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Knowledge, Attitude and Practice of Mothers Attending Kudai and Al-Hijrah Primary Health Care Center in Makkah towards Vitamin D Supplementation to Their Infants 2021

Anwar Hameed Alharbi*, Abrar Faleh Albarakati, Jehad Helal Alqurashi

Family medicine resident, MOH-MAKKAH, Saudi Arabia

Abstract: A descriptive study design carried out to assess the mother's knowledge, attitudes and practices toward vitamin D supplementation to their infants at the south sector of Makkah Al-Mukarramah (Kudai and Al-Hijrah PHC center in the well-baby and vaccination clinics). The study sample includes (366) mothers of infants of one year or less attending Kudai and Al-Hijrah PHC center in Makkah city for well-baby clinic and vaccination clinic and all nationalities. The study instrument is a questionnaire composed of 4 parts includes: sociodemographic characteristic, knowledge, attitudes, and practices about vitamin D supplementation. The data collected from the respondents by using questionnaire. Content validity of the instrument was determined by panel of experts, while the reliability of the questionnaire determined by internal consistency reliability (Cronbach’s Alpha reliability), and analyzed electronically by (SPSS) application. The study findings indicated that the highest proportion of mothers aged 15-35 years, secondary and highly educated, 85% not working. Doctor is the main source of information. The majority of mothers have weak to average knowledge, average to high attitude and high to average practice. Significant differences were found at mothers' knowledge in relation to age, nationality, education, occupation and income. Significant differences were found at mothers' attitude in relation to nationality, education, and income. Additionally, significant differences were found between mothers' practices in relation to education, and income.

Keywords: knowledge, attitude, practice, mothers, vitamin D supplementation, infants

Received December 05, 2021; Revised January 11, 2022; Accepted January 20, 2022

Citation: Anwar Hameed Alharbi, Abrar Faleh Albarakati, Jehad Helal Alqurashi, Knowledge, Attitude and Practice of Mothers Attending Kudai and Al-Hijrah Primary Health Care Center in Makkah towards Vitamin D Supplementation to Their Infants 2021. American Journal of Medical Sciences and Medicine, 10 (1). 1-10. January 2022. doi:10.12691/ajmsm-10-1-1

1. Introduction

Vitamin D is a fat-soluble vitamin. We have many sources to get vitamin D either by natural dietary sources in food such as (tuna, salmon, fatty liver, or fortified food), oral supplement, or ultraviolet sunlight. Vitamin D has an important role in the body, it facilitates and helps dietary calcium and phosphorus absorption from the intestine and inhibition of parathyroid hormone [1].

People who have a high risk of low vitamin D are Infants, children, and older adults because of insufficient vitamin D intake from diet, sun exposure, and infants who are consuming inadequate amounts of formula-fed (less than 1 Liter) per day or exclusively breastfeeding [2]. The classical manifestations of vitamin D deficiency in infants are rickets, seizures, and difficulty breathing. Most infants with rickets may present with very low serum 25(OH) D concentration and they didn't receive vitamin D supplements [3].

According to a systemic review about the prevalence of vitamin D deficiency in in Saudi Arabia, among different populations (adults, children and adolescents, newborns, and pregnant/lactating women) is 81.0% (Confidence Interval 95% 68.0–90.0). And it was in the newborn 59%. Additionally, Mothers taking responsibility for the health status of their infants so the researches need to assess the knowledge, attitude, and practice of them and no similar studies were conducted in primary health care (PHC) in Makkah city, Saudi Arabia [4,5].

2. Aim of the Study

To assess the knowledge, attitude, and practice of mothers attending Kudai and Al-Hijrah PHC center towards vitamin D supplementation to their infants in Makkah city 2021.

3. Methodology

3.1. Study Design

A descriptive cross-sectional study design was used.

3.2. Study Area

The study was conducted at the south sector of Makkah Al-Mukarramah (Kudai and Al-Hijrah PHC center in the well-baby and vaccination clinics).

3.3. Study Population

Mothers of infants age 0-12 months attending Kudai and Al-Hijrah PHC center in Makkah city for well-baby clinic and vaccination clinic were involved in the study.

3.4. Inclusion Criteria

All mothers of infants age 0-12 months attending Kudai and Al-Hijrah PHC center in Makkah city for well-baby clinic and vaccination clinic and all nationalities.

3.5. Sample Size

The total number of mothers attending with their infants in the well-baby clinic and vaccination clinic in Kudai and Al-Hijrah PHC for 6 months was 7560. The sample size was calculated by applying Raosoft sample size calculator based on (The margin of error: 5%, Confidence level: 95% and the response distribution was considered to be 50%) accordingly the sample size is 366 of mothers attending with their infants.

3.6. Data Collection Tool

A questionnaire was developed by the researchers adapted from two questionnaires of similar researches to collect the data for this study by Rasheed [6] Alramdhan El-Zubair[7].

The questionnaire consists of four parts. First part is consisting of questions related to Maternal and infant socio-demographic data. Second part composed of 11 questions to assess the mothers Knowledge. Third part consisted of 5 questions to assess the mothers Attitude toward vitamin D supplement. Fourth part concerned with assessment of the mothers' practice test through 5 questions.

Approval from the Ministry of Health (MOH) and permission from the primary health care director and mothers was obtained. The researchers explained the purpose of the study and interview the mothers attending the well-baby clinic and vaccination clinic while waiting for their time. The data was collected through 1 month in January 2021.

An interview will be conducted for each candidate to complete the questionnaire. The questionnaire was designed in the Arabic language with a cover letter-contain objective of the study, consent, and the assurance of confidentiality. The validity of the questionnaire was checked by three consultants in the fields of family medicine and preventive medicine. reliability of the questionnaire was tested (0.877).

Scoring system:

Questionnaire scoring:

Knowledge responses were divided into three categories according to the attained score (maximum score=15). A score of less than 50% (weak), from 50-75% (average), and more than or equal 75% (high) knowledge. And so on Attitude with (maximum score=10) and practices with (maximum score=4).

Data entry and analysis

Data was entered and analyzed by using the statistical package for the social sciences (SPSS) program version 23. A p-value of 0.05 or less will be considered as statistically significant.

Pilot study

The researchers were conducting the pilot study on 10% of the sample size. This sample was not be included in the actual study and used only to assess the applicability, modify the questionnaire, and testing the time to complete it.

Ethical consideration:

• Written consent was obtained from each participant. All information was keep confidential and only used for the study purpose.

4. Results

Table 1 showed that more than half of mothers (52.04%) aged from 25-35 years while one quarter (26.98%) aged from 15-25 years. More than half of them (52.04%) were Saudi, secondary and highly educated (24.25%, 38.42%. most of them (85.56%) were not employed with a family income of less than 5000 (57.49%). More than half (50.95%) have 2-4 children.

Table 1. Frequency distribution of mothers' sociodemographic data

Table 2 revealed that more than half of children (61.85%) aged from 7 months – 1 year, male (51.50%), majority of them (39.24%) were fed by mixed breast feeding and bottle feeding, while most of them fed by breast feeding only (36.51%) for a time from the second month to years (37.77% from 2-7 months and 40.29% from 7-12 months). More than half of mothers (51.50%) used milk fortified with vitamin D. more than one third of them (38.63%) give one liter of milk daily for their children. Approximately all children (96.46%) have no health problems.

Table 2. Frequency distribution of children biosociodemographic characteristics

Table 3 showed that majority of mothers (84.20%) read or heard about Vitamin D, reported a sun rays and food supplement as the natural sources of Vitamin D (84.74%) and think that vitamin D is important for their child's health (92.92%). More than half of them (59.13%) know that there are recommendations on how to use a vitamin D supplement for children from their doctors (68.66%). More than half of them (56.68%) reported that the appropriate age to start taking a vitamin D supplement is after birth and the dose will differ according to type of feeding (43.52%) with a recommended dose of 400 international units (four drops) (53.00%). Near to two thirds of mothers (69.48%) know that Vitamin D deficiency cause diseases in children as rachitis and Immunodeficiency (53.13%, 33.42%). Most of them (89.10%) approved that vitamin D important in bone growth and strengthening immunity for children.

Table 3. Frequency distribution of mothers' knowledge regarding infant vitamin D supplementation

Table 4 revealed that majority of mothers (91.83%) agrees to give vit D to their children if prescribed. A proportion of them agrees that breast feeding (59.40%) and exposed to the sun (39.78%) are not sufficient source of vit D for the child. More than half of them (58.31%) disagree about as long as the mother takes vitamin D, the child does not need to take a vitamin D supplement and they will advise their friends and relatives to give a vitamin D supplement to their children (78.2%).

Table 5 shows that half of mothers (49.86%) use vitamin D supplement for their children with a dose of 400 international units (four drops) (61.73%) from the time of birth (68.72%) for seven times daily (62.69%) and continue for 7-12 months (37.86%).

Regarding knowledge, Table 6 and Figure 1 (a,b,c). shows that most of mothers ranged from average (45.5%) and weak (42.5%) knowledge with a mean of 7.980±2.994. as for attitude, the highest percentage fluctuating from average (55.6%) and high (31.3%) with a mean of 6.588±1.907. Concerning practices, more than half of mothers (56.4%) have a high level of practice with a mean of 2.617±1.138.

Table 4. Frequency distribution of mothers' attitude regarding infant vitamin D supplementation

Table 5. Frequency distribution of mothers' practice regarding infant vitamin D supplementation

Table 6. Ranking of mothers' knowledge, attitude and practice level by number, percent and Mean Score

Figure 1a,b,c. Ranking of mothers' knowledge, attitude and practice level by number, percent and Mean Score

Table 7 and Figure 2 shows a statistical significant difference between mothers knowledge in relation to their age, nationality, education, occupation and family income (P=<0.001).

Table 7. The differences between mothers' knowledge and their demographic variables

Figure 2. The differences between mothers' knowledge and their demographic variables

Table 8 and Figure 3 shows a statistical significant difference between mothers attitude in relation to their nationality, education, occupation and family income (P=<0.001).

Table 8. The differences between mothers' attitude and their demographic variables

Figure 3. The differences between mothers' attitude and their demographic variables

Table 9 and Figure 4 shows a statistical significant difference between mothers practices in relation to their education (P=0.015) and family income (P=<0.006).

Table 9. The differences between mothers' practices and their demographic variables

Figure 4. The differences between mothers' practices and their demographic variables

5. Discussion

Vitamin D is essential for the health of infants. Populations at risk for vitamin D deficiency are those for which, for environmental, cultural, or medical reasons, exposure to sunlight is poor and the dietary intake of vitamin D is low. The infants born in such populations have low vitamin D stores and may receive little additional vitamin D if they are breast-fed without supplements for long periods. In the short term, lack of vitamin D supplementation in infancy leads to biochemical disturbances, reduced bone mineralization, slower growth, and eventual alterations in bone shape and increased risk of fracture, the hallmarks of rickets. In the longer term, lack of vitamin D supplementation may result in reduced bone size and mass during childhood and an increased risk of type 1 diabetes mellitus. Clear recommendations are needed regarding the intake of vitamin D during pregnancy and infancy [2,8,9,10].

Based on the study results that showed that most of mothers were aged from 15-35 years, non-employed with a positive to average attitude regarding vitamin D supplement. When comparing these results with the study that conducted by Abbas et al. [11], we found that those in the same line regarding mothers age and occupation. Similar poor knowledge, fair attitude among mothers regarding vitamin D supplement for their infants were reported by Rasheed., 2017 [6].

While the study results revealed weak to average knowledge, average to positive attitude and high to average practice. Soliman et al. [12] concluded that Less than one quarter of the mothers had a good knowledge while about three fifths of the mothers had a positive attitude & less than half of them had a good practice towards vitamin D and its supplementation. It also recommended that awareness campaigns may help in improving awareness about vitamin D importance.

When questioning about the source of information regarding vitamin D it was found that the majority of participants in our study heard about it commonly from their doctors, in similar to Emirates and Irish mothers in whom the main source of their information were their doctors. The majority of mothers who gave vitamin D to their infant, got the advice from private doctors, indicating that appropriate communication about Vitamin D supplementation should be encouraged from health care providers [13,14,15].

Moreover, the study results found high level of knowledge in older Saudi mothers, highly educated, employed with high family income. Positive attitude was accompanied with educated Saudi mothers with high family income. Good practices were commonly found in highly educated mothers and high family income. These results are supported by Zadka et al. [16] who found statistically significant influences on the level of knowledge about the functions and sources of vitamin D were place of residence (i.e., better knowledge in the countryside) and mothers’ level of education (i.e., the better educated, the greater knowledge). In the case of monthly income level, such impact was observed only in relation to the knowledge of vitamin D functions. Concerning the frequency of supplementation, only maternal level of education had a statistically significant effect (i.e., the higher the education level, the higher the frequency of supplementation). In addition, mothers who were aware of functions of vitamin D and nutritional sources, significantly more frequently supplemented vitamin D.

6. Conclusion

The study findings indicated that the highest proportion of mothers aged 15-35 years, secondary and highly educated, 85% not working. Doctor is the main source of information. The majority of mothers have weak to average knowledge, average to high attitude and high to average practice. Significant differences were found at mothers' knowledge in relation to age, nationality, education, occupation and income. Significant differences were found at mothers' attitude in relation to nationality, education, and income. Additionally, significant differences were found between mothers' practices in relation to education, and income.

References

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[2]   | Dratva J, Merten S, Ackermann-Liebrich U, Vitamin D supplementation in Swiss infants. Swiss Medical Weekly, 2006; 136(29-30), 473-481.
[3]   | World Health Organization. Vitamin d supplementation for infants 2017. Available from: https://www.who.int/elena/titles/bbc/vitamind_infants/en/.
[4]   | Al-Daghri NM, Vitamin D in Saudi Arabia: prevalence, distribution and disease associations. The Journal of Steroid Biochemistry and Molecular Biology, 2018; 175, 102-107.
[5]   | AlFaleh KM, Al-Manie AM, Al-Mahmoud HF, Al-Razqan HM, Al-Mutlaq AB, Al-Rumaih SA, Al-Mandeel HM, Prevalence of vitamin D deficiency in Saudi newborns at a tertiary care center. Saudi Medical Journal, 2014; 35(2): 178-182.
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[9]   | Oberhelman SS, Cozine EW, Umaretiya PJ, Maxson JA, Thacher TD, Vitamin D and the breastfeeding infant: family medicine clinicians’ knowledge, attitudes, and practices. Journal of Human Lactation, 2018; 34(2): 331-336.
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[12]   | Soliman NS, Wahdan MM, Abouelezz NF, Sabbour SM, Knowledge, Attitude and Practice towards Vitamin D Importance and Supplementation among Mothers of under Five Children in a Primary Health Care Center in Cairo. Egyptian Journal of Community Medicine, 2020; 38(4): 62-75.
[13]   | Rasheed H, Hegazy RA, Gawdat HI, et al. Serum Vitamin D, Vitamin D, Receptor Gene Polymorphism in Mycosis Fungoides Patients: A Case Control Study. PLoS One. 2016; 11(6): e0158014.
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[16]   | Zadka K, Pałkowska-Goździk E, Rosołowska-Huszcz D, The state of knowledge about nutrition sources of vitamin D, its role in the human body, and necessity of supplementation among parents in central poland. International Journal of Environmental Research and Public Health, 2018; 15(7): 1489.