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Abdulmoein Eid Al-Agha*, Shahad Hamdan Alorabi, Sundus Mohammed Wali Noor Saeed, Nora Muhammad Shalabi
Department of Pediatrics, King Abdulaziz University, Jeddah, Saudi Arabia
Received date: Mar 21, 2016; Accepted date: May 05, 2016; Published date: May 12, 2016
Citation: Al-Agha AE, Alorabi SH, NoorSaeed SM, Shalabi NM (2016) Awareness of Vitamin D and its Deficiency in Jeddah Population, Saudi Arabia. J Comm Pub Health Nurs 2:120. doi:10.4172/2471-9846.1000120
Copyright: © 2016 Al-Agha AE, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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Introduction: Vitamin D deficiency considered to be the most common nutritional deficiency and one of the most common undiagnosed medical conditions in the world. It appears to be a widespread global problem prevalent in all age groups, with a reported prevalence of 30-80% in children and adults This significant decreased in vitamin D level worldwide in different age group shows lack of awareness about vitamin D importance and its resources.
The aim of our study: To assess awareness, perception and understanding of vitamin D deficiency among families living in Jeddah/Saudi Arabia. Determining the resources of information about vitamin D deficiency in our society.
Methods: A cross sectional retrospective study was conducted in ambulatory and pediatric clinic at KAUH and many malls in Jeddah - Saudi Arabia. Data were obtained from a questioner designed to collect information about vitamin D. The study population was formed of 1752 parents of children aged from 2 to 18, and dividing them to 746 highly educated, 491 low educated.
Results: It was found that the highly educated parents got the right answers in most of the questions, However both high and low education parents had the media as their source of information. However that the majority have heard about vitamin D, 82.9% fail to identify the best time for sun exposure and 65.5% recognize inability to go outside due to work or weather issues as common cause of vitamin D deficiency.
Recommendations: *Improving health education to exposing to sunlight and consume vitamin D medication may be an effective step toward preventing vitamin D inadequacy. Powered by Editorial Manager® and ProduXion Manager® from Aries Systems Corporation.
*Doctors should emphasize on the importance of vitamin D and the consequences of its deficiency.
*Teachers should emphasize on vitamin D importance.
*Further efforts from media to increase vitamin D awareness among population.
Vitamin D; Awareness; Rickets; Deficiency; Media
Vitamin D deficiency is an important public health problem in both developing and undeveloped countries, it is considered to be the most common nutritional deficiency and one of the most common undiagnosed medical conditions in the world [1]. It shows to be a worldwide problem in different age groups, with a reported prevalence of 30-80% in children and adults [2,3]. As well, with prevalence equal to 38.6% in Saudi Arabia [4].
The importance of vitamin D in body metabolism and many immune functions has been well established and proven through literatures [5]. With Previous studies demonstrate relation between vitamin D deficiency and various medical disorders like depression, type 1 diabetes, Syndrome X, as well as chronic widespread muscle and bone pain [6-10]. And even in infancy it causes rickets and hypocalcemic fits [11,12].
On the other hand, New evidence shows that concealing clothes is considerable risk factor to develop vitamin D deficiency/ insufficiency [13,14].
There are several factor has been linked to vitamin D deficiency in infancy like low dietary of vitamin D, and decreased sunlight exposure due to fear of cancer, pigmentation, or weather variation [15].
This significant decreased in vitamin D level worldwide in different age group shows lack of awareness about vitamin D importance and its resources.
So, awareness of the significance of vitamin D in the regulation of normal physiology as well as the consequences of its deficiency is needed to save our general population from widespread bone and other vitamin D deficiency disorders [16-18].
We aimed to assess the family awareness, perception and understanding of vitamin D deficiency among families living in Jeddah /Saudi Arabia and to determine the most useful sources of information about vitamin D and its deficiency in our society.
A cross sectional retrospective study was conducted in ambulatory and pediatric clinic at King Abdulaziz University Hospital and many malls in Jeddah - Saudi Arabia from 1st September 2015 to 1st December 2015, data were obtained from a questionnaire designed to collect information on self-reported and direct knowledge questions about vitamin D. The study population was formed of 1752 parents of children aged from 2 to 18, and dividing them to 746 highly educated (bachelor degree and more), 491 low educated (high school and less) and verbal consent was taken.
Ethical approval for this study was obtained from the Research Ethics Committee at King Abdulaziz University Hospital (KAUH).
Questionnaire
The survey was about eighteen vitamin D related questions. If they have been diagnosed with vitamin D deficiency or heard about it. If they have idea about food which is rich in vitamin D and if it is important for their health. The best time for sun exposure, duration, which body parts should be exposed, the amount of vitamin D we get from the sun for daily need, the reason for lack of exposure and which groups are at risk to get vitamin D deficiency. What are the sources of their information.
If they have a child with vitamin D deficiency, what was the symptoms that led to the diagnosis, was the diagnosis in the initial examination or due to sibling suffering from vitamin D deficiency, is the child have any sign of rickets on x-ray, and what are the risk factors for rickets.
Data analysis was performed using SPSS Statistics version 16.0 software (IBM Corp., Armonk, NY, USA).
The percent of each answer in the questionnaire is shown in Table 1.
| Yes(%) | No(%) | Don't knew(%) | ||
|---|---|---|---|---|
| 1-Heard about Vitamin D deficiency | 89.6 | 9.4 | 1 | |
| 2-Think it is important for your health | 93.9 | 4 | 2.1 | |
| 3-You were told that you have vitamin D deficiency | 46.6 | 43.2 | 10.2 | |
| 4-Idea about foods rich in vitamin D | 69 | 22.8 | 8.2 | |
| 5-source of information: | Media | 64.2 | 35.8 | |
| Doctors | 51.9 | 48.1 | ||
| Family | 29.4 | 70.6 | ||
| Friends | 24.2 | 75.8 | ||
| 6-The most appropriate time of exposure to the sun | Early morning | 82.1 | ||
| Afternoon | 12.6 | |||
| Extremely hot times | 2 | |||
| Don't Know | 3.3 | |||
| 7-In your opinion which category is more prone to have vitamin D deficiency | Children under 5 | 61.7 | 38.3 | |
| Pregnant and lactating | 66.9 | 33.1 | ||
| Old age>65years | 50.7 | 49.3 | ||
| office workers | 30.1 | 69.9 | ||
| Covered all body parts | 41.1 | 58.9 | ||
| 8-The appropriate duration of sun exposure for adequate vitamin D status | Less than 30 min | 47.2 | ||
| 30-60 min | 40.2 | |||
| More than 60 min | 5.7 | |||
| Not sure | 6.9 | |||
| 9-Best time for exposure | 7 am-9am | 83.9 | 16.1 | |
| 10 am-3 pm | 17.1 | 82.9 | ||
| 3 pm-5 pm | 19.8 | 80.2 | ||
| 5 pm-7pm | 21.9 | 78.1 | ||
| 10-Body parts that must be exposed to the sun | Hand and face | 18.4 | ||
| Hands and arms and face | 15.8 | |||
| Hand, arms, face, and legs | 62.1 | |||
| others | 3.7 | |||
| 11-Reason for no exposure | No enough information about vitamin D deficiency | 50.6 | 49.4 | |
| Fear of skin cancer and sun burns | 26.3 | 73.7 | ||
| not able to go outside due to work or weather issues | 65.5 | 34.5 | ||
| not able to go outside due to health or physical issues | 18.6 | 81.4 | ||
| 12-How much of vitamin D comes from the sun | 10% | 8.7 | ||
| 25% | 25.5 | |||
| 50% | 38.2 | |||
| 90% | 27.7 | |||
| 13-Have your children been diagnosed with vitamin D deficiency | 38.2 | 61.8 | ||
| 14-Signs and symptoms that led to diagnosis of vitamin D deficiency | Epilepsy | 3.5 | 96.5 | |
| Cacomelia | 9.8 | 90.2 | ||
| Bone fracture | 26.5 | 73.5 | ||
| Delay movement | 19.9 | 80.1 | ||
| Respiratory disease | 13.3 | 86.7 | ||
| Weak growth | 19.8 | 80.2 | ||
| weak nerves | 7 | 93 | ||
| Bone pain | 28.5 | 71.5 | ||
| 15-Diagnosed due to initial examination | 13.2 | 74.8 | 12 | |
| 16-Signs of rickets on x-ray | 4.3 | 86.6 | 9 | |
| 17-Did your child take any medication | 10.3 | 89.7 | ||
| 18-What is the risk factor that increase rickets | Dark Skin | 13.5 | 86.5 | |
| Insufficient dietary supplement | 58.5 | 41.5 | ||
| Insufficient vitamin D supplement | 33.9 | 66.1 | ||
| Insufficient sun exposure due to life style | 66.5 | 33.5 | ||
Table 1: show the percent of each answer in the questionnaire.
The knowledge
With the majority 89.6% have heard about vitamin D, 64.2% their source of information was media. Although 69.0% said that they have some idea about food rich in vitamin D, 46.6% were diagnosed with vitamin D deficiency.
Sun exposure
The highest percent 83.9% of population chose 7 am to 9 am as the best time for sun exposure, with 62.1% thought that hands, arms, face and legs should be exposed to be beneficial. 47.2% said that exposure to sun is enough for less than 30 minutes. 8.7% said 10% of the vitamin D gained from the sun while 38.2% chose 50%.
Reason for inadequate exposure
65.5% confirm that difficulty going outside due to work or weather issues is one of the main cause. Run in the second place the lack of information about vitamin D deficiency with 50.6%.
Risk groups
Most of population 66.9% identifies pregnancy as high risk for vitamin D deficiency, while only 41.1% recognize covering body as risk factor.
Vitamin D deficiency
38.2% were diagnosed with vitamin D deficiency only 13.2% were diagnosed due to initial examination, and 28.5% their main complaint was bone pain while 26.5% diagnosed due to bone fracture.
Rickets
At the time of diagnosis only 4.3% had signs of rickets on x-ray. 66.5% think that lifestyle is a major cause for rickets in Saudi Arabia, followed by 58.5% dietary supplement insufficiency and majority didn't think that dark skin is a risk for rickets 86.5%.
In regards to education level and awareness , we found that the highly educated parents got the right answers in most of the questions, However both high and low education parents had the media as their source of information (Table 2).
| Yes(%) | No(%) | |||
|---|---|---|---|---|
| 1-Heard about Vitamin D deficiency | High education | 61.1 | 53.3 | |
| Low education | 38.8 | 46.7 | ||
| 2-Think it is important for your health | High education | 60.8 | 53.1 | |
| Low education | 39.2 | 46.9 | ||
| 3-You were told that you have vitamin D deficiency | High education | 63.4 | 58.6 | |
| Low education | 36.6 | 41.5 | ||
| 4-Idea about foods rich in vitamin D | High education | 62.5 | 55.3 | |
| Low education | 37.5 | 44.7 | ||
| 5-source of information: | High education | Media | 63.1 | |
| Doctors | 62.9 | |||
| Family | 58.2 | |||
| Friends | 60 | |||
| Low education | Media | 36.9 | ||
| Doctors | 37.1 | |||
| Family | 41.8 | |||
| Friends | 40 | |||
| 6-The most appropriate time of exposure to the sun | High education | Early morning | 60.9 | |
| Afternoon | 56.2 | |||
| Extremely hot times | 72 | |||
| Don't Know | 42.5 | |||
| Low education | Early morning | 39.1 | ||
| Afternoon | 43.7 | |||
| Extremely hot times | 28 | |||
| Don't Know | 57.5 | |||
| 8-The appropriate duration of sun exposure for adequate | High education | Less than 30 min | 60.7 | |
| 30-60 min | 60.4 | |||
| More than 60 min | 52.9 | |||
| Not sure | 51.4 | |||
| Low education | Less than 30 min | 39.3 | ||
| 30-60 min | 39.6 | |||
| More than 60 min | 47.1 | |||
| Not sure | 48.7 | |||
| 9-Best time for exposure | High education | 7 am-9am | 61.2 | |
| 10 am-3 pm | 68.1 | |||
| 3 pm-5 pm | 64.2 | |||
| 5 pm-7pm | 66.1 | |||
| Low education | 7 am-9am | 38.8 | ||
| 10 am-3 pm | 31.9 | |||
| 3 pm-5 pm | 35.8 | |||
| 5 pm-7pm | 33.9 | |||
| 11-Reason for no exposure | High education | No enough information about vitamin D deficiency | 59.2 | |
| Fear of skin cancer and sun burns | 62.8 | |||
| work or weather issues | 63.8 | |||
| health or physical issues | 66 | |||
| Low education | No enough information about vitamin D deficiency | 40.8 | ||
| Fear of skin cancer and sun burns | 37.2 | |||
| work or weather issues | 36.1 | |||
| health or physical issues | 34 | |||
| 13-Have your children been diagnosed with vitamin D deficiency | High education | 58.6 | 63.5 | |
| Low education | 41.3 | 36.6 | ||
| 17-Did your child take any medication | High education | 71.7 | 60.7 | |
| Low education | 28.3 | 39.3 | ||
Table 2: Show the relation between the answers and parent's educational level.
In this study, it was found that majority of the families have heard about vitamin D and the main source is media. One of the common causes of vitamin D deficiency is inability to go outside due to work or weather issues whilst lake of knowledge about best time of sun exposure is playing a significant role regardless of the parent’s educational level.
Various studies around the world have been conducted to evaluate the awareness among people regarding vitamin D. Our present study supported by Al-Saleh et al. which stat that: in most parts of the Middle East, including Saudi Arabia, one of the main causes of vitamin D deficiency is the lack of sun exposure due to indoor lifestyle in both children and adults. In addition a recent study done by Kensarah and Azzeh of school children from Makkah (KSA), found higher incidence of vitamin D deficiency in females which mainly caused by restriction of sunlight exposure. While study conducted by Kung et al. showed that 62.3% did not like being exposed to sun [19].
Out of 1752 of those who had participated in this study, about 1145 had some idea about food rich in vitamin D and most of participants knew the duration to get sufficient daily vitamin D from the sun which indicates good knowledge. Regardless what was found in Rajaretnam study that people often thought they required more time in the sun to produce adequate vitamin D.
It found that media play an important role as source of the information in vitamin D awareness in many researches with a percent (64.2%) in our research, and (40%) in study done by Vu et al. ,while Al- Saleh et al. research the majority of the children got their information from their parents and media.
It is clear now that awareness about vitamin D worldwide is not sufficient and culture and gender play important role, as reported in Pirrone et al. study.
Ultimately, improving knowledge and public health education to tackle modifiable preconceptions and behavior (exposure to sunlight and/or consumption of a multivitamin tablet that contains 10 micrograms (400 IU) vitamin D) may be an effective first step toward increasing individual responsibility for preventing vitamin D inadequacy [19,20].
Doctors should emphasize and explain to the patients and their families the importance of vitamin D and the consequences of its deficiency, whether by adding extra time in the clinic to educate them more, sharing simple complete medical information in media since it got the highest percent as a source of the families information or by arranging regular awareness campaigns to the community.
Teachers should emphasize on vitamin D and its importance because students are in the period of growing ages. As shown in study done by Rajaretnam et al. That most students had a good knowledge from their teachers, lecturers or even some professors.
Media is major player in awareness about general health issue, so it will be good if they increase the time and effort for programs aimed for health promotion.
Design open area for women to allow greater exposure to sunlight where women can uncover freely. In girls, increasing incidental sun exposure through routine, daily, outdoor activities will help increase sun exposure for vitamin D activation.
As regards this study, as data was collected with a questionnaire (closed questions), the information gathered is limited.
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