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ISSN: 2155-9600
Journal of Nutrition & Food Sciences
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Impact Assessment of Nutrition Education Programme on Nutritional Status of Adolescent Girls

Vishakha Sharma1 and Vishakha Singh2*

1College of Home Science, Maharana Pratap University of Agriculture and Technology, Udaipur, Rajasthan, India

2Department of Foods and Nutrition, College of Home Science, Maharana Pratap University of Agriculture and Technology, Udaipur, Rajasthan, India

*Corresponding Author:
Vishakha Singh
Assistant Professor
Department of Foods and Nutrition
College of Home Science
Maharana Pratap University of Agriculture and Technology
Udaipur 313001, Rajasthan, India
Tel: 0294 2471302
E-mail: [email protected]

Received Date: April 06, 2017; Accepted Date: April 10, 2017; Published Date: April 17, 2017

Citation: Sharma V, Singh V (2017) Impact Assessment of Nutrition Education Programme on Nutritional Status of Adolescent Girls. J Nutr Food Sci 7:597. doi: 10.4172/2155-9600.1000597

Copyright: © 2017 Sharma V, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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Abstract

The present study was conducted with the objective to assess impact of Nutrition Education Programme (NEP) on nutritional status of adolescent girls. Fifty girls enrolled in Kasturba Gandhi Balika Vidhayalaya were selected. Study was conducted in Mangrop village of Suwana block of Bhilwara district. Different aspects of nutrition were selected i.e., food, food groups, functions of food, nutritional deficiency disorders. Food intake was calculated using 24 h recall method. Anthropometric measurements viz. height and weight were measured and Body Mass Index (BMI) was also calculated of each girl. Thinness has been assessed using the indicator BMI-for-age. Result of the study related to anthropometric measurement revealed that maximum percentage of subjects belonged to underweight, followed by ideal BMI. According to the z-score moderate malnutrition was found in 30% respondents at base line and after NEP it was found in 28% of respondent. At base line 68% of the respondents were lying in normal category, after NEP this percent was increased up to 72%. Food intake data showed that the mean nutrient intake of all the nutrients except calcium were lower than the recommended dietary allowances. Their diet was found grossly inadequate at base line in cereals, pulses, milk and milk products, green leafy vegetables, fruits, other vegetables and fats and oils, whereas adequacy for sugar was found more than Recommended Dietary Intake. The results of the study thus conclude that NEP made a significant impact in nutritional status of adolescent girls.

Keywords

Nutrition; Diet; Underweight; Food intake

Introduction

The adolescent girl still remains neither young plant that neither gets light nor water. She remains the flower that could have blossomed but didn’t” (Kamla Bhasin from “Our Daughter”). The word adolescence comes from the Latin word adolescere which means “to grow” or “grow to maturity”. Adolescence is a period of transition when the individual changes physically and psychologically from a child into adult. Adolescence in contrast to puberty is not a single stage but a range of 13-18 years. The period of adolescence is accomplished by its profound changes in growth rates, body composition and marked physiological and endocrinal changes. India is the second most populous country in the world with total population of over 1081 million. Adolescents form a large section of population, about 22.5%, that is, about 225 million. They represent a window of opportunity to prepare for healthy adult life. Education of girls has been a high priority with the Government of India. In Rajasthan literacy rate is 67.06%, of which male and female literacy rate is 80.51 or 52.66% respectively. To achieve actual development of the society, both men and women need to be empowered in all the aspects. To target pockets where girls education is lagging behind, the Government of India has launched two focused interventions for girls–the National Programme for Education of Girls at Elementary Level (NPEGEL) and the Kasturba Gandhi Balika Vidhyalaya (KGBV) to reach out to girls from marginalised social groups in over 3282 educationally backward blocks in the country where the female rural literacy is below the national average and the gender gap in literacy is above the national average. The importance of nutrition is nothing new. Back in 400 B.C., Hippocrates said “Let food be your medicine and medicine be your food.” Today nutrition is more important than ever. Nutritional status is one of the indicators of the overall well-being of population and human resource development. India, being a country in development transition, faces the dual burden of pre-transition, lifestyle-related degenerative disease such as obesity, diabetes, hypertension, cardiovascular disease and cancer. Health is a fundamental human right and health is central to the concept of quality of life [1]. Currently, India is in nutrition transition with 10% rural adults and 20% urban adults suffering from over nutrition, leading to an emerging double burden of malnutrition. To strengthen any nation there is need of healthy mothers. Nutritional awareness is important today in India, many young girls and women are malnourished and anaemic [2]. Due to lack of accurate information and proper guidance, adolescents are prone to various nutritional morbidities. Only healthy mothers can produce healthy citizens [3]. They do not have proper knowledge about their nutritional requirement; inadequate knowledge may cause various health problems. Adolescence is a period of rapid growth and maturation in human development after infancy. The nutritional status of adolescent girls, the ‘future mothers’ contributes significantly to the nutritional status of the community. It is only recently that efforts, though small, are made to include adolescent girls as beneficiaries in some of the health and nutrition intervention programs. Therefore, it is needed to educate and train these adolescent girls regarding health and nutritional awareness. The present study has been carried out with following objectives: To assess the existing nutritional status of adolescent girls enrolled in Kasturba Gandhi Balika Vidyalaya. To develop educational material for nutrition education programme. To assess the impact of nutrition education on nutritional status of the target group.

Methodology

Fifty adolescent girls (13-18 years) enrolled in KGBV were selected for the present study. KGBV was selected because these schools are residential thus easy to approach. Study was conducted in Mangrop village of Suwana block of Bhilwara district. Different aspects of nutrition were selected for NEP i.e., food, food groups, functions of food, nutritional deficiency disorders. A structured pre tested tool was developed to assess nutritional status of adolescent girls. Questionnaire technique was selected for this purpose because the respondents were educated and could fill the questionnaire easily.

Food intake was calculated using 24 h recall method for one day. Type of food consumed was assessed and quantity of raw food was reported in grams. Percentage adequacy of food intake was assessed by balance diet for adolescent girls (13-15 and 16-17 years) recommended by NIN [4] used to analyse the percent adequacy of food intake, whereas calculation was done as follows:

image

Nutrient intake was calculated using food composition tables (Tables 1 and 2). Mean nutrient intake for one day was compared with recommended dietary allowances (NIN) [4] and percent adequacy was calculated as follows:

image

Classification BMI (kg/m2)
Principal cut-off points Additional cut-off points
Underweight <18.50 <18.50
Severe thinness <16.00 <16.00
Moderate thinness 16.00-16.99 16.00-16.99
Mild thinness 17.00-18.49 17.00-18.49
Normal range 18.50-24.99 18.50-22.99
23.00-24.99
Overweight ≥25.00 ≥25.00
Pre-obese 25.00-29.99 25.00-27.49
27.50-29.99
Obese ≥30.00 ≥30.00
Obese class I 30.00-34.99 30.00-32.49
32.50-34.99
Obese class II 35.00-39.99 35.00-37.49
37.50-39.99
Obese class III ≥40.00 ≥40.00

Table 1: BMI classification based on WHO.

>Median -2SD to + <1SD Normal
Median < -2SD to > -3SD Moderate under nutrition
<Median -3SD Severe under nutrition
Median > + 1SD to < +3SD Overweight
> +3SD Obesity

Table 2: WHO, 2007 Classification BMI for age (z-score).

Nutritional anthropometry: Anthropometric measurements viz. height and weight were measured as per the guidelines suggested by ICMR standards. Height was measured by using a height scale nearest to 0.1 cm. A portable personal weighing scale was used to measure the weight in kilograms nearest to 0.1 kg, with ordinary casual clothing and without shoes.

Body mass index: The Anthropometric measurements of the adolescent girls were used for calculating the body mass index which was expressed as ratio of weight (kg) to height in metre square.

image

Further, the individuals were classified into different classes based on WHO [5].

BMI for age: Thinness has been assessed using the indicator BMIfor- age according to the z-score of WHO [5].

Different aspects of nutrition (food, food groups, functions of food, nutritional deficiency disorders) were selected after an extensive review of literature relevant and available on nutrition like school text book.

An information package was developed using selected messages and for this in depth content was collected from the relevant and available literature. For each selected aspect flash cards, slides, posters and games were developed. The content was delivered through lecturette supplemented with audio visual aids in the form of videos, charts, flashcard, folders and slides. In present study nutrition education package was delivered to the target group by the investigator who visited the school at least twice in a week for six weeks continuously. The knowledge test was administered twice i.e., before the delivery of training to know the initial knowledge and after 15 ± 2 days of completion of the training to find out retention in knowledge. After collecting data, it is necessary to analyse it with the help of statistics to arrive at proper and adequate conclusion. Frequency, percentage, means percent score, paired t-test were used to analyse general background information and knowledge of respondents before and after ±15 days of training.

Results

All the respondents (100%) were belonging to Hindu family. Majority of respondents (64%) were from Other Backward Caste (OBC) and 32% were from schedule caste. 64% adolescent girls had joint type of family structure. Majority (92%) of them were vegetarian. Only 4% were from ovo vegetarian. Their main family occupation was business, farming and laborer work. 60% of respondents had ₹ 5000- 10000 as their monthly family income.

Data in Table 3 and Figure 1 reveal that at base line adequacy of milk and milk products and sugar was high in both the age groups. The adequacy of cereals in 13-15 years and 16-17 years of age group was inadequate i.e., 38.78% and 34.41% respectively. After the programme it was increased by 64.86% and 63.76% in 13-15 and 16-17 years of age group, respectively. Due to irregular intake of pulses by adolescent which is influenced by their low intake, the adequacy was lower in both the age group i.e., 39% in 13-15 and 40% in 16-17 years of age group. The adequacy of milk and milk products at base line was 83.6% in 13- 15 years, while in 16-17 years of age group it was 92.85%. But after the programme the adequacy of milk and milk products was found to be lower may be because at baseline survey milk was used in sweet preparation (Kheer).

S. No Food groups Age groups RDI# Details Pre test Post test t-value
1. Cereals 13-15 330 Mean
SD
SE
112.80
53.806
7.60
214.46
88.38
12.49
11.9*
16-17 330 Mean
SD
SE
113.57
11.80
4.4
210.43
24.70
9.33
8.5*
2. Pulses 13-15 60 Mean
SD
SE
23.40
10.94
1.55
34.66
16.03
2.26
3.8*
16-17 75 Mean
SD
SE
30 38.57
14.63
5.53
1.5NS
3. Milk and milk products 13-15 500 Mean
SD
SE
353
167.63
23.70
144.44
94.35
13.34
14.5*
16-17 500 Mean
SD
SE
464.28
95.704
157.14
97.59
36.88
8.3*
4. Other vegetables 13-15 200 Mean
SD
SE
24.74
13.19
1.86
62.22
31.97
4.52
7.99*
16-17 200 Mean
SD
SE
29.71
7.31
2.76
58.00
26.86
10.15
2.7*
5. Fruits 13-15 100 Mean
SD
SE
8.60
3.50
0.49
- -
16-17 100 Mean
SD
SE
10 -  
6.. Fats and oil 13-15 35 Mean
SD
SE
15.40
6.28
.888
24.88
4.51
.63
68.1*
16-17 40 Mean
SD
SE
17.86
.37
.14
25.71
3.45
1.30
22.9*
7. Sugar 13-15 25 Mean
SD
SE
29.60
12.15
1.71
12.86
9.03
1.27
20.5*
16-17 25 Mean
SD
SE
34.42
1.622
.247
24.88
2.556
.390
20.5*

Table 3: Food intakes of adolescent girls N=50.

nutrition-food-sciences-adolescent-girls

Figure 1: Percent adequacy of food intake by adolescent girls.

Due to rear consumption of fruits the adequacy for fruits was low in both the age groups. The consumption of sugar was much higher than the recommended dietary intake in both age groups at base line i.e., 136% in 13-15 years and 137.65% in 16-17 years of age group. There was a significant difference in the adequacy of cereals, milk and milk products, other vegetables, fats and oils, and sugar, while there was no significant difference in the adequacy of pulses in 16-17 years of age group before and after the programme.

Data in Table 4 and Figure 2 reveals that protein intake in both the age groups was found inadequate i.e., 64% in 13-15 years age group and 63.47% in 17-18 years age group. Intake of fat was also inadequate in 13-15 years i.e., 8.33% while in 16-17 years it was 10.28%. The adequacy of carbohydrate in the diets of adolescent of 13-15 years and 16-17 years was 46 and 62.94% respectively while the adequacy of energy was 41.09% for 13-15 years and 45.71% for 16-17 years. Further tab reported that after the NEP adequacy of carbohydrate and energy was increased but it was also less than the recommendations.

nutrition-food-sciences-nutrients-intake

Figure 2: Percent adequacy of nutrients intake by adolescent girls.

S. No. Food groups Age groups RDA# Details Pre test Post test t-value
1. Energy
(kcal/day) 
16-17 2440 Mean
SD
SE
1115.55
65.765
23.252
1330.7
154.822
54.738
4.018*
2. Protein
(g/day)
13-15 51.9 Mean
SD
SE
35.06
5.422
0.827
40.81
7.64
1.165
4.59*
16-17 55.5 Mean
SD
SE
35.23
2.747
0.971
44.26
6.711  
2.373
4.09*
3. Carbohydrate
(g/day)       
13-15 349.5 Mean
SD
SE
160.79
23.673
3.61
219.98
39.732
6.059
9.438*
16-17 366 Mean
SD
SE
152.39
7.953
2.812
232.97
24.092
8.518
8.487*
4. Fat
(g/day)
13-15 40 Mean
SD
SE
3.75
0.66
0.10
24.64
4.23
0.64
33.77*
16-17 35 Mean
SD
SE
3.61
0.186
0.066
24.64
3.87
1.37
14.966*
5. Calcium
(mg/day)
13-15 800 Mean
SD
SE
583.05
115.134
17.558
347.9
111.17
16.95
10.95*
16-17 800 Mean
SD
SE
640.91
116.455
41.173
368.41
124.457
44.002
6.511*
6.. Iron
(mg/day)
13-15 27 Mean
SD
SE
9.21
1.631
0.249
12.04
2.502
0.382
6.97*
16-17 26 Mean
SD
SE
8.61
0.488
0.172
12.77
1.039
0.367
9.343*
7. Zinc
(mg/day)
13-15 11 Mean
SD
SE
3.47
0.701
0.107
6.39
1.283
0.196
13.92*
16-17 12 Mean
SD
SE
3.14
0.24      
0.08
6.92    
0.69
0.24
12.717*
8. β Carotene (µg/day) 13-15 4800 Mean
SD
SE
979.83
199.71
30.455
468.74
190.935
29.117
13.57*
16-17 4800 Mean
SD
SE
1092.2
209.24
73.97
491.63
201.70
71.31
9.032*
9. Ascorbic acid (mg/day) 13-15 40 Mean
SD
SE
11.58
1.871
0.285
9.05
2.835
0.432
5.04*
16-17 40 Mean
SD
SE
12.69
1.97
0.7
9.28
2.57
0.91
3.8*
10. Dietary folate (µg/day) 13-15 150 Mean
SD
SE
1.81
0.599
0.091
2.06
0.946
0.144
1.6*
16-17 200 Mean
SD
SE
1.81
0.39
0.14
2.09
0.38
0.13
1.63NS

Table 4: Mean nutrient intake of adolescents girls N=50.

The adequacy of calcium intake for adolescent of 13-15 years was 72.88% and for 16-17 years it was 80.11%. The iron intake of adolescent girls in13-15 years of age group and 16-17 years of age group was 34.07 and 33.07% adequate, respectively. After the programme adequacy of iron was 44.55 and 49.11 in 13-15 years and 16-17 years. It was found that adequacy of iron was half of the RDI may be because of low inclusion of iron rich foods in daily diet. At base line the adequacy of carotene in the diets of girls was only 20.41% in 13-15 years and 22.75% in 16-17 years while after the programme it was 90% inadequate by RDI (Table 5).

Variables Pre Post t-value
Mean height (m) 1.52 1.53 1.33NS
Mean weight (kg) 36.05 36.46 3.2*
BMI 16.24 16.37 2.4*
NS: Non-Significant, *Significant at 0.05 per cent

Table 5: Anthropometric data of adolescent girls N=50.

Intake of ascorbic acid was in 13-15 years of age group and 16- 17 years of age group was very low i.e., 28.95 and 31.7, respectively. Folate intake was very inadequate in both the age groups i.e., 1.2% in 13-15 years and 0.9% in 16-17 years only. There was no significant difference in the adequacy of folate during both the tests. The adequacy of zinc intake was 30.9% in 13-15 years and 25.83% in 16-17 years. It can be concluded from the Figure 2 that adequacy of all the nutrients (except calcium and carotene) was increased after nutrition education programme but they all were inadequate when compared to RDI (Table 6).

BMI Type of malnutrition Pre test Post test
f % f %
<18.50 Underweight 43 86 42 82
<16.00 Severe thinness 20 40 19 38
16.00-16.99 Moderate thinness 13 26 14 28
17.00-18.49 Mild thinness 9 18 10 20
18.50-24.99 Normal range 7 14 8 16
≥25.00 Overweight - - - -
25.00-29.99 Pre-obese - - - -
≥30.00 Obese - - - -
30.00-34.99 Obese class I - - - -
35.00-39.99 Obese class II - - - -
≥40.00 Obese class III - - - -

Table 6: Type of malnutrition in adolescent girls N=50.

Data regarding anthropometric measurements showed that the mean height of adolescent girls was at base line was 1.52 m and after imparting nutrition education it was 1.53 m. The mean weight of the adolescent girls was at baseline and after NEP 36.05 and 36.46 units respectively (Table 7).

BMI for age Pre test Post test
f % f %
According to z-score
Severe under nutrition <Median -3SD 0 0 0 0
Moderate  Median < -2SD to > -3SD 15 30 13 26
Normal >Median -2SD to + <1SD 34 68 36 72
Overweight Median > +1SD to < +3SD 1 2 1 2
Obesity >+3SD 0 0 0 0

Table 7: Anthropometric indicators (BMI for age) N=50.

Maximum percentage of subjects belonged to (86% at baseline and 84% after NEP) underweight, followed by ideal BMI (14% at baseline and 16% after NEP). None of the subjects belonged to over-weight and obese grade category. According to the z-score of WHO (2007), Moderate malnutrition was found to be present in 30% respondents at base line and after NEP it was found in 28% of respondents. Base line survey indicated that 68% of respondents were in lying in normal category. After imparting nutrition education the% of normal category was increased up to 72% of overweight was same as baseline.

Conclusion

Diet survey has its own importance because food gap is the principal contributor to under-nutrition in India. Nutrients intake was assessed by 24 h recall method, deficiencies of all nutrients in adolescent girls were observed. Base line survey indicated that lack of awareness, poor socio economic background, dietary inadequacy, poor quality of diet was the main factors associated with low dietary intake of these girls. But after imparting nutrition education food intake was significantly increased but it was also less than RDA. Their school menu was also found to be inadequate compare to RDI for adolescent girls.

The requirement of nutrients was not adequately even after programme but the intake of energy, fat, and protein had increased after the programme. The results of the present investigation reveal that nutrition education was effective in increasing the level of nutrient intake. Further because of their curiosity in learning new things and potential learning power, gain in knowledge was high. Choudhary et al. [6] conducted a study to assess nutritional status of adolescents. Results revealed that adolescent girls had clinical nutritional deficiency diseases. Two-third of study subjects were undernourished (BMI<18.5 kg/m2), nearly one-third experiencing chronic energy deficiency grade-III (BMI<16 kg/m2). Another study was conducted by National Nutrition Monitoring Bureau [7] reported that intake of all foods, except cereals & millets and roots & tubers was below the Recommended Daily Allowance (RDA) in all ages. Consumption of protective foods such as green leafy vegetables, fruits and milk were grossly inadequate. The proportion of adolescents consuming inadequate amounts was higher in case of macronutrients than that of protein, energy and total fat. More than 2/3rd of adolescents were consuming <70% of RDA for vitamin A and riboflavin. Extent of deficiency with respect to iron was higher.

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