Prevalence and associated causes of nutritional anaemia in school girls aged 11-14 years in Masindi District, Western Uganda
Barugahara, Evelyn Isingoma
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Introduction: Nutritional anemia is the most prevalent nutritional disorder amongst children worldwide. It is associated with serious and life threatening consequences such as morbidity and mortality. Anaemic pupils have poor cognitive function that leads to reduced mental capacity and lower school retention, attendance and enrollment. This can result in reduced school performance. In Uganda, there is little available national data on anaemia for children aged 11-14 years and yet studies have shown that during this period, the growth spurt increases the need for iron. There is also need for girls in this age group to store iron in good amounts for later requirements like menstruation and pregnancy. Objectives: To investigate the prevalence and associated causes of nutritional anemia in school children. Methodology: The study was cross sectional in nature. Two girls’ primary schools one representing the urban and another rural were purposively selected for this study. A sample of 109 pupils from the upper primary section was randomly selected. A food frequency index, 24-hour dietary recall, structured questionnaires and key informant interviews were used to collect data on diet, health and knowledge factors. Malaria was self reported while the prevalence of anaemia was determined on site using oxyhaemoglobin method. Results and Discussions: The overall prevalence of anaemia was 45.9% and it was higher in the urban school (Nyamigisa) 61.1% than the rural (Ikoba) 30.9%. There was more consumption of plant foods of low iron bioavailability than animal foods. This resulted in a majority of pupils having a less than recommended adequacy in the intake of iron (50.5%), folic acid (72.5%), riboflavin (50.5%) and energy (66.7%) especially in Nyamigisa Girls’ Demonstration School. Nutrient intake was associated with the haemoglobin level and was significant for iron, χ2 = 28.550; protein, χ2 = 25.546; folic acid, χ2 = 21.649; riboflavin, χ2 = 21.218 and energy, χ2 = 18.393. Malaria cases are high especially in the rural school (73.6%) since there is less use of mosquito nets (13%). Though deworming was a common health seeking behaviour in schools (84.4%), information gathered from key informant interviews indicated that deworming programs in schools are not yet consistent due to lack of enough supplies of tablets. Majority of students in Ikoba received deworming tablets from the clinic attached to the school (83.7%) unlike in Nyamigisa where drugs were administered by teachers. This was statistically significant (χ2 =37.335, p = 0.00) and therefore affected the compliance and effectiveness of drugs. Supplementation with iron and folic acid has not yet taken off in schools. Majority of pupils had a poor knowledge of nutritional anaemia. Nutritional education and counseling on appropriate feeding practices has not yet taken off in schools. The primary school syllabus also lacks some of the basic information concerning nutritional anaemia. Anaemia was significantly correlated with the nutrient content of food (r = 0.609), malaria (r = 0.542), worms (r = 0.514), location of school (r = 0.43), stomachaches (r = 0.308) and bleeding (r = 0.241). This is because of the effect of these factors on the haemoglobin level. Lack of knowledge on anaemia was not significantly correlated with the cause of anaemia (r = -0.145). Conclusion and Recommendations: High prevalence of anaemia is therefore largely associated with dietary factors such as type of foods eaten and their iron bioavailability and health factors such as malaria and worms. There is need for intervention programs to improve on the dietary intake and bioavailability of iron in school children for example promotion of the availability and access to animal and fortified foods. Public health programs should also focus on reducing preventable health factors especially malaria and worms by encouraging use of Insecticide Treated Nets (ITNs) and strengthening the School Health Program.