.3 36.8 ± 2.8 153.0 44.4

14 106 147 ± 1.8 40.5 ± 3.8 155.1 46.7

15 98 148 ± 5.1 42.8 ± 5.3 155.3 48.2

16 90 149.8 ± 3.5 44.5 ± 3 155.4 49.8

17 42 150.3 ± 4.0 44 ± 5.8 156.4 49.9

18 38 150 ± 3.7 45.3 ± 3.1 156.8 50.1

19 12 152 ± 4.0 46.8 ± 3.9 _ _

When compared with ICMR standard, adolescent girls in the present study

were shorter and lighter.

Agarwal D.K. (1992) studied the growth parameters on 12899 boys and 9951

girls of affluent class from 8 states of the country. Indian adolescent girls of affluent

class are shorter and lighter as compared to those from developed countries. However

they are similar to their counterparts of Asian origin. 40

61

TABLE-21

Distribution of adolescent girls according to their knowledge about menstruation before attainment of menarche (n=440)

Knowledge Number Percentage

Yes 158 35.9

No 282 64.1

Total 440 100

Out of 440 adolescent girls, only 158 (35.9%) had knowledge about

menstruation and 282 (64.1%) didn’t have knowledge regarding menstruation before

attainment of menarche.

Ram Rao A(1963) in his study found that only 33.4% of girls had the

awareness about menarche, before the actual event though they belong to high socio –

economic group.16

A study from Patnagar (1995) had revealed that 28% girls had prior

knowledge regarding menstruation.58

Prasad B.G.et al (1972) in a study at Lucknow found that only 39.00% girls

had prior knowledge about menstruation.52

This reflects upon the standard of awareness in the society to such important

event.

62

TABLE -22

Distribution of adolescent girls according to their knowledge regarding normal

age at menarche (n=158)

Knowledge about age at menarche Number Percentage

11 06 4 12 23 14.6 13 74 46.7 14 46 29 15 09 5.7

Total 158 100 Range: 11 to 15 years

Maximum 120(75.7%) girls opined that normal age at menarche is between

13 to 14 years of age.

In the rural Patanagar study, 44% reported that age at menarche was between

13 to 15 years. 58

TABLE – 23

Distribution of adolescent girls according to main source of information about menstruation (n=158)

Source Number Percentage

Mother 68 43.00 Friends 39 24.7 Sister 24 15.3 Relatives 17 10.7 Neighbors 10 6.3 Total 158 100

In the present study, majority 68 (43.00%) adolescent girls gained information

from mother. Only 10 (6.3%) girls gained information from neighbors.

63

A study from Patnagar (1995) reveals that 47.00%received information from

mother .26.00% from friend and 11.00% from sister. 58

Durge P.M. et al (1993) in their study in rural girls of Nagpur found that main

source of information was friends (61.1%)followed by mothers (29.4%)and other

source (9.5%). 54

TABLE –24

Distribution of adolescent girls who wants to abstain from activities during menstruation

Abstain from

activities Number Percentage

Yes 294 66.8 No 146 33.2 Total 440 100

Out of 440 adolescent girls, 294 (66.8 %) girls want to abstain from their

activities during menstruation and 146 (33.2%) girls don’t want to abstain from their

activities.

64

TABLE – 25

Distribution of adolescent girls according to their age at menarche

Age Number Percentage

11 10 2.3 12 72 16.4 13 102 23.2 14 222 50.4 15 30 6.8 16 04 0.9

Total 440 100 Mean age at menarche 13.45 ± 0.95years.

Out of total 440 girls 222 (50.4 %) had menarche at the age of 14 years. Only

4(0.9%) girls attained menarche at 16 years.

The following table compares the mean age at menarche quoted by different

authors with present study

Author Study population

No. of girls & age group Range Mean age

menarche E. P. Koshi

(1971) Rural 568 (9-20 yrs) 8 – 17 yrs 14.1 ± 1.6

B. G. Prasad (1972) Urban 192 (18 – 25) 11 – 15 yrs 13.6

D. K. Agarwal (1992) Urban 9951 (5 – 18 yrs) 12.6

P. M. Durge (1993) Rural 200 12.1 – 15.6 13.5

K. Agarwal (1997) Rural 300 (11 – 18 yrs) --- 12.8

Wills Sheela (1993) Urban 500 (14 – 17 yrs) 12.2 – 17 13.6

R. A. Vaidya (1990) Urban 782 8.2 – 15 12

Present study Rural 440(10-19 yrs) 11-16yrs 13.45±0.95

65

TABLE-26

Association between religion and age at menarche

Age at menarche Religion less than13 years more than 13 years

Total

Number % Number % Number % Hindu 139 75.5 181 70.7 320 72.8 Muslim 45 24.5 75 29.3 120 27.2 Total 184 100 256 100 440 100 X2=1.2, df=1, p>0.05

Among 184 girls who attained menarche at or before 13 years of age,

139(75.5%)were Hindus, 45(24.5%)were Muslims.

Out of 256 girls who attained menarche after 13 years of age 181(70.7

%)were Hindus, 75(29.3 %)were Muslims. There is no statistically significant

association between religion and age at menarche.

TABLE-27

Association with age at menarche and socio economic status

High SES Middle SES Low SES Total Age at menarche

Number % Number % Number % Number %

<13 years 37 67.3 48 66.7 99 31.6 184 41.8 >13 years 18 32.7 24 33.3 214 68.4 256 58.2 Total 55 100 72 100 313 100 440 100

X2=46.03, df=2, p<0.001

66

Large percentage of adolescent girls 214(68.4%) from lower socio economic

status attained menarche after the age of 13 years.

Large percentage of adolescent girls 37 (67.3%) from higher socio economic

status attained menarche before the age of 13 years.

X2 test showed a statistically significant relationship between age at menarche

and socio-economic status.

Bhalla M (1975) have demonstrated that with increasing per capita income the

mean menarcheal age declines.47

Satyavathi K. and Agarwal K.N (1979) reported significant association

between higher socio economic status with earlier menarche and found that in India

well off girls had average age at menarche 12.8 yrs and poor girls at 14.4yrs85

Higher socioeconomic status usually associated with small family norm, better

living conditions, proper nutrition and many other factors could be reason for earlier

growth spurt in turn explaining earlier age at menarche

67

TABLE – 28

Distribution of adolescent girls according to their reaction to first period (n=440)

Reactions Number Percentage

Scared 232 52.7

Shy 140 31.8

Sad 56 12.7

Sin 08 1.8

Happy 04 0.9

Total 440 100

Out of 440 girls, 436 girls had negative reactions to menarche like scared, shy,

sad and sin.

In the present study majority (52.7%) girls were scared at onset of

menstuation. This may be because they had no knowledge about menstruation prior to

menarche.

Rama Rao A. (1963) had highlighted the fact that girls with no previous

knowledge about menstruation felt more scared at menarche. Majority of girls had

negative reaction to menarche and this might be reflection of taboos and prejudices in

society about menstruation.16

The study conducted at Ambejogai by P.S. Deo (2005) et al among school

girls reports that the reaction to first period was 44.6% felt scared, 33.9% indifferent,

4.05% discomfort, 4.05% disgusted, 5% guilty and 6% sad .61

68

TABLE – 29

Distribution of adolescent girls according to material used during

menstruation(n=440)

Material Used Number Percentage

Pads 08 1.8

Old cloth 430 97.7

Both 02 0.5

Total 440 100

In this study out of 440 girls, 430 (97.7%) used old cloth, 08 (1.8%) are used

pad and only 02 (0.5%) used both.

Srinivas D.K(1997) found that 84% girls used cloth and only 4% used

commercially available pads, 3% used cotton and 9% girls did not use anything.60

Elango Vasantha (1994) in her study in Bangalore observed that 96% slum

girls used old cloth, 2.9% used commercially available pads & 1.1% did not use

anything during menstrual period.62

TABLE –30

Modes of disposal of menstrual pads/cloth after use (n=440)

Mode of Disposal Number Percentage

Wash & reuse of cloth 368 83.6 Disposal with general waste 43 9.8 Indiscriminate disposal 29 6.6 Total 440 100

69

It is clear from the above table that majority of the adolescent girls i.e.,368

( 83.6%) were reusing the cloth.43 (9.8 %)of girls were disposing with general waste

and 29(6.6 %) resorted to indiscriminate disposal.

TABLE – 31

Distribution of adolescent girls with respect to their practices during menstruation period(n=440)

Practices Number Percentage

Avoiding holy places 406 92.3

Not touching other people 108 24.5

No entry in kitchen 42 9.5

Isolated 40 9.0

No taboos practiced 04 0.9

*Multiple answers

Among 440 girls, 406 (92.3%) were avoiding holy places, 40 (9%) were

isolated and only 4 (0.9%) were not practicing any taboo.

Desai .P. (1990) found that 80.0% of his respondents practiced some or other

type of taboo.59

Ahuja A et al (1995) noted that 84% of her study people practiced some sort

of taboo during menstruation and 50% of them avoided holy places, religious

function and 20% were restricted from kitchen work.58

70

TABLE-32

Distribution of adolescent girls according to regularity of menstrual cycle

(n=440)

Regularity Number Percentage Regular 404 91.8 Irregular 36 8.2 Total 440 100

Out of 440 adolescent girls, 404 (91.8%) girls had regular menstrual cycles

and 36 (8.2%) had irregular menstrual cycles.

Wills Sheila (1993) in her study of girls 14 – 17 years of age reported that

88.15% had regular cycles while9.14% had irregular cycles and 2.71% had

amenorrhoea.55

Vaidya R.A. (1998) studied 574 menstruating girls aged 10 – 17 years,

83.45% of the girls had regular cycles while 16.55% had irregular cycle.56

TABLE-33

Distribution of adolescent girls according to inter- menstrual interval (n=440)

Inter-menstrual interval Number Percentage

Less than 21 days 02 0.5 21 to 35 days 408 92.7 More than 35 days 30 6.8 Total 440 100

Mean inter- menstrual interval = 28.7±3.26 days

71

In the present study 408 (92.7%) of the adolescent girls were menstruating at the

interval of 21 to 35 days. The mean inter-menstrual period is 28.7±3.26 days.

Prasad B.G. et al (1972) observed that 74.5% of the adolescent girls in their

study were menstruating at the interval of 26 to 30 days. The mean inter menstrual

period was 28.21 ±1.58 days.52

TABLE – 34

Distribution of adolescent girls according to amount of blood flow

Amount of blood flow Number Percentage

Scanty 16 3.6

Moderate 398 90.5

Heavy 26 5.9

Total 440 100

The amount of blood flow was moderate in 398 (90.5 %) girls, heavy 26 (5.9

%) and scanty in 16 (3.6%) girls out of 440 girls.

Wills Shiela (1993) observed in her study of urban girls revealed that 85.71%

girls had moderate blood flow, 6.91% had heavy and 7.16% girls had scanty blood

flow.55

Vaidya.R.A (1998) in the study of adolescent girls revealed that 85.7% girls

had moderate blood flow, 6.11% had scanty blood flow and 8.19% had heavy blood

flow. 56

72

TABLE –35

Distribution of adolescent girls according to days of blood flow

Days of Blood flow Number Percentage

Less than 3 days 28 6.4

3 – 5 days 386 87.7

More than 5 days 26 5.9

Total 440 100

Mean duration of blood flow=3.95± 0.7 days

Out of total 440 adolescent girls, 386 (87.7%) girls had blood flow for 3 – 5

days. The mean duration of blood flow is 3.95 ± 0.7days.

The mean duration for menstrual bleeding as reported by Rama Rao A (1963)

was 5.05 ± 1.19 days16and by Prasad B .G. et al (1972) was 4.9 ± 1.35 days among

urban girls.52

73

TABLE – 36

Distribution of adolescent girls according to their premenstrual symptoms

Symptoms Number Percentage Cramps 196 44.6 Abdominal pain 100 22.7 Headache 30 6.8 Backache 48 10.9 Body ache 28 6.4 Constipation 14 3.2 Depression 02 0.45 Irritability 25 5.7 No symptoms 30 6.8

*Multiple answers

Average symptoms were 1.25.

Out of total 440 respondents, 30 (6.8%) girls were free from premenstrual

symptoms, 196 (44.6%) had cramps, followed by 100 (22.7%) had abdominal pain

and depression in 2 (0.45%) girls was the least common premenstrual symptom.

Prasad B.G. et al (1972) in the study of urban girls from Lucknow observed

that 93.8% girls had average 2.2 premenstrual symptoms. In his study majority of

girls had abdominal pain (67.2%). Girls had other symptoms like cramps in thigh

muscle, backache, psychological upset, change in appetite, headache, and

constipation.52

74

TABLE – 37

Distribution of adolescent girls according to menstrual symptoms

Symptoms Number Percentage Abdominal pain 345 78.4 Cramp 132 30 Uncomfortable 56 12.7 Backache 53 12.1 Body ache 48 10.9 Headache 08 1.8 Irritability 20 4.6 Depression 06 1.4 No symptoms 38 8.7

* Multiple Answers

Average symptoms were1.5.

Out of total 440 adolescent girls, 345 (78.4%) girls had abdominal pain

during menstruation followed by132 (30%)cramp, and 6(1.4%) girls had depression.

8.7% did not have any symptoms during menses. The average number of menstrual

symptom was 1.5.

Prasad.B.G et al (1972) in his study observed that93.8% girls had average 2.1

menstrual complaints. In his study also, maximum number of girls (68.3%) had

abdominal pain during menstruation and other symptoms were pain in legs, backache,

psychological upset, headache, constipation etc.52

75

TABLE-38

Distribution of adolescent girls according to menstrual disorders

Disorder of menstruation

Number Percentage

Dysmenorrhoea 123 28

Menorrhagia 26 5.9

Irregular menses 33 7.5

Polymenorrhoea 2 0.45

No disorder 256 58.2

Total 440 100

Figure-5

No disorder58.2%

Polymenorrhoea0.45%

Irregular menses

7.5%

Menorrhagia5.9%

Dysmenorrhoea28%

Table shows distribution of adolescent girls according to menstrual disorders.

Out of 440 adolescent girls 256 (58.2%)had no menstrual problems. Dysmenorrhoea

was present in 123(27.9%), irregular menses 33(7.5%), menorrhagia 26 (5.9%)and

polymenorrhoea 2 (0.5%)

76

Durge P. M et al (1993) in her study on 200 adolescent girls of Nagpur district

found that of 145 who attained menarche, 75% of the girls were free of menstrual

disorders. 20.4% of the girls had dysmenorrhoea while 4.6% had other problems like

scanty menses and menorrhagia. 54

In a study done in Baroda by Desai (1990) 55% girls had dysmenorrhoea,

18.6% had menorrhagia.59

TABLE-39

Distribution of early and late adolescent girls according to menstrual

disorder (n=440)

Early adolescence Late adolescence Total Disorder of menstruation Number % Number % Number %

Z test

Dysmenorrhoea 34 21.25 89 31.8 123 28 2.5**

Menorrhagia 10 6.25 16 5.7 26 5.9 0.2

Irregular menses 12 7.5 21 7.5 33 7.5 0

Polymenorrhoea 00 00 02 0.7 02 0.45 NA

No disorder 104 65 152 54.3 256 58.2 2.25**

Total 160 100 280 100 440 100

**P<0.05, Significant.

Table shows distribution of early and late adolescent girls according to

menstrual disorder. Out of 440 girls 256 (58.18%) had no menstrual disorder. A

significantly higher proportion of girls in late adolescent group were free from

menstrual disorder than early adolescent girls. Significantly more late adolescent girls

were having dysmenorrhoea than early adolescent girls. This might be due to change

of anovulatory cycles to ovulatory cycles.

77

TABLE-40

Prevalence of intestinal parasites among adolescent girls

Stool samples Tested Number Percentage

Positive 72 16.4

Negative 368 83.6

Total 440 100

Stool examination was done in all 440 adolescent girls. Out of 440 stool

samples 72(16.4%) were positive for helminthes (worms, ova cysts). Infestation with

Ascariasis and Ancylostoma were commonest forms of parasitosis observed among

them.

In a study conducted by VG Rao et al (2003) in Kundam block of Jabalpur

District, Madhya Pradesh revealed prevalence rate of intestinal parasitosis of 57%

among adolescent girls. In his study infestation with Ancylostoma and Hymenolepsis

nana were commonest forms of parasitosis.68

78

TABLE-41

Distribution of adolescent girls according to haemoglobin status

49 60 109

Early adolescents Late adolescents Total Hb%

Number % Number % Number %

Mild anaemia

65 40.6 121 43.2 186 42.3

Moderate anaemia

47 29.4 54 19.3 101 23

Severe anaemia

02 1.2 06 2.1 08 1.8

Normal 46 28.8 99 35.4 145 32.9

Total 160 100 280 100 440 100

Pooled X2 =4.9, df =2,p>0.05

Overall prevalence of anaemia was 67.1% (295). Majority i. e.186 (42.3%)

were having mild anaemia. Only 8(1.8%) were having severe anaemia. In early

adolescent girls 71.2% were having anaemia and in late adolescent girls 64.6% were

having anaemia. There is no statistically significant difference between these two

groups.

Kotecha (2000)reported 74% anaemia in adolescent girls in Gujarat.74

Jondhale et al (1999) studied prevalence of anaemia, which was found to be

88.3%. 7

Tiwari K et al(2000) studied the prevalence of anaemia among adolescent girls

of urban Kathmandu and found that 60.5% girls were anaemic. The same study

revealed that there is no significant difference in the prevalence of anaemia between

age group of girls.76

79

TABLE –42

The association of family composition and anaemic cases

Anaemic Cases

Positive Negative

Total Family

Composition


Nuclear 145 49.1 103 71 248 56.4

Joint 150 50.9 42 29 192 43.6

Total 295 100 145 100 440 100

X2 =18.9 ,df=1, P < 0.001

Figure-6

145 150

103

42

020406080

100120140160

No.

of A

dole

scen

t G

irls

Positive Negative

Anaemic Cases

NuclearJoint

There is statistically significant association between family composition and

anaemia. The anaemic cases were more in joint family compared to nuclear family.

This may be because of good nutrition.

In a study from rural area of Meerut by CMS Rawat (2001) revealed that

prevalence of anaemia was significantly higher among adolescent girls belonging to

joint family than those belonging to nuclear family.67

80

TABLE – 43

The association of mother education with anaemic cases

Anaemic cases

Positive Negative

Total Mother’s

Education


Illiterate 224 75.9 76 54.7 300 69.1

Primary 30 10.2 28 20.1 58 13.4

Secondary 18 6.1 11 7.9 29 6.7

High School 10 3.4 11 7.9 21 4.8

PUC 7 2.3 5 3.5 12 2.8

Graduate 6 2.1 8 5.7 14 3.2

Total 295 100 139 100 434 100

X2 = 22.14, d.f = 5, P < 0.001

The anemia cases were found to be higher in those adolescent girls having

illiterate mothers and this is statistically significant.


prevalence of anaemia was significantly higher among adolescent girls having

illiterate mothers.67

81

TABLE – 44

The association of socio economic status with anaemic cases

30 55 25

Anaemic cases Positive Negative

Total SES

Number % Number % Number % I 3 1.1 5 3.4 8 1.8

II 22 7.4 25 17.2 47 10.7

III 38 12.9 34 23.4 72 16.4

IV 112 37.9 56 38.6 168 38.2

V 120 40.7 25 17.2 145 32.9

Total 295 100 145 100 440 100

Pooled X2 = 34.1, df = 3, P < 0.001

Figure - 7

25 254038

112120

30 34

020

80

120140

I & II III IV V

No.

of A

dole

scen

ts G

irls

PositiveNegative100

5660

A statistically significant association was found between anaemia and socio

economic status. Anaemia was higher in adolescent girls belonging to socio-

economic class V&IV. Anaemia significantly reduced with rise in socio-economic

status, being minimum in adolescent girls belonging to class I.

82


prevalence of anaemia was found to be significantly associated with socio-economic

status as anaemia was higher in socio economic class V and minimum in class I.67

TABLE 45

Association between presence of intestinal parasitic infestations and

presence of anaemia

Intestinal parasitic infestations Present Absent

Cases

Number % Number %

Total

Anaemia cases 46 63.9 249 67.66 295

Non –Anaemic cases

26 36.1 119 32.33 145

Total 72 100 368 100 440

X2=0.388,df=1,p>0.05

The above table shows no association between presence of intestinal parasitic

infestation and presence of anaemia.

Out of 295 anaemic adolescent girls 46(15.6%) had intestinal parasitic

infestations.

Out of 145 non-anaemic adolescent girls 26(18%)had intestinal parasitic

infestations.

83

There is no statistically significant association between presence of intestinal

parasitic infestation and anaemia.

The intestinal parasites are not the principal cause of anaemia in this study

group and at the best they may be contributory.

84

SUMMARY Community based study was undertaken to find out the sociodemographic

profile, knowledge and practices about menstruation and prevalence of anaemia

among adolescent girls who have attained menarche in rural field practice area,

Shivanagi of Shri. B. M. Patil Medical College, Bijapur.

1) Out of 440 adolescent girls studied, 36.4% were in early adolescence and

63.6% were in late adolescence group.

2) 72.7% girls were Hindu. 56.4% girls belonged to Nuclear family.

3) Out of 440 adolescent girls 71.1% were from low socio-economic class

(class IV and V).

4) 48.6% fathers of adolescent girls were illiterate whereas 69.1% mothers

were illiterate. 46.2% fathers were working as labourer and 59.2%

mothers were housewives.

5) 48.6% girls studied up to high school & 12.7% were illiterate.

6) Out of 440 girls, 15% i.e. 66 girls were married. The mean age at

marriage is 13.9 ± 2.29 years. The earliest age at marriage recorded in this

study was 7yrs. A statistically significant association was found between

85

education status of adolescent girls and marital status. No association was

found between socioeconomic status and marital status.

7) In this study, 62.5% girls were studying; remaining 37.5% girls

discontinued the studies, important reason being the attitude of parents.

Other reasons are domestic work, financial constrains and marriage.

8) 59.1% girls were vegetarian & 40.1% were having mixed diet. Among

these girls mean caloric intake was about 65% of RDA while protein

intake was 45% of RDA.

9) As compared to ICMR standards for weight and height, girls in present

study were lighter & shorter.

10) Out of 440 adolescent girls, only 35.9% had knowledge about

menstruation prior to attainment of menarche. 75.7% girls were of the

opinion that normal age at menarche is between 13-15 years. Main source

of information about menstruation was mother (43%).

11) The mean age of menarche was found to be 13.45 ± 0.95 years with 50.4%

of the girls attaining menarche at 14 years of age. It was found that the

onset of menarche is influenced by socioeconomic status but it is not

influenced by religion.

86

12) Majority of adolescent girls in this study had negative reaction to

menarche like scared (52.7%), shy (31.8%), sad (12.7%) & sin (1.8%).

13) 97.7% girls used old cloth as menstrual pads. 83.6% girls wash & reuse

the same cloth.

14) It was also noted that 92.3% girls avoided holy places, 24.5% avoided

touching other people during menstruation. Only 0.9% did not practice

taboos during menstruation.

15) 91.8% girls had regular menstrual cycles. In 92.7% girls the inter-

menstrual interval was 21 to 35 days. The mean inter – menstrual period

was 28.7 ± 3.26 days. 90.9% girls had moderate menstrual blood flow.

87.7% girls had menstrual blood flow for 3-5 days. The mean duration of

menstrual blood flow being 3.95 ± 0.7days.

16) It was observed that 58.2% girls were free from menstrual disorder. A

significantly higher proportion of girls in late adolescent group were free

from menstrual disorder than early adolescent girls. Of the many

problems, the most commonly experienced menstrual problem was

dysmenorrhoea (28%) and this was more in late adolescent girls. This was

statistically significantly and it may be due to change of anovulatory to

ovulatory cycles.

87

17) Cramps in lower limbs (44.6%) was the most commonly experienced

premenstrual symptom. Abdominal pain (78.4%) was the most commonly

experienced menstrual symptom.

18) Prevalence of intestinal parasites among the adolescent girls in the present

study is 16.4%. Ascaria lumbricoides and Ancylostoma duodenale were

the commonest intestinal helminths observed among them.

19) Out of 440 girls, 295 girls i.e.67.1% had anaemia. Among anaemic

adolescent girls 63% had mild anaemia.

20) Prevalence of anaemia was found to have statistically significant

association with type of family, socio-economic status and mother

education. There was no statistically significant association between

presence of intestinal parasitic infestation and anaemia.

88

CONCLUSIONS

1. 87.3% of adolescent girls in the present study were literate which is more as

compared to state literacy rate of 57%.

2. Among adolescent girls who went to school, 37.5% discontinued study.

Principle reason being parental attitude.

3. It is disheartening to know that 15% of the adolescent girls are married before

legal age of marriage. As education level of girls increases, age of marriage

gets delayed.

4. Good number of adolescent girls were undernourished. Undernutrition during

this phase of rapid growth leads to underweight and stunting in adolescent

girls.

5. Nearly 36% adolescent girls were lacking knowledge about menstruation

prior to menarche. This lack of knowledge lead to negative reaction to

menarche.

6. Girls in high socio-economic class attained menarche early and those from

low socioeconomic classes attain menarche at late age. This may be due to

undernutrition, which affects the physical growth.

89

7. Almost all adolescent girls practiced taboos during menstruation.

8. Dysmenorrhoea is the most common menstrual disorder.

9. In this study prevalence of intestinal helminthes is 16.4%.

10. In the present study prevalence of anaemia among adolescent girls is 67.1%.

Joint family, illiteracy in mothers and low socio-economic status have

contributed to anaemia in adolescent girls.

90

RECOMMENDATIONS

1. Special efforts should be taken for females to increase their literacy. This can

be done by providing evening schools, recruitment of women teacher and

convincing the parents about the importance of female education.

2. Education of girls and parents about intake of balanced diet should be

strengthened. Growth monitoring of schoolgirls at regular interval of every

three months throughout schooling should be made compulsory to detect early

nutritional deficiency.

3. Health education regarding reproductive cycle, hygiene and nutrition should

be incorporated in the school curriculum.

4. Strengthening of primary health centre and subcentres in term of educational

material and trained staff for providing services for adolescents should be

done. There should be clinic for adolescent girls on fixed days.

5. Unfavorable consequences of taboos practiced during menstruation should be

explained to the parents and also to adolescent girls

6. Attempts to improve socio-economic status in rural area should be continued

effectively with programmes like Integrated Rural Development Programme.

91

AREA MAP

Shri. B. M. Patil Medical College Bijapur

92

Interviewing the adolescent girl.

Anthropometric measure ment of the adolescent girl: Taking weight

Hemoglobin estimation of adolescent girls in Rural Health Training Centre.

93

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ANNEXURE

PROFORMA

DEPARTMENT OF COMMUNITY MEDICINE

B.L.D.E.A’S SHRI B.M.PATIL MEDICAL COLLEGE, BIJAPUR

PROFORMA FOR STUDY OF SOCIODEMOGRAPHIC PROFILE AND

PREVALENCE OF ANAEMIA IN ADOLESCENT GIRLS IN RURAL FIELD

PRACTICE AREA OF B.L.D.E.A’S SHRI B.M.PATIL MEDICAL COLLEGE,

BIJAPUR.

Guide: Dr. M.M. Angadi Interviewer: Dr. Manjula S. Patil

General Information

Study Area: Shivanagi

1) Name:

2) Age:

3) Address:

4) Religion : Hindu/ Muslim/ Christian/ others

5) Occupation ; Student/ Labourer/ Weaving/house hold activities

6) Education : Illiterate/ Primary /Secondary/ High school/PUC

7) Are you currently studying? Yes/No

If yes which std______

If no, reasons for discontinuing

Opposition by parents /Domestic work/Financial constrains/Not

interested/Marriage

8) Martial status: Unmarried / Married / Widow / Divorced / Separated

If married a) Age at marriage _______

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9) Type of Family: Nuclear / Joint

10) Father education: Illiterate / Primary / Secondary/ High school/PUC/ Graduation /

Post-graduation.

11) Mother education: Illiterate / Primary / Secondary/ High school/PUC/

Graduation / Post-graduation.

12) Father Occupation: Agriculture / Labourer / Business / Service / Others

13) Mother occupation: House wife / Labourer/ Service/ Others

14) Total number of members in the family

15) Total income of the family

16) Per- capita income

17) Socio-economic classification:

18) Environmental hygiene:

a) Types of house: Kaccha -1 / Kaccha – Pucca – 2 / Pucca – 3

b) Source of water supply: Open well -1 / Borewell – 2 / Tap supply – 3

c) Type of latrine: Open air – 1 / Common – 2 / Water seal – 3

d) Drainage: Open – 1 / Any other – 2 / closed – 3

e) Overcrowding: Total area. Square feet Present – 3 / Absent – 1

f) Kitchen: Separate Yes – 3 / No – 1

g) Ventilation Present – 3 / Absent – 1

Points 21………………………………….Good

20- 8 ……………………………………..Fair

7………………………………………….Poor

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19) Personal History:

i) Diet: Veg /Non-Veg/Mixed diet

ii) Nutritional History: Oral questionnaire method –3 days recall

Particulars Food Items Amount Calories Proteins Breakfast Lunch Dinner Others in between Total

20) Knowledge regarding menstruation

a) Did you knew about menstruation before you attained menarche Yes / No

b) Sources of information regarding menstruation: Mother / Sister / Friends /

Neighbours / Relatives/Books/Radio/Television/Teacher

c) Normally at what age girls attain menarche

d) Do you feel that you should abstain from day to day activities during

menstruation? Yes / No

21) Age at Menarche

22) Reaction to first period – Scared / Shy / Sad / Sin / Happy

23) What kind of sanitary protection do you use during menstruation. Old cloth / Pad

/

both.

24) Modes of disposal of menstrual Pads / Cloth after use: Wash & reuse of cloth /

Disposal with general waste / indiscriminate disposal.

25) Did you abstain yourself from doing the following activities during menstruation.

Avoiding holy places / Not touching others / No entry into kitchen / Isolated / No

105

taboos practiced.

26) Menstrual cycle:

i) Regular / Irregular

ii) Inter menstrual interval - < 21 days / 21 – 35 days / > 35 days

iii) Amount of blood flow: Scanty / Moderate / Heavy

iv) Days of blood flow: < 3 days / 3-5 days / > 5 days

27) Premenstrual discomfort: Cramps/Abdominal pain / Headache / Backache /

Bodyache / Constipation /Depression / Irritability / No symptoms.

28) Symptoms of discomfort during menstruation:

Abdominal pain i) < 12 hrs ii) 12-24hrs / Cramps/Uncomfortable/ Backache

/ Bodyache/ Headache/ Irritability/ Depression / No symptoms.

29) General physical Examination:

1) Height _________

Weight _________

2) Eye :Pallor present /absent

3) Tongue: Normal / Bald / Magenta red coloured tongue

4) Nails: Normal pallor / koilonychia / Platynychia

5) Oedema in dependent parts: Present / Absent

6) Vital signs: Pulse_______BP________Temp________RR_______

30) Systemic examination:

1) RS

2) CVS

3) PA

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4) CNS

Investigation:

i) Hb%__________

ii) Stool examination_________

107

a study on the neckshaftangle of femur

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