This document provides a synopsis for a study assessing the effectiveness of nutrition balls on haemoglobin levels among young adolescent girls in India. The study aims to evaluate haemoglobin levels before and after administering nutrition balls made from jaggery and amla powder. The background discusses the high prevalence of anaemia in India, especially among adolescent girls. A literature review found studies showing anaemia's relationship to poor nutrition and socioeconomic status. The study aims to test the hypothesis that nutrition balls can effectively increase haemoglobin levels and help address iron deficiency anaemia.

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TITLE:
A STUDY TO ASSESS THE EFFECTIVENESS OF
NUTRITION BALL ON
HAEMOGLOBIN LEVEL AMONG THE YOUNG ADOLESCENT
GIRLS IN SELECTED SCHOOL OF VADODRA
DISTRICT, GUJARAT”
A SYNOPSIS
Submitted to
PARUL UNIVERSITY
In
Partial fulfilment for the degree
Of
DOCTOR OF PHILOSOPHY (Ph. D.)
IN (Faculty of Nursing)
Supervised by Submitted by
Dr.________________ SANGEETACHATTERJEE
Enrolment No:______________
FACULTY/ DEPARTMENT OF-NURSING
PARUL UNIVERSITY
P.O LIMDA, TAL: WAGHODIA, DIST: VADODARA,
GUJARAT STATE, INDIA-391760
MONTH, YEAR
“EFFECTIVENESS OF NUTRITION BALL ON HAEMOGLOBINLEVEL AMONG
YOUNG ADOLESCENT GIRLS WITH IRON DEFICIENCYANAEMIA AT SELECTED
SCHOOL OF VADODARA”
INTRODUCTION
“Adolescence is perhaps nature’s way of preparing parents to Welcome the empty nest” –
Karen Savage

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Health is a fundamental human right and health is central to the concept of quality of life (Sundar Lal,
2007). A child ‘s nutritional status can have a great impact on their growth and development. In the
absence of proper nutrition, a state of many nutritional problems may occur. One of the important
components of RCH – II is the adolescent ‘s health.
The definition of health according to WHO, "Health is a state of complete physical, mental,
and social well-being and not merely the absence of disease or infirmity".
Human is passed throughout the life in different stages like infant, children, adolescent, adult,
and older. Adolescent is a period were number of changes take place. The World Health
Organization (WHO) defines adolescents as young people aged 10-19 years. 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. Adolescence is also a sensitive period, particularly for
girls. Adolescence is a time of intense physical growth. It is also a stage of stress and strain.
Most of them are having poor access to proper health care, nutrition and education.
In today’s era the young adolescent faces many health problems due to their life style
modifications like eating junk food, snacking, skipping meals, etc. Some are malnourished
because of lack of knowledge regarding dietary pattern, poor socioeconomic status, low income
etc. The other cause of health problem in adolescent girls is a heavy menstrual period. Which
can lead to low haemoglobin level in blood, and it leads to anemia. There are different types of
anemia like Iron deficiency anaemia, sickle cell anemia, haemolytic anaemia, megaloblastic
anaemia, Aplastic anaemia.
According to American Society of Haematology, "Iron is very important in maintaining
many body functions, including the production of haemoglobin, the molecule in your blood
that carries oxygen. Iron is also necessary to maintain healthy cells, skin, hair, and nails. Iron
from the food you eat is absorbed into the body by the cells that line the gastrointestinal tract;
the body only absorbs a small fraction of the iron you ingest. The iron is then released into the
blood stream, where a protein called transferrin attaches to it and delivers the iron to the liver.
Iron is stored in the liver as ferritin and released as needed to make new red blood cells in the
bone marrow. When red blood cells are no longer able to function (after about 120 days in
circulation), they are re-absorbed by the spleen. Iron from these old cells can also be recycled
by the body.”
As per the guidelines of National Health Portal Normal range of haemoglobin in women is
12.1 to 15.1 gm/dl, in men is 13.8 to 17.2 gm/dl and in children is 11 to 16 g/dl. [4]

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According to WHO, “Anaemia is a condition in which the number of red blood cells (and
consequently their oxygen-carrying capacity) is insufficient to meet the body’s physiologic
needs.”
Another definition of anaemia is, "It is a clinical condition that results from an inadequate
supply of healthy red blood cells, the volume of packed RBCs and/or the quantity of
haemoglobin. Anaemia is caused in one of three ways: Decreased production of healthy RBCs,
Increased RBCs destruction
And loss of blood.
So if the person is having less than normal range of haemoglobin level and may feel tired,
fatigue easily, appear pale, develop palpitations, and become shortness of breath can called
''Anaemic". Children with chronic anemia are prone to infections and learning problems.
Adolescence is a “coming of age”, as children grow into young adults. These teen years are a
period of intense growth, not only physically, but also mentally and socially. During this time,
20% of final adult height and 50% of adult weight are attained. Because of this rapid growth;
adolescents are especially vulnerable to anaemia. Proper nutrition, including adequate iron
intake, plays an important part of teenager ‘s growth and development. During adolescence,
teenagers will acquire the knowledge and skills that will help them to become independent,
successful young adults. Iron deficiency and iron deficiency anaemia can affect this learning
and 2 developments, but parents can help their teenagers stay healthy by teaching them some
easy ways to prevent iron deficiency.
Iron deficiency is the most prevalent micronutrient deficiency among adolescents. In teenagers,
iron deficiency is more than just being pale and tired. It can affect their development and school
performance. Studies have shown that adolescents with anaemia have decreased verbal
learning and memory capacity. Even before anaemia might develop, iron deficiency can cause
shortened attention span, alertness and learning in adolescents.
Adolescents with chronic illness, heavy menstrual blood loss (>80 ml/month) or who are
underweight or malnourished are at increased risk for iron deficiency and should be screened
during health supervision or specialty clinic visits. Overweight and obese children also appear
to be at increased risk for iron deficiency and should undergo screening
According to WHO estimates, India is one of the countries in the world that has highest prevalence of
anaemia WHO estimates that 27 percent of adolescents in developing countries are anaemic; the Inter
National Centre of Research for Women (ICRW) studies documented high rates in India (55 percent),
Nepal (42 percent),Cameroon (32 percent) and Guatemala (48 percent). Anaemia prevalence in young
children continues to remain over 70% in most parts of India and Asia despite a policy being in place
and a program that has been initiated for a long time.
Anaemia is not a specific entity but an indication of an underlying pathologic process or disease. As
many as 4–5 billion people i.e., 66–80% of world ‘s population may be iron deficient. More than 30%
of the world ‘s population i.e., 2 billion people 3 are anaemic due to iron deficiency. In total, 8,00,000
(15%) of deaths are attributed to iron deficiency. WHO lists iron deficiency as one of ―Top Ten Risk
Factors contributing to “Death” Iron deficiency anaemia is more common in South Asian countries
including, India, Bangladesh and Pakistan than anywhere else in the world. By contrast, the prevalence
of Iron deficiency anaemia in neighbouring countries such as Bangladesh and Pakistan have fallen to
55%. The reduction of Iron Deficiency Anaemia prevalence in China is especially remarkable i.e., the

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prevalence was halved from 20% to the current level of 8% within a decade. It is very difficult to
ascertain the true incidence of Iron Deficiency Anaemia, as the aetiology of anaemia is multifactorial.
Not eating enough iron can lead to anaemia, which causes tiredness and reduces the body ‘s ability to
fight of infection. Childhood obesity figures increase as youngsters get older so it’s vital that to make
sure healthy options are both appealing and affordable are available to young people. The UK National
Diet and Nutrition Survey, which involved more than 2,000 adults and children, found that teenage
girl’s diets were generally less healthy than boys. Boys eat an average three portions of fruit and
vegetables a day compared with 2.7 for girls.
The Third National Health and Nutrition Examination Survey (NHANES III) found a 9 percent
incidence of iron deficiency and a 2 percent incidence of anaemia among American females between
the ages 12 and 18years; the respective values were 11 and 3 percent in girls between the ages of 16
and 19 years. Less than 1 percent of adolescent males had iron deficiency. Studies in other countries
have found higher rates of iron deficiency in male and female adolescents. The National Family Health
Survey (NFHS-3)conducted atIndia in 2007-2008, While 56 per cent of 4 adolescent girls are anaemic,
boys too are falling prey to the disease. Around 30 per cent of adolescent boys are suffering from
anaemia.
Iron deficiency anaemia is primarily due to inadequate intake of food, both in quantity and quality. In
availability of nutritional food, lack of money for purchasing food, traditional beliefs and taboos about
child ‘s diet and in sufficient balanced diet are resulting in anaemia. It is the underlying and associated
cause of childhood illness and death among the pre-school age group. It makes the child susceptible to
infection, and lower recovery from illness.
Teenage years are an important first opportunity to be responsible for their own food choices, so it‘s
worrying that so many in this age group are still not getting the nutrition properly. Malnourished
children are prone to develop continuous bouts of some illness. This condition can be easily set right if
we eat the right food in the right amount daily i.e., if the children ‘s consume a balanced diet every day
and develop good eating habits for good health.
NEED OF THE STUDY
“The adolescent girls still remain a young plant that neither gets light nor water, she remains
the flower that could have blossomed but didn’t.... Kamala Bhasin
Sadly it‘s surprising that teenage girls have a worse diet than their male counterparts as pressure on
females to stay slim seems to be starting at an increasingly young age. The youngsters’ diets are
becoming increasingly unhealthy and higher numbers are becoming overweight. This focus on weight
could be taking its toll on some of their vitamin and mineral intake, creating a nutritional gap which
could lead to its own health issues in the future.
It is estimated that according to WHO, approximately 24.8 % world’s population are affected
with an anaemia and 50% of an anaemic case is due to iron deficiency. Currently 1.62 billion
population is affected all over the world.
In India anaemia is a severe health problem, because 74.3% population are affected by
anaemia. Almost 58% of pregnant women are anaemic. In south Asia India contributed 80%
of the maternal deaths due to anaemia. According to the reports of National Family Health
Survey (NFHS) - 3 (2015 - 16) and the National Nutrition Monitoring Bureau Survey
(NNMBS) over 55% of adolescent girls are having anaemia that is alarmingly high. In Gujarat
prevalence rate of anaemia in the year 2015-16 is 54.9% in women, 21.7% in men and 62.6%
in children.

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Jaggery has a characteristic of dark colour due to the presence of high iron content in it. It can
help to improve the level of haemoglobin. 100 gm of raw jaggery contains 3mg iron.
Anaemia is major health burden around the world. Low haemoglobin level is to be one of
the most prevalent forms of malnutrition. There is an urgent need to develop effective and
sustainable interventions to improve the haemoglobin level in the blood. Anaemia is
responsible for significant morbidity and mortality, particularly in under developed countries.
Many studies revealed that organic forms of nutrients derived from natural sources are much
easier than synthetic nutrients. Thus, the iron content in jaggery is easily absorbable and gives
more nutritive value than manmade forms of iron supplements. jaggery is a good choice for
improvement of haemoglobin level. It is cost effective, easily available, no side effects and it
can be easily stored.
STATEMENT OF THE PROBLEM
“A STUDY TO EVALUATE THE EFFECTIVENESS OF NUTRITION BALL ON
HAEMOGLOBIN LEVEL AMONG YOUNG ADOLESCENT GIRLS WITH IRON
DEFICIENCY ANAEMIA AT SELECTED SCHOOL OF VADODARA.
OBJECTIVES
 To assess the haemoglobin level among adolescent girls at selected school of Vadodara
 To evaluate the effectiveness of nutrition ball on haemoglobin level among adolescent
girls with iron deficiency anaemia at selected school of Vadodara.
 To find out the association between the haemoglobin levels with selected demographic
variables.
HYPOTHESES
Ho : There is no significant difference between the pre-test and post-test level of haemoglobin
among young adolescent girls at selected schools of Vadodara
H1 There will be a significant difference between pre-test and post test score of haemoglobin
level among young adolescent girls at selected schools of Vadodara.
H 2 There will be significant association between the post-test level of haemoglobin among
young adolescent girls with selected demographic variables.

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ASSUMPTION
 Adolescent girls are prone to develop the iron deficiency anaemia due to menstruation,
insufficient iron in the diet and poor absorption of iron in the body.
 Dietary intake of iron supplement in form of nutritional ball will improve the level of
haemoglobin among young adolescent girls.
DELIMITATION
 The study is limited to young adolescent girls studying in selected school of Vadodara
 The study will be limited to girls in the age group between 11- 14 years
OPERATIONAL DEFINITION
 Assess: It this study assess refers to determining the value of haemoglobin.
 Effectiveness: It refers to the increase in haemoglobin level after administering of
jaggery balls.
Young Adolescent Girls: In this study young adolescent girls refers to the females
belonging to the age group between 11 to 14 years.
 Haemoglobin Level: It is the protein which is responsible for transporting oxygen
in the blood. The haemoglobin level is between 8 to 12 g/dl.
 Nutrition Balls: In this study it refers to the iron rich supplement it includes Jagerry
50gms and Amla 10gms to be prepare hygienically, all ingredients will be powdered
and then it will be converted into balls.
 SelectedSchools of Vadodara District: In this study, selected schools refers to those
places where adolescent girls are studying.
 Vadodara District: In this study Vadodara district refers to the region where
research setting is located.
REVIEW OF LITERATURE
Review of literature is one of the most important steps in the research process. A literature
review is an account of the previous efforts and achievements of scholars and researchers on a
phenomenon. It is a description and analysis of the literature relevant to a particular field or
topic. It provides an overview of what work already had been carried out, who are the key
researchers who did that work, which of the questions are already answered regarding a
particular area of research interest, what methods and methodologies were used to answer the

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particular questions and what are the prevailing theories and hypotheses. It provides a practical
guide to a particular topic. For health care professionals, they are useful reports that keep them
updated with what is present in the field. Comprehensive knowledge of the literature of the
field is essential to most research studies.
The related literature is organizedand presentedunder the following
headings:
1. ROL related to prevalence of haemoglobin and anaemia among young adult.
2. ROL related to Factors and symptoms to iron deficiency Anaemia
3. ROL related to effectiveness of natural therapy to increase haemoglobin level.
1. ROL relatedto prevalence of haemoglobinand anaemia among young
adult
A cross sectional study on anaemia among adolescent girls in rural area was conducted by
Siddharam S M, Venketesh G M, Thejeshwari H L. The major goal of this study was to
determine the prevalence of anaemia among adolescent girls. Second objective was to study
the socio demographic variables correlated with anaemia. The study was conducted in selected
Anganwadi centres of rural area of Hassan district Karnataka, south India. The study total
prevalence of anaemia was 45.2%. In that finding 40% were mild anaemia, 55% were moderate
anaemia and 5% were severe anaemia. The study findings were proving that anaemia
prevalence rate was highly shows in adolescent girls, which gives proves that anaemia was
mainly shows in lower socioeconomic family. It concludes that nutritional factors or status of
adolescent girls was major impacting factors for causing anaemia.
A descriptive study to assess the prevalence of anaemia among women, was held
by Sathya P, Gandhimathi R and Viruthasarani K. The major objective of this study was to
determine the prevalence of anaemia among women. Sample size for this study was 245
women. The samples were selected by using the purposive sampling technique. The study were
conducted at selected urban areas of Coimbatore district. Tallquist method was using for
determine the haemoglobin level among women. Thus, the study findings clearly shows that
total of 250 women, in that 10 (4%) had severe anaemia (<8.0 g/dl), 145 (58%) had moderate
anaemia (8-10.9 g/dl), 6 (2.4%) had mild anaemia (11-11.9 g/dl), and 89 (35.6%) had their
normal haemoglobin level (>12.0g/dl). Conclusion of this study was shows that prevalence
and incidence of anaemia is more in developing countries like India. Study was mainly focused
on to determine the anaemic women in this research study setting
A cross-sectional study on haemoglobin status of non-school going adolescent girls
was conducted by Gandham Bulliyya, Gitanjali Mallick, Girija Sankar Sethy, and Santanu
Kumar Kar. The objective of this study was to identify prevalence of anaemia among non-
school going adolescent girls and to identify the correlation between Hb concentration, socio
demographic variables and nutritional factors. The sample size was total 1937 healthy
adolescent girls with age group between 11-19 years. Sample technique was probability
proportionate to size cluster sampling was using. The setting was choose for this study was
includes bargarh, khurda, and Jaipur district in Orissa. Study findings was clearly shows that
mean haemoglobin concentration value was 9.7±1.4 g/dL (range, 4.5–13.4 g/dL). In that, total

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1,869 (96.5%) adolescent girls were anaemic with Hb value was <12.0 g/dL. It also includes
4.4% adolescent girls were severe anaemia, 46.9% adolescent girls were moderate anaemia and
45.2% adolescent girls were mild anaemia.
A cross-sectional study on prevalence of anaemia and its associated risk factors among
adolescent girls of central Kerala was conducted by P.M. Siva, A. Sobha, and V.D. Manjula.
The aim of this study was to identify prevalence of anaemia and its factors associated with
adolescent girls. Total 257 adolescent girls were taken from ettumanoor panchayat, the field
practice area of Government Medical College, Kottayam. Pre-test and post-test was done
during the study. Data were collected regarding socio demographic variables and factors
correlated with anaemia. The result of p-value was <0.05, which indicated that level of
significance was fixed.
B Sudhagandhi, Sivapatham Sundaresan, W Ebenezer William, A Prema was
conducted study on prevalence of anaemia in the school children. The study was start from
September 2019 to end with February 2020. The major purpose of this study was identified the
prevalence of anaemia among school children and its correlation with demographic variables
like age, gender and body mass index. The study was conducted at government schools of
kattangulathur, tamilnadu, India. Total 900 samples are taken from government school in age
group between 8-16 years. Thus, study findings conclude that prevalence of anaemia among
overall children with age group between 8-16 years was 52.88% or (476/900).
2. ROL related to Factors and symptoms to iron deficiency Anaemia
A descriptive study conducted by Neena Gupta in 2018 on symptoms of anaemia at
Jabalpur.The study revealed that majority 36(42.9%) girls had history of shortness of breath on
exertion, 36 (42.9%) girls had complaint of easy fatigability, and 41(48.8%) girls had loss of
appetite. In a study on supplementation effect of iron and folic acid capsule on anemic
adolescent girls it was reported, that majority of subjects participated in the study complained
for lethargy (72.22%) and breathlessness on exertion (64.81 %) Problem of anorexia was faced
by about (35.18%) of the subjects.
An analytical study conducted by Asheri, H., Kianmehr in 2017 among Indian adolescent girls
In physical examination of adolescent girls with mild anaemia depicted that, majority of girls
48 (57.1%) girls had pale conjunctiva. Appearance of tongue was pale color for 34(40.5%)
girls. 14 (28.6%) girls had pale skin and pale 27 face. In a study on supplementation effect of
iron and folic acid capsule on anemic adolescent girls the symptoms of anaemia were observed
among all the subjects with wide range of variation. Paleness of eyes was in maximum number
of the subjects (62.96 %). However, the paleness of skin and flat nails was found in (66.66%)
and (33.33%) percent of subjects respectively.
A descriptive study conducted by Lloyd Van Winkle in 2009 to assess menstrual history of
anaemia among adolescent girls in Jhirli: Among 84 girls, 79(94%) girls had regular flow of
menstruation and 5(6%) girls had irregular menstrual flow, only 1(1.2%) girl had excess flow
of menstruation her haemoglobin level was 10.2 gm/dl. Among girls, however, menstruation
increases the risk for iron deficiency anaemia throughout their adolescent and childbearing
years. An important risk factor for iron deficiency anaemia is heavier menstrual bleeding

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3. ROL relatedto effectivenessofnatural therapy to increase haemoglobin
level
Resmi.S, Fathima Latheef, R.Vijayaraghavan were conducted study on effectiveness of herbal
extract in enhancing the level of Hb among adolescent girls with iron deficiency anemia. . The
main aim was assessing the effectiveness of herbal extract in increasing the level of Hb of
adolescent girls with iron deficiency anaemia. True experimental research design was adopted
for this study. Study was conducted at gangothri international public school, Bangalore district
with 20 adolescent girl’s age group between 14-17 years who are having iron deficiency
anaemia. The herbal extract was given for a time of 1 month. The data tool was include
structured interview, check list questions and sahli's method for assessing the diagnostic
findings and blood test for assessing the Hb level. Pre-test was done before giving the
intervention and post-test was done at the end of one month. The findings includes mean score
was 9.7 and standard error was 1.218 in pre-test and post-test mean score was 11.03 and
standard error was 1.685. The ''t'' value was 2.9759 and df = 18, the mean difference values of
pre-test and post-test was significant at p<0.05 level. Study findings shows that herbal mixture
was effective in increasing the level of Hb.
Mrs L. Aslin Johnsi, was conducted study on effectiveness of Alma juice on haemoglobin
level among young adult female with anaemia. The study purpose was to evaluate the
effectiveness of Alma juice on haemoglobin level among young adult females. One group pre-
test-post-test design was adopted with total 60 samples were selected by purposive sampling
technique at sree mookambika college of nursing, kulasekharam. The data tool includes digital
haemoglobin meter and demographic data. In the first day of pre-test Hb level was estimated.
Amla juice was given for period of 1 month. The study it proves that the level of Hb was
improved after providing the amla juice with ''t'' value was 19.33, df was 59 and ''p < 0.05''. S.
Resmi, Fathima Latheef and Vijayaraghavan was conducted an experimental study on
effectiveness of amla, jaggery and pumpkin leaves extract on the level of haemoglobin, vitamin
c and iron among adolescent girls with iron deficiency anaemia. The study purpose was to find
the effectiveness of amla, jageery and pumpkin leaves mixture on level of haemoglobin,
vitamin C and iron among adolescent girls with iron deficiency anaemia. Total consisting of
120 samples, adolescent girl’s age group between 14-17 years selected by using the simple
random technique. 60 samples in experimental group were taken from gangothri public School
and 60 samples in control group were taken from srigandhadakaval public School. Study shows
that there was significant difference in the pre-test and post-test level of Hb, vitamin C and iron
in the experimental group. Increasing of mean value in Hb from 9.942 to 10.99, vitamin C from
4.302 to 5.63 and iron from 77.6 to 99.58 in experimental group.
CONCEPTUAL FRAMEWORK BASED ON GENERAL SYSTEM THEORY

10. 10
GENERAL SYSTEM THEORY All the living system is open in which there is continuous
exchange of matter, energy and information. The system returns output to the environment
responses of system. It may be positive or negative.
The system component includes:
1. Input
2. Throughput
3. Output
1.INPUT
A system input is defined as the movement of information or matter energy from the
environment to the system. Input is the information needed by the system given to understand
to assess the level of haemoglobin according to WHO classification of anaemia as per hb level
by the use of haemocumeter 301 analyzer and observation checklist among young adolescent
girls in selected schools of Vadodara district.
2. THROUGHPUT
When there is transformation of input or output by the system is usually called throughput.
Throughput consider as intervention cum result process in general, in present study hb level
will be assessed on the very first day before introducing intervention. Then the intervention,
the nutrition ball will be given for one month Post-test hb level will be measured on the day of
7th, 15th and 30th day from pre-test.
3. OUTPUT
A system output is the movement of information or matter energy from the system to
environment. The information continuously processed through the system and released as
output in the study. The concept of outcome refers to the improve the level of haemoglobin
level in young adolescent girls.

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CONCEPTUAL FRAMEWORK BASED ON GENERAL SYSTEM THEORY BY
LUDVIG VON BERTANFFY
INPUT THROUGHPUT
OUTPUT
SCIODEMOGRAPHIC
FACTORS
Age, type of family, number
of family members, monthly
income, diet, diet frequency,
menstrual history
ASSESSMENT OF HB
LEVEL ACCORDING TO
WHO(GM% )
1.NORMAL-12
2.MILD ANEMIA -10-11.9
3.MODERATE-7-9.9
4.SEVERE-<7
IMPROVEMENT
IN HB LEVEL
NO
IMPROVEMENT
IN HB LEVEL
PRE-TEST
1ST
DAY
INTERVENTION
(ADMINISTRATION OF
NUTRITION BALL FOR
30 DAYS)
POST TEST
(7TH DAY
15TH DAY
30TH DAY)

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RESEARCH APPROACH:
Research approach is the most significant of any research. The appropriate
choice of the research approachdepends upon the purposeof the research study
which has been under them.
Quantitative researchapproach will be used to assess the effectiveness of
nutrition ball on haemoglobin level.
RESEARCH DESIGN:
Design: Pre-Experimental (One group pre – test post-test) design
Purpose: To Assess the Effectiveness of nutrition ball on Haemoglobin
Level among the young Adolescent Girls
Study Setting: Selected Schools of Vadodara
Target Population: young adolescent girls with iron deficiency anemia
Sample and Sampling Technique
Young Adolescent
Girls in Selected
School Of
Vadodara
Data Analysis
Descriptive and
Inferential
Statistics
Non-Probability
Purposive
Sampling
Technique
Reports
Data Analysis
Descriptive and
Inferential Statistics
Schematic Representation of Research Plan

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VARIABLE UNDER STUDY Attributes or characteristics that can have more than one
value called as variable. In this proposed study there will be independent, dependent and
demographic variable.
Independent variable: Variables that are purposely manipulated or changed by the
researcher called as independent variables. In the proposed study the independent variable is
nutrition ball.
DependentVariable: Variables that change as the independent variable is manipulated
by the researcher. In the proposed study the dependent variable is haemoglobin level of
adolescent girls.
Demographic variables: Socio-demographic variables includes age, type of family,
number of family members, monthly family income, diet, diet frequency, and menstrual history
includes age of menarche, duration and interval.
RESEARCH SETTINGS:
The study setting is the location in which the research is conducted and in this proposed
study the research setting is selected schools of Vadodara district.
TARGET POPULATION: The target population in this study will be young adolescent girls
with iron deficiency anaemia.
ACCESSIBLE POPULATION: young Adolescent girls with iron deficiency studying in
selected school of Vadodara
SAMPLE: A part or subset of population selected to participate in research study. In this
proposed study the sample is adolescent girls who fulfil inclusion criteria.
SAMPLE SIZE: total 350 samples

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SAMPLING TECHNIQUE
Non probability purposive sampling technique will be used in this proposed study
CRITERIA FOR SELECTION OF SAMPLES: It refers to the list of the characteristics
essential for inclusion or exclusion in the target population.
Inclusive Criteria: The study include-
 Age group 11-14 years
 With the haemoglobin levels between 8-12 g/dl
 Interested to participate in the study
 Available at the time of data collection
Exclusive Criteria: The study excludes-
 Girl students diagnosed with blood disorder.
 Girl students having menstrual disorder specifically menorrhagia and
Metrorrhagia.
 Girl students who have food related allergy
DEVELOPMENT AND DESCRIPTION OF THE TOOL The main aim of the study is to
evaluate the effectiveness of beetroot juice with jaggery on Hb level.
Data collection instruments and related information are-
 Demographic variables
 Biochemical test to measure the haemoglobin level by using haemocumeter 301
analyser.
The Tool Consists Of Two Sections:
Section – A: A demographic data of includes age, type of family, number of family
members, monthly family income, diet, diet frequency, menstrual history includes age
of menarche, duration and interval.
Section– B: Clinical assessment of symptoms of anaemia with observation checklist
used to assess the symptoms of anaemia among adolescent girls.
Section– C: This section includes a biochemical test

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SCORING PROCEDURE AND SCORING KEY
ASSESSMENT OF HB LEVEL ACCORDING TO WHO(GM% )
1.NORMAL-12
2.MILD ANEMIA -10-11.9
3.MODERATE-7-9.9
4.SEVERE-<7
Nutrition Ball
It includes iron rich supplement in the form of ball and Vitamin C.
 Jaggery 50 gms - 5.7 mg of iron
 Amla (10gm) - Vitamin C 40mg

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PARTICIPANT INFORMATION SHEET
This information sheet is for participants who are suffering from lower haemoglobin
level.
The Title of our research: “A Study to Assess the Effectiveness Of nutrition ball On
Haemoglobin Level Among Young Adolescent Girls at Selected School of Vadodara
District".
Name of Principal Investigator: Sangeeta Chatterjee Contact no: 9714834751
Name of research Supervisor: Dr. Muley Prasad
Name and address of organization- Parul University
P.o limda, tal: waghodia,
dist.: Vadodara,
Gujarat state, india-391760
Introduction: I am going to give you information and invite you to be part of this research.
Before you decide, you can talk to anyone you feel comfortable with about research. There
may be some words that you do not understand. Please ask me to stop as we go through the
information and I will take time to explain. If you have question later, you can ask them of me.
Purpose of the research: The purpose of this study is to assessthe effectivenessof nutrition
ball on haemoglobin level among young adolescent girls.
Participant selection: Non-Probability Purposive Sampling Technique
Voluntary participation: Your participation in this research is entirely voluntary. It is your
choice whether to participate or not. Whether you choose to participate or not, will not have
any effect on the health service you are currently receiving. You may change your mind later
and stop participating even if you agreed earlier.
Procedure and protocol: The investigator will obtain formal written permission from
the concerned authority. The purpose of the study will be explained to the participants
and clear written informed ascent will be obtained by the participants.
Risks: No risk
Benefits: the nutrition ball will help to increase the haemoglobin level among
adolescent girls.
Confidentiality: We will not be sharing the identity of those participating in the
research. Sharing of result: The results of the research would be used for academic
purpose. We will publish the results in order that other interested people may learn
from our research. Your identity will not be revealed in any information released to
third parties or published.

17. 17
Right to refuse or withdraw: You are free to withdraw from this study at any time,
without giving any reason, without your medical care or legal rights being affected.
Signature, name and address of participant:
Signature, name and address of witness (If applicable):

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INFORMED CONSENT FORM
Study title: “A Study to Assess the Effectiveness of nutrition ball On Haemoglobin Level
Among Young Adolescent Girls at Selected School of Vadodara District".
Study Number (if present):
Participant’s Initials………………………………………
Participant’s name……………………………………….
Date of birth/age…………………………………………
i. I confirm that I have read and understood the information sheet dated
……………. for the above study and have had the opportunity to ask
questions. [ ]
ii. I understood that my participation in this study is voluntary and that I am free
to withdraw at any time, without giving any reason, without my medical care
or legal rights being affected. [ ]
iii. I understand that the investigator part of his project, the ethics committee and
the regulatory authorities will not need my permission to look at my health
records both in respect of the current study and any further research that may
be conducted in relation to it, even if I withdraw from the trail. I agree to this
access. However, I understand that my identity will not be revealed in any
information released to third parties or published [ ]
iv. I agree not to restrict the use of any data or results that arise from this study
provided such a use is only for scientific purpose [ ]
v. I agree to take part in the above study. [ ]
Signature of the participant: Date: ____________
Signature of the investigator: Date: _____________
Study investigator name: _________________________________________
Signature of witness: Date: ____________

19. 19
PERFORMA OF DEMOGRAPHIC VARIABLES
Sample No:
Participants Instruction: The interviewer is directed to ask questions one by
one, according to the response given by the respondent.
Please read the questions carefully and answer by selecting an opinion
applicable to you by placing in the given box.
1. Age in years
(A) 11 years
(B)12 years
(C)13 years
(D)14 years
2. Type of Family
A) Nuclear B) Joint C) Extended
3. Number of Family Members
A) Two
B) Three
C) Four
D) > Four
4. Monthly family Income in Rupees
A) Rs.5000/-
B) Rs.5000/- to Rs.10,000/-
C) Rs.10,000/- to Rs. 15,000/-
D) > Rs.15,000/-
5. Diet
A) Vegetarian B) Eggetarian C) Mix
6. Diet Frequency
A) Two times per day
B) Three times per day
C) > three times per day
7. Menstrual History
(i) Age of Menarche
A) < 12 Years B) 13 Years C) 14 Years D) > 14 Years

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(ii) Duration
(A) 26 days
(B) 27 days
(C) 28 days
(D) 29 days
(E) 30 days
(iii) Interval
(A) Regular (B) Irregular

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BIOCHEMICAL TEST
Sr.no Sample
no.
Haemoglobin level remarks
1st day 7th day 15th day 31st day

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CLINICAL ASSESSMENT CHECK LIST
S.no Sign and symptoms of
anaemia
Pre-test Post-test
1 Paleness of conjunctiva yes no yes no
2 Pale tongue
3 Anorexia
4 Irritability
5 Fatigue
6 Shortness of breath
7 Exercise intolerance
8 Pica
9 Palpitation
10 Glossitis
11 Stomatitis
12 Facial puffiness
13 Angular cheilosis
14 Koilonychia
15 Pedal oedema

23. 23
PLAN FOR DATA ANALYSIS: Analysis is the method of organizing,
sorting, and scrutinizing data in such a way that research question can be
answered or meaningful inferences can be drawn.
Plan for data analysis would be as follows:
 A master data sheet will be prepared in order to complete the data by the investigator.
 Baseline Performa containing demographic variable
 Paired - t test in order to evaluate the effectiveness of nutrition level the level of
haemoglobin.
 Chi square in order to find out the association between demographic variables and
haemoglobin level.

24. 24
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Nurses", Second Edition, Elsevier Publication, and Pg. No: 3
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2011, Page No. 689.
3) Blood Disorders, Anemia, American Society Of Haematology, Helping
Haematologist Conquer Blood Diseases Worldwide.
https://www.hematology.org/Patients/Anemia/Iron-Deficiency.aspx
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Information (Chi), Set Up At National Institute Of Health And Family Welfare
(NIHFW), By The Ministry Of Health And Family Welfare (MHFW), Government Of
India.
https://www.hematology.org/Patients/Anemia/Iron-Deficiency.aspx
5) Vitamins and Minerals Nutrition Information System, Haemoglobin Concentration
for the Diagnosis of Anemia And Assessment Of Severity, World Health Organization,
WHO/NMH/NHD/MNM/11. https://www.who.int/vmnis/indicators/haemoglobin.pdf
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juice
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Control. A Guide for Programme Managers of WHO, Geneva; 2001.
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Gujarat (2015 – 16); P.121
10) Resmi.S, Fathima Latheef, R.Vijayaraghavan, "Effectiveness Of Herbal Extract In
Enhancing The Level Of Hb Among Adolescent Girls With Iron Deficiency Anemia
At Selected Higher Secondary Schools At Bangalore", International Journal Of Health
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www.ijhsr.org
CHAPTER IX
11) Resmi S , Fathima Latheef , R. Vijayaraghavan, " Effect Of Nutritional Support
Therapy On Level Of Haemoglobin, Vitamin C, Iron And Its Impact On Physical Work
Capacity And Intelligence Among Adolescent Girls With Iron Deficiency Anaemia",
International Journal Of Research Ayurveda Pharm. 8 (3), 2017: 99103.

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12) Dr. N. Gayathri Priya , Mrs M. Malarvizhi, Mrs Annal Jega Jothi Beet Root Juice
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Delhi: Reed Elsevier India (p) ltd: 2014. p. 124-125,138, 39, 210, 286, 287, 41,121(22)
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