|Year : 2014 | Volume
| Issue : 1 | Page : 26-29
A cross-sectional study to appraise the perceptual nutrition and health guidance given to adolescents in a rural block in the State of Haryana
Arun Kumar1, Ram Bilas Jain2, Pardeep Khanna2
1 Department of Community Medicine, Shaheed Hasan Khan Mewati Government Medical College, Nalhar, Mewat, India
2 Department of Community Medicine, Pt. B. D. Sharma, PGIMS, Rohtak, Haryana, India
|Date of Web Publication||24-Dec-2013|
Department of Community Medicine, Shaheed Hasan Khan Mewati Government Medical College, Nalhar, Mewat, Haryana
Source of Support: None, Conflict of Interest: None
Context: Adolescence is a period of rapid transition of such a magnitude that it is associated with the onset or exacerbation of a number of nutrition- and health-related problems. Teachers and health service providers are expectedly the educated stakeholders who could provide them the needed correct nutrition and health guidance.
Aims: To assess the extent of nutrition- and health-related guidance given to adolescents by their school teachers and health service providers from the perspective of adolescents.
Settings and Design: The design of the study was cross-sectional. It was conducted in Block Beri District, Jhajjar (Haryana).
Materials and Methods: The study was conducted on a sample of 320 students in the adolescent age group. Adolescents from the ninth to twelfth grade classes (80 from each school) were selected by simple random sampling, from four randomly chosen large Government Senior Secondary schools, with a strength of more than 250 students (two girls and two boys/co-ed Senior Secondary Schools). Data were collected on pre-designed, pretested, and semi-structured schedules by conducting in-depth interviews with the study adolescents.
Statistical Analyses Used: Proportions, chi square test, Fisher exact test, chi square test with Yates correction, t test.
Results and Conclusions: Guidance received from their teachers regarding character building and/or moral values (267/320) (83.4%), personal hygiene (278/320) (86.9%), and orodental hygiene (252/320) (78.8%), was good. Overall, the guidance on nutrition/anemia and substance abuse received from teachers was found to be (168/320) (52.5%) and (173/320) (54.1%), respectively. Guidance on issues like human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS)/sexually transmitted diseases (STDs)/Reproductive tract infection (RTIs)/menstrual hygiene received by adolescents from both their teachers and health service providers (HSPs) was found to be very low, that is, 61/320 (19.1%) and 59/320 (18.4%) adolescents, respectively.
Keywords: Adolescents, health guidance, health service providers, Jhajjar, nutrition guidance, teachers
|How to cite this article:|
Kumar A, Jain RB, Khanna P. A cross-sectional study to appraise the perceptual nutrition and health guidance given to adolescents in a rural block in the State of Haryana. J Med Nutr Nutraceut 2014;3:26-9
|How to cite this URL:|
Kumar A, Jain RB, Khanna P. A cross-sectional study to appraise the perceptual nutrition and health guidance given to adolescents in a rural block in the State of Haryana. J Med Nutr Nutraceut [serial online] 2014 [cited 2022 Aug 11];3:26-9. Available from: https://www.jmnn.org/text.asp?2014/3/1/26/123441
FNx01 Permission sought from Indian Journal of Endocrinology and
| Introduction|| |
Adolescents are defined as young individuals in the age group of 10 to 19 years.  Nearly one-fifth of the world's population, that is, ~1.2 billion is comprised of adolescents, and four out of five live in developing countries.  They are an important asset of a country, because they will become tomorrow's young men and women and provide the human potential required for the country's development. It is, therefore, necessary that today's adolescent be healthy so that tomorrow he may be able to contribute his maximum to national development. Adolescence is a period of rapid development, which presents not only opportunities for progress, but also risks to health and nutritional status, ,,, and hence, they need adult guidance.  Teachers and health service providers (HSPs) are expectedly among the educated key stakeholders who could to a large extent, fill this gap in the guidance needs of adolescents.  To identify the realistic situation, we assessed the extent and pattern of nutrition- and health-related guidance given to adolescents by their school teachers and health service providers, from the perspective of the adolescents. It was part of a larger study, which assessed overall support and guidance to adolescents by their teachers and health services providers.
| Materials and Methods|| |
It was a cross-sectional study that was carried out in the Block Beri District, Jhajjar (Haryana), which was the rural field practice area attached to the Department of Community Medicine, Pt. B. D. Sharma Postgraduate Institute of Medical Sciences, Rohtak (Haryana) (PGIMS Rohtak). As there could be issues of non-responses in early rather than late adolescence, the study was conducted in a study population comprising of adolescents (both male and female) in the age group of 13 to 19 years, studying in Government (Govt.) schools located in Block Beri. As on 31 March, 2009, the population of the block was 149,604 as per a routine survey conducted by health workers of the area. The estimated adolescent population in the block was approximately 32,900.
Assuming the prevalence of awareness among adolescents with regard to adolescent changes as 50%, a confidence interval (CI) of 95%, and acceptable absolute error of 6%, the sample size was calculated to be 278. For an assumed risk of non-response of up to 10% among the adolescents, the calculated sample size was 306. Hence, a round figure of 320 was decided to be taken as the final sample size of adolescent students.
The sample of 320 study adolescents was selected by way of multi-staged sampling. First, the schools were selected and then equal numbers of adolescents were selected from classes nine to twelve, as it was in those classes that students of the required adolescent age group were likely to be enrolled. The schools were stratified into boys' and girls' schools, to eliminate the possible variability in perceived nutrition and health guidance from their teachers and health service providers, due to different sexes. As most of the adolescents were found in large schools and in view of the feasibility of the study, out of a total of seven Govt. High schools and 19 Govt. Senior Secondary schools located in the block, four large schools with a strength of more than 250 students (two girls' and two boys' senior secondary schools) were selected by simple random sampling. From each of these schools, 80 adolescent students were selected by stratified random sampling, from the ninth to twelfth classes, using the students' attendance registers. Thus stratification was done at two levels i.e. while selecting the schools and then at the level of classes. This provided us the calculated sample size of 320. Those who had completed 13 years of age and were apparently healthy were enrolled in the study. Data were collected by interviewing the study adolescents using pre-designed, pretested, and semi-structured schedules after obtaining the informed consent from the adolescents and heads of the schools. The collected data was entered in an anonymous form, in MS Excel, in a coded format, and was later analyzed using the statistical software. Ethical approval/prior permission to carry out the study was sought from the Institutional Postgraduate Board of Studies.
| Results|| |
The response rate was 100% among the respondents. The mean age of the male adolescents (15.7 years) was slightly higher as compared to that of the females (15.0 years), with an overall combined mean age of 15.3 years, as shown in [Table 1].  The guidance received from their teachers regarding character building and/or moral values (267/320) (83.4%), personal hygiene (278/320) (86.9%), and orodental hygiene (252/320) (78.8%), was good. Overall, the guidance on nutrition/anemia and substance abuse received from teachers was found to be (168/320) (52.5%) and (173/320) (54.1%), respectively. Guidance on issues like HIV/AIDS/STDs/RTIs/and menstrual hygiene, received by adolescents from both their teachers and HSPs was found to be very low, that is, 61/320 (19.1%) and 59/320 (18.4%) adolescents, respectively. The rest of the findings were as shown in the [Table 2].
|Table 2: Perception of the study of adolescents regarding nutrition and health guidance from teachers and health service providers|
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| Discussion|| |
Very few studies have been conducted previously on this topic. However, whatever relevant studies were available, have been discussed here. The nutrition- and health-related guidance received by the adolescents has been assessed in various dimensions, focused on their needs. Guidance from their teachers regarding character building and/or moral values, personal hygiene, and orodental hygiene, has been received among 83.4, 86.9, and 78.8% of the study adolescents, respectively, which is good. These satisfactory findings indicate that these issues are usually addressed/taken care of in schools during assembly-cum-prayer sessions and during regular classes. There is no significant difference between boys and girls regarding the guidance received on these issues from their teachers [P = 0.652, 0.185, 1] [Table 2]. Even though the difference in personal hygiene-related guidance received by the girls and the boys from their teachers is not statistically significant at the 5% significance level [P = 0.185], it is seen that female adolescents have received slightly more personal hygiene guidance (89.4%) from their teachers in comparison to the boys (84.4%). This shows that the teachers have focused slightly more on the girls. This is also consistent with the local and Indian culture, where girls are given more prominence and guided on such skills because of the greater household responsibilities assigned to them in order to take care of their families [Table 2].
Overall, guidance on nutrition/anemia and substance abuse was found to have been received from the teachers by 52.5 and 54.1% of the study adolescents, respectively. These figures were not substantially bad. The findings showed that the issues on nutrition/anemia and substance abuse were not being taken care of regularly in the schools, but were taken care of less frequently, for example, when there was any complaint or the necessity to do so. However, this kind of guidance from the teachers, as well as from the HSPs, varied differently between the two sexes. Guidance on substance abuse received from the teachers (106/160) (66.3%) was significantly higher among the boys as compared to the girls (67/160) (41.9%) [P = <0.05]. Another interesting finding was that the guidance on nutrition and anemia received from their teachers was significantly higher among girls as compared to boys. [P = 0.000]. These findings were plausible, as it was a known fact that the problems of substance abuse were mainly pertaining to males,  while those of nutrition and anemia were more closely related to female adolescents. ,
Apart from the above-mentioned findings, there was a possibility that issues like guidance on nutrition and anemia or human immunodeficiency virus/acquired immunodeficiency syndrome/sexually transmitted diseases/reproductive tract infections (HIV/AIDS/STDs/RTIs)/menstrual hygiene might have been considered by the teachers as issues pertaining to the responsibility of the Health Department, which might have resulted in the low percentage of adolescents receiving such guidance, (168/320) (52.5%), 61/320 (~19%), respectively, from their teachers, as compared to other issues like character building, moral values, personal hygiene, and so on, (252/320) (~79%) to (278/320) (~87%). Guidance on issues like HIV/AIDS/STDs/RTIs/menstrual hygiene received from both the teachers and HSPs was found to be very low, 61/320 (19.1%) and 59/320 (18.4%), respectively. This showed that these issues were hardly ever discussed, which could perhaps be due to the conservative society and population from the rural background, as was the case in the current study. No significant difference was found between the boys (31/160) (19.4%) and girls (30/160) (18.8%) as regards the guidance received on HIV/AIDS/and the like. by adolescents from their teachers. [P = 0.886].
On all the above-mentioned issues, the guidance received from HSPs was significantly higher among boys than girls. This finding was also consistent with the locally prevalent cultural inhibitions for girls in which they were less likely to move out of their houses, and hence, they were less likely to have interactions with HSPs at subcenters or other health institutions. In addition to the this, even on issues more pertinent to females, like nutrition and anemia, the guidance received from HSPs was found to be significantly higher among boys (66/160) (~ 43%) than girls (43/160) (~27%). Thus, in addition to emphasizing the significance of appropriate growth, , there is a need to generate a demand among adolescents for accessible correct nutrition and health guidance from the educated key stakeholders, that is, teachers and health service providers. For some adolescent cases, for example, diabetes or as the case may be, a demand generation for motivational interviewing may also be useful for their extended health guidance needs. 
| Conclusion|| |
With respect to character building and/or moral values, personal hygiene, and orodental hygiene, respectively, 83.4, 86.9, and 78.8% adolescents receive guidance from their teachers. Moreover, 52.5 and 54.1% adolescents receive guidance on nutrition/anemia and substance abuse, respectively, from their teachers. More female adolescents receive guidance on nutrition/anemia from their teachers and more male adolescents receive guidance on substance abuse from their teachers. Approximately 19 and 18% of the adolescents receive guidance on issues like HIV/AIDS/STDs/RTIs/menstrual hygiene from their teachers and HSPs, respectively, which is very low.
There is a need to sensitize and generate demand among adolescents about their need for the right kind of guidance from the educated key stakeholders, that is, teachers and health service providers. Few other potential interventions have also been proposed. To overcome the potential barriers, outreach camps can be organized/planned to provide nutrition and health guidance services in schools, while respecting the students' right to confidentiality. The existing health guidance services may also be made more adolescent friendly, particularly on the issues of HIV/menstrual hygiene, and the like, by maintaining flexible service hours and ensuring privacy. Some period in the time table of schools can be earmarked for meeting the adolescents' nutrition and health guidance needs. Check lists can also be developed and utilized by teachers/health service providers to cover the various aspects of guidance on nutrition and health, to avoid missing any such important issue.
| References|| |
|1.||World Health Organisation. Adolescent friendly health services: An agenda for change. Geneva: World Health Organization; 2002. p. 5. |
|2.||World Health Organization, United Nations Population Fund, United Nations Children′s Fund. Action for adolescent health: Towards a common agenda: Recommendations from a Joint Study. Geneva: World Health Organization; 1997. |
|3.||Kalra S, Unnikrishnan AG. Obesity in India: The weight of the nation. J Med Nutr Nutraceut 2012:1;37-41. |
|4.||Raj M. Essential hypertension in adolescents and children: Recent advances in causative mechanisms. Indian J Endocrinol Metab 2011;15 Suppl 4:S367-73. |
|5.||Bhavani N. Pediatric endocrine hypertension. Indian J Endocrinol Metab 2011;15 Suppl 4:S361-6. |
|6.||Ministry of Health and Family Welfare, Government of India. National Rural Health Mission: Implementation guide on RCH II: Adolescent reproductive sexual health strategy. New Delhi: Ministry of Health and Family Welfare Government of India; 2006. p. 23. |
|7.||Kumar A, Jain RB, Khanna P. Assessment of self awareness among rural adolescents: A cross sectional study. Indian J Endocrinol Metab forth coming Suppl 2:ESICON 2013. |
|8.||Tsering D, Pal R, Dasgupta A. Licit and illicit substance use by adolescent students in eastern India: Prevalence and associated risk factors. J Neurosci Rural Pract 2010;1:76-81. |
|9.||Viveki RG, Halappanavar AB, Viveki PR, Halki SB, Maled VS, Deshpande PS. Prevalence of Anaemia and Its Epidemiological Determinants in Pregnant Women. Al Ameen J Med Sci 2012;5:216-23. |
|10.||Bharati P, Som S, Chakrabarty S, Bharati S, Pal M. Prevalence of anemia and its determinants among nonpregnant and pregnant women in India. Asia Pac J Public Health 2008;20:347-59. |
|11.||Khadilkar V, Khadilkar A. Growth charts: A diagnostic tool. Indian J Endocrinol Metab 2011;15 Suppl 3:S166-71. |
|12.||Khadilkar V, Kalra S, Khadilkar A. Growth charts. Indian J Endocrinol Metab 2011;15 Suppl 3:S154-5. |
|13.||Kalra S, Sridhar GR, Balhara YP, Sahay RK, Bantwal G, Baruah MP. National recommendations: Psychosocial management of diabetes in India. Indian J Endocrinol Metab 2013;17:376-95. |
[Table 1], [Table 2]