A quantitative evaluative approach was used to evaluate the effectiveness of dietary intervention on Iron deficiency anemia among the nursing students of selected nursing colleges of Mangaluru.

In this study one group pre test post test research design was used (Figure 1).

In this study 30 female nursing students with Hemoglobin <12gm/dl were selected for the intervention.

The sample size is calculated using the sample estimation formula

Substituting the values of previous similar study:

d =1.97, S.D =3.1, Zα =1.96 at 95 % confidence level, sample size is n=10.

Since the calculated sample size was small, the researcher increased the sample size to 30. Hence 30 students were selected. The investigators increased the sample size for improved accuracy, as larger sample size reduces the margin of errors and increases the precision.

In this study purposive sampling technique was used to select the sample of nursing students from selected colleges of Mangaluru.

It is concerned with the scope of coverage of the content area to be measured. More often it is applied in tests of knowledge measurement. It is mostly used in measuring complex psychologic tests of a person. It is a case of expert judgement about the content area included in the research instrument to measure a particular phenomenon.

In this study the prepared demographic proforma and the signs and symptoms checklist along with objectives and criteria checklist was submitted to four experts for content validation. Experts were requested to give their opinion and suggestions regarding each item in the tool. The items were modified according to the recommendations and suggestions of the experts. All the items in the tool were agreed by all the experts.

The reliability was established by using intra rater reliability. Karl Pearson coefficient correlation formula was used. Obtained r value for signs and symptoms checklist was 0.89. Hence the tool was reliable.

Permission was obtained from the ethical committee prior to the study.

Ethical approval was obtained from the Institutional Ethics Committee.

It was decided to analyse the data by both descriptive and inferential statistics. To compute the data. A master data sheet was prepared. Demographic proforma containing sample characteristics was analysed by using frequency and percentage. Hemoglobin level would be presented in the form of Hb percentage. t test would be used to find out the significant difference between the mean pre and post test Hb percentage. Signs and symptoms of anemia was presented in terms of frequency and percentage. λ² test used to find out the association of demographic variables and hemoglobin level. The findings are presented in the form of tables.

The baseline proforma of the samples showed that the highest percentage of the samples. (56.6%) are in the age group 19 years. Whereas least of them (10%) are in the age group of 18 years. None of them in group are married. Highest percentages are in the 1^st and 2^nd birth order (46.6% and 40%) respectively. Majority (66.6%) are having more than 4 members in the family. Most of the samples (96.6%) belongs to nuclear family and none of them are from extended family. The highest percentage of (40%) sample family monthly income is between 20,000 – 35,000. Whereas least (13.3%) of them have income above 35,000/- per month. Majority of the samples are Christians (60%). All the samples are non-vegetarian (100%). Highest percentage of samples obtained health education from friends and relatives and similar percentage (13.3%) obtained health information from newspapers, magazines, and health professionals. The majority of the samples (66.6%) are from rural area. Majority of them (80%) have not taken deworming once in six months. Majorities of the samples (66.6%) are hostelites whereas the least percentage are day scholars. Most of the samples (90%) are not doing exercise regularly. The majority of the samples (86.6%) are involved in walking and none of the sample is involved in cycling and yoga.

The pre test mean hemoglobin percentage is 10.62gm/dl ± 0.87 and the post test mean hemoglobin level is 12gm/dl ± 1.04. This shows that the post test mean hemoglobin level is reduced from the pre test mean hemoglobin level.

The data in the Table 4 shows that the pre test mean signs and symptoms score is 4.1 ± 0.9 and the post test mean signs and symptoms score is 1.86 ± 0.68. This shows that the post test mean signs and symptoms score is reduced from the pre test.

In the pre test, majority (70%) of them had mild anemia and none of them were severely anemic. But 30% are moderately anemic, whereas in the post test all have mild anemia. None of them are severely or moderately anemic.

Data in the Table 6, findings show that, majority of the samples (76.6%) had pallor in conjunctiva in pretest and in the post test 10% of them had pallor in conjunctiva. Only 6 students had pallor in nails in the pretest and none of them has pallor in nails in post test. Only one sample had tachycardia in pre test and none of them had tachycardia in the pos test. Two sample in the pretest had puffiness of face and after intervention only on sample had it. Least percentage (10%) of the samples had irritability in the pre test and it reduced (3.3%) in the post test. Highest percentage (56.6%) of the samples had brittle hair in the pretest and it reduced to 40 percentage in the post test. Most of the samples (96.6%) were having fatigue in the pre test, and after post test only 60% of the samples are fatigue. Highest percentage of the sample in the pre test had symptoms like loss of appetite and head ache (60% and 63.3% respectively) and least percentage had loss of appetite and head ache after post test (13.3%) and least percentage (10%) had breathlessness in the pre test and none of them had breathlessness in the post test. Only 5 samples had giddiness in pre test and it reduced to 2 in the post test, two samples had bone pain the pre test, and in the post test only one sample had it.

Post test mean (12.00) hemoglobin percentage is increased than the pretest (10.62). The mean difference before and after the intervention is significant (p < 0.05) at 5% level of significance. Hence null hypothesis is rejected, and research hypothesis is accepted, thus it shows the dietary intervention is effective increasing the hemoglobin level

The mean difference before and after the dietary intervention is significant (p < 0.05) at 5% level of significance. Hence null hypothesis is rejected and research hypothesis is accepted. Thus, it shows that dietary intervention is effective in reducing the signs and symptoms of Iron deficiency anemia.

There is no significant association of selected demographic variables with post test signs and symptoms scores of iron deficiency anaemia among nursing students as the calculated λ² value is less than the table calculation at 0.05 level of significance (p < 0.05). Hence the null hypothesis is accepted, and the research hypothesis is rejected.

Table 2

SL. No.	Pre test			Post test
	Obtained range of score	Mean	S.D	Obtained range of score	Mean	S.D
1.	8.5-11.8	10.62	0.87	9.3-14.3	12.00	1.04

Table 3

SI.NO.	Pre test			Post test
	Obtained Range score	Mean	S.D	Obtained Range score	Mean	S.D
1.	3-7	4.1	0.9	1-3	1.86	0.61

Table 4

Level of Anemia	Pretest		Post test
	f	%	F	%
Mild	21	70%	30	100%
Moderate	9	30%	0	0
Severe	0	0	0	0

Table 5

Sl No	Content	Pre Test		Post Test
		Frequency (f)	Percentage (%)	Frequency (f)	Percentage (%)
I.	Signs
1.	Pallor
	• Conjunctiva • Tongue • Nail	23 - 6	76.6 - 20	3 - -	10 - -
2.	Glossitis	-	-	-	-
3.	Stomatitis	-	-	-	-
4.	Oedema
	• Face • Leg	- -	- -	- -	- -
5.	Tachycardia	1	3.3	-	-
6.	Puffiness of face	2	6.6	1	3.3
7.	Irritability	3	10	1	3.3
8.	Brittle hair	17	56.6	12	40
II.	Symptoms
9.	Fatigue	29	96.6	18	60
10.	Loss of appetite	18	60	4	13.3
11.	Headache	19	63.3	4	13.3
12.	Breathlessness	3	10	-	-
13.	Giddiness	5	16.6	2	6.6
14.	Palpitation	-	-	-	-
15.	Bone pain	2	6.6	1	3.3
16.	Numbness	-	-	-	-

Table 6

SI.NO.	Variable	Range (g/d L)	Mean	SD	Mean difference	t value	Table t value	dF	Inference
1.	Pre test	8.5-11.8	10.62	0.875	1.38	11.07	2.05	29	Significant
2.	Post test	9.3-14.3	12.003	1.046

P < 0.05

Table 7

Test	Mean	SD	Mean Difference	t value	Table t value	Df	Inference
Pretest	4.1	0.9	2.24	12.59	2.05	29	Significant
Post test	1.86	0.618

P < 0.05

In the present study the findings shows that there was significant difference between the mean pre test and post test haemoglobin percentage at 0.05 level of significance (p < 0.05). Similar findings were also observed in the study conducted at rural areas in Dharapuram ⁶, Dindigul ⁷, Hubballi ⁸, Pondicherry ⁹ and at Thiruvallur ¹⁰ showed similar result that the mean pre test and post test hemoglobin percentage difference was significant at 0.05 level of significance.

In the present study, findings shows that there was significant difference between pre test and post test Iron deficiency anemia signs and symptoms score at 0.05 level of significance (p<0.05), similarly findings of the study conducted at Dindigul ⁷ and at Thiruvallur ¹⁰ similar result was observed, That the mean pre test and post test signs and symptoms score difference was significant.

In the current study chi square test was used to find the association of selected demographic variables with post test signs and symptoms scores of Iron deficiency anemia among nursing students and found that there is no significant association of birth order, total family members, family income, health information, residence, de-worming, present living status with signs and symptoms score of samples with Iron deficiency anemia as the calculated chi square value is less than the table value at 0.05 level of significance (p< 0.05). Hence the null hypothesis is accepted, and the research hypothesis is rejected similarly study conducted on adolescents girls at Nanchiyampalayam showed no association with signs and symptoms score of Iron deficiency anemia after nutritional intervention among adolescent girls 11. Hence it is concluded that demographic variables have no association with signs and symptoms of Iron deficiency anemia.