Frequency Regarding Awareness of Thalassemia amongst the Students, Paramedical Staff and Employees of Tertiary Care Hospital

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1 ORIGINAL ARTICLE Frequency Regarding Awareness of Thalassemia amongst the Students, Paramedical Staff and Employees of Tertiary Care Hospital Daniyal Ahmed1, Muhammad Nauman Nawaz1, Kiran Tauseef2, Muhammad Bilal Hussain Khan1, Muhammad Mashal1, Humaira Zafar2, ABSTRACT OBJECTIVE: To assess the frequency of individuals having awareness regarding Thalassemia. STUDY DESIGN: A Descriptive cross sectional study. PLACE AND DURATION: Al-Nafees Medical College and Hospital, Isra University Islamabad Campus from 1th May 201 to 1th June 201. METHODOLOGY: A designed questionnaire with five sections for the study was used which includes (Demographics, Awareness about Diagnosis, Treatment and Prevention). It was distributed to selected participants from medical students, medical staff members, paramedical students, paramedical staff members, non-medical students and non-medical staff members. A written informed consent was the prerequisite of study. RESULTS: One hundred and thirty (n=130) participants were enrolled in the current study. Overall Awareness of thalassemia is more in females i.e. 2% (n=67) as compared to males i.e. 43% (n=6). Medical employees 1% (n=2) and students 1% (n=2) have the highest level of knowledge and awareness about thalassemia followed by para medical students % (n=1), para medical staff 11% (n=14), non-medical students 18% (n=23) and non-medical staff 16% (n=21). While the level of knowledge about thalassemia was good, the percentage of participants who had themselves screened was only % (n=16). CONCLUSION: Only individuals related to medical either doctors or paramedics had good awareness regarding hereditary disease transformation and diagnosis of thalassemia. While the participants of non-medical profession had less awareness. KEY WORDS: Thalassemia, Awareness, Medical Students, Para- Medical, Non-Medical HOW TO CITE THIS: Ahmed D, Nawaz MN, Tauseef K, Khan MBH, Mashal M, Zafar H. Frequency Regarding Awareness of Thalassemia amongst the Students, Paramedical Staff and Employees of Tertiary Care Hospital. Isra Med J. 2017; (3): This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License ( which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. INTRODUCTION the prevalence of Beta-Thalassemia is about 6% and more than 000 child births in Pakistan each year are affected with BetaThalassemia. There are around 0,000 patients registered all over the country1-3. While in Iran, 8000 pregnancies are at risk each year. Thalassemia is most prevalent in people of the Mediterranean basin, Italian, Greek, Middle Eastern, Asian and African ancestry 4. Premarital screening and pre-natal diagnosis play an important role in decreasing the prevalence and preventing thalassemia. Premarital screening involves testing both the partners to know whether one of them or both are thalassemia carriers. This information can be used to find the probability of the child of having thalassemia major. Pre-natal diagnosis can be done during pregnancy by performing Chorionic Villous Sampling at 10 weeks of pregnancy. After birth, most of the patients show signs and symptoms within first 2 years of life. A complete blood count with peripheral film is most of the time sufficient to diagnose a case of thalassemia but Hb electrophoresis and genetic testing could also be done.4 Incidence of thalassemia is increasing due to lack of awareness about its cause, screening (premarital / peri-natal), diagnosis and treatment. Awareness will be the result of health education. Health education has an important role in reducing the rate of hereditary disorders. So this study has been Thalassemia is a hereditary autosomal recessive disorder. It is characterized by the mutation in genes which are responsible for production of hemoglobin. It is further subdivided on the bases of chains of hemoglobin which are defective. It has two subtypes i.e. α-thalassemia and β-thalassemia (Minor, Intermediate and Major). Some other types of thalassemia also exist e.g. Cooley's anemia and Mediterranean anemia.1,2 Thalassemia is the most common inherited disorder with highest prevalence in areas endemic with malaria. 1,2 In Pakistan, 1. F inal Year MBBS Student, 2. Associate Professor of Pathology Al-Nafees Medical College & Hospital Isra University Islamabad Campus Pakistan Correspondence to: Humaira Zafar Associate Professor of Microbiology Al-Nafees Medical College & Hospital Isra University Islamabad Campus Pakistan dr.humairazafar@yahoo.com Received for Publication: Accepted for Publication:

2 conducted to check the level of awareness about thalassemia among medical students, junior doctors, nursing staff, nursing students, non- medical staff (lab technicians and operators) and non- medical (DPT) students at Al-Nafees Medical College and Hospital. This study was conducted to assess the frequency of individuals having awareness regarding Thalassemia. METHODOLOGY A Descriptive cross sectional study was done in and the participants that were selected from Al-Nafees Medical College th & Hospital over the time period of 2 months from 1 May 201 th to 1 June 201. A simple random sampling technique was used. The total sample size was 130 (N) individuals. The study population was selected from 2 major categories (Employees & Students), while 3 Sub Categories (Medical, Para Medical and Non-Medical). Only those candidates were selected who gave the written consent and fulfilled the inclusion criteria were included. While non willing candidates were excluded. The questionnaire was designed by the Authors,6 of current study using other studies in past. The Questionnaire contains five Sections (Demographics, General Awareness, Awareness of Diagnosis, Treatment and Prevention of thalassemia). Ethical approval was obtained from ethical review board of Al- Nafees Medical College and Hospital. A consent form was filled by all the selected participants before getting enrolled in the study. After taking the written consent from the selected candidates, the questionnaire was distributed and was filled by the candidates. The identity of the selected candidates remained anonymous throughout the study. The questionnaires were then collected from the candidates and was then entered in a specially designed software i.e. statistical package of social science (SPSS) version 23. And was used for frequency in terms of percentages were commented the quantitative variables for statistical inference. RESULTS One hundred and thirty (n=130) participants were enrolled in study from different departments and of different levels. Our Response rate was 100% (i.e. n=130). 1% (n=2) Medical employees were enrolled in which 60% (n=1) were post graduates and 40% (n=10) were graduates. 1% (n=2) Nonmedical employees were enrolled in which 8% (n=2) got primary education, 24% (n=6) got secondary education, 24% (n=6) were undergraduates, 28% (n=7) were graduates and 16% (n=4) were post graduates. % (n=1) participants from para-medical staff were enrolled in which 3% (n=8) were post graduates, 40% (n=6) were graduates and 7% (n=1) got secondary education. We also included undergraduate level students from MBBS, DPT and Nursing i.e. 1% (n=2), 1% (n=2) and % (n=1) respectively, as shown in figure - 1. FIG- 1: DISTRIBUTION OF PARTICIPANTS WITH RESPECT TO THEIR CATEGORIES AND SUB-CATEGORIES (N=130). TABLE-I: DISTRIBUTION OF PARTICIPANTS WITH RESPECT TO GENDER AND CATEGORY (N=130). About the type of disease, if we see the level of knowledge of employees than Medical Employees i.e. 100% (n=2) and Para- Medical Staff i.e. 3% (n=14) while Non-Medical Employees i.e. 44% (n=11) only individuals knew that thalassemia is a hereditary disorder. If we see the level of knowledge of students than MBBS Students i.e. 100% (n=2) and Nursing Students i.e. 100% (n=1) while DPT Students i.e. 80% (n=20) only individuals knew that thalassemia is a hereditary disorder. This is shown in table - II. About the diagnostic test of disease, if we see the level of knowledge of employees than Medical Employees i.e. 100% (n=2) and Para-Medical Staff i.e. 3% (n=14) while Non- Medical Employees i.e. % (n=1) only individuals knew that thalassemia can be diagnosed by blood test. If we see the level 162

3 of knowledge of students than MBBS Students i.e. 100% (n=2) and Nursing Students i.e. 100% (n=1) while DPT Students i.e. 2% (n=23) only individuals knew that thalassemia can be diagnosed by blood test. This is shown in table - II. About the Character of disease, if we see the level of knowledge of employees than Medical Employees i.e. 84% (n=21) and Para- Medical Staff i.e. 20% (n=3) while Non-Medical Employees i.e. 20% (n=) only individuals knew that thalassemia can be asymptomatic. If we see the level of knowledge of students than MBBS Students i.e. 48% (n=) and Nursing Students i.e. 67% (n=10) while DPT Students i.e. 28% (n=7) only individuals knew that thalassemia can be asymptomatic. This is shown in table - II. About the Prevention and Screening of disease, if we see the level of knowledge of employees than Medical Employees i.e. 16% (n=4) and Para-Medical Staff i.e. 13% (n=2) while Non- Medical Employees i.e. % (n=3) only individuals knew that thalassemia can be Screened and Prevented. If we see the level of knowledge of students than MBBS Students i.e. 8% (n=2) and Nursing Students i.e. 27% (n=4) while DPT Students i.e. 4% (n=1) only individuals knew that thalassemia can be Screened and Prevented. This is shown in table - II. TABLE - II: THALASSEMIA AWARENESS ON VARIOUS ASPECTS (N=130) DISCUSSION Our study shows the level of knowledge of enrolled participants was around 74% with the help of 3 parameters i.e. kind of disease, its diagnosis and its type which is on lower side than the study done in Malaysia among future health care providers, in which the author evaluated knowledge in 4 different levels (excellent, Good, Average, Poor) in 3 categories (MBBS, Nursing, Pharmacy students) which shows Nursing students had excellent knowledge than MBBS and then Pharmacy Students i.e. `Poor knowledge', overall responders level of knowledge 7 was about 0%, which is on higher side from the current study (i.e. around 7%) and from another Pakistani study that was done in non-medical universities where 4.% (207 out of 380) 8 knew about Thalassemia, and by a study done among Malaysian villagers where 46.4% responders knew about Thalassemia, another study in Malaysian population among medical and non-medical students shows that 3.% medical students and 46.01% non-medical students knew about thalassemia, Similarly studies done in Iran shows that the level of knowledge among Thalassemic patients about thalassemia was poor in about 3%, while 32.% and 28.% had little and 10 satisfying information respectively, another study done at Karachi, Pakistan among students of Pharm D, MBBS, and general population in which only 22% selected population (total Population 200) knew about thalassemia whereas remaining 78% population neither aware of the disease nor its 11 consequences. Our study shows that Awareness of thalassemia is more in females i.e. 2% (n=67) than males i.e. 43% (n=6) which has similar results to other studies like a study done among Malaysian villagers where females have more awareness i.e. 47% than males i.e. 4.7%, study done in Malaysia among future health care providers shows that 8%-1% females has excellent to average level of knowledge which is more than males 7%-8% has excellent to average level of knowledge 7 about thalassemia, another computer assisted telephone interview survey done at Malaysian population which shows that females has more awareness i.e. 80.8% than males i.e. 67.3% among the interviewed participants. Our study shows that medical related participants knew that thalassemia is a hereditary disorder (i.e. 100%), while paramedical 6.% and non-medical 62% has similar results to other studies done at different occasion at different places. Study in Malaysian population among medical and non-medical students shows that 66.33% medical students and 36.67% nonmedical students knew that thalassemia is a familial (Hereditary) disease while 2.2% medical and 74.08% nonmedical said that thalassemia is not a familial (Hereditary) disease and 84.13% medical and 1.87% non-medical did not knew that thalassemia is a familial (Hereditary) disease or not. Our study shows that medical related participants knew that thalassemia can be diagnosed by blood test (i.e. 100%), while para-medical 6.% and non-medical 84%, and the other result is medical related participants knew that thalassemia can be asymptomatic (i.e. 66%), while para-medical 43.% and nonmedical 26%, both the results are comparable with other studies like Study in Malaysian population among medical and 163

4 non-medical students shows that 6.6% medical students and 1.7% non-medical students knew that thalassemia is related to blood i.e. decreased red cell count while 27.28% medical and 72.82% non-medical did not knew about the thalassemia and its problems, same study also shows that 71.1% medical students and 28.0% non-medical students knew that thalassemic patients are anemic while 46.1% medical and 3.8% nonmedical said that thalassemic patients are not anemic and 23.47% medical and 76.3% non-medical did not knew that thalassemic patients are anemic or not, another computer assisted telephone interview survey done at Malaysian population which shows that 76.4% respondents knew that thalassemia is a hematological disorder i.e. decreased Red cell count and 2.8% knew that blood test is used to diagnose weather a person is suffering from thalassemia or not, and by a study done among Malaysian villagers where 71.2% responders knew that Thalassemia can be diagnosed by blood test. According to our study overall % participants were screened for thalassemia comparable to other studies like, study done among parents of thalamic child in Pakistan has low awareness 13 about importance of blood screening test i.e. 1.8%, another computer assisted telephone interview survey done at Malaysian population which shows that 13.6% respondents were screened for thalassemia and majority of them were Chinese (30.8%) followed by Indians (17.4%), another study in Malaysian population among medical and non-medical students shows that.3% medical students and 44.6% nonm e d i c a l s t u d e n t r e s p o n d e r s w e r e t e s t e d f o r thalassemia/thalassemia trait and only 2 out of 300 (0.%) student responders were screened for thalassemia. Another study done at Lahore, Pakistan among the parents of thalamic child shows that 84.3% parents has knowledge about the screening of thalassemia while 1.7% didn't even knew about screening of thalassemia although all parents were of 6 thalassemic child. These studies show that participants who were related to health care profession had better level of knowledge than those who were not related to the health profession. This is because health providers get lectures and study books on hematological related disorders while the other population that are not related to health profession did not get any campaigns and programs that increases their level of knowledge neither they study the books. CONCLUSION Only individuals related to medical either doctors or paramedics had good awareness regarding hereditary disease transformation and diagnosis of thalassemia. While the participants of non-medical profession had less awareness. l RECOMMENDATIONS It is recommend that the awareness campaigns related to thalassemia should also focus on education about prevention through screening and prenatal diagnosis. This can help in decreasing the incidence of thalassemia in the l country. The awareness campaigns should focus the non-medical professionals as well. Limitations The sample size was small and the study was conducted in a medical college and hospital so the results may differ from studies done on a larger sample or on general population. Contribution of Author: Ahmed D: Designed Research Study, Literature Review, Data Interpretation, Manuscript Writing, Nawaz MN: Manuscript writing, Tauseef K: Conceived idea, Khan MBH: Literature Search, Designed Research Study. Mashal M: Data Collection. Zafar H: Manuscript Final Approval Disclaimer: None. Conflict of Interest: None. Source of Funding: None. REFERENCES 1. WHO. Global epidemiology of haemoglobin disorders and derived service indicators. (Cited date: 2nd June 2016) Website: [ 86/6/ /en/] 2. WHO. Genes and human disease (Thalassemia). (Cited date: 2nd June 2016) Website: [ genomics/public/geneticdiseases/en/index2.html#thalas saemia] 3. Thalassaemia Thalassaemia Federation of Pakistan. (Cited date: 2nd June 2016) Website: [ what-is-thalassaemia/] 4. Thalassemia-Mayo Clinic (Cited date: 2nd June 2016) W e b s i t e : [ h t t p : / / w w w. m a y o c l i n i c. o r g /diseasesconditions/ thalassemia/home/ovc ]. Kukreja A, Khan A, Xian L, Razley A, Rahim Z. Awareness Of Thalassaemia Among Rural Folks In Penang, Malaysia. Inter J Health. 200;(1): Ishaq F, Abid H, Kokab F, Akhtar A, Mahmood S. Awareness among parents of β-thalassemia major patients, regarding prenatal diagnosis and premarital screening. J Coll Phys Surg Pak. 20;22(4): Haque AT, Fatimah A, Lailis N, Amilin Z, Zain M, Haque M. 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