INTRODUCTION:

An ounce of prevention is worth

A pound of cure

- Swami Vivekananda

Health has been recognized as a fundamental right to all human beings, which implies of right to good physical and mental health. Maternal health is the nation’s wealth. Women are more affected with some health disorders. Nutritional adequacy is one of the key determinants of the quality of human resources for women. Most preventable but yet more prevalent

WHO (2012) stated that anemia is the most common nutritional deficiency disorder in the world, which contributes as a leading cause, complications of pregnancy and its outcome. It has estimated that the prevalence of anemia in developed countries is 14% and in the developing countries is 51%. In India the prevalence as 65-75%, about 1/3 of the global population is anemic. India has the highest prevalence of anemia and 41.8% of pregnant women worldwide are anemic.

Millennium Development Goal (MDG) (2012) pointed that India recorded around 57, 000 maternal deaths in 2010, which translate into a whopping six every hour and one every 10 minutes, The current Maternal Mortality Rate (MMR) of India is 212 per one lakh live births, whereas the country`s related to maternal in this respect is 109 per one lakh live births by 2015.

Adolescence is a period in life that everyone must ‘survive’ in order to become an adult, although some goes through it more turbulently than others. Falling approximately between the age of 12 to 19 years, adolescence is characterized by time in a child’s life, as well as regression into our own adolescence, to physical changes, more complex and hidden changes occur in an adolescent’s attitude, outlook, and self-identity. Although these physiological changes happen slowly, the environment is part of the key to survive this difficult period and become a stronger person¹.

Our job as health care professionals in today’s society requires an understanding of this problematic better prepare us to rise the generations of tomorrow. Another note worthy point is that the world adolescent population is 22.5% and 85% of them are living in developing countries².

Global data base by WHO (2007) on child growth and malnutrition and National Family Health Survey⁹– 2 (2007) in India, had suggested that adolescent girls of urban, semi urban and rural schools in India are found to be anemic and the prevalence rate to be between 61.9 to 82.1 percentage, being highest among rural girls of higher order as compared to urban poor girls irrespective of their age and menarcheal status. This could be due to differences in dietary habits, worm infestations, poor hygiene, and poor environmental sanitation. Anaemia prevalence was more among girls of low weight, height and BMI as compared to those who were heavier, tall and having higher BMI³.

Ghulam Nabi Azad⁹ (2013) pointed that the national rural health mission, a national "iron plus" initiative has been launched in which Weekly Iron and Folic Acid Supplementation (WIFS) is given to adolescent girls, boys and all women in the reproductive age group.

Justin Butlers7, Murphy, O‟Riordan, et.al., (2012) stated that Anemia is not a disease but actually is a condition that results in a group of symptoms such as weakness, fatigue, vertigo, dizziness, pallor, headache, ringing in the ears, headache, an inability to catch ones breath after physical exertion, and a racing or irregular heart beat. Some women are asymptomatic, but many become tired easily.

Nebraska⁵, Mikhail Tombak et al (2012) stated that Beet juice is a blood purifier, blood builder and helps in the creation of red blood cells. Beet juice improves blood structure and cures diseases of the circulatory system, large intestine and digestive system; Beets are very powerful cleansers of the liver and kidney, which help cleanse the circulatory system. Drinking fresh beet juice may help reverse your problems with anemia or other blood issues such as high cholesterol.

Ellen Coleman⁸ (2012) explained that a diet rich in vegetables has health benefits. It‟s been proposed that these health effects may be due inadequate intake of vegetarian while iron is found in all vegetables; it‟s especially abundant in beetroot and leafy greens. Dietary iron lowers anaemia, that dietary iron supplementation in the form of beetroot juice increase the haemoglobin level. Iron has numerous functions in the body, including the regulation of blood flow, muscle contractility, glucose and calcium homeostasis, and mitochondrial respiration.

Wirnani garner¹¹ et al (2011) explained that Nutrient-rich beet juice contains high levels of iron that binds oxygen to red blood cells, and supplies the body with oxygen. Beet juice is particularly beneficial as a anemia remedy for children, teenagers and pregnancy. According to naturopath, author of “Foods That Heal.”

Fsaumi (2008) conducted an experimental study among 20 malnourished adolescent girls in the age group of 12 – 16 years who were divided into two groups, 10 as experimental and 10 as control. The girls of the experimental group were given nutritional supplement beetroot (50gm/day) for a period of 25 days and the control group was given placebo for the same period. Diet pattern was same for all the 20 subjects. Result showed that there was an increase in the serum haemoglobin level (72%) and folic acid (68%) level in the experimental group after the administration of beetroot supplementation (m=10.31, SD=1.32146) irrespective of their demographic variables. It is concluded that the increase in serum haemoglobin levels irrespective of their demographic variables in the experimental group as compared to control group was definitely due to the effect of beetroot

Viadel,¹⁰ et.al., (2008) conducted a study on the effectiveness of uncooked beetroot‟s iron content and absorption compared with the synthetic iron content absorption. The study revealed that along with every iron rich food it is essential to take vitamin „c‟ for rapid absorption. Hence in beetroot vitamin „c‟ components are already present. Compared with synthetic iron content absorption (r = 0.032), uncooked beetroot has natural source of iron and vitamin „c‟ has faster absorption. So the absorption of iron in beetroot is easier to get absorbed than the synthetic iron content

Prevention is better than cure. The researcher observed that there is less focus on assessment and management of anemia among adolescent girls. Beetroot juice has significant effects on human blood and blood forming qualities due to its higher iron content. It regenerates and reactivates the red blood cells. It supplies fresh oxygen to the body and helps the normal function of vesicular breathing. With these in mind the present study was undertaken by the researchers to focus on the needs of the adolescent girls.

OBJECTIVES:

1. To compare the level of hemoglobin before and after administration of beetroot juice among adolescent girls.

2. To find out the association between the level of hemoglobin with the selected demographic variables after administration of beetroot juice.

METHODS AND MATERIALS:

Research Approach:

Quantitative, quasi experimental, evaluative approach.

Research design:

One group pre test and post test design

Sample and sampling technique:

Population:

Adolescent girls between the age group of 13 to 19 years were selected for the study.

Sample:

The sample consists of sixty adolescent girls in selected college at Pudukkottai.

Sampling Technique:

Non Probability convenient sampling technique.

Tools and technique:

The tool consists of two sections.

Section A: Demographic profile such as age, sex, education family background, socio economic status.

Section B: Assessment of the level of Hb by using Taliques blot paper.

Pilot study:

After obtaining formal permission from the higher authorities and the ethical committee of Karpaga Vinayaga College of Nursing, Pudukkottai, the pilot study was conducted with a sample size of six adolescent girls. The level of anemia was assessed using Taliques blot paper. The beetroot juice was administered for a period of 20 days and the haemoglobin level was reassessed using the same method after 20 days. Beetroot juice was prepared by crushing fresh beetroot and to the pulp boiled cooled water with 20 grams of jaggery was added. The study was found to be reliable and feasible. Test retest method was used to establish the reliability of tool and the ‘r’ value was found to be 0.7. So the tool was reliable.

Data collection procedure:

A written consent was obtained from the subjects by assuring confidentiality of information. The purpose of the study was to assess the haemoglobin level. After obtaining the consent, the samples that fall in the inclusion criteria were selected. The level of anemia was assessed using Taliques blot paper. The beetroot juice was administered for a period of 20 days and the haemoglobin level was reassessed using the same method after 20 days. Beetroot juice was prepared by crushing fresh beetroot and to the pulp boiled cooled water with 20 grams of jaggery was added.

Statistical analysis:

The collected data were tabulated and analyzed by using description and inferential statistical method. Frequency, percentage was used to describe the demographic variables.

Mean and standard deviation was used to assess the pre test and post test level of hemoglobin among the adolescent girls.

RESULTS:

Section I –socio demographic profile

The study results revealed that majority 80% of the adolescent girls were in the age group of 17 years, most of them were in their first year of study 70%, majority 67% belongs to low socio economic background, 90% of the adolescents were from rural area, majority 82% of the adolescents were non vegetarian and majority 65% of the adolescents were aware of anaemia.

Table 1: Comparison of mean and standard deviation of the pre and post test scores on level of anemia among adolescent girls.

N = 60

S. No	Experimental group	Pre-test		Post-test		T-Value
		Mean	SD	Mean	SD
1.	Effectiveness of Beetroot juice on level of anemia	9.6	3.89	10.1	2.97	2.19

The table 1 results revealed that there was a significant increase in the overall haemoglobin level among adolescent girls after the intake of Beet root juice.

Association between level of hemoglobin and selected demographic variable:

There was no significant association found between level of hemoglobin and selected demographic variable of adolescent girls such as age, class of study, socio economic status, area of residence, diet pattern and awareness about anemia.

DISCUSSION:

The findings of the study concluded that the Pre test assessment of level of anemia among adolescent girls revealed that among 60 samples majority 66% of the adolescent girls were having moderate anemia, about 20% of the adolescent girls were having mild anemia. About 14% of the adolescent girls were having severe anemia.

Post test assessment on level of anemia among adolescent girls after administration of beetroot juice, revealed that majority 68% of the adolescent girls were having normal hemoglobin level. About 12(24%) of the adolescent girls were having moderate hemoglobin level and about 4(8%) of adolescent girls were having severe hemoglobin level.

Comparison of mean and standard deviation of the pre and post test scores on level of anemia among adolescent girls revealed that there was a significant increase in the overall haemoglobin level among adolescent girls after the intake of Beet root juice.

The findings of the study were supported by Jagadeesh¹² (2010) conducted a pre-experimental study to assess the effectiveness of beetroot extract on anemia among adolescent girls at selected school Mysore. 60 samples were selected between the age group of 14 and 16 years by convenience sampling technique. Levels of anemia were assessed by clinical, physiological signs and symptoms before and after administration of intervention. Beetroot juice was administered (100ml) for 20 days. After that post test was assessed there was a significant improvement in the hemoglobin level (82%) p<0.01.

CONCLUSION:

Beetroot juice was to found to the very effective in improving the Hb level of the adolescent girls. Hence beetroot juice can be recommended by the nurses as one of the cheapest and richest sources of iron to improve the Hb level of all the adolescent girls.

IMPLICATIONS:

There are several important implications for nursing practice.

Nursing Service:

Emphasis can be given to the adolescent girls regarding self care rather than allowing them and their family to become dependent on the health care personnel. Beetroot juice can be prescribed by the nurses to the school students for improving their level of hemoglobin.

Nursing Education:

Nurse educator should be updated with knowledge of complimentary alternative medicine for reducing anemia. Nurse educators should take initiative in organizing continuing nursing education program on complementary and alternative medicine. Booklet can be developed about various foods that are highly rich in iron and easily available.

Nursing Administration:

Nurse administrator should motivate the mass media to educate the importance of consuming iron rich diet. Nurse administrator should arrange demonstration program in the community and hospitals regarding the preparation of iron foods.

Nursing Research:

This study can be done in a large scale as replication to standardize the results.

RECOMMENDATION FOR FURTHER RESEARCH:

A similar study can be conducted using large sample. A comparative study can be conducted with other foods and between the adolescent girls residing in the urban and rural population.

ACKNOWLEDGEMENT:

The investigator is extremely thankful to the Management of Karpaga Vinayaga Educational Trust, Pudukkottai for giving a valuable opportunity to pursue the study in the esteemed institution.

The investigator is extremely thankful to Dr. Kavitha Subramanian Trustee and Mr. N. Subramanian, Secretary of Karpaga Vinayaga Educational Trust, Pudukkottai for giving a continuous motivation and support to pursue the study in the esteemed institution.

The investigator is highly thankful to the participants of the study without them the study would not have been completed.

REFERENCES:

1. Adele Pilleteri, (1999). Maternal Child Health Nursing Care of Child bearing and Child rearing. 3rd edition. Lippincott Publishers, Philadelphia.

2. Bobak, (1995). Maternity nursing. 4th edition. Mosby publication, London.

3. Lowder Milk. (2010), Maternity and Newborn Nursing. (8th edition), Mosby publishers.

4. Dutta, D.C, (2004). Text book of obstetrics. 6th edition. New central book agency (P) Ltd, India.

5. Nebraska (2011) Beetroot May Improve Heart Health and Reduce Anaemia. Natural Standard the Authority on Integrative Medicine. vol.5(2)

6. World Health Organization. (2001). Iron Deficiency Anemia – Assessment, Prevention and Control. A guide for programme managers.

7. Justine Butlers (2012) Ironing out the Facts. Retrieved from www.health science.com

8. Earth clinic folk medicine. (2010). “Natural Cures for Anemia” Retrieved From http://www.9mul.ac.uk/news/news release.

9. Ghulam Nabi Azad, National Family Health Survey (2013). Adolescents in India are anaemic and the statistics. Retrieved From www.recent statistics .com

10. Viadel et.al. (2008). Iron Rich Food for Anaemia. Retrieved From www.medline.com

11. Wirnani garner (2011) prepare home remedies for anaemia Retrieved From www.ayush.com

12. Jagadeesh. V (2010). An Experimental Study to Assess the Effectiveness of Beetroot Extract on Iron Deficiency Anemia among Adolescent Girls Unpublished Master‟s Thesis, Rajiv Gandhi University of Health Sciences Bangalore, Karnataka.

Received on 23.01.2019 Modified on 10.02.2019

Int. J. Nur. Edu. and Research. 2019; 7(2):233-236.

DOI: 10.5958/2454-2660.2019.00050.4