Bangalore, Karnataka Proforma for Registration of Subject for Dissertation

BANGALORE, KARNATAKAPROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATIONJAGADEESH .V I YEAR M.Sc (NURSING) PAEDIATRIC NURSING YEAR 2009-2010CAUVERY COLLEGE OF NURSING # 42 / 2B, 2C, TERESIAN COLLEGE SIDDARTHA LAYOUT MYSORE. RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCESBANGALORE, KARNATAKAANNEXURE – IPROFORMA FOR REGISTRATION OF STUDENT FOR DISSERTATION1. NAME OF THE CANDIDATE JAGADEESH .V & ADDRESS I YEAR M.Sc NURSING CAUVERY COLLEGE OF NURSING SUBASH NAGAR, MYSORE – 570007 NAME OF THE 2. INSTITUTION CAUVERY COLLEGE OF NURSING, MYSORE – 570007 COURSE OF STUDY & 3 SUBJECT MASTER IN PAEDIATRIC NURSINGDATE OF ADMISSION TO 4. THE COURSE 15.06.2009TITLE OF THE TOPIC 5 AN EXPERIMENTAL STUDY TO ASSESS THE EFFECTIVENESS OF BEETROOT EXTRACT ON IRON DEFECIENCY ANEMIA AMONG ADOLESCENT GIRLS STATEMENT OF THE 6. PROBLEM AN EXPERIMENTAL STUDY TO ASSESS THE EFFECTIVENESS OF BEETROOT EXTRACT ON IRON DEFECIENCY ANEMIA AMONG ADOLESCENT GIRLS 6. BRIEF RESUME OF THE INTENTED WORK6.1 INTRODUCTIONThe best and the most beautiful things in the world cannot be seen, nor touched… but are felt by the heart. Jawaharlal Nehru said, “Children are the wealth of tomorrow, take care of them, if you wish to have a strong India, ever ready to meet various challenges.” Hence the children still remain as young plants that neither get light nor water, they remain the flowers that could have blossomed. Looking back on their adolescence, adults often conjure up grand memories, and laugh at their mistakes. Adolescence is a period in life that every one must ‘survive’ in order to become an adult, although some goes through it more turbulently than others. Falling approximately between the age of12 to 19 years, adolescence is characterized by physical changes, more complex and hidden changes occur in an adolescent’s attitude, outlook, and self-identity. Ultimately, the ‘goal’ of adolescence is to gain personal independence, and a sense of self. Although these physiological changes happen slowly, the environment is part of the key to survive this difficult period and become a stronger person. Our job as health care professionals in today’s society requires an understanding of this problematic time in a child’s life, as well as regression into our own adolescence, to better prepare ourselves to rise the generations of tomorrow. Socially, the feelings of adolescent group are at its maximum and want to shine, and prove themselves. Another note worthy point is that the world adolescent population is 22.5% and 85% of them are living in developing countries. Kellec, (1996) Anemia is a quantitative or qualitative deficiency of circulating red cells. The situation back home in India and other developing countries is perhaps worse. The causal factors of Anemia are decreased iron supply from inadequate diet, poor bioavailability of iron, increased physiological requirements, abnormal iron loses, malabsorption of iron. Among the world population, two billion people are affected by anemia and mostly it is due to iron deficiency. Global data base by WHO (2007) on child growth and malnutrition and NationalFamily Health Survey – 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. Anemia prevalence was more among girls of low weight, height and BMI as compared to those who were heavier, tall and having higher BMI.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. 6.2 Need for the studyIron deficiency to be one of the most prevalent forms of malnutrition, yet there has been lack of consensus about the nature and magnitude of the health consequences of iron deficiency and the Public Health importance of iron-deficiency among population, which was made as part of Global Burden of Disease (GBD) 2000 Project.Iron deficiency has its direct contributions to cognitive impairment, decreased work productivity, and death from severe anemia. Based on meta-analysis of observational studies, mortality risk estimates are decreased for each 1 g/dl increase in mean haemoglobin concentration. On average, globally 50% of the anemia is assumed to be attributable to iron deficiency. Iron deficiency anemia ranks 9th among 26 risk factors included in the GBD 2000, and accounts for 841,000 deaths, and 35,057,000 disability adjusted life. There is an urgent need to develop effective and sustainable interventions to control iron-deficiency anemia.The highest prevalence of Anemia exists in the developing world where its causes are multi-factorial defects in human. Anemia is responsible for significant morbidity and mortality, particularly in under developed countries. Understanding the causes of anemia and potential mechanisms are crucial to our ability to interface in reducing this burden. In the past decade, our understanding of the etiology and mechanisms of anemia were less especially in developed countries which has now advanced significantly. This review will focus on recent advances in our understanding of the burden of Anemia in specific sub-group, the causes and mechanisms of Anemia, and consequences of Anemia on the human. John, 2007 studied the healing effects of beetroot juice. He reported that,Beetroot juice is a healing juice. It acts as a blood building herb that detoxifies blood and renews it with minerals and natural sugars. Beetroot juice provides phosphorus, sodium, magnesium, calcium, iron and potassium as well as fibre, Vitamin A, C,Niacin, Folic acid and Biotin. The study revealed that organic forms of nutrients derived from natural sources are much easier to assimilate than synthetic nutrients.Thus the iron content in beetroot juice is easily assimilated and gives more nutritive value than man made forms of iron supplements. Beetroot is a good choice for correction of anemia. It is cost effective, easily available, no side effects and it can be easily stored. Investigator personally experienced the signs and symptoms of anemia during the adolescent period. Thankachen et al., (2004) conducted a descriptive study on anemia in relation to economical status of the adolescent girls. The study revealed that anemia is the most common form of malnutrition among adolescents today. Adolescents (10-19 years) constitute >20% of our population in India and 50% suffer from Iron deficiencyAnemia. Adolescents from both urban and rural areas are affected by anemia, among whom girls (79%) are higher than boys (21%). Poor economical status, infection and less intake of iron also influence and increase the incidence of anemia among children and adolescent girls. Beetroot strengthens the body’s immune power and has proved to be an excellent remedy for anemia, especially for children and adolescents where other blood forming remedies have failed. Thus, the researcher was interested to conduct a pre- experimental study to know the effectiveness of beetroot extract upon anemia that may lead to less difficulty and higher success rate.6.3 REVIEW OF LITERATUREReview of literature is an essential component of the research process. It is critical examination of a publication related to a topic of interest. Review should be comprehensive and evaluative. Review of literature helps to plan and conduct the study in a systematic manner.This chapter deals with the review of published research studies and form related material for the present study .The review helped the investigator to develop an insight into the problem area. This helped the investigator in building the foundation of the study. Review of literature helps the researcher to build on existing work he/ she should understand what is already known in the topic (Polit and Hungler 2007) For the present study literature is reviewed and organized, under three broad headings. Studies related to prevalence of anemia among adolescent girls. Studies related to the effectiveness of beetroot extract upon anemia. Studies related to prevalence of anemia among adolescent girlsChoudary et al., (2007) conducted a cross sectional study to assess anemia among unmarried adolescent girls in South India, 100 adolescent girls, aged from 11 to18 years were selected as samples by purposive sampling method. Blood samples were collected and haemoglobin test was done. The result showed that 29% of adolescent girls were affected with severe anemia, rest of them had mild anemia 71% (P<0.05).Anemia has a significant association with low socio economic status, religion and reporting of infrequent or non-consumption of meat. He concluded that the haemoglobin status of the adolescent girls need to be improved through dietary modification along with the iron supplements and nutritional education.Dreyfuss et al., (2007) conducted an analytical study to assess the anemia among Indian adolescent girls under the project by Health and Family Welfare Bureau.Blood collection was done and serum ferritin, peripheral blood smear and Haemoglobin test were done and analysis was carried out. The result showed that in India severe anemia ranges from 1.6% to 11.7% among adolescent girls, moderate anemia seen in rural area were more (38%) than in urban (11.9%) area (P< 0.05). He concluded that the adolescent girls are vulnerable to iron deficiency anemia, which interferes in their physical capacity and work performance. Adolescent period is the preparatory period for the physical development for the future mothers. The young reproductive age group women are more susceptible to anemia, because of their poor dietary intake.Rohini et al., (2007) conducted are a retrospective study to assess the prevalence of anemia among adolescent girls in 16 slums at Pune. 1142 Adolescents were selected as samples. Data collection was done based on bio physiological measures, dietary history morbidity history, anthropometric measures, mental history, frequency of lemon consumption with meals, consumption of locally available iron rich foods. The result showed that 1.3% of girls were severely anemic and 58% of girls were moderately anemic (P< 0.01) in the study population. Sunitha et al., 2007 conducted a descriptive study to assess the prevalence of anemia among adolescent girls in Jhirli. Random sampling technique was used and 105 school going adolescents were selected as samples. Blood samples were collected and analyzed and a record of one-week dietary recall was maintained. The result showed that 82% of girls were anemic based on their dietary intake (P= 0.15). The report was concluded that anemia is an emerging problem among the world population, nearly2000 million adolescent girls are suffering from this iron deficiency anemia.Suman.k et.al (2006) conducted a cross sectional study to screen out the health pattern of the adolescent girls in the age group of 10-14 years. A total of 110 healthy adolescents were taken as samples by random sampling technique. Diet survey and serum haemoglobin level were assessed. The result showed that less than 10% of the girls had 12gm/dl of haemoglobin and others were anemic with haemoglobin level in the range of 6 to 11.9 gm/dl (p<0.05). The report concluded that the daily food allowance for adolescent girls were inadequate for which the amount of iron and vitamins should be increased.Sabita, 2006 conducted a descriptive study to assess the prevalence rate of anemia among school going adolescents at Jabalpur. A sample of 183 adolescents were taken from the age group of 12 to 18 years. The estimation of haemoglobin was done by cyanmethaemoglobin method and serum Ferritin was estimated. The overall prevalence of anemia was significantly higher among the girls (23.9%) when compared to boys (3.75%). Anemia was observed more among rural (25.4%) adolescents than urban (14.2%) adolescents. There was a deficiency of 81.7% and 41.6% of serumFerritin among adolescent girls and boys respectively Nandita, 2006 conducted a descriptive study to assess the prevalence of anemia and impact of anemia control programme among adolescent girls for which 512 school going adolescent girls were selected. The result showed that the prevalence of anemia in adolescent girls to be 80.6%. Dietary intake of the adolescent girls revealed that there was an inadequate intake of food. Almost 90.9% of adolescent girls were consuming less than 50% of required dietary allowance, the finding showed that there was a high prevalence of anemia among the study population ( P< 0.001) due to inadequate intake of food and there by a poor dietary intake of iron.Pawashe (2006) conducted a study regarding iron nutritional status of adolescent girls belonging to an urban slum and rural areas. Overall anemia was observed in 25% of the girls irrespective of their residence. A higher percentage of rural girls (37.5%) especially below the age of 12 years showed evidence of anemia.Thereafter, the prevalence was similar in both urban and rural girls who had not attained menarche. With increasing age, urban girls who had attained menarche showed an increase in the prevalence of anemia. The prevalence of iron deficiency (serum ferritin< 12 mcg /dl) showed a progressive increase from 28% to 60% over 12 years especially in the girls (P= 0.03). Findings suggested that distribution of iron and folate tablets to correct anemia to the vulnerable groups is essential. Leenstra et al. (2004) conducted a cross sectional study by using multistage random sampling design with a total of 648 adolescent school girls aged 12-18 years were randomly selected. The prevalence of anemia (Hb <12gldl) was 21.1%. Only one girl had the haemoglobin less than 7gldl. The prevalence of anemia among adolescent girls were 19.8%, in which 30.4% of anemic was exclusively due to iron deficiency.Malaria and schistosomiasis were the main risk factor in other girls (14-18). Findings suggested that menstruating girls are at higher risk of developing anemia.Sachdev et al., (2002) evaluated the effort of iron supplementation on the incidence of infections in children. Samples of 7892 children were selected for oral or parenteral iron supplementation or fortified formula milk or cereals. Incidence of all recorded infectious illnesses, such as respiratory tract infection, diarrhoea, malaria and other infection. The pooled estimate of the incidence rate ratio (iron v placebo) was1.02; the incidence rate difference (iron minus placebo) for all recorded illnesses was0.06 episodes per child per year. However, there was an increase in the risk of developing diarrhoea (incidence rate 1.11, 1.01 to1.23, P=0.04) but this would not have an overall importance on public health (incidence rate difference 0.05 episodes per child per year, 0.03 to 0.13; P=0.21). The occurrence of other illnesses and positive results on malaria smears were not significantly affected by iron administration. Findings revealed that iron supplementation has no apparent harmful effect on the overall incidence of infectious illnesses in children, though it slightly increased the risk of developing diarrhoea.Parmar et al, (2000) conducted a study on prevalence of anemia at Chandigarh a sample of 1120 apparently healthy adolescent (12 to 18 years) was subjected to anthropometric examination and haemoglobin estimation. The estimation of haemoglobin was done by cyanmethaemoglobin method, for 183 students. The overall prevalence of anemia calculated as pre WHO guidelines was significantly higher among girls (23.9%) as compared to boys (p<0.01). Anemia was observed more in rural (25.4%) as compared to urban (14.2%) adolescents (p<0.01). Finding suggested that rural adolescent girls had higher prevalence of anemia. Dietary modification and consumption of meagre amounts of habitual food increase total iron consumption by 25 to 30%. Processes like germination (Sprouting of green grams) and consumption of green leafy vegetables would be an additional and a long term method for the prevention of Iron deficiency anemia (IAP). Manimaya et al., (2000) conducted a descriptive study to assess the prevalence of anemia among adolescent girls for which 630 school going adolescent girls were selected. The result showed that the prevalence of anemia in adolescent girls to be80.6%. Dietary intake of the adolescent girls revealed that there was an inadequate intake of food. Almost 84.3% of adolescent girls were consuming less than forty percent of required dietary allowance and the finding showed that there was a high prevalence of anemia among the study population (p<0.001) due to inadequate intake of iron supplementation. Muslimmanton et al., (2000) conducted a cross sectional study to identify the different nutritional and iron status characteristics of young adolescent girls (10-12 years) with iron deficiency anemia and anemia without iron deficiency in the rural coastal area of Indonesia. Anemic girls (N=133) were selected out of 1358 girls from34 elementary schools. Haemoglobin, serum ferritin, serum transferrin receptor and zinc were measured for their nutritional status. Out of 133 anemic girls, 29 (21.8%) suffered from iron deficiency anemia, which is not significantly related to age and menarche. Further studies recommended to explore other factors associated with anemia and iron deficiency anemia, such as the thalassemia trait and vitamin A deficiency. The current iron folate supplementation programme for pregnant women should be expanded to adolescent girls.Chandrakala, 2000 conducted a study to assess the nutritional status of rural adolescent girls, to measure their knowledge about maternal and nutritional needs, to measure their dietary intake, and to determine the socio-cultural aspects among 47 adolescent girls aged between 13-18 years who attended a workshop on health and development organized by the Center of Maternal and Child Health at Vellore, in India.The overall mean haemoglobin value was 10.0g/dl 73.5% of the subjects who had haemoglobin value below 12g/dl (WHO Standard) and hence classified as anemic. The mean haemoglobin level increased with increasing age with the lowest being 13years(9.8g/dl) and the highest at the age of 17 years (11.9gm /dl). The mean age of menarche was 14.3 years. The diet was predominantly rice. Consumption of vegetables, milk and meat were very low, which might have been the causes for prevalence of anemia among girls. The findings show that rural adolescent girls have mild to moderate anemia.Thus, awareness must be created and nutritional supplements need to be provided.Studies related to the effectiveness of beetroot extract upon anemia Davies et al., (2006) conducted an experimental study on beetroot juice consumption in reducing anemia among adolescent girls in U.S.A. Study was designed to show that beetroot juice increases the blood forming qualities. Due to its higher concentration of iron, it regenerates and reactivates the red blood cells. One serving of beetroot juice (100ml) was given for 20 days, to the experimental group. After 20 days of beetroot juice intake, there was a significant improvement in the haemoglobin level(82%) for the experimental group (P<0.001). Winson, (2005) conducted a correlation 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 (r = 0.42). So the absorption of iron in beetroot is easier to get absorbed than the synthetic iron contents Jeminar, (2003) conducted an experimental study to assess the effectiveness ofBeetroot extract upon anemia in Vahington. In which 105 adolescents were selected as samples by random sampling method and was Blood samples were collected from them, before and after the intervention. Beetroot extract was given once in a day for 25 days.The result showed that 76% of adolescents were anemic before the treatment. There was significant improvement in the haemoglobin level (82%) of the study population(P=0.05). He concluded that vegetarians are at higher risk of developing iron deficiency anemia than non-vegetarians. Vegetarians have to take higher quality of iron rich foods in higher quantity and beetroot has a significant positive impact on the iron storage in the human body Milkan (2003) Conducted a hematological studies in Venesulla. There were 53 anemic girls selected as samples. Blood samples were taken and analysis was done before and after the intervention with beetroot juice administration, to know the effectiveness of beetroot in anemia correction. The result showed that 79% of the haemoglobin level has increased after therapy in the girls (P= 0.001). He concluded that beetroot has an effect on anemia. Fsaumi, 2003 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 supplementation. Fritz et al., (2002) conducted an experimental study to assess the effectiveness of beetroot juice in anemia correction in Indonesia 105 school children with iron deficiency anemia were selected, aged from 6-11 years, experimental and control groups were allocated by random sampling method.Beetroot juice (100 ml) was given by oral upto 20 days. Haemoglobin level was checked at pre and post intervention. There was significant improvement in the haemoglobin level (79.72%) of the samples (p < 0.001) than the control group (p< 0.05). He concluded that the intake of beetroot juice has significant character in reducing the prevalence of iron deficiency in children. 6.4 Statement of the problem“An experimental study to evaluate the effectiveness of beetroot extract upon iron deficiency anaemia among adolescent girls at selected school in Mysore”6.5 Objectives of the study1. To compare the level of haemoglobin before and after administration of beetroot extract among adolescent girls.2. To find out the association between the level of haemoglobin and the clinical variables before and after the administration of beetroot extract.3. To find out the association between the level of haemoglobin and the demographic variables before and after administration of beetroot extract.6.6 HypothesisH1 There will be significant difference between the level of haemoglobin before and after the administration of beetroot extract among adolescent girls.H2 There will be significant association between the demographic variables and the level of haemoglobin before and after the administration of beetroot extract among adolescent girls.H3 There will be significant association between the clinical variables and level of haemoglobin before and after the administration of beetroot extract among adolescent girls. 6.7 Operational definitionsEffectivenessIt refers to the increase in serum haemoglobin level after administering beetroot extract for a period of 20 days.AnemiaIn this study anemia refers to a reduction of the serum haemoglobin level below the range of 12 gm/dl in healthy adolescent girls.Adolescent girlsIn this present study adolescent girls refer to the females belonging to the age group of 14-17 years.Beetroot ExtractBeetroot extract is prepared by cutting a fresh beetroot into small pieces which are blended well. 50 ml of pulp diluted in 50 ml of boiled cool water and add 15 grams of jaggery.6.8 AssumptionsThe study assumed that, Most of the adolescent girls are anemic. Increased iron absorption is reflected with an increase in haemoglobin level. Anemia is preventable and treatable. Nurses play a major role in correction of anemia. 6.9 Delimitations The study will be conducted among adolescent girls who are studying in a selected school in Mysore. The study will be limited to girls in the age group of 13 – 19 years. The girls who are studying 8th standard to 12th standard. The girls who attained menarche.7. RESEARCH METHODOLOGYMethodology is the most important part of any research study, which enables the researcher to form a blue print for the study undertaken. This chapter represents the methodology adopted by the researcher for the study. It includes the research approach, the setting population, sampling techniques, selection of tool, content validity & reliability, pilot study, data collection, procedure & plan for analysis.The present study is aimed at the assessment of effectiveness of beetroot extract upon anemia among adolescent girls at a selected school in Mysore.7.1 Research designPolit and Hungler (1999) stated that a research design incorporates the most important methodology called decisions that the researcher make in conducting a research study. It helps the researcher in the selection of subjects, manipulation of independent variables to be studied. One group pre test post test design, which is pre experimental in nature, is adopted for conducting the study. The research design is represented diagrammatically as follows.O1 x O2O1 – Pre test to assess the haemoglobin level, degree of signs and symptoms of anemia and the level of knowledge of adolescent girls regarding anemia X – Administration of Beetroot extract.O2 – Post test to assess the haemoglobin level, degree of signs and Symptoms of anemia. 7.2 Research settingThe physical location and condition in which data collection takes place (Polit and Hungler, 1999). The study will be conducted at Selected School in Mysore. 7.3 Population, sample and sampling TechniquePopulation is the entire aggregation of cases which meet designed set of criteria(Polit and Beck 2004). The target population for this study is the adolescent girls who are in the age group of 13-19 years the accessible population is adolescent girls who are studying Selected School in Mysore.According to Polit & Beck (2004) a sample consists of a subset of the units which comprises the population. Sample size for the present study is 60 adolescent girls in the age group of 13-19 years, who satisfies the inclusion criteria. It is stated by Polit and Beck (2004) that sampling refers to the process of selecting a portion of the population to represent the entire population .The participants of the present study are selected by purposive sampling technique. It is a Non probability purposive sampling technique in which the researcher will select the participants based on the inclusion criteria.7.4 Sampling criteriaInclusion criteriaThe study include girls who are  in the age group of 14-17 years. Interested to participate in the study. with the haemoglobin levels less than 12 gm%. attained menarche. Exclusion criteriaThe study excludes girls  with any systemic disease/associated illness. with history of menorrhogia/ metrorrhoea.7.5 Selection and development of toolThe study is aimed at evaluating the effectiveness of beetroot extract upon anemia. Data collection instruments and related information are  Demographic variable proforma clinical variable proforma  check list for signs and symptoms of anemia and  Structured questionnaire to assess the knowledge of anemia among adolescent girls Rating scale on satisfaction of Beetroot extract.7.6 Plan for Data analysisThe data will analyzed with the help of descriptive statistics like mean, percentage, standard deviation and inferential statistics like paired ‘t’ test and chi-square test. The association between demographic data & depend variables will be analyzed with the help of chi-square test.7.7 Ethical Considerations: ▫ Does study require any investigation or intervention to be conducted on anemic patients? YES ▫ Has ethical clearance been obtained from hospital authorities in case study requires investigation? YES ▫ Informed consent will be taken from the participants and the concerned authorities of the school.8. REFERENCESAmirtha Gowri, (2005), Assessment of mental and motor abilities of school going children with Anaemia, The Indian of Journal of Nutrition and Dieticts, 42(99), 34-35.Aswathi,s ., Pande,V,K, Prevalence of malnutrition and intestinal parasites in preschool slum children in Luknow, The Journal of Indian Pediatrics,35(9) ,34-36.Basanthappa B.T (1998), Community Health Nursing”, ,(1st Ed), New Delhi, JaypeeBrothers Publications,112,413.Chandra,R.K, Iorn rich foods, Indian Journal of Pediatrics, 19(12), .31-32.Choudary Basanthi., Phyto chemical screening of green leafy vegetables of assamese dietaries believed to empower with medicine properties, The Indian Journal ofNurition and Dieticts, 43(23),392.Dorothy ,R.Marlow., Barbara (1988) ,Text book of Pediatric Nursing,( 6th Ed),Philadelphia, W.B.Sounders Company,1117-1118Donna, L., Wong (1995), Nursing care of infants and children, (5th Ed), Mosby publication,1007-1009 Eichton Wald. H (1988), Nelson Text book of Pediatrics, (13th Ed), Philadelphia, W.B.Saunders Compan,107-109Ghai, D.P (1993) Essentials Pediatrics , (3rd Ed), New Delhi, Interprint Publishers,214-215.Kasthuri Sunder Rao, (1997), Introduction community health nursing( 3rd)Newdelhi, PT publications,94-96.Park, (1997), Text book of preventive and social medicine( 15th Ed), Jabalpur, JaypeeBrothers, 412-413.Polit F.D., Hangler B.P, (2000), Nursing Research,( 6th Ed), New York, J.P Lipponcott&Co, 512-521Polit, Denise, F., Beck, T., (2004). Nursing Research (7th Edi). Philadelphia:Lippincott Williams and Wilkins, 51-52.Potter P.A., Perry, A.G, Fundamentals of nursing concepts process and practice( 3rdEd) , Mosby publisher,1002-1003.Sheshadri.s, Weekly supplementation of iron supplementation in rural areas, IndianJournal of Pediatrics, 22(14),25-26.Suraj Gupta, (1977), The short text book of pediatrics, (7th ed), New Delhi, JaypeeBrothers,303-304. 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