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Level of Knowledge and Adherence to Vitamin D Supplementation among Infants Attending Well-Baby Clinic in Al Nawariyah Primary Health Care Center in Makkah, Saudi Arabia, 2018: A Cross-sectional Study

Meaad Ahmed Sulaimani*, Hisham Abdulsalam Bashawri

Family Medicine Resident, Ministry of Health, Saudi Arabia

Abstract: Background Vitamin D is known to have essential roles in the human body. However, the case of vitamin deficiency is reported to increase in many infants worldwide, especially in Saudi Arabia. Mothers, having adequate knowledge about vitamin D and its supplementation, may lead to possible lowering of the cases of vitamin D deficiency and its complications. Aim of the study: This study aimed to estimate the prevalence, level of knowledge and determinants of adherence to Vitamin D supplementation among infants attending the well-baby clinic in Al Nawariyah PHCC at Makkah, Saudi Arabia. Methodology: A cross-sectional study was conducted among 125 mothers of infants attending the well-baby clinic in Al Nawariyah PHCC at Makkah, Saudi Arabia. Male and female infants of any nationalities was considered as the inclusion criteria, while the exclusion measure was set as infants who are non-arabic (or English-speaking), not accompanied by their mothers and has medical disease. Validated questionnaires concerning demographic data and knowledge scores on Vitamin D and its supplementation were given in Arabic version. Results: Results revealed that high prevalence (76.0%) of low level of adherence to vitamin D supplementation of the mothers was due to limited information about it regardless of how they feed their children. In terms of knowledge of mothers towards Vitamin D, most (96.0%) were not informed that there are recommendations on how to use vitamin D supplements for children. Family is the major reported source (60.0%) of information concerning Vitamin D, followed by doctor (20.0%) and media (20.0%). Using Chi-square test, the educational qualification of mothers (p = 0.038) and the manner of infant feeding (p = 0.041) were found to be significant characteristics that affected the decision of the respondents to negatively practice supplementation of Vitamin D, leading to reported low adherence. Conclusion: This study was conducted to estimate the prevalence, level of knowledge on vitamin D and adherence to supplementation of the mothers of infants. Most of the respondents was found to have limited information about vitamin D deficiency, and the high prevalence of low level of adherence to vitamin D supplementation of the participants, whether under breast-, artificial or mix- type of infant feeding, was mainly due to limited information about this matter. Overall, the mothers of infants under study had poor knowledge and adherence to vitamin D supplementation, suggesting that all mothers, regardless of the educational attainment and the manner of infant feeding, must be exposed to health care and educational program in order for them to increase their knowledge about the importance of micronutrients – its function and supplementation - towards infants, especially the vitamin D.

Keywords: knowledge, Vitamin D, supplementation, infants, Makkah

Received October 10, 2019; Revised November 24, 2019; Accepted December 04, 2019

Citation: Meaad Ahmed Sulaimani, Hisham Abdulsalam Bashawri, Level of Knowledge and Adherence to Vitamin D Supplementation among Infants Attending Well-Baby Clinic in Al Nawariyah Primary Health Care Center in Makkah, Saudi Arabia, 2018: A Cross-sectional Study. American Journal of Medical Sciences and Medicine, 7 (4). 173-183. January 2019. doi:10.12691/ajmsm-7-4-5

1. Introduction

1.1. Background

World Health Organization (WHO) define infant, a child from the first month after birth to 12 months of age, more specific the period from 28 days to 12 months old.

The infant period is one of the most critical stages of a personal life which is represent the most rapid growth and physical development experience. To achieve optimal growth and healthy development we need sufficient nutrition [1]. The WHO recommended that the infant should be exclusive breastfeeding until six months, then introduce safe complementary foods to the infant with a continuation of breastfeeding until two years or beyond.

Vitamin D is a fat-soluble sec steroids hormone that is necessary for normal absorption of calcium from the gut, also have a wide range of molecular and cellular functions. The Sources of Vitamin D are Sun exposure, Fortified sources (Cereal, Milk, Orange juice), Non-fortified food sources (Breast milk, Cod liver oil, Egg yolk, Mackerel, Salmon, Sardines, Tuna), Vitamin D Supplement [2]. Folsom and DiMaggio in their article in the American Academy of Pediatric (AAP) News recommended at 2013 and revised at 2016 that an exclusively breastfed Infants or infant receive less than 1 liter of formula daily should be supplemented with 400 IU of vitamin D daily, which start in the first days of life and continuing until they are 12 months of age [3].

1.2. Rationale

The vitamin D deficiency and iron deficiency anaemia are common preventable diseases .Vitamin D has essential roles in the body, including bone growth, bone remodelling, modulation of cell growth, neuromuscular and immune function development, and a decrease of inflammation [2]. Furthermore, the prevalence of 0-4 years old in Saudi Arabia is 10.6 % among the Saudis with an estimated 2.14 million people in 1437 [4,6].

Moreover, up to the researcher knowledge, there are no a previous studies according to the adherence to Vitamin D supplements recommendations among Saudi infants.

1.3. Aim of the Study

This study aims to estimate the prevalence to adherence to Vitamin D supplements recommendations Among Infants, Makkah over a period of 3 weeks.

1.4. Objectives

1. To identify the level of adherence to Vitamin D supplements recommendations among Infants attending the well-baby clinic in Al- Nawariyah PHC in Makkah January 2018.

2. To determine factors associated with the adherence to Vitamin D supplements recommendations Among Infants attending the well-baby clinic in Al- Nawariyah PHC in Makkah January 2018.

3. To assess the knowledge of mothers about Vitamin D supplements recommendations in Infants attending the well-baby clinic in Al- Nawariyah PHC in Makkah al January 2018.

2. Literature Review

2.1. Prevalence of Vitamin D Deficiency

A systematic review was carried in PubMed/Medline in April-June 2013 to identify articles on vitamin D status worldwide published in the last ten years, shows the prevalence of vitamin D deficiency in infants worldwide. A total of 12 studies were found; 3 in America, 1 in Europe, 1 in Africa, 6 in Asia, and 1 in Oceania. The highest prevalence of vitamin D deficiency was found in neonates from the Middle East [5].

Prospective Cohort Study was done in USA 2016, and the sample was taken from 265 umbilical cord, showed Vitamin D deficiency in 38.9 % and insufficiency in 29.8% among infant. There was an association between deficient vitamin D level and maternity factors as (race, younger age, multiple pregnancies) [6].

A study was conducted in the United Arab Emirates. 2003; the sample was obtained from infants with median age six weeks, showed 82% of the 78 infants tested had hypovitaminosis D (serum 25-OHD <10 ng/mL) [7].

The infant is born with low vitamin D stores; a study was carried out at King Khalid University Hospital, Riyadh, Saudi Arabia 2013, Umbilical samples of 200 newborns were collected and show Deficient vitamin D levels were detected in 59% of the sample [8].

Another case-control study in Dammam, Saudi Arabia 2005, study of 61 infants with rickets (mean age, 14.8 months) and 58 controls (mean age, 16.5 months) found that 75% of patients were deficient in vitamin D, compared with 25% of control children [9].

2.2. Adverse Outcome of Vitamin D Deficiency

Low level of 25-hydroxy vitamin D (25-(OH)-D) is highly prevalent in children worldwide and has been associated with increased risks of adverse health outcomes. As rickets, osteomalacia, osteomalacia myopathy, sarcopenia, and weakness, growth retardation, hypocalcemia, seizure and tetany, autism, cardiovascular diseases, diabetes mellitus, cancers (prostate, colon, breast), infectious diseases (viral, tuberculosis), and autoimmune diseases, such as multiple sclerosis and Hashimoto’s thyroiditis [3].

A study was performed in Saudi Arabia 2009 in 283 rickets infant and found that 67% male, was diagnosed with nutritional rickets due to Vitamin D deficiency who were between 6 and 14 months of age. The most frequent clinical presentation was hypo-calcemic convulsions (34%) followed by chest infections (33%) and gastroenteritis (25%) [10].

A study was carried out 2011, showed Neonates born with 25-OHD concentrations <50 nmol/L had a sixfold (95% confidence interval: 1.6-24.9; P = .01) increased the risk of RSV LRTI in the first year of living compared with those with 25-OHD concentrations ≥75 nmol/L [11].

2.3. Adherence to Vitamin D Recommendations among the Infants

A study was performed in USA 2009-2012 to assess the adherence to Vitamin D recommendations among the Infants aged 0 to 11 Months. Results showed 27.4% (95% confidence interval [CI] = 24.1, 30.9) of US infants (0-11 months) met the recommendations for vitamin D intake on a given day, which did not differ by infant age (30.6% for 0-5 months vs. 24.3% for 6-11 months; P > .05). breastfed infants were less likely to meet the recommendations compared with non-breastfed infants (19.3% vs. 31.4%; P < .01), so the majority of US infants were not adhering to the vitamin D recommendations [12].

A cross-sectional study was done in Canada October 2009 by a telephone survey of 343 mothers delivering a healthy term infant to assess the adherence to Vitamin D recommendations by the mother. Of mothers exclusively breastfeeding, 74% reported meeting the Health Canada recommendation. The leading cause for not adhering to the guidance was the assumption by mothers who began to feed fortified formula (400 IUL–1) that supplementation was no longer necessary. 50% of infants receiving mixed feedings without supplementation before six months did not achieve the recommended intake [13].

Another study was done in USA 2008, to assess the compliance to vitamin D recommendation among infants. Among exclusive breastfeeding infants, only 5% to 13% met the recommendation. Among mixed-fed infants, only 9% to 14% would have met the recommendation. Among those who consumed formula just 20% to 37% would have met the 2008 recommendation. The use of vitamin D supplements was not according to the recommendations [14].

3. Methodology

3.1. Study Design

This is a cross sectional study.

3.2. Study Area

Makkah is located in western region in Saudi Arabia. It is the holy city for all Muslims, which contain the masjid al haram and al ka’abah. It is one of the most important and populated city. In addition it have multiple nationalities and different socioeconomic status. The city is divided into four inner and three outer sections of primary health care, which contains 85 PHC centers. Al- Nawariyah PHC it is belongs to Al Zaher sector which serves six regions. It is includes several clinics such as chronic disease, general, well-baby and antenatal. The study will be conducted in the well-baby clinic.

3.3. Study Population

Infants are attending the well-baby clinic at al Nawariyah primary health care in Makkah.

3.4. Eligibility Criteria

Inclusion criteria:

Ÿ Infants are attending the well-baby clinic.

Ÿ Male and female infants.

Ÿ All nationalities.

Exclusion criteria:

Ÿ Non-Arabic or English speaker.

Ÿ Infant has a medical disease.

Ÿ Infant come without his mother.

3.5. Sample Size

The total number of mother attending with their infants the well-baby clinic in al Nawariyah PHC for three weeks is expected to be 250.

From the literature review of the same subject the prevalence of adherence to the vitamin D supplement recommendation among infant as average as 20%. 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 20%) accordingly the Sample size is 125 of mother attending with their infants.

3.6. Sampling Technique

By personal contact the researcher found that the most visiting PHC centers for well-baby clinic are Al- Nawariyah PHC, Al- Eskan, Al-Azeziah and Al-kaakih. Then the researcher selected Al- Nawariyah PHC randomly by using a numbered list of PHC through online random number generator.By using systematic sampling random as dividing the total population by the required sample size; (250 / 125 = 2). The researcher will take every second mother. The first mother will be as index case.

3.7. Data Collection Tool

A questionnaire will be carefully designed by the researcher to serve the purpose of this study. Questionnaires of similar studies will be review before finalizing the study Questionnaire. An interview Questionnaire will uses for data collection.

The Questionnaire will be designed in the Arabic language with a cover letter to clarify the objectives of the study and the assurance of confidentiality.

First section: demographic data. Second section: question to assess the Adherence to the vitamin D recommendation among infant and the knowledge of the recommendation.

The validity of questionnaire will ascertained by three consultants in the fields of family medicine and community medicine.

The researcher will examines the reliability of the questionnaire by testing and retesting.

3.8. Data Collection Technique

The researcher will visits the selected PHC after getting the approval from the ministry of health. The researcher will obtained permission from primary health care director and mother. She will explained the purpose of the study to all mother attending the well-baby clinic.

The mother will interviewed by the researcher herself inside the well-baby clinic. Before giving vaccine to the infant to prevent disturbance to mother . The data will collect through 3 weeks in January 2018.

3.9. Study Variables

Dependent variable:

Ÿ Adherence to the vitamin D recommendation among infant.

Ÿ Knowledge

Independent variables:

Ÿ Age of mother

Ÿ Nationality

Ÿ Marital status

Ÿ Education

Ÿ Occupation

Ÿ Income

Ÿ Mother with chronic disease

Ÿ The number of children

Ÿ Age of infant

Ÿ The nationality of the infant

Ÿ The Gender of the infant

Ÿ Exclusive Breastfeeding infant

Ÿ Parity breastfeeding infant.

Ÿ Formula feeding infant.

3.10. Data Entry and Analysis

Data will be collected and verified by hand then coded before entry to personal computer.

Data entry and analysis will carried out using the statistical program for social sciences (SPSS) version 24 (IBM Corp., Armonk, NY). P-value will considered statistically significance if it is < 0.05.

3.11. Pilot Study

A pilot study will conducted in Al Zaher PHC center on 10% of the sample size before the actual research, and these subjects will not include within the real study.

Therefore, questionnaire applicability and understanding will be tested.

Data from pilot study will analyzed but will not include in the main study.

3.12. Ethical Considerations

Ÿ Written permission from higher authorities in ministry of health (public health) will obtained.

Ÿ Written permission from the joint program of family medicine will be obtained before conducting the study.

Ÿ Permission of al Nawariyah PCH center director will obtained.

Ÿ Verbal consent will obtained from each participant.

Ÿ All information will keep confidential and will not disclose except for the study purpose.

3.13. Relevance & Expectations

Ÿ The researcher expects from the study, low level of adherence to the recommendations.

Ÿ The researcher expects from the study, low level of knowledge about the recommendations.

Ÿ The researcher expects from the study increase the awareness about the recommendations.

Ÿ The researcher expects that the study will improves the compliance of supplement recommendations.

3.14. Limitations

The researcher expects there may be limitation in time.

3.15. Budget

This study is self-funded.

4. Result

4.1. Socio-demographic Characteristics

In this cross-sectional type of study, each mother of 125 infants (out of 125 sample size) were interviewed and answered the questionnaires given in the well-baby clinic at Al-Nawariyah primary health care center (PHCC) in Makkah Al-Mukarrama. Among the studied population, the average number of children were found to be 2.42 (SD=1.4; Min=1; Max=40), whereas the mean age of babies was found to be 6.47 months old (SD= 3.0; Min=2; Max=12) with their mothers having a mean age of 29.46 years old (SD=5.2; Min= 17; Max=40), respectively (Table 1). In terms of their socio-demographic characteristics, majority of the mothers (83.2%) and fathers (84.8%) of the studied infants were of Saudi nationality, having most (99.2%) of the mothers to be in “married” status (Table 2). More than one-third of the mothers have attained a University (44.0%) and Secondary (39.2%) levels of education, while only less than 17% had illiterate (4.0%), primary (7.2%), intermediate (3.2%) and postgraduate (2.4%) educational achievements. Similar observation were seen for the fathers of the infants in which more than one-third have graduated in University (37.6%) and Secondary (44.0%) school levels. With regard to work, about two-third (66.4%) of the mothers were housewife whereas a small percentage of them have worked in government (6.4%), private company (4.0%) and still a student (7.2%). For the work of fathers, majority (58.4%) have worked in the government, while around one-third (34.4%) had a private job and small percentage were looking for a job (7.2%). In terms of health disorders, most of the mothers of infants under study were found to have no chronic disease. The family income of more than half (55.2%) of the respondents ranged from 5000-10000 Saudi Riyal/month, followed by about nearly one-fourth (24.8%) of family having less than 5000 Saudi Riyal/month and 20% with more than 10,000 Saudi Riyal/month income . For the sexual characteristics of the studied babies, roughly half of them (52.0%) were female while almost half (48.0%) were male. Majority (87.2%) of these babies had regular vaccinations in accordance to vaccination schedule. Moreover, the health of the studied children were mostly described by their mothers as “good” (96.8%) rather than fair (3.2%). In terms of type of feeding, more than one-third (37.6%) of them were under artificial feeding, whereas nearly one-third were under breastfeeding (31.2%) and mix type of feeding (31.2%).

Table 1. Average number of children and ages of mother and baby among the studied population

Table 2. Socio-demographic characteristics of the studied population (N=125)

4.2. Nutritional Characteristics of infants Under Artificial, Breast- and Mix Type of Feedings

Table 3 shows the nutritional characteristics of infants under breastfeeding or mix type of feeding (N=78). Majority (56.4%) of them were not using Vitamin D supplement, while around one-fourth (25.6%) and 17.9% of the mothers were regularly and sometimes introducing Vitamin D supplement to their children. For those under Vitamin D supplementation (N=34), almost three-fourth (73.5%) received 400 IU (4 drops) Vitamin D, whereas only 11.8% received 200 IU (2 drops). Roughly two-third (67.6%) of the mothers of these infants obtained their supplement from a primary health care center. On the other hand, for infants who were not using Vitamin D supplements (N=44), more than three-fourth (79.5%) of mothers decided not to practice Vitamin D supplementation due to limited information about it, followed by 38.6% with reason of “breastfeeding is enough”, 34.1% who reported that they were not prescribed with Vitamin D, 18.2% who did not see the importance of this vitamin and 2.3% who were busy about their other children. In addition, most (98.7%) of the mothers of studied infants did not use supplements or other medicines for their children.

Table 3. Nutritional characteristics of infants under breastfeeding or mix type of feeding (N=78)

In describing the nutritional characteristics of babies under artificial type of feeding (N=47), majority (51.1%) of their mothers did not know if they were using Vitamin D-fortified milk (Table 4). About two-third (61.7%) of them reported that they do not provided 1 liter of milk (about 8 small 120-mL bottles) to their children. In terms of supplementation, most of the mothers did not practice providing Vitamin D supplements to their children for a major reason (87.0%) that they had limited information about it. Only about one-fourth (26.3%) and about one-eight (13.2%) reported that they were giving Vitamin D supplement on a regular and occasional basis, out of which two-third (66.7%) introduced 400 IU (four drops) Vitamin D supplement to their children.

4.3. Knowledge of Mothers towards Vitamin D

The knowledge of mothers towards Vitamin D was also assessed in this study. Nearly two-third (65.6%) of mothers have ever read or heard about Vitamin deficiency in children, whereas only around one-third (34.4%) have not as shown in Table 5. Majority (65.6%) thought that vitamin D is important for the health of their children, however large percentage of them (84.8%) had limited information about vitamin deficiency. With regard to supplementation, most (96.0%) were not informed that there are recommendations on how to use vitamin D supplements for children. Family is the major reported source (60.0%) of information concerning Vitamin D, followed by doctor (20.0%) and media (20.0%). More than one-third (36.8%) of the mothers under study thought that the suitable age to give vitamin D was right after birth, whereas small percentages thought to provide the vitamin D at 1 year and above (3.2%), at 6 months (3.2%) and at 3 months (0.8%). In terms of the recommended dosage of Vitamin D, three-fourth (75.2%) were not knowledgeable about it, whereas only about one-fourth (24.8%) thought it to be 400 IU. Around forty-five percent (45.6%) did not know that is there a relationship between the type of feeding and the required dose of vitamin D, followed by 39.2% who indicated that there is a relationship and 15.2% who reported that there is not.

Table 4. Nutritional characteristics of babies under artificial type of feeding (N=47)

Table 5. Knowledge towards Vitamin D of the studied population (N=125)

Table 6. Adherence to Vitamin D of the studied population (N=125)

Table 7. Association of socio-demographic characteristics towards adherence to Vitamin D supplementation (N=125)

4.4. Adherence and Factors Affecting the Adherence to Vitamin D Supplementation among Infants

Afterwards, the level of adherence to Vitamin D supplementation among infants was evaluated. Around three-fourth (76.0%) of respondents was found to not adhere to vitamin D supplementation, while only one-fourth (24.0%) have practiced it (Table 6). Table 7 shows the association of socio-demographic factors towards adherence to Vitamin D supplement. Chi-Square Test at p value of < 0.05 was used to determine the level of significance between the variables being compared. This suggests that the educational qualification of mothers and the manner of feeding were significant characteristics that affected the decision of the respondents to negatively practice supplementation of Vitamin D, leading to reported low adherence. All other socio-demographic characteristics (Table 7) were not significantly associated with adherence to Vitamin D supplementation.

4.5. Vitamin D Knowledge Score and Supplementation of Mothers

The knowledge of mothers about Vitamin D supplementation for infants was also assessed in this study. As shown in Table 8, the mean level of Vitamin D knowledge score among the studied population was found to be 2.52 (SD=2.0; Min=0; Max=7), respectively. Majority (71.2%) of the mothers under study had poor level of knowledge towards Vitamin D, whereas only 20.8% and 8.0% had good and excellent knowledge about it (Table 9). These results imply that being informed and knowledgeable about the importance of vitamin D significantly affect the decision-making of mothers to positively practice vitamin D supplementation for their respective babies. The association of level of knowledge on Vitamin D towards the socio-demographic characteristics of the participants was also evaluated. Results revealed that the level of knowledge on Vitamin D was significantly associated with the age of baby at p value of 0.020 using One-Way ANOVA analysis. On the other hand, by employing Chi-square test at <0.05 level, the knowledge on Vitamin D of the respondents was found to have significant statistical association with the educational attainment of mother (p= 0.014). Table 11 show that majority of mothers who achieved intermediate and below (88.9%), secondary (81.6%) and university and post graduate (56.9%) levels of education had poor knowledge concerning Vitamin D. This suggest the all mothers, regardless of educational attainment, must be exposed to health care and educational program in order for them to increase their knowledge about the importance of micronutrients – its function and supplementation - towards infants, especially the vitamin D, thereby helping decrease the vitamin deficiency cases in Saudi Arabia.

Knowing that the age of baby had significant association towards the level of knowledge on Vitamin D according to One-Way ANOVA analysis, these variables being compared were further assessed using the Games Howell test (Table 12). Results show no significant mean differences (p>0.05) when the mean of ‘poor’ level of knowledge on vitamin D was compared to the mean of ‘good’ and ‘excellent’ levels, ‘good’ compared to ‘poor’ and ‘excellent’ levels, and ‘excellent’ compared to ‘poor’ and ‘good’ levels. However, the result of One-Way ANOVA analysis implies that the means of different levels (poor, good and excellent) of knowledge on vitamin D were significantly associated with each other. This implies that the result of Games Howell test does not necessarily suggest that there was a significant difference between the mean values of levels of knowledge on vitamin D when compared against the baby age, but can be due to some included extreme data or outliers in the determination of the said mean values.

Table 8. Average level of Vitamin D knowledge score among the studied population

Table 9. Frequency of Vitamin D knowledge level among the studied population (N=125)

Table 10. Association between the level of knowledge on Vitamin D and adherence to Vitamin D supplement of the studied population (N=125)

Table 11. Association of socio-demographic characteristics towards level of knowledge on Vitamin D (N=125)

Table 12. Multiple comparison analysis of age of baby toward the levels of knowledge on vitamin D

5. Discussion

In this study, the level and knowledge on vitamin D and adherence to supplementation of the mothers of infants attending the well-baby clinic at Al-Nawariyah PHCC, Makkah Al-Mukarrama, Saudi Arabia, was evaluated. Results revealed that majority (65.6%) of the mothers under study thought that vitamin D is important for the health of their children, however large percentage of them (84.8%) had limited information about vitamin deficiency. Similarly, the work of Hoel and colleagues [15], Babelghaith and co-workers [16], Alamoudi and others [17] in Saudi Arabia showed that the participants under their studies exhibited limited knowledge when it comes to Vitamin D and its deficiency. Al-Saleh and others [18] mentioned that possible reasons for the said deficiency can be the insufficient knowledge about vitamin D, suggesting an increase in public awareness, especially to mothers, to be promoted to manage the increasing prevalence of Vitamin D deficiency and avoid its further complications. Contrary to the result of current study, a similar cross-sectional study in Majmaah City, Saudi Arabia reported that majority (80.5%) of the participants were aware about vitamin D [19].

In this study, family is the major reported source (60.0%) of information concerning Vitamin D, followed by doctor (20.0%) and media (20.0%). Other studies in Saudi Arabia indicated the primary source of the Vitamin D knowledge of respondents as media [19], Doctor [20] and health care professionals [21].

The mean level of Vitamin D knowledge score among the studied population was found to be 2.52 (SD=2.0; Min=0; Max=7), respectively. However, this value is two-fold lower than the reported overall knowledge mean score of 5.9 ± 1.2 of the participants in the study of Alamoudi and colleagues [17] in Jeddah, Saudi Arabia.

Regarding adherence to vitamin D supplementation, majority (76.0%) of the respondents was found to not adhere to vitamin D supplementation. In other Arab country, Alotaibi and co-workers [19] also reported that majority (74.8%) of the participants in their study did not take vitamin D supplements. Comparable results were also seen to other published non-Arab works wherein a percentage ranging from 2 to 19% of breastfeeding infants were reported to be under vitamin D supplementation [12,14,22,23]. Contrary to the result of current study, 90% have received vitamin D supplementation in the prospective cohort study of pregnant women and their children [24]. The low percentage of adherence to Vitamin D of the mothers under study can possibly be due to their poor knowledge on vitamin D and its deficiency. Pediatricians and allied health care providers have significant roles in advising or educating parents to practice supplementation for their infants.

6. Conclusion

This research was done to estimate the level and knowledge on adherence to vitamin D supplementation of the mothers of infants attending the well-baby clinic at Al-Nawariyah PHCC, Makkah Saudi Arabia. Most of the respondents had limited information about vitamin D deficiency despite majority have thought that vitamin D is important for the health of their children. Similarly, the high prevalence (76.0%) of low level of adherence to vitamin D supplementation of the participants, whether under breast-, artificial or mix type of infant feeding, was mainly due to limited information about this matter. In addition, most were not informed that there are recommendations on how to use vitamin D supplements for children and majority had limited knowledge about its recommended dosage.

The factor, adherence to vitamin D supplementation, showed significant association towards the educational attainment of mothers and the manner of infant feeding such as breast- and mix- and artificial types of feeding, wherein majority of respondents under both factors exhibited significantly low adherence to vitamin D supplementation.

In terms of knowledge, majority of the mothers under study had poor level of knowledge towards Vitamin D. The level of knowledge on vitamin D and adherence to Vitamin D supplementation of the participants showed significant association, wherein most who had poor knowledge on vitamin D did not practice adherence to vitamin D supplementation. This implies that being informed and knowledgeable about the importance of vitamin D significantly affect the decision-making of mothers to positively practice vitamin D supplementation for their respective babies .With regard to socio-demographic characteristics, the level of knowledge on Vitamin D of the respondents was found to have significant statistical association against the educational attainment of mother and the baby age, specifically resulting to mothers being reported to have poor knowledge concerning Vitamin D.Overall, the mothers of infants under study had poor knowledge and adherence to vitamin D supplementation, suggesting that all mothers, regardless of the educational attainment and the manner of infant feeding, must be exposed to health care and educational program in order for them to increase their knowledge about the importance of micronutrients – its function, benefits and supplementation - towards infants, especially the vitamin D, thereby helping decrease the vitamin deficiency cases and avoid its possible complications in Saudi Arabia.

7. Recommendations

The poor knowledge and adherence to vitamin D supplementation of the participants suggest that all mothers must be exposed to health care and educational program in order for them to increase their knowledge about the importance of micronutrients – its function, benefits and supplementation - towards infants, especially the vitamin D, thereby helping decrease the vitamin deficiency cases and avoid its further complications in Saudi Arabia. Pediatricians and allied health care providers are highly encouraged to educate or advise parents to practice vitamin D supplementation for their infants. Media can also be a good platform in increasing the awareness about the importance of vitamin D and its supplementation towards infants.

References

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