Knowledge Attitude And Knowledge Attitude And

Practice Regarding Folic Acid Practice Regarding Folic Acid

Deficiency:Deficiency:

A Hidden HungerA Hidden Hunger

Dr. Aliya Hisam, Mahmood Ur Rehman, Syed Fawad Dr. Aliya Hisam, Mahmood Ur Rehman, Syed Fawad MashhadiMashhadi

Community Medicine Department, Army Medical College,

Rawalpindi

ContentsContents

• Introduction

• Objectives

• Methodology

• Results

• Conclusion

IntroductionIntroduction• Globally, an estimated two billion people

are affected by deficiencies of essential vitamins and minerals, collectively known as hidden hunger, which negatively impact on health and economic development.

• The unified global efforts to mitigate the high burden of the hidden hunger, in populations around the world are crucial to the achievement of most of the MDGs.

• Weinstein SJ, Hartman TJ, Stolzenberg-Solomon R, Pietinen P, Barrett MJ, Taylor PR, Virtamo J, Albanes D. Null association between prostate cancer and serum folate, vitamin B(6), vitamin B(12), and homocysteine. Cancer Epidemiol Biomarkers Prev. 2003 Nov;12(11 (pt 1)):1271-2.

• The worldwide incidence of neural tube defects (NTDs) ranges from 1.0 to 10.0 per 1,000 births.

o S Jill James, Marta Pogribna et al. Abnormal folate metabolism and mutation in the methylenetetrahydrofolate reductase gene may be maternal risk factors for Down syndrome. American Journal of Clinical Nutrition. 1999 October; 70 (4): 495-501.

• In Pakistan, Out of all the pregnant women visiting tertiary care hospitals of Rawalpindi for the 1st antenatal visit, 57% had iron; 20% had folate and 19%

had combine iron and folate deficiency.o Khan DA, Fatima S, Imran R, Khan FA.. Iron, folate and cobalamin

deficiency in anaemic pregnant females in tertiary care centre at Rawalpindi. J Ayub Med Coll Abbottabad..2010 Jan-Mar;22(1):17-21

• Adequate maternal consumption of folic acid before pregnancy and during the early weeks of gestation can reduce the risk of having a child with a neural tube defect (NTD).

• As we are progressing towards the Millennium Development Goals (MDGs), it is essential to identify the burden of disease of micronutrient deficiency.

• Nicola A. Hursthouse,1 Andrew R. Gray,2 Jody C. Miller,1 Meredith C. Rose,1 and Lisa A. Houghton1,*. Folate Status of Reproductive Age Women and Neural Tube Defect Risk: The Effect of Long-Term Folic Acid Supplementation at Doses of 140 µg and 400 µg per Day. Nutrients .2011 January;3(1):49-62

Rational Rational • The necessity of this study was to create

awareness in community regarding the hidden hunger by creating awareness regarding importance of this micronutrient deficiency (folic acid) especially in the most vulnerable group.

• Purpose of our research was to find out awareness , attitude and practice regarding folic acid (i.e. sources, benefits, requirement in pregnancy, use of folic acid supplements) among married women (age 21-42 years) visiting tertiary care hospital in Rawalpindi.

• Association between the education level and practice of folic acid intake was also analysed.

•

ObjectivesObjectives

• To find out Knowledge Attitude and Practice regarding Folic Acid Deficiency among Women of Child bearing age (WPCBA).

• To find out the Association of Education Level with Practice of Folic Acid in WPCBA.

Operational DefinitionOperational Definition• Knowledge

o Regarding various sources of folic acido Advantages of using folic acid o Defects due to folic acid deficiency

• Attitudeo Positive or negative response about folate useo Willingness to know more about folic acid

• Practiceo Prevalence of folic acid use in pre-pregnancy

period and the 1st trimester of pregnancy

• Women of child bearing age (WOCBA)o Married women of age group between 22-42 years

MethodologyMethodology• Study Design:

o Descriptive Cross Sectional Study.

• Setting : o CMH and MH Rawalpindi.

• Duration of Study: o 6 months duration from Sept. 2012 to Feb. 2013

• Sample Size: o Using WHO sample size calculator, the sample

size was calculated to be approximately 400 (with Confidence Level (CL) of 95%, Anticipated population proportion (P) of 0.2 and Absolute precision (d) of 0.04.

• Sampling Technique: o Non-probability convenient sampling technique

Methodology Methodology • Data Collection Procedure:

o Patients coming to outpatient department,

emergency and different wards of Military

Hospital and Combined Military Hospital of

Rawalpindi were selected. After taking

verbal consent from patients, questionnaire

was filled.

• Data collection tools:

o Structured Closed Ended Questionnaire

Methodology Methodology • Data Analysis Procedure:

o Data was entered and analysed using Statistical

package for Social Sciences (SPSS) version 20.

o Data including variable such as age, education,

knowledge, attitude and practice were presented

in the form of frequencies and percentages.

o Chi-square test of significance with 95%

confidence level was used to find association

between education level and practice of folic acid

intake among WOCBA.

ResultsResults

ConclusionConclusion• Knowledge regarding folic acid deficiency among

WOCBA was low along with the poor attitude.

• Practice was also not satisfactory as only about half had received folic acid supplementation during their pre-pregnancy and antenatal period.

• Education status plays important role in preventing micronutrient deficiency. There is a dire need to increase awareness regarding importance of this hidden hunger among WOCBA especially by involving health care professionals, community health workers, pharmacist and especially media as it is completely preventable hidden public health problem.

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