Health Camp for Adolescent Girls in Urban Slum of Mumbai.

Introduction
Adolescents constitute over 21.4% of the population in India. This age group (10-19 years) needs special attention because of the turmoil of adolescence which they face due to the different stages of development that they undergo, different circumstances they come across, their different needs and diverse problems. This period is very crucial since these are the formative years in the life of an individual when major physical, psychological and behavioral changes take place and additional roles and responsibilities are expected from them.1
Menarche is often considered as the central event of female puberty, from both medical and social perspectives, as it suggests the possibility of fertility. The average age of onset of the menstrual cycle varies from 11 years old or as late as 15. Menarche further calls for special attention because of the physical and emotional problems associated with it. Often they are not prepared for these changes due to cultural shyness, which are not addressed by parents, teachers, elders. Often they have misinformation which can lead to negative attitudes, fears and myths. The menstrual cycle is a normal monthly function of a healthy female body; the main concern is heavy bleeding, irregular cycles and pain during menses (dysmenorrhoea). 2 The psychological and emotional problems associated with menarche are of considerable magnitude and they may associate with nutritional problem among these girls. Anemia is the major nutritional deficiency often found in this group in India and other developing countries. Hence, the present programme was done with the objective of assessing the health problems amongst adolescent girls in slum areas of Mumbai (Central Mumbai) Maharashtra state.

Objectives

1.to find out the reproductive problems among adolescent girls in urban slum area.

2. to determine the prevalence of anemia among these adolescent girls by hemoglobin estimation

Material and Methods
The health camp was conducted among adolescent girls from urban slum and low-socio economic housing complexes in Worli, central Mumbai.
The following stages were involved in the selection of the group.

• A good rapport was developed with the Child Development Project Officer (CDPO), Mumbai Central, and Anganwadi workers of the Integrated Child Development Scheme (ICDS programme) to get an idea about the perceived health needs among adolescent girls in the areas
• The areas are defined into bits (one bit consisting of 20-25 Anganwadi centres). Out of the 6 bits, 2 bits were selected by Simple Random Sampling, from nearby Anganwadi centres. Three adolescent girls were selected from each Anganwadi.
• A total of 123 adolescent girls attended in the health camp. The data on age, height, weight, BMI and menstrual problems were obtained. The haemoglobin concentration was measured using Sahil’s method.

Measurements
History taking included general, medical, surgical procedures and menstrual history. General Examination including weight, Height, oral cavity, blood pressure in sitting position and chest auscultation, hemoglobin by Sahil’s method and blood group.

Height
Height in centimeters was marked on a wall with the help of a measuring tape. All girls were measured against this wall after removing their foot wear and ask to stand with heels together and their heads positioned so that the line of vision was perpendicular to the body.

Weight
Weight was recorded in kg without footwear.
Body Mass Index (BMI)
The body mass index (BMI) was calculated using the standard formula: BMI = Weight (kg)/Height 2 (m 2).

Haemoglobin
Hb was estimated by Sahil’s method using haemoglobinometer with blood obtained through finger prick (ring finger).

Results

• Out of 123 adolescent girls, most belonged to 10 and 14 years of age (74), followed by 15years (19), 16years (16), 17years (7), 18years (6) and 20 years (1) years of age.
• Out of 123 adolescent girls, 9 were in 12th class, 14 in class 11, 20 in class 10, 19 in class 9, 12 in class 8, 23 in class 7, 19 in class 6, 5 in class 5 and 2 in class 4.
• The height ranged between 117 and 162 cm.
• The weight ranged between21 and 61 kg.
• As per the WHO Criteria 34% (n=42) girls had normal BMI (18.5-24.9), 61% (n=75) girls were underweight (BMI<18.5), n="6)">
• Hemoglobin estimation revealed that 10% (n=12) had severe anemia i.e. Hb less than 8 gm %, 78% (n=96) had hemoglobin level between 8 and 10 gm% i.e. anemia while only 12% (n=15) had hemoglobin between 10 and 12gm%.
• Menarche was attained by 74 adolescents while 49 girls had not yet started with menses. Age of menarche among the above 74 girls ranged between 10 and 16 years of age. Eight girls had pain in abdomen/ Dysmenorhoea, muscle pain, headache and giddiness as symptoms before the onset of menstruation, 4 girls complained of irregular menses and rest 62 did not report any menstrual complaints. 4 girls had complaints suggesting Urinary Tract Infection, one girl had problem of disturbance of vision, one complained of acne on face and all girls respiratory normal.
• History suggestive of calcium deficiency was reported by one girl, four girls reported chest pain with cough and cold.
• On oral Examination for all the 123 adolescent girls. Dental hygiene was satisfactory for 83 girls while 40 girls had dental caries and were referred for dental treatment.

Treating Anemia

• History of worms taken but none of them could give answers
• Medical Doctors had given iron supplementary medicines with folic acid for one month in addition Calcium tablets were also given.
• Provided advice for iron rich diet green leafy vegetable, pulses & eggs etc.
• Regular health checks up.

Conclusion
The important observation as follows.

• 61% adolescent girls were undernourished (BMI-less than 18.5).
• 88 % anemic mainly due to of poor diet, heavy bleeding during menstruation & fashion trend of slimness.
• 33% Dental Caries is the commonest dental problem encountered
• 16% of 74 girls had menstrual problem.

Future Plan

• To organize sessions on nutrition for mothers and daughters.
• Education and information on general health and menstrual hygiene as interactive session for adolescent girls, mothers and Anganwadi teachers.