Journal of Blood Disorders & Transfusion

Awareness Assessment towards Anemia in the Western Region of Saudi Arabia

Rana Ghazi Zaini^* Deanship of Community Service and Sustainable Development, Taif University, Taif, Saudi Arabia
^*Correspondence: Rana Ghazi Zaini, Dean of Deanship of Community Service and Sustainable Development, Associate Professor in Haematology, Taif University, Taif, Saudi Arabia, Tel: +966(0)55 55 30937, Email:

Received: 08-Jan-2019 Published: 28-Feb-2019

Introduction

Anemia is a common public health problem that affecting people at any age among developing and developed countries. It characterized by abnormal low hemoglobin level and related to different health complications range from mild to severe such as headache, fatigue, low productivity and maternal mortality. In 2002, the World Health Organization (WHO) has been identified anemia as one of the top ten risks for mortality [1].

Blood hemoglobin concentration consider the most reliable indicator of anemia, however, it is not enough to determine the cause and type of anemia [2]. In Saudi Arabia (2004) anemia was diagnosed based on hemoglobin and hematocrit concentrations among adult and elderly and found that 38% and 55% were anemic respectively [3].

Several number of medical disorders have been reported to be associated with increase the risk of developing anemia including; iron deficiency, micronutrient deficiencies (e.g. vitamins A, vitamins B12 and folate), acquired or inherited disorders influence red blood cells (RBCs) synthesis and hemoglobin production (e.g. haemoglobinopathies) and acute and chronic illnesses (e.g. tuberculosis, human immune deficiency virus, stomach cancer and malaria) (World Health Organization, 2015). Iron deficiency is reflected almost 50% of anemia cases, yet the percentage of the prevalence is varies among different regions, conditions and individuals [4,5].

In Turkey, a study has been found that lower consumption of red meat as well as irregular eating habits are highly associated with development of anemia among children between 12-16 years old [6]. Microcytic anemia was reported in-patient diagnosed with decreased iron absorption as a result of tea drinking simultaneously with meat consumption [7]. Within the same study they also found that haeme iron from cooked meats is not affected by consumption of tea. On the other hand, different research study was performed on rats and reported that consumption of tea and coffee was not associated with anemia [7].

According to the WHO, the most affected group with anemia is pregnant women, about 56 million were affected from all over the world from 1993 to 2005 [8]. Moreover, in developing countries anemia is considering one of the most common health problems in pregnant women in the range of 40% to 60% [9]. Abnormal (upward) shift of the haemoglobin distribution curve were reported among male and female cigarette smoker. In addition, several chronic diseases, which can be complicated by anemia, have been associated with cigarette smoking. However, cigarette smoking in healthy individuals causes an increase in haemoglobin concentration as a result of exposure to carbon monoxide (CO) [10]. Shah and Naik found that aplastic anemia was diagnosed in workers who used benzene without any protective measures for longer than a year in Surat, India [11]. The generated cement dust from construction of buildings and roads showed statistically significant decrease in haemoglobin level and red blood cell (RBC) among construction workers [12]. More than 150 years ago Richard Brigh was the first who reported the association between anemia and chronic renal failure due to inhibition of erythropoiesis production or /and shortened red cell survival [13].

Unfortunately, there were limited number of studies showed the general awareness level of anemia and its causes among population at the western region of Saudi Arabia. Thus, the aim of this study was to assess awareness level about anemia and its causes between Saudi and non-Saudi population in three cities; Makkah, Jeddah and Taif.

Materials and Methods

This study carried out between November to December 2018, in 433 Saudi and non-Saudi male and female adults who were living in Makkah, Jeddah or Taif city at the western region. Data were collected using pre-piloted online questionnaires consist of 21 questions. The first part of the questionnaire was about the demographic data of participants (gender, age, nationality, city, educational level, sector and social status). The second part of the questionnaire focused on measuring the awareness of anemia and its risks factors. It consisted of 13- closed-ended questions with the only possible answer of yes or no.

Data analysis

Responses to the second parts of the questionnaire were assessed by closed-ended with the only possible answer of yes or no. The data was collected and analyzed statistically using SPSS version 16.

Results

A total of 433 Saudi and non-Saudi male and female from the western regions of Saudi Arabia (Makkah, Jeddah or Taif city) were completed the electronic questionnaire. The range of respondents' age was between 18 to over 50 years. The majority of respondents were Saudi and female with 89% (385/433) and 77% (335/433) respectively. The demographic data of this study is shown in (Table 1).

Table 1: Showed the number and percentage of participant’s variables including; age, educational level, city, nationality and work field.

The basic awareness about anemia and their risk factors were assessed within 13 items of the questionnaire. The majority of the participants demonstrated good understanding regarding what is the anemia 89% (386/433). Higher percentage of participants knows that some types of anemia can be inherited 77% (334/433).

In addition, more than half of the participants with 57% (248/433) and 70 % (302/433) were aware of that not eating meat for long period and drinking red tea while eating may lead to anemia respectively. The majority of participants with good level of knowledge about that the pregnancy might cause anemia among pregnant women 75% (325/433). However, most of the participants who were not aware of the association between pregnancy and anemia were female with 67% (72/107) (Table 2). The results also reported that most participants were aware of the association between smoking and imbalance in blood function 74% (321/433) (Table 2). Respondents’ awareness about the association of anemia with exposure to the smell of benzene and working in cement factories for long periods were limited with 15% and 14% respectively. This study also investigated respondents’ awareness about development of anemia as a result of chronic kidney failure 58% (252/433) and due to some immune diseases 52% (224/433) (Table 2). Only 35% were aware that chronic hemorrhoids can lead to mild or severe anemia. Many participants were aware of the link between stomach ulcers and duodenal ulcers and anemia 63% (274/433). It has been also reported that 53% (231/433) of participants were aware of the relation between types of intestinal worms and causing of anemia. According to the results of this study it has been shown that 98% (92/94) of the participants from the medical field were answer all the questionnaire questions which related to anemia and it’s risk factors correctly (Table 2). Moreover, it has been shown that there is a significant proportion between the educational level and degree of anemia awareness.

Table 2: Showed the number and percentage of participants answers about the anemia’s related risk factors.

Discussion

Anemia is a common public health problem-affecting people at any age among developing and developed countries. Several risk factors have been reported to increase the chance of developing anemia in different research studies. This study presented the level of awareness toward anemia and their risk factors among Saudi and non-Saudi at western region of Saudi Arabia.

Generally, from the results of this study it is obvious that a true understanding about anemia is presented from the majority of the participants. This study has also reported that 77% of the study population was aware of the fact that some types of anemia can be inherited. Similar to our study results, a study performed in Qassim and showed that the majority of the participants were aware of drinking red tea during the meal and pregnancies are associated with anemia [14]. Hussain and shu have reported that 52% of women participants of their study were well known that drinking tea at the same time of consuming diet can impair the iron absorption leading to anemia [15]. However, the results of this study showed limited awareness about exposing and inhalation of some chemicals such as benzene and working in cement factories for long period and development of anemia from most of the participants. In this study 25% of participants were not aware of the association between pregnancy and anemia out of which 67% were female. This concurs with [14] study which reported that male respondents were more aware of that the pregnancy might cause anemia more than female respondents.

This study suggests some actions to eradicate or minimize the incidence of anemia. These actions include increasing awareness and education for the purpose of changing life style and consumption patterns as well as additional intakes of supplements in some clinical cases and pregnancy under medical supervision.

Acknowledgements

The authors are grateful to all participants at western region of Saudi Arabia who participated in this study. Also, special thanks for Mr. Bahri Al-Shareef for helping in questionnaire distribution.

Ethical Approval

Ethical approval for this study was obtained from the ethics review committee of Applied Medical Sciences College at Al-Taif University. All information obtained at of this study was kept confidential.

Conflict of Interest

The authors have no conflict of interests to disclose.

REFERENCES

1. World Health Organization. Global Health Risks: Mortality and burden of disease attributable to selected major risks. last accessed 11th December 2018. 2009;
2. Stevens GA, Finucane MM, De-Regil LM, Paciorek CJ, Flaxman SR, Branca F. Global, regional, and national trends in haemoglobin concentration and prevalence of total and severe anemia in children and pregnant and non-pregnant women for 1995-2011: a systematic analysis of population-representative data. Lancet Glob Health 2013;109:70001-70009.
3. Alhamdan AA. Nutritional status of Saudi males living in the Riyadh nursing home. Asia Pac J Clin Nutr. 2004; 13:373-376.
4. United Nations Children’s Fund, United Nations University, World Health Organization. Iron deficiency anemia assessment, prevention, and control: a guide for programme managers. Geneva: World Health Organization; 2001 last accessed 7th December 2018.2001;
5. Stoltzfus RJ, Mullany L, Black RE, Ezzati M, Lopez Ad, Rodgers A, et al. Iron deficiency anaemia: Comparative quantification of health risks: global and regional burden of disease attributable to selected major risk factors. Geneva: World Health Organization. 2004;163–210.
6. McAfee AJ,  McSorley EM, Cuskelly GJ, Moss BW, Wallace JM, Bonham MP, et al. Red meat consumption: An overview of the risks and benefits. Meat Sci. 2010;84:1-13.
7. Chung SY, Janelle ML. Effects of Tea Consumption on Nutrition and Health. J Nutr. 2000;130:2409-2412.
8. De Benoist B, McLean E, Egli I, Cogswell M. Worldwide prevalence of anemia 1993-2005. WHO Global Database on Anemia Geneva, World Health Organization. 2008;
9. Munasinghe S. Anemia in pregnancy in Malawi-a review. Malawi Med J 2006;18:160-174.
10. Puente-Maestu L, Bahonza N, Perez MC, Ruiz de Ona JM, Rodriguez Hermosa JL, Tatay E, et al. Relation- ship between tobacco smoke exposure and the concentrations of carboxyhemoglobin and hemoglobin. Arch Bronconeumol. 1998;34:339-343.
11. Shah C, Naik PK. Aplastic Anemia Due to Exposure to Benzene in Diamond Workers in Surat (India) Kiran. Blood. 2006;108:37-63.
12. Farheen A, Hazari MA, Khatoon F, Sultana F, Qudsiya SM. Hematological parameters are acutely effected by cement dust exposure in construction workers. Ann Med Physiol. 2017;1:31-35.
13. Eschbac J. The anemia of chronic renal failure:Pathophysiology and the effects of recombinant erythropoietin Principal discusant: Kidney Int 1989;5:134-148.
14. Waggiallah H A, Alzohairy M. Awareness Of Anemia Causes Among Saudi Population In Qassim Region, Saudi Arabia?. Natl J Integr Res Med. 2013;4:35-40.
15. Hussain T, Shu LY. Awareness of iron deficiency anemia among women of Reproductive age in Hubei Province, China. Asian J Med Sci. 2010;1:12-13.