GMJ ORAL PROCEEDINGS

GULF MEDICAL JOURNAL

CROSS-SECTIONAL STUDY ON AWARENESS OF DIET, IRON

DEFICIENCY ANEMIA, AND IRON SUPPLEMENTS AMONG
STUDENTS OF GULF MEDICAL UNIVERSITY
Saba Naeem1*, Jumana Mohamed Fouad Al-Salloum1, Nabila Sani Adamu1, Yahya Salisu1, Arun
Shirwaikar2, Annie Shirwaikar2
1Students, College of Pharmacy, 2College of Pharmacy, Gulf Medical University, Ajman, UAE
*Presenting Author

ABSTRACT
Objectives:
1. To assess the prevalence of iron deficiency anemia (IDA) among students of Gulf Medical
University (GMU)
2. To find correlation between diet, gender, and self-reported hemoglobin levels of the students
3. To increase awareness about active ingredients used in iron supplements
4. To assess students’ knowledge about time required for iron supplements to raise hemoglobin
levels
Materials & Methods: A cross-sectional study using a self-reported questionnaire was carried out
among students of GMU. Students’ knowledge was assessed using a scoring system, and the median
knowledge score was the cut-off value for adequacy of knowledge. The data was analyzed using
Statistical Package for Social Sciences, Version 21, followed by a chi-square test to determine the
significance of association. A p value of <0.05 was accepted as the significant level.
Results: A total of 335 students (237 females and 98 males), with an average age of 20.7 ± 1.75
years, participated in the study. The prevalence of anemia was high among female students (87.70%,
n = 208). Students consuming iron-rich food displayed consistently higher hemoglobin levels (62%,
n = 203). A large number of male students (46.20%, n = 150) regularly consumed meat. Just 28%
participants (n = 91) were aware about the causes of IDA. Few participants (13.9%, n = 45) had
knowledge of the active ingredients used in iron formulations, while just 44.7% participants (n =
133) had knowledge of their side effects. Only 42.20% participants were aware that it may take up to
three months for their hemoglobin levels to normalize after the use of iron supplements.
Conclusion: On-campus activities should be undertaken to increase awareness among university
students about their diet, IDA, and responsible use of dietary iron supplements.
Keywords: Iron deficiency anemia, hemoglobin, iron supplements, awareness, active ingredients
Citation: Naeem S, Al-Salloum JMF, Adamu NS, Salisu Y, Shirwaikar A, Shirwaikar A. Cross-
sectional study on awareness of diet, iron deficiency anemia, and iron supplements among students
of Gulf Medical University. Gulf Medical Journal. 2016;5(S1):S109–S114.

INTRODUCTION stores. It is the most common nutritional

Iron deficiency anemia (IDA) is a condition in
which blood has reduced number of red blood
cells (RBCs) due to a decrease in the body’s iron
Correspondence: Prof. Annie Shirwaikar,
College of Pharmacy, Gulf Medical University,
Ajman, UAE. Email: dr.annie@gmu.ac.ae
disorder globally and accounts for 50% of
anemia cases1, 2. The cause of IDA can be
inadequate iron intake, reduced iron absorption,
high iron needs, and an increase in loss of iron3.
It is crucial to identify the cause of IDA and
learn about the proper use of iron supplements.
A.K. Osman observed high prevalence of IDA

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SABA NAEEM, ET AL
in the UAE at 44.8%4, 5. Food items such as
meat and liver are a rich source of heme iron.
As a result, the regions that consume meat
regularly have lower cases of IDA. Other
reasons for developing IDA include drugs that
can reduce iron absorption, menstruation, and
helminth infections6.
Iron supplements are used to treat or
prevent IDA as they improve health and
performance7. Iron supplements are available
either as elemental iron, ferrous sulfate, or
ferrous fumarate8, 9. Iron plays an important
role in the production of RBCs, thereby
enabling the transport of oxygen to body
tissues10. IDA occurs when the iron stores in
the body are depleted. It can take up to three
months for hemoglobin levels to adequately
increase after the use of iron supplements11.
Rationale
Iron supplements are freely available over the
counter, and the general public has easy access
to them. Hence, their utilization pattern is
primarily influenced by an individual’s
knowledge. As there is paucity of published
information about the knowledge level of
university students regarding iron supplements,
the current study could lead further research in
this field.
Healthcare professionals are obligated to
educate people as part of their job. Requisite
knowledge among consumers of iron
supplements could help tackle related
misconceptions. The current study could help
reduce the risk of improper utilization of iron
supplements, and address the issue of
inadequate knowledge about IDA and iron
supplements; these would benefit the scientific
community and society at large.
Objectives
1. To assess the prevalence of IDA among
students of Gulf Medical University (GMU)
2. To find correlation between diet, gender,
and self-reported hemoglobin levels of the
students
3. To increase awareness about active
ingredients used in iron supplements
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110 www.gulfmedicaljournal.com
GMJ. ASM 2016;5(S1):S109–S114
4. To assess students’ knowledge about time
required for iron supplements to raise
hemoglobin levels
MATERIALS & METHODS
A cross-sectional study was carried out among
the students of GMU, Ajman, over a period of
three months. The sample size was calculated
on the basis of the data reported in a previous
study. The sample included 335 consenting
students (100%, 237 females and 98 males) of
18 years and above from the MBBS, Pharm.D,
DMD, BPT, BHS, and BBMS programs in
GMU who were available in the campus at the
time of data collection.
The data was collected using a self-
administered questionnaire. It included
questions on the following domains: socio-
demographic characteristics and knowledge
about diet, IDA, and iron supplements. The
questionnaire was pilot tested for feasibility and
clarity of questions with 5–10 students before
commencing the study.
The study was conducted after obtaining
the approval of the GMU Ethics Committee.
An informed consent was obtained from all
participants. The confidentiality of the
participants’ details and information shared was
maintained.
After explaining the purpose of the study,
the questionnaire was distributed to the
students.
The study excluded students aged below 18
years, those that failed to provide an informed
consent, and those with hemoglobinopathies
such as thalassemia. The data collected was
compiled into a spreadsheet and analyzed using
Statistical Package for Social Sciences (SPSS),
Version 21. To find the significance of
association, a chi-square test was carried out. A
p value of <0.05 was accepted as the significant
level.
RESULTS
The hemoglobin levels shared by the students
were checked within 3–6 months of the study.
Of the 237 female and 98 male students that
STUDY ON DIET, IRON DEFICIENCY ANEMIA, AND IRON
SUPPLEMENT AWARENESS AMONG GMU STUDENTS GMJ. ASM 2016;5(S1):S109–S114

participated in the study, 208 female and 12 Figure 3. Correlation of students’ consumption of
male students were found to be anemic. iron-rich food with their gender (n = 326)

Figure 1 shows that anemia was highly 50.00%

46.20%
prevalent in female participants (87.70%, n =
208) than male participants (12.30%, n = 12).
Figure 1. Prevalence of anemia among male (n = 98) 40.00% 38.60%
Males
and female participants (n = 237)
Females
100.00%
30.00% 28.00%
87.70%
22.80%
75.00%
20.00%
14.40%
13.70%
12.90%
50.00% 10.50%
10.00% 8.40%
4.50%

25.00%
0.00%
12.30%
Always Very often Sometimes Rarely Never

0.00%
Anemic Not anemic
Figure 2 displays that students consuming
iron-rich food, such as meat, fish, and poultry,
had consistently higher hemoglobin levels than
those consuming these sources rarely,
irrespective of the amount consumed.
Figure 2. Correlation of students’ diet with their self-
reported hemoglobin levels (n = 329)
80.00%
Figure 4 displays that 28% participants (n =
91) were aware that IDA can be caused by all
the mentioned conditions. However, the
highest percentage of participants (35%, n =
114) believed that insufficient dietary iron
intake is the only or major reason for IDA.
Figure 4. Knowledge about possible causes of IDA (n
= 327)
Insufficient dietary iron 35.00%
intake

67.00% Bleeding due to injury 5.00%

62.00%
60.00% 57.00% Parasitic worms 5.00%

43.00% Pregnancy 7.20%

38.00%
40.00%
Heavy menstruation 11.50%

Vit B12/folate deficiency 5.40%

20.00% 17.40%

Drug induced 3.40%

0.00% All of the above 28.00%

Always Rarely Always Rarely Always Rarely
Meat, fish, and Meat, fish, and Meat, fish, and
poultry (8–10 poultry (12–15.5 poultry (13.5–
g/l) g/l) 17.5 g/l)
Figure 3 shows that higher number of males
(46.20%, n = 150) regularly consumed meat
than females (38.60%, n = 125).
0.00% 10.00% 20.00% 30.00% 40.00%
Figure 5 shows that most participants
(23.4%, n = 76) did not know which active
ingredient is used in iron supplements. Some
participants (19.8%, n = 65) believed that

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SABA NAEEM, ET AL GMJ. ASM 2016;5(S1):S109–S114

ferrous sulfate is the only active ingredient in Figure 7. Knowledge about time required to raise
iron formulations. Just 13.9% students (n = 45) hemoglobin levels after consuming iron supplements
(n = 302)
were aware that all the active ingredients
mentioned in the figure were part of iron 70.00%
supplements.
60.00% 57.80%
Figure 5. Knowledge about active ingredients
commonly used in iron formulations (n = 327)
50.00%
42.20%

Ferrous sulfate 19.80% 40.00%

30.00%
Ferrous fumarate 17.90%

20.00%
Ferrous gluconate 11.50%
10.00%

Ferrous ascorbate 11.60% 0.00%

Wrong answers (1 week, 1 Right answer (3 months)
month, 1 year)
None of them 1.90%

DISCUSSION
All of them 13.90%
The results of the current study indicate higher
prevalence of anemia in females than males
I do not know 23.40%
(Figure 1). Few studies are available that
0.00% 10.00% 20.00% compare the prevalence of IDA between males
and females. In a study conducted among
Figure 6 displays that 44.7% participants (n female college students in the University of
= 133) knew that the side effects of iron Sharjah (UoS), 26.7% participants were found
supplements can be diarrhea, constipation, and to be anemic12. The results of another study
black stool. carried out among female students in Taibah
Figure 6. Knowledge about side effects caused by iron University in Saudi Arabia showed 64%
supplements (n = 298) participants were anemic13. Consequently, the
prevalence of anemia among the female
students of GMU (87.70%) was higher than
that among female students of UoS and Taibah
University.
18.10%
Black stool The findings of the current study indicate
44.70% Constipation that the participants that consumed iron-rich
14.80%
Diarrhea food items, such as meat, poultry, fish, and
All of the above liver, had higher hemoglobin levels. These
22.40% results are very reliable as iron absorption is
higher (15–18%) from foods that contain heme
iron; red meat, seafood, and poultry products
are the best sources of heme iron14.
Figure 7 shows that just 42.20% In the current study, males were observed
participants were aware that it may take up to to consume more iron-rich food than females,
three months for hemoglobin levels to which could be one of the reasons why the
normalize after the use of iron supplements. prevalence of IDA in males was low, along with

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STUDY ON DIET, IRON DEFICIENCY ANEMIA, AND IRON
SUPPLEMENT AWARENESS AMONG GMU STUDENTS GMJ. ASM 2016;5(S1):S109–S114
additional reasons such as the absence of
menstruation.
The results of the current study show that
the participants had minimal knowledge about
the causes of IDA. In addition, 35%
participants believed that reduced intake of
iron-rich food is the only or most important
cause of IDA. However, IDA can be caused by
multiple factors, including certain drugs (such as
antacids and calcium tablets), heavy
menstruation, parasitic worms, and vitamin B12
deficiency6.
The findings of the current study show that
knowledge about the composition of iron
supplements was low among the participants,
and many students were not aware of the active
ingredients used in iron supplements.
Moreover, very few students were aware that
iron is available as ferrous sulfate, ferrous
ascorbate, ferrous fumarate, and ferrous
gluconate. According to a study carried out by
M.G. Zariwala et al. in 2013, ferrous sulfate is
the most widely used ingredient in iron
formulations and dissolves the fastest7. Most
students were aware that iron supplements can
cause black stool, constipation, and diarrhea. In
a study conducted by N.L. Sloan et al. in 2002,
pregnant women consuming iron supplements
reported all of the above side effects, with the
intensity of these side effects increasing with
dosage. Moreover, these side effects caused
some women to discontinue their therapy or
reduce the dosage15.
In the current study, participants’
knowledge about time taken for hemoglobin
levels to adequately increase after the use of
iron supplements was reasonably high. In
adults, a three-month therapy is required to
replenish iron stores and correct anemia.
Furthermore, it is recommended that anemic
patients should check their blood counts every
three months for one year after initiating
therapy for IDA16.
CONCLUSION
The prevalence of anemia was higher in females
than males. The intake of iron-rich food was
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lower in females and participants having lower
hemoglobin levels, regardless of their gender.
The participants were aware of the causes of
IDA, but their knowledge about the active
ingredients used in iron supplements was very
limited. However, the participants had adequate
knowledge about the side effects of iron
supplements and time required for hemoglobin
levels to normalize after the use of iron
supplements.
On-campus activities should be organized
to increase awareness among university students
about their diet, IDA, and responsible use of
dietary iron supplements. Healthcare students
should acquire skills to adequately counsel
consumers about dietary iron supplements
through conferences and workshops.
LIMITATIONS
The study used self-reported data. Moreover,
due to the small sample size, the results of the
study cannot be generalized.
ACKNOWLEDGEMENTS
The authors would like to thank Gulf Medical
University for statistical support and facilities to
conduct the study. In addition, the authors are
grateful to research supervisors Prof. Annie
Shirwaikar and Prof. Arun Shirwaikar.
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