Iron deficiency anemia (IDA) is the most prevalent cause of anemia worldwide. Studies conducted in Riyadh and Tabuk have revealed a significant lack of understanding regarding IDA and its prevention. Consequently, there is a pressing need to enhance awareness among the adult population to mitigate IDA risk factors and promote better knowledge of the condition.

This study aims to assess the level of IDA awareness among the adult population in Makkah, Saudi Arabia. A descriptive cross-sectional study was conducted among the general population in Makkah City between 2023 and 2024. Participants completed a well-structured, Arabic-based questionnaire. A total of 1,395 participants were included, with (72.30%) being female. The majority of respondents (58.30%) were within the 18-25 age group. Regarding marital status, (60.10%) of participants were single. Educational levels varied, with (63.40%) holding a bachelor's degree. Most participants (88.40%) were Saudi nationals, and (50.80%) identified as students. Concerning knowledge levels about iron deficiency anemia, (84.50%) of the participants demonstrated poor knowledge. Boosting educational efforts is vital for increasing IDA awareness and reducing its incidence.

• Anemia;

• Iron deficiency anemia;

• IDA;

• Awareness;

• Saudi Arabia

Alharbi I, Qashqari HA, Binsiddiq ZH, Felimban SA, Alabdali SF, et al. (2024) Awareness of Iron Deficiency Anemia among the Adult Population in Makkah, Saudi Arabia. J Hematol Transfus 11(2): 1122

IDA: Iron Deficiency Anemia; WHO: World Health Organization

Anemia is a worldwide problem that affects all countries [1]. According to a study done in 2021, approximately 1.92 billion of the global population are anemic [2]. Also, WHO reported that the demographic categories most vulnerable to anemia were children under the age of five (40%), pregnant women (37%), and women of reproductive age (30%) [1].

Anemia is a condition in which the amount of hemoglobin, or red blood cells necessary to carry oxygen is inadequate to cover all of the body's physiological requirements. It is linked to an increased risk of maternal and child mortality [1].

Anemia can be caused by dietary deficiencies that include iron, folic acid, and vitamin B12 deficiency, genetic problems such as thalassemia and sickle cell disease, or an autoimmune factor like hemolytic anemia, among other things, though iron deficiency anemia (IDA) is the most common cause globally [3].

Low dietary iron intake, poor iron absorption from diets, increased iron needs, recurrent blood loss, or pregnancy are the main risk factors for iron-deficiency anemia. Individuals and entire communities' ability to work is decreased by iron deficiency anemia, with major ramifications for the economy and advancement of the country. Furthermore, iron deficiency anemia has a negative impact on children's cognitive and physical development, as well as their performance [1].

Even in Saudi Arabia anemia considered as a common medical issue, a study conducted in 2007-2008 at Taibah University on 268 female students found that 64% of them were anemic [4]. Moreover, another study applied in Riyadh city revealed that frequency among female teenagers (ages 16 to 18) was 40.5% [5]. And regarding IDA, one report shows that Iron deficiency anemia affects 32.5% of pregnant women in the Middle East, 43.5% of preschoolers, 31.3% of schoolchildren, and 28% of adolescents [6]. Also, study conducted in Riyadh city 2007 found that Saudi women had lower amounts of hemoglobin and hematocrit with extremely low dietary iron intake compared to male which determined that adult Saudi women had a greater prevalence of IDA [7]. With all of this anemia widespread, a study done in Riyadh in 2020 with 450 participants revealed that just one-third of the participants had a good awareness of IDA [8]. In addition, a 2019 study in Tabuk, Saudi Arabia, discovered a significant lack of understanding of IDA and its prevention among both genders. Accordingly, it is necessary to enhance awareness among the adult population to avoid IDA risk factors and promote better knowledge of the condition [9,10].

Therefore, we intend to conduct an initial study to assess the level of IDA awareness among the adult population in Makkah, Saudi Arabia 

A cross-sectional study was conducted among the general population of Makkah city, Saudi Arabia during October 2023 to May 2024. including all adults, both male and female, and of any nationality residing in Mecca city. Exclusions applied to individuals who declined participation and those within the general population under the age of 18.

The minimum sample size required for this study was estimated by OpenEpi version 3.0, in consideration for the confidence interval at 95% and 5% margin of error . The sample size was calculated to be 384 participants and was adjusted to be 422 to compensate for 10% in case of any possible data loss.

Data was collected through an online self-administered, pretested Arabic questionnaire via Google Forms was adapted from Mohammad SM et al, [8].

The questionnaire contains three sections. First, a consent and agreement to participate form. Second, a sociodemographic data form, including gender, age, marital status, educational level, nationality, occupation, and history of chronic diseases. The last section focuses on measuring awareness of IDA.

Statistical analysis

The statistical analysis was done using SPSS (IBM version 26). The categorical data were presented as frequencies and percentages. The chi-square test was used to show the association of awareness about iron deficiency anemia with sociodemographic data. The chi-square test shows frequencies, percentages, and P values. Binary logistic regression was constructed to predict the relationship of awareness about iron deficiency anemia with sociodemographic data. Results of the regression were presented as odds ratio and their respective 95% confidence intervals. A p-value of < 0.05 is an indication of statistical significance.

This study was approved by the Biomedical Research Ethics Committee of Umm Al-Qura University, Saudi Arabia (Approval Number: HAPO-02-K-012-2023-10-1822). A combined system of codes, numbers and pseudonyms will be set up to ensure confidentiality of participants' information. Only researchers will have access to the data.

Sociodemographic data

A total of 1,395 participants were included (after the exclusion of the individuals who refused to participate in the study), with (72.30%) being females. In terms of age distribution, the majority of respondents fell within the 18-25 age group (58.30%). Regarding marital status, (60.10%) of participants were single. Educational levels varied, with the highest percentage having a bachelor's degree (63.40%). The majority of participants were Saudi nationals (88.40%). In terms of occupation, (50.80%) identified as students [Table 1].

Table 1: Sociodemographic data (n =1395).

Knowledge about iron deficiency anemia (Awareness, causes, symptoms, and treatment)

In [Table 2], the participant's awareness and knowledge regarding iron deficiency anemia were assessed, revealing that (75.80%) had heard of the term.

Table 2: Knowledge about iron deficiency anemia (Awareness, causes, symptoms, and treatment) (n = 139).

When queried about the causes of iron deficiency anemia, the majority cited poor nutrition (64.20%). Regarding symptoms, (67.50%) recognized pallor. In terms of prevention, (57.60%) believed iron deficiency anemia could be prevented. Moreover, (76.40%) affirmed that iron deficiency anemia is treatable. Regarding treatment methods, (67.50%) indicated a combination of diet change and iron supplements. In terms of knowledge levels about iron deficiency anemia, most of the participants had poor knowledge (< 75%) about it (84.50%). Figure 1

Figure 1: Stack bar chart showing percentages of chronic diseases.

revealed that most of the participants were obese (27.40%). WHO defines obesity as body mass index (BMI) > 30 [1].

Association between awareness about iron deficiency anemia and sociodemographic data

The analysis of associations between demographic variables and awareness of iron deficiency anemia revealed significant patterns. In terms of gender, a significantly higher proportion of females (79.40%) reported awareness compared to males (66.30%), with a P value of < 0.001. Age also played a role, as the age group 18-25 exhibited higher awareness (73.30%) than older age groups (>45) with (82.50%) awareness, yielding a significant P value of 0.013. Marital status demonstrated significant differences (P value = 0.048), with single individuals (73.20%) having higher awareness compared to married, divorced, and widowed participants. Educational level exhibited substantial differences (P value < 0.001), with post-graduates (85.70%) and bachelor's degree holders (78.80%) showing higher awareness, while elementary and middle school categories had lower awareness (70.60% and 46.40%, respectively). Nationality and occupation did not show a significant association with awareness [Table 3].

Table 3: Association between awareness about iron deficiency anemia and sociodemographic data.

Predictors of awareness about iron deficiency anemia based on the statistically significant sociodemographic data

The odds ratios (OR) and corresponding confidence intervals (CI) were calculated to assess the association between demographic factors and awareness of iron deficiency anemia. For gender, females demonstrated significantly higher odds of awareness (OR=2.464, 95% CI: 1.853-3.276, p < 0.001) compared to males. In terms of age, participants aged >45 exhibited significantly higher odds of awareness (OR=2.092, 95% CI: 1.134-3.858, p = 0.018) compared to the reference group (18- 25). Marital status and educational levels did not show significant associations with awareness [Table 4].

Table 4: Predictors of awareness about iron deficiency anemia based on the statistically significant sociodemographic data.

Association between knowledge about iron deficiency anemia and sociodemographic data

 The analysis of participants' knowledge levels regarding iron deficiency anemia revealed significant associations with demographic variables. In terms of gender, a higher proportion of males exhibited poor knowledge (90.70%) compared to females (82.20%), with a significant P value of < 0.001. Similarly, age demonstrated significant differences, with older participants (>45) showing higher levels of poor knowledge (91.10%) compared to younger age groups, with a significant P value of 0.001. Marital status also displayed significant associations, with married individuals exhibiting higher levels of poor knowledge (90.30%) compared to single, divorced, and widowed participants. Retired participants showed higher levels of poor knowledge (93.80%) compared to the other occupation groups. Educational level and nationality did not show statistically significant associations with knowledge levels. These findings highlight the influence of gender, age, marital status, and occupation on knowledge levels regarding iron deficiency anemia among the adult population in Makkah City, suggesting targeted educational interventions tailored to specific demographic groups [Table 5].

Table 5: Association between knowledge levels of iron deficiency anemia and sociodemographic data.

Predictors of knowledge about iron deficiency anemia based on the statistically significant sociodemographic data

The odds ratios (OR) and corresponding confidence intervals (CI) were computed to assess the association between demographic factors and knowledge levels regarding iron deficiency anemia. Gender exhibited a significant association, with females having higher odds of good knowledge (OR=1.791, 95% CI: 1.191-2.694, P value =0.005) compared to males. Age, marital status, and occupation did not show statistically significant associations with knowledge levels. These findings suggest that gender plays a significant role in knowledge levels regarding iron deficiency anemia, while other demographic factors may have less pronounced associations [Table 6].

Table 6: Predictors of knowledge of iron deficiency anemia based on the statistically significant sociodemographic data.

Anemia is a widespread health issue that affects almost every country and all age groups. It is more prevalent in thirdworld countries as well as communities with low socioeconomic status. It can affect any individual of any age, race or gender. However, it is more prevalent in young children, in women, and during pregnancy. Iron deficiency anemia (IDA) is responsible for approximately half of all cases of anemia globally, making it the most common micronutrient deficiency [8]. This study investigated the degree of IDA awareness among the adult population in Makkah, Saudi Arabia. Also, it identified the association between awareness of IDA and sociodemographic data.

The study revealed that most of the participants 84.50% demonstrated poor knowledge regarding IDA, as indicated by achieving correct answers on 75% or more of the questions. Our findings correlate with Mohammad et al. 2020 study, which was conducted among 450 adults living in Riyadh, Saudi Arabia. It revealed that 27.6% of the participants had good knowledge about IDA [8]. Another study conducted by Tashara et al. 2015 among 120 women of reproductive age at selected villages of Udupi taluk, India, revealed that the majority of participants, 55.8%, had inadequate knowledge [11]. On the other hand, studies conducted by Waggiallah et al. 2013 a total of 1281 Saudi citizens in the Qassim region, Saudi Arabia [12], as well as another study by Algarni et al. 2020 a total of 321 parents aged 18 years and above, in the western region, Saudi Arabia [13], showed good levels of awareness by 89.2% and 73%, respectively. The varying results can be explained by specific target populations that have higher educational qualifications, which may explain the high levels of knowledge of the condition.

In our study findings, 64.2% of participants believed that the cause of IDA is poor nutrition. This is consistent with Alsaab et al. 2023 study, which was conducted among 1068 citizens in Riyadh, Saudi Arabia. Their study demonstrated that 84.3% of participants believed malnutrition was the major cause of IDA [14]. While another previous study that was conducted by Jalambo et al. 2017 among 330 female adolescents aged between 15 and 19 years old in the Gaza Strip, Palestine, showed inadequate awareness about the causes of IDA by 91.6% [15]. This could be due to the socioeconomic status differences.

Moreover, 67.50% of the participants recognized pallor. However, the findings of our study are not consistent with those of two previous studies. The first, conducted by Alsaab et al. 2023, showed that 62.1% of participants identified hair loss as one of the signs and symptoms of IDA [16]. The other study, which was conducted by Mohammad et al., indicated that 52.2% of participants believed that the most common reported symptom was weight loss [8]. This can be due to the different forms of questionnaires used in those studies.

Our study revealed that 57.60% of participants believed iron deficiency anemia could be prevented. These findings correlate with Mohammad et al. 2020 study, which showed that 56.9% of participants believed IDA could be prevented [8]. On the other hand, Abd Elhakeem et al. 2019 study, which was conducted among 300 pregnant mothers from eight Primary Health Centers in the Tabuk region, Saudi Arabia, revealed that 8.0% of participants agree that IDA can be prevented during pregnancy [9]. This can be explained by different perceptions in geographic locations, such as those who live in urban vs rural places.

Our findings show that good awareness was observed more in female as compared to male populations which is consistent with a prior study that was conducted by Algarni et al., [13]. In contrast, another study conducted by Waggiallah et al. 2013 showed males have higher awareness than females [12]. Furthermore, the highest level of awareness was in post-graduate participants. Nevertheless, in a study conducted by Mohammad et al. 2020 those people who hold bachelor's degrees as their highest level of education had the highest level of awareness [8]. These variations in awareness may be attributed to the differences in data collection methods of those various studies.

In our population, the age group of 18-25 years has higher education levels than other age groups compared to the situation 50 years ago [16]. Although the age group should have higher knowledge, assumably because of education. The higher knowledge of the age group > 45 is probably because of higher experience, especially since most of them are parents and have children. As we know, preschool children < 5 years of age have the highest risk of having Iron Deficiency Anemia [17].

When it comes to the management of IDA, 67.5% of participants thought that the combination of both diet changes and oral supplements is the most suitable method for the management of Iron Deficiency Anemia. This finding was also noted in other studies, such as what Algarni et al. 2020 study already found. They have shown that 61.06% of the participants in their study believed that both changes in diet and intake of oral supplements are the best options [13].

Finally, we think that our study sample, which was composed of 1,395 participants in Makkah city, Saudi Arabia, reflects the generalizability of these target populations. It is the first study which measures the level of awareness among adult population in the city. 

IDA is a pervasive health challenge affecting populations globally. This study emphasizes the necessity of focused health educational initiatives including nutritional diet promotion mainly on iron supplements, symptom recognition, and preventive measures to raise public awareness of IDA, particularly in areas with lower socioeconomic status and educational attainment.

Future research should include diverse regions to improve representativeness. Enhancing educational interventions is crucial to improve IDA awareness and address its prevalence effectively.

The study is vulnerable to recall bias and the potential distortion of awareness levels, primarily stemming from the use of an online format, which introduces the risk of selection or recruitment bias. Moreover, reliance on self-reported data further compounds these concerns.

The authors would like to thank Dr. Ibrahim Alharbi, College of Medicine at Umm Al-Qura University, for his valuable contribution and effort in supervising each step of this research project. We also indebted all data collectors and participants for their participation.

It is advisable to consider expanding the study in subsequent phases to include diverse regions within Saudi Arabia. This approach would contribute to enhancing the representativeness of the findings.

1. World Health Organization Anemia. 2023.
2. Gardner WM, Razo C, McHugh TA, Hagins H, Vilchis-Tella VM, Hennessy C, et al. Prevalence, years lived with disability, and trends in anaemia burden by severity and cause, 1990–2021: findings from the Global Burden of Disease Study 2021. Lancet Haematol. 2023; 10: 713-734.
3. Pradesh MH, Rakesh Kumar I. Iron deficiency anemia (IDA), their prevalence, and awareness among Girls of reproductive age of Distt. Int Lett Natural Sci. 2015; 2: 24-32.
4. Hassan NN Al.The prevalence of iron deficiency anemia in a Saudi University female students. J Microsc Ultrastruct. 2015; 3: 25-28.
5. Musaiger A.0. Iron Deficiency Anaemia Among Children and Pregnant Women in the Arab Gulf Countries: The Need for Action. Nutr Health. 2002; 16: 161-171.
6. Al-Alimi A.A, Bashanfer S, Morish M.A. Prevalence of Iron Deficiency Anemia among University Students in Hodeida Province, Yemen. Anemia. 2018.
7. Al-Assaf A.H. Anemia and Iron Intake of Adult Saudis in Riyadh City- Saudi Arabia. Pakistan Journal of Nutrition. 2007; 6: 355-358.
8. Mohammad S, Algahtani M, Alsharif A, Alshehri R, Ghali K, Al-Almaei H, et al. Awareness of iron deficiency anemia among the adult population in Riyadh, Saudi Arabia. IJMDC. 2020; 4: 2259-2266.
9. Abd Elhakeem Aboud SH, Abd Elwahab El Sayed H, Abdel-Fatah Ibrahim H. Knowledge, Attitude and Practice Regarding Prevention of Iron Deficiency Anemia among Pregnant Women in Tabuk Region. IJPRPM. 2019; 8: 87–97.
10. Jimenez K,   Kulnigg-Dabsch   S,   Gasche   C.   Management   of   Iron Deficiency Anemia. Gastroenterology Hepatol (N Y). 2015; 11: 241-250.
11. Francis Tashara I, Kunjamma Achen   R,   Quadras   R,   Valencia MD, Jenevive Jyothi PD, Sankar A. Knowledge and self-reported practices on prevention of iron deficiency anemia among women of reproductive age in rural area. International Journal of Advances in Scientific Research. 2015; 1: 289-292.
12. Waggiallah HA, Alzohairy M. Awareness Of Anemia Causes Among Saudi Population Awareness Of Anemia Causes Among Saudi Population In Qassim Region, Saudi Arabia. NJIRM. 2013; 4: 35-40.
13. Algarni A, Alalo A, Bukhari H, Humayani H, Alorabi T, Bukhari T, et al. Parents awareness on iron deficiency anemia in children in western region, Saudi Arabia. IJMDC. 2020; 4: 43-48.
14. Alsaab S, Omar Alhussayn S, Ziyad Altokhais A, Alotaibi A I, Alsahli F A, Alotaibi AB, et al. The assessment of knowledge and awareness about iron deficiency anemia among the population of Riyadh province. J Family Med Prim Care. 2023; 12: 2237-2240.
15. Jalambo MO, Naser IA, Sharif R, Karim NA. Knowledge, attitude and practices of iron deficient and iron deficient anaemic adolescents in the Gaza strip, Palestine. Asian Journal of Clinical Nutrition. 2017; 9: 51-56.
16. Ministry of Education. Data and Statistics. 2021.
17. Viteri FE, Gonzalez H. Adverse outcomes of poor micronutrient status in childhood and adolescence. Nutr Rev. 2002; 60: 77-83.