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| ORIGINAL ARTICLE |
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| Year : 2022 | Volume
: 7
| Issue : 1 | Page : 52-58 |
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Public knowledge and awareness toward glucose-6-phosphate dehydrogenase deficiency in Jazan region
Hassan A Hamali1, Asma A Muasbil1, Taif H Otaif1, Maha K Qahtani1, Muhammad Saboor2, Gasim Dobie1, Aymen M Madkhali1, Mohammad Suhail Akhter1, Rama Mohan Chandika3, Abdullah A Mobarki1
1 Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
2 Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, Jazan University; Medical Research Center, Jazan University, Jazan, Saudi Arabia
3 Department of Clinical Nutrition, Faculty of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
| Date of Submission | 12-Feb-2022 |
| Date of Decision | 25-May-2022 |
| Date of Acceptance | 30-Jun-2022 |
| Date of Web Publication | 27-Jul-2022 |
Correspondence Address:
Dr. Hassan A Hamali
Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, Jazan University, P.O. Box 1906, Jazan 45142
Saudi Arabia
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/KKUJHS.KKUJHS_11_22
Background: Glucose-6-phosphate dehydrogenase (G6PD) deficiency anemia is the most common metabolic red cell abnormality worldwide. G6PD deficiency anemia is very common in Saudi Arabia. Objective: The aims of the current study were to evaluate and assess knowledge and awareness about G6PD deficiency anemia and to find any association between sociodemographic variables and knowledge about this disease in the Saudi population in Jazan region. Materials and Methods: A cross-sectional descriptive study was conducted at Jazan University. Results: A total of 709 individuals completed the questionnaire and were considered in the study. In general, the study population had overall fair knowledge, scoring 50% or above on all domains of the study. In addition, we found a significant association between sociodemographic variables, specifically gender, family income and education level, and knowledge/awareness of G6PD deficiency anemia. Conclusion: Our study found fair to good knowledge of G6PD itself, but not of the mode of inheritance among the study population. The study suggests that public health campaigns and screening programs should be conducted and established to screen for these disorders at younger ages, instead of only relying on premarital screening program.
Keywords: Anemia, awareness, glucose-6-phosphate dehydrogenase deficiency, knowledge, odds ratio
How to cite this article:
Hamali HA, Muasbil AA, Otaif TH, Qahtani MK, Saboor M, Dobie G, Madkhali AM, Akhter MS, Chandika RM, Mobarki AA. Public knowledge and awareness toward glucose-6-phosphate dehydrogenase deficiency in Jazan region. King Khalid Univ J Health Sci 2022;7:52-8 |
How to cite this URL:
Hamali HA, Muasbil AA, Otaif TH, Qahtani MK, Saboor M, Dobie G, Madkhali AM, Akhter MS, Chandika RM, Mobarki AA. Public knowledge and awareness toward glucose-6-phosphate dehydrogenase deficiency in Jazan region. King Khalid Univ J Health Sci [serial online] 2022 [cited 2023 Mar 29];7:52-8. Available from: https://www.kkujhs.org/text.asp?2022/7/1/52/352516 |
| Introduction | |  |
Glucose-6-phosphate dehydrogenase (G6PD) deficiency is the most common inherited metabolic red cell abnormality, affecting approximately 400 million individuals worldwide, and had led to the death of more than 33,000 afflicted individuals in 2015. It predominantly affects males, as it is an X-linked recessive disorder, but females can also inherit the disease.[1] The G6PD enzyme has a crucial role in the pentose phosphate pathway, which is critical to the survival of red blood cells. G6PD deficiency makes the red blood cells vulnerable and susceptible to hemolysis in the presence of certain factors, such as ingestion of fava beans, infection, or some treatment regimens and chemical exposures. Overall, the clinical manifestations of G6PD deficiency are heterogeneous and occur in varying degrees of severity, with hemolysis being the main feature.[1],[2],[3]
G6PD deficiency is common in tropical and subtropical regions (including Africa, Asia, the Mediterranean, and the Middle East). The incidence of G6PD deficiency in males in the Mediterranean area is estimated at between 1% and 2%. Its distribution has been linked to malaria-endemic areas.[3],[4] In Gulf countries, the estimated incidence rate of G6PD deficiency is up to 27%.[5],[6],[7],[8],[9],[10],[11],[12],[13],[14],[15] In Saudi Arabia, the incidence rate has been reported to be high in many studies, ranging from 0% to 52%, and varies from province to province,[16],[17],[18] with highest reported in the eastern province followed by Jazan province.[19] The Ministry of Health reported the overall prevalence of G6PD is 8.4% among male in Saudi Arabia.[17] In Jazan region, the overall frequency of G6PD deficiency anemia in ranges from 2.7% to 20.4% in males and 2.9%–11.1% in females.[16]
Despite the disease is very common in Saudi Arabia, there are few reported studies concerning knowledge and awareness of G6PD deficiency in the Saudi community,[20],[21] including one study from Jazan region about mothers' perception of neonatal jaundice.[22] Since there are very few studies with limited data of public knowledge and awareness of the disorder, and the foods that trigger its clinical manifestations, it is of great benefit to the society to thoroughly evaluate and understand the existent knowledge of G6PD deficiency among the public in Jazan region. Thus, it is felt that awareness regarding G6PD deficiency anemia shall be extensively studied as it will open new avenues to fight against the spread of the disease and formulate strategies by the policymakers in Saudi Arabia. In addition, the education campaigns in high prevalence region/cities are important of making the society aware of the disorder and with great impact on the outcomes. In the light of its deemed demand, the current study was conducted with the aims to evaluate and assess the knowledge and awareness of the deficiency and find any association between sociodemographic variables and knowledge about G6PD deficiency anemia in the Saudi population in Jazan region.
| Materials and Methods | | |
The current cross-sectional descriptive study was conducted from September 1, 2021, to September 10, 2021, at Jazan University. The study's questions were closed-ended questions adopted for the previous studies.[21],[23],[24] At first, a pilot study was conducted among 30 participants to determine the questions' consistency with the hypothesis. Based on the observations from the pilot study and the approval from the specialist of the department, a final questionnaire form was prepared. The validated questionnaire was designed in Google Forms and was electronically distributed randomly among male and female adult students at Jazan University and their families in Gizan city, Jazan region, Saudi Arabia, using social media platform. The inclusion criterion was to assess students at Jazan University and adults living in Jazan region, while the exclusion criterion was any students and adults living outside Jazan region.
All responses were kept anonymous and confidential. The questionnaire had several variables consisting of four parts. The first part was related to sociodemographic data including gender, nationality, age, education level, marital status, family income, and family history of chronic diseases. The second part was concerned with assessing general knowledge on G6PD deficiency anemia. The third part was concerned with knowledge about symptoms of G6PD deficiency. The last part was concerned with assessing knowledge about the G6PD deficiency diet.
Sample size
The formula used in this study for sample size calculation with population single proportion is given below:
where N = Sample size, Z = Reliability coefficient (Z = 2.58 at a 1% level of significance), P = Proportion, and d = Absolute precision. The study on knowledge of and misconceptions about sickle cell anemia and glucose-6-phosphate dehydrogenase deficiency among adult sickle cell anemia patients in the Al-Qatif area (eastern KSA) reported that the prevalence of good knowledge was 0.437, with absolute precision of 7%, type I error (α) of 0.01, and type II error (β) of 0.2 (power of the test 80%).[21] The sample size was calculated as 587. The required sample size with a 20% nonresponse rate was 704. In total, 728 responses were received and 19 were identified as incomplete questionnaires. Finally, 709 participant responses were used for the study analysis.
Statistical analysis
The data from the responses were collected in a Microsoft Office 2010 Excel spreadsheet and rechecked by a second person to ensure the accuracy of the data. Statistical calculations were carried out with the Statistical Package for the Social Sciences (SPSS) version 22.0 software (SPSS Inc., IBM, Chicago, Illinois, USA). Data are presented as frequencies and percentages for the qualitative variables. Descriptive statistics was used to calculate the mean and standards for the quantitative variables. The Chi-square test was applied to obtain the association among qualitative variables. Bivariate logistic regression analysis was performed using the crude odds ratio with a 95% confidence interval, and P < 0.05 was considered statistically significant.
The data were coded as a score: 0 for each wrong and “do not know” answer and 1 for each correct answer, with the maximum score of 27 points. A total of 27 items were constituted in three domains. The mean of each domain and the overall mean were calculated. The study had 3 main domains. The first domain was about the General knowledge of G6PD (10 items) with calculated mean score 5. The second domain was about the knowledge of symptoms of G6PD (7 items) with calculated mean score 3.5. The last domain was awareness about the food that triggers or misconceptions that aggravate G6PD anemia (10 items) with calculated mean score was 5. The total of the items of the 3 domains was 27 with overall calculated mean and maximum scores were 13.5 and 27 points, respectively. Any participant's mean score greater than the domain and overall mean value was assumed to be good knowledge, while a mean score less than or equal to the domain or overall mean score was assumed to be poor knowledge.
Ethical consideration
The study setup and questionnaire were ethically approved by the Standing Committee for Scientific Research Ethics – Jazan University. The objective and study questions were explained to all participants at the start of the questionnaire.
| Results | | |
The study population consisted of 709 individuals. Cronbach's alpha index was 0.956 for the 27 items including the 3 domains: general knowledge of G6PD (10 items), knowledge of symptoms of G6PD (7 items), and awareness about the food that triggers or misconceptions that aggravate G6PD anemia (10 items). Excellent reliability or internal consistency between the items was observed.
Sociodemographic data of the study population
The sociodemographic data, which included gender, nationality, age, education level, marital status, monthly family income (in Saudi Riyals), and history of inherited or chronic disorders, are shown in [Table 1]. Among the study population, 319 responses (45%) were submitted by males and 390 responses (55.0%) by females. The majority of the study population was Saudi, representing 94.2% of the total participants. 36% of the study population were below 20 years of age, 47.8% were between 20 and 40 years of age, and 16.2% were older than 40. The education level of the study population was mostly bachelor/diploma level, representing 66.4%, followed by below high school level at 25.8% and 7.8% at the graduate (master's/PhD) level. The family income of 28.8% of the study population was 5000–10,000 SAR, 27.8% made above >15,000 SAR, 23.8% of the study population made 10,000–15,000 SAR, and 19.6% of the study population made <5000 Saudi Riyals. The results of the data reflected that 299 (42.2%) responses had a family history of some diseases [Table 1]. Out of the 42.2% (299 responses) of positive history of inherited or chronic disorders, 198 responses, representing 66.2%, had anemia (including thalassemia and sickle cell anemia), 15 responses (5%) had G6PD, and 86 responses (28.8%) had other disorders (data now shown).
General knowledge of glucose-6-phosphate dehydrogenase among the study population
[Table 2] shows the general knowledge of G6PD anemia of the study population. The responses of the study population on the general knowledge questions revealed that 62.8% and 42.5% had not heard of G6PD anemia and fava bean anemia, respectively. Furthermore, 42.9% of the study population did not know if the G6PD deficiency was a type of anemia and 41.6% did not know if it was an inherited disorder [Table 2]. 77.7% of the participants answered either “no” or “do not know” as to whether the gender of a person is linked with G6PD deficiency anemia, and 44.85% did not know if both parents must be carriers to have a child with G6PD deficiency anemia. In addition, 53.4% of the studied population either said “no” or “do not know” when asked if fava beans can trigger G6PD deficiency anemia. Of the total population, 60.2% answered that screening for G6PD deficiency anemia should be included in the premarital screening [Table 2]. | Table 2: General knowledge of the study population toward glucose-6-phosphate dehydrogenase deficiency anemia
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Knowledge of the symptoms of glucose-6-phosphate dehydrogenase deficiency anemia among the study population
The knowledge of the symptoms of the study population about G6PD deficiency anemia is illustrated in [Table 3]. More than 50% of the study population answered “do not know” to all questions regarding the symptoms of G6PD deficiency anemia. | Table 3: Knowledge of the study population toward symptoms of glucose-6-phosphate dehydrogenase deficiency anemia
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Awareness of food triggering glucose-6-phosphate dehydrogenase deficiency anemia among the study population
Among the study population, more than 50% answered that fava beans and fava bean-derived food can trigger G6PD deficiency anemia and patients with G6PD deficiency anemia should abstain from these foods. On the other hand, misconceptions regarding foods were also noticed within the study population, as more than 80% of respondents answered either “yes” or “do not know” to foods that do not trigger the symptoms of G6PD [Table 4]. | Table 4: Awareness of the study population of the food triggering the glucose-6-phosphate dehydrogenase anemia
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Distribution of participants according to their level of knowledge about glucose-6-phosphate dehydrogenase disease
The study population showed fair general knowledge about G6PD deficiency anemia, reaching an overall of 53.3% [Figure 1]. More than 50% of the study population had fair general knowledge about G6PD deficiency anemia in all aspects of the study. Fair knowledge was observed among 50.5% on general knowledge of the disease, 51.3% on the symptoms of the disease, and 54.3% on the food that triggers the symptoms of the disease. | Figure 1: Distribution of participants according to their level of knowledge about G6PD disease. G6PD: Glucose-6-phosphate dehydrogenase
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Association between knowledge and sociodemographic characteristics of the study population
The association between knowledge and sociodemographic characteristics of the study population about G6PD deficiency anemia is shown in [Table 5]. Female participants had better knowledge than male participants (P < 0.001). Good knowledge of G6PD deficiency anemia (reaching a statistically significant value P < 0.05) was also observed with higher education level and family income. | Table 5: Association between knowledge and sociodemographic characteristics
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Logistic regression analysis
Binary logistic regression analysis was performed with significant demographic factors[Table 5], including gender, education level, and family income, for predicting the level of knowledge about G6PD deficiency anemia within the studied population [Table 6]. The odds ratio for females when compared with males was 2.244 and highly significant (P < 0.01), which indicates that the odds of having good knowledge were two times higher in female participants than male participants. Regarding education level, the highest odds ratio (3.170) and highly significant (P < 0.01) values were observed for the graduate (master's/PhD)-level participants when compared with below high school education participants. Family monthly income (in SAR) between 10,000 and 15,000 participants had the highest odds ratio 1.663 and a significant P < 0.05 when compared with the <5000 income participants. | Table 6: Logistic regression analysis with significant factors for predicting the level of knowledge about glucose-6-phosphate dehydrogenase disease among studied population
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Source of information on glucose-6-phosphate dehydrogenase deficiency anemia
The responses regarding source of information were varied. The majority of the responses of the study population answered “do not know anything” (33.71%), followed by the Internet and social media (23.27%), lessons (15.66%), doctor visit (14.29%), and finally, a friend/relative (3.95%) (data not shown).
| Discussion | | |
G6PD deficiency anemia is the most common enzymatic inherited disorder of red cells across the globe.[1] The disease is highly prevalent in the Mediterranean area and the Middle East, including Saudi Arabia.[16],[17],[18] The scientific name of the disease is G6PD deficiency anemia and is also called fava bean anemia, as fava beans (and some medications) can trigger hemolytic anemia in G6PD deficient individuals.[1] Few reports in the region have studied the knowledge and awareness of G6PD deficiency anemia and clinical manifestations.[20],[23],[25] In Jazan region, a study has reported poor knowledge of G6PD neonatal jaundice, and no prior knowledge of the disease.[22]
The study population in the current study had fair basic knowledge of G6PD deficiency anemia, scoring 50.5% overall in general knowledge [Figure 1]. In more detail, although fair knowledge can be observed and 57% had heard of the disease before, poor knowledge (62.9%) was observed when the scientific name (G6PD deficiency anemia) was used [Table 1]. This finding is in agreement with the reported studies in Egypt[25] and Bahrain[23] but in contrast to a study from Iraq.[26] Fava bean anemia, the alternative name for G6PD deficiency anemia, is very commonly used in Egypt as well.[25]
Female participants had a better general knowledge of G6PD deficiency anemia than male participants (P < 0.05). In a similar study, fair knowledge of G6PD deficiency has been observed among the study population, with a similar age distribution in Bahrain.[23] However, the current findings are in contrast to a previous study conducted in Riyadh, Saudi Arabia.[20]
The study population showed a fair knowledge on whether G6PD is an inherited disorder. However, poor knowledge about whether G6PD deficiency anemia is linked to gender or whether G6PD is a type of anemia was noticeable. Several reports have shown lack of knowledge regarding the pattern of inheritance of G6PD deficiency anemia[20],[23] and other types of anemia.[27],[28]
The main source of knowledge in the current study was social media, including the Internet. This finding differs from the other report in Jazan region (Southwestern area of Saudi Arabia)[22] and from Al-Qatif (Eastern area of Saudi Arabia).[21] The disagreement is expected, as the study from Magfouri et al.[22] in Jazan region studied the perception of mothers on neonatal jaundice, so the source of knowledge was the treating physicians, while the study from Al-Suwaid et al.[21] aimed to evaluate the knowledge and misconception of two diseases (i.e., sickle cell disease and G6PD deficiency anemia). Sickle cell disease is very common in Saudi Arabia, especially in the Eastern and Southwestern regions of Saudi Arabia.[29]
G6PD deficiency anemia is a heterogeneous disorder with broad-spectrum clinical manifestations and symptoms.[1],[2],[3] The study population showed fair awareness of the foods to be avoided that can trigger the clinical manifestations of the disorder. This is in line with previous reports in the Saudi community[20] and different from findings in the Bahraini community.[27]
| Conclusion | | |
The findings of the current study showed fair knowledge and poor awareness of the disease among population in Jazan region. There is a need for intensive programming about G6PD deficiency anemia in Saudi Arabia. It is strongly recommended to establish educational lessons and health campaigns for the public about G6PD deficiency anemia, including its mood of inheritance, clinical manifestations, and factors that result in hemolytic anemia. Policymakers should plan public health programs and education campaigns about inherited disorders, including anemia, in Jazan region. In addition, as inherited anemia is prevalent in Jazan region,[16],[29],[30],[31],[32] screening programs should be established to screen for these disorders at younger ages, instead of simply relying on premarital screening programs.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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[Figure 1]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]
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