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Table of Contents
ORIGINAL ARTICLE
Year : 2019  |  Volume : 12  |  Issue : 1  |  Page : 23-28

Knowledge and attitude of post-natal mothers in al ain medical district about hereditary blood disorders (sickle cell disease, thalassemia and glucose-6-phosphate dehydrogenase deficiency)


1 Department of Family Medicine, Zayed Military Hospital-Al Batayeh Branch, Al-Ain, United Arab Emirates
2 Department of Community Medicine, Faculty of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates

Date of Web Publication27-Feb-2019

Correspondence Address:
Faisal Abdulla AlShamsi
Department of Family Medicine, Zayed Military Hospital-Al Batayeh Branch, PO Box 2844 UAQ
United Arab Emirates
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/HMJ.HMJ_60_18

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  Abstract 


Background: Hereditary haemolytic anaemia has been considered as a major health problem in many countries including the United Arab Emirates (UAE), while the prevalence is not decreasing due to lack of knowledge, unorganised teamwork and services, lack of support groups and inadequate research in the fields of prevention and control. Aim and Objectives: The study aimed at assessing the knowledge and attitude of post-natal mothers in Al-Ain medical district towards common hereditary haemolytic anaemias (glucose-6-phosphate dehydrogenase [G6PD] deficiency, thalassemia and sickle cell anaemia), as a step towards decreasing the prevalence of these diseases amongst the population. Our main objective was to assess understanding of common hereditary haemolytic anaemias as well as to measure the attitude of mothers in Al Ain towards these diseases. Methods: The study was analytical cross-section survey conducted in the period from 23 August to 16 September 2003, in Al Ain Medical District, UAE, in three main hospitals: Al Ain Hospital, Tawam Hospital and Oasis Hospital. An interview-administered questionnaire was used for data collection. Data analysis was done using SPSS version 11. Results: Analysis of the study showed a significant difference amongst participants who heard about G6PD deficiency, according to different age groups, the (18–24) age group had more knowledge about G6PD deficiency when compare with other age groups (P = 0.008). Another significant difference amongst individuals who heard about G6PD deficiency, according to different educational level was as follows: 31% less than secondary school, 60.6% completed secondary school and 50% for higher educational level (P = 0.033). Similarly, for G6PD deficiency, mothers from GCC countries were more aware of G6PD deficiency when compare with other nationals (P = 0.006). Of the total participants, 90% agreed on the importance of genetic counselling before marriage. As the best method of increasing knowledge about hereditary anaemias, media campaigns were the preferred approach having 70.6% voting for it, followed by the approach of educating schoolchildren with 43.1% approval. Conclusion: There is a lack of knowledge amongst post-natal mothers in Al Ain Medical District about common hereditary anaemias compared to a good attitude towards prevention of these disorders.

Keywords: Attitude, glucose-6-phosphate dehydrogenase deficiency, hereditary anaemias, knowledge, pre-marital screening, sickle cell disease, thalassemia


How to cite this article:
AlShamsi FA, Al Mahmmod FA, Al Hammadi AH. Knowledge and attitude of post-natal mothers in al ain medical district about hereditary blood disorders (sickle cell disease, thalassemia and glucose-6-phosphate dehydrogenase deficiency). Hamdan Med J 2019;12:23-8

How to cite this URL:
AlShamsi FA, Al Mahmmod FA, Al Hammadi AH. Knowledge and attitude of post-natal mothers in al ain medical district about hereditary blood disorders (sickle cell disease, thalassemia and glucose-6-phosphate dehydrogenase deficiency). Hamdan Med J [serial online] 2019 [cited 2019 May 20];12:23-8. Available from: http://www.hamdanjournal.org/text.asp?2019/12/1/23/253100




  Introduction Top


Hereditary anaemias, consisting mainly from glucose-6-phosphate dehydrogenase deficiency (G6PD deficiency), thalassemia and sickle cell anaemia (SCD) has been considered as a major health problem in many countries including United Arab Emirates (UAE), nevertheless, the prevalence is not decreasing due to lack of knowledge about these diseases amongst the UAE population, unorganised teamwork and services, lack of support groups and inadequate research in the fields of prevention and control.[1] In addition, consanguineous marriages play an important role in spreading these conditions in the UAE. Consanguinity rate was estimated by 50.5% in the UAE community.[2] As researchers are willing to contribute to the well-being of the society, we believe that carrying out a survey on the current knowledge and attitude of mothers in Al Ain city towards these diseases would help us have an assessment of the society in this regard, which may help future research in the fields of prevention. In addition, the findings of the study would increase the level of the awareness of participants by providing then with simple and understandable information about these disorders.

We search the PubMed website using Mesh keywords 'hereditary anaemia', we found number of useful studies that compared the prevalence of these diseases between UAE and other countries. Certainly, no studies were available on knowledge and attitude regarding these disorders. A useful study carried out by Abdulrazzaq et al. from UAEU, regarding the prevalence and the genetic composition of G6PD deficiency in UAE.[3] The mentioned study showed that the prevalence of G6PD deficiency in UAE were 9.1% (15% in males and 5% in females).[3] Other similar studies were carried out regarding thalassemia in UAE.[4],[5],[6] The thalassemia prevalence was not mentioned clearly, being common but less common than G6PD deficiency. Miller et al. found that some hereditary anaemias prevalence amongst children: G6PD deficiency 9.1%, sickle cell trait 4.6% and beta-thalassemia 8.7%.[7]

The study aims at assessing the awareness, knowledge and attitude of post-natal mother towards common hereditary anaemias (G6PD deficiency, SCD and thalassemia). The objectives of the study are: (1) to obtain information about the understanding of common hereditary anaemias (G6PD deficiency, SCD and thalassemia), (2) to compare knowledge between national population and non-nationals population, (3) to compare knowledge amongst different age groups, (4) to compare knowledge between educated and non-educated mothers and (5) to determine the attitude of post-natal mothers towards the importance of genetic pre-marital screening in controlling spread of these disorders. In our hypothesis, we assume that there is a lack of knowledge amongst post-natal mothers in Al Ain Medical District about common hereditary anaemias compared to good attitude towards prevention of these disorders.


  Methods Top


About the project

This study was conducted in Al Ain city, UAE, in the period between 23 August 2003 and 16 September 2003. The population of the study included all post-natal mothers in Al Ain city who had been admitted in the three main hospitals (Al Ain Hospital, Tawam Hospital and Oasis Hospital) during the period of the study.

Ethical approval

The Faculty of Medicine and Health Sciences Research Ethics Committee approved the study on the 30 August 2003.

Study design

The study was a cross-sectional survey.

Study population

The sample was consisted of all post-natal mothers in Al Ain city during the survey. The sample size was estimated as 100 participants which was reasonable according to the limited time available. Inclusion criteria: All mothers of neonates up to 28 days and speaking Arabic or English. Exclusion criteria: mothers outside post-natal period and who cannot speak Arabic or English.

Questionnaire

The survey questionnaire was a pre-coded, interview-administered and was written in both versions (Arabic or English). It consisted of 33 structured closed-ended questions to be answered by putting a tick in the box beside the chosen answer (multiple choice question). The questionnaire was divided into five main sections. The first section included the demographic data (age, level of education, number of children and nationality). The second section included three questions on G6PD deficiency (awareness, what make it worse and prevention). The third section included three questions on sickle cell disease (awareness, what make it worse and prevention). The fourth section included two questions on thalassemia (awareness and prevention). The fifth section included two question regarding opinions on pre-marital genetic screening and the prevalence of these conditions in the UAE. Finally, this last section included two question about attitude towards marriage between affected individuals or carriers and opinions on the best approach to increase awareness and knowledge of hereditary anaemias in the community. The study questionnaire was designed in English and then was translated into Arabic.

Sampling

The sample consisted of all post-natal mothers who had been admitted on obstetric wards in three main hospitals (Al Ain Hospital, Tawam Hospital and Oasis Hospital) in Al Ain Medical district during the period from 1 to 8 September 2003. The sample size reached was 103 participants. The total number of eligible participants who were approached was 137. Of those 137, we excluded 6 mothers (5 in Al Ain Hospital and 1 in Oasis Hospital) due to the language barrier. Furthermore, 15 mothers (8 in Tawam, 6 in Oasis and 1 in Al Ain Hospital) refused the interview. In addition, 13 mothers (9 in Tawam, 2 in Oasis and 2 in Al Ain Hospital) were absent at the time of interview. The overall response rate of the study was 75% (47 were interviewed in Al Ain Hospital, 26 in Tawam Hospital and 29 in Oasis Hospital).

Data collection

The interviews had done by researchers in Al Ain Hospital and Tawam Hospital, while Oasis Hospital assigned a female staff to conduct the interviews.

Statistical analysis

Data were analysed using SPSS Statistics version 11 (IBM corporation, Armonk, NY, USA), where all the data were double checked for keystroke errors and all errors were corrected. The initial assessment of the data was done using frequency tables and cross-tabulation. For measurement of significant differences between categorical variable, Chi-square was used. The level of significance was set as P < 0.05.


  Results Top


The participant's age ranged between 18 and 40 years (median: 25 years; mode: 26 years). More than half of the participants (n = 55; 53.4%) were between 25 and 34 years old, 30 (29.1%) were ≥ 35 years old and 18 (17.5%) were between 18 and 24 years old. Half of the participants were Emiratis 52 (50.4%), while the remaining 34 (33%) were Arabs and Asians and 17 (16.5%) mothers were from other Gulf Cooperation Council (GCC) countries. A total of 40 participants (38.9%) had between one and two children, 32 (31%) had three to five children and 31 (30.1%) had six or more children. A total of 42 of mothers (40.8) had a degree less than secondary school, 33 (32%) had a secondary school education and 28 (27.2%) had a university education. [Table 1] shows a summary of participants demographic characteristics.
Table 1: Baseline characteristics

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The results indicated that 47 (46%) of mothers had heard about G6PD deficiency. Amongst those participants, only 27 mothers (57.4%) knew that some foods and medications can worse G6PD deficiency. However, a total of 29 (28.1%) participants knew about thalassemia and 20 (19%) of participants knew about sickle cell disease, as described in [Table 2]. Amongst the participants who identified sickle cell disease (n = 20; 19%), fewer participants were aware about signs and symptoms of sickle cell crisis (n = 3; 15%) [Figure 1] and [Figure 2].
Table 2: Knowledge about hereditary anaemias

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Figure 1: Knowledge about hereditary anaemias

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Figure 2: Factors make glucose-6-phosphate dehydrogenase deficiency worse

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About of half of mothers (50.2%) indicated that hereditary anaemias are common in Al Ain city. Ninety-three of participants (90.3%) agreed for the importance of pre-marital screening for these conditions. About 96 (93%) of respondents disagreed on the marriage of family member to carrier or someone having one of these conditions [Table 3]. Majority of respondents (70.6%) suggested media campaigns as preferred measure to increase public awareness, followed by 43% who identified school education as effective method [Figure 3].
Table 3: Attitude and opinion about hereditary anaemias and preventive measures

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Figure 3: Suggestions for increasing hereditary anaemias awareness

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When we tested the relationship between G6PD deficiency awareness and age group, the responses were significantly different [Table 4]. The (18–24) age group had more knowledge about G6PD deficiency when compare with other age groups (P = 0.008). Furthermore, the association between the G6PD deficiency awareness and educational level was statistically significant (P = 0.033). Mothers who completed their secondary school were more aware about G6PD deficiency. Mothers from GCC countries were more aware of G6PD deficiency (P = 0.006). There was no significant difference in the G6PD deficiency awareness between number of children (P = 0.983).
Table 4: Glucose-6-phosphate dehydrogenase deficiency awareness for different characteristics of the participants

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In addition, the association between the SCD awareness and educational level was statistically significant (P = 0.007). Mothers who did not complete their secondary school were less aware about SCD. In addition, mothers from GCC countries were more aware about SCD when we compared them with other nationalities (P = 0.005). There was no significant difference in SCD awareness across age groups (P = 0.220) and number of children (P = 0.841) [Table 5].
Table 5: Sickle cell anaemia awareness for different characteristics of the participants

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Moreover, we did not find any significant association between thalassemia awareness and age group, education level, number of children and nationality (P = 0.442, P = 0.173, P = 0.888 and P = 0.347, respectively) For more information, refer to [Table 6].
Table 6: Thalassemia awareness for different characteristics of the participants

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  Discussion Top


Almost half of the respondents have heard and are aware of G6PD (45.7%) as an inherited genetic disorder. The is due to G6PD deficiency is now being taught as part of Biology curriculum in secondary schools. We did not found any research that discusses the public awareness of G6PD deficiency in UAE or any GCC countries. Only, we found two studies had been done in UAE for G6PD deficiency prevalence which was 9.1%.[3],[7]

Almost, the third of participated mothers are aware of sickle cell disease (28%). This level was lower than that reported in other researches. One study had been done on the USA between university students show that 55% of participants heard about SCD.[8] We did not find a study similar to our sample population (post-natal mothers).

Miller et al. found that thalassemia prevalence was estimated by 8.7% amongst school students, but our participants awareness in our study was low (19%).[7] A study had been done on Greece regarding public thalassemia knowledge showed that 93% of study population were aware.[9] Thalassemia knowledge in study sample were low because the questionnaire was long and thalassemia knowledge was the last section in it. If participant answer No, she can skip to next section.

Of the 103 post-natal mother, half (50.2%) thought that hereditary anaemias are common in Al Ain. Emiratis mothers (63.5%) believed more than other mothers (GCC, Arab and Asian) (29.4%, 38.2) in the study population that hereditary anaemias are common in our community (P = 0.014). Furthermore, Majority of the study population (90.3%) believe that pre-marital screening is the best method for prevention. This positive attitude of our study population may be because participants are likely to be exposed to relatives who suffer from hereditary anaemias. Al-Kahtani found that (75.2%) of the study population accepted the concept of pre-marital health counselling.[10] The WHO Working Group for G6PD deficiency (1989) recommended that countries with a prevalence of 3%–5% or more in males needed a screening program for all newborns and educational campaigns.[11]

Strengths and limitations

Our study has limitations. The interview questionnaire was originally in English and then was translated into Arabic. The results could be affected by interview bias. The sample represents only post-natal mothers in Al Ain city and the results might not be generalisable to the all UAE community. Moreover, the small sample size and missing sample method are sources of potential bias to the study results. Furthermore, the study had been done on 2003 and we presented the results on 2018 which consider a weak point.

Recommendations

Future studies in the UAE are needed to evaluate the knowledge and attitude of community towards pre-marital screening and G6PD deficiency. In addition, based on the previously findings, the study recommends that regular awareness campaigns should be carried out in the UAE community regarding common hereditary anaemias. Moreover, we strongly suggest the implantation of mandatory pre-marital screening in the UAE. Finally, media play an important role in health education and increasing awareness in our community about hereditary anaemias.


  Conclusion Top


The findings of this study showed a fair level of general awareness about common hereditary anaemias and high level of positive attitude regarding pre-marital screening. Furthermore, policymakers should be encouraged to support health promotion to increase the community awareness level about hereditary anaemias (G6PD, SCD and thalassemia). Moreover, media campaigns should be done to increase knowledge and positive attitude amongst the UAE community.

Acknowledgement

Our thanks and deepest appreciation goes to Dr. Peter Barrs and Dr. Fatimah Al-Muskari (Department of Community Medicine, Faculty of Medicine and Health Sciences [FMHS], United Arab Emirates University [UAEU]) for their guidance and support throughout the study period. We also thank Dr. Mohammed Sadiq (Department of Community Medicine, FMHS, UAEU) for his helping in translating the English into Arabic edition. Furthermore, we are more grateful to Dr. Hafiz Omar Ahmed, Mr. Hussein Al-Agab and Mr. S.V. Shinelal for great assistance with the analysis process. We also most thankful to Dr. A. G. Nicol (Chairman of Department of Community Medicine, FMHS, UAEU), Dr. Mark Newson-Smith (Department of Community Medicine, FMHS, UAEU) and Professor M. Ellis (Department of Internal Medicine, FMHS, UAEU) for their permission to conduct the survey in Tawam Hospital, Al-Ain, UAE.

Our deepest appreciation goes to Dr. Said Al-Sharji (Director of Al-Ain Hospital), Dr. Matar Al-Daramaki (Vice Director of Al-Ain Hospital), Dr. Mariam Al-Mazrooei (Vice Director of Tawam Hospital), Mahasen Al-Sheikh (Head of Nursing staff in Tawam Hospital) and Professor Ledel (Director of Oasis Hospital) for their kind permission to conduct the study in each of these hospital, Al-Ain, UAE.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Dhamcharee V, Romyanan O, Ninlagarn T. Genetic counseling for thalassemia in Thailand: Problems and solutions. Southeast Asian J Trop Med Public Health 2001;32:413-8.  Back to cited text no. 1
    
2.
Al-Gazali LI, Bener A, Abdulrazzaq YM, Micallef R, al-Khayat AI, Gaber T, et al. Consanguineous marriages in the United Arab Emirates. J Biosoc Sci 1997;29:491-7.  Back to cited text no. 2
    
3.
Abdulrazzaq YM, Micallef R, Qureshi M, Dawodu A, Ahmed I, Khidr A, et al. Diversity in expression of glucose-6-phosphate dehydrogenase deficiency in females. Clin Genet 1999;55:13-9.  Back to cited text no. 3
    
4.
El-Kalla S, Mathews AR. Molecular characterization of beta-thalassemia in the United Arab Emirates. Hemoglobin 1993;17:355-62.  Back to cited text no. 4
    
5.
Quaife R, Al-Gazali L, Abbes S, Fitzgerald P, Fitches A, Valler D, et al. The spectrum of beta thalassaemia mutations in the UAE national population. J Med Genet 1994;31:59-61.  Back to cited text no. 5
    
6.
De Leo R, Deidda G, Novelletto A, el-Kalla S, Mathews AR, Felicetti L, et al. Analysis of beta-thalassemia mutations in the United Arab Emirates provides evidence for recurrent origin of the IVSI nt 5 (G-C) mutation. Hum Mutat 1995;5:327-8.  Back to cited text no. 6
    
7.
Miller CJ, Dunn EV, Berg B, Abdouni SF. A hematological survey of preschool children of the United Arab Emirates. Saudi Med J 2003;24:609-13.  Back to cited text no. 7
    
8.
Ogamdi SO. African American students' awareness of sickle cell disease. J Am Coll Health 1994;42:234-6.  Back to cited text no. 8
    
9.
Politis C, Richardson C, Yfantopoulos JG. Public knowledge of thalassemia in Greece and current concepts of the social status of the thalassemic patients. Soc Sci Med 1991;32:59-64.  Back to cited text no. 9
    
10.
Al-Kahtani NH. Acceptance of premarital health counseling in Riyadh city, 1417h. J Family Community Med 2000;7:27-34.  Back to cited text no. 10
    
11.
Glucose-6-phosphate dehydrogenase deficiency. WHO working group. Bull World Health Organ 1989;67:601-11.  Back to cited text no. 11
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]



 

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