RESEARCH REPORT

“KNOWLEDGE, ATTITUDE & PRACTICES REGARDING IRON

DEFICIENCY ANEMIA AMONG EDUCATED PEOPLE OF
ISLAMABAD, PAKISTAN.”

Samia Shoukat Abbasi

005-CMLT/BS-2015

BS (Hons.) Medical Laboratory Technology

Supervisor

Muhammad Usman

M.Phil. Ph.D. Scholar (Microbiology)

Scientific Officer (Microbiology)

Co-Supervisor

Bilal Habib

Medical Lab Technologist

College of Medical Lab Technology, NIH

Sana Habib Abbasi

Statistical Officer

N.I.H. Islamabad

Date of submission: March 20, 2019

COLLEGE OF MEDICAL LABORATORY TECHNOLOGY, SHAHEED

ZULFIQAR ALI BHUTTO MEDICAL UNIVERSITY ISLAMABAD
2019
“IN THE NAME OF ALLAH, WHO IS THE MOST MERCIFUL AND COMPASSIONATE,
THE MOST GRACIOUS AND BENEFICENT WHOSE HELP AND GUIDANCE WE
ALWAYS SOLICIT AT EVERY STEP, AT EVERY MOMENT. THE ONLY OWNER OF
THE DAY OF RECOMPENSE (I.E. THE DAY OF RESURRECTION) YOU (ALONE) WE
WORSHIP, AND YOU (ALONE) WE ASK FOR HELP. GUIDE US TO THE STRAIGHT
WAY. THE WAY OF THOSE ON WHOM YOU HAVE BESTOWED YOUR GRACE, NOT
(THE WAY) OF THOSE WHO EARNED YOUR ANGER, NOR OF THOSE WHO WENT
ASTRAY. (THE QUR'AN- SURAH AL-FATIHAH)”.
 DEDICATION

I would love to dedicate this thesis to my beloved parents, who sacrificed for me on every
step of my life. They stood behind me with love and many prayers in every situation of my
life. After Allah, my life will always be in their debt. Secondly, I would like to mention my
teachers Mr. Jamil Akhter, Ma’am Sana Habib Abbasi, and Mr. Bilal Malik, especially
Mr. Muhammad Usman for always supporting me. Special thanks to all my friends and
family who remained on my side all this time.
TABLE OF CONTENTS PAGE NO

1. ACKNOWLEDGMENT …………………………………………. 05
2. ABSTRACT………………………………………………………. 06
3. INTRODUCTION………………………………………………… 07
4. AIMS AND OBJECTIVES……………………………………….. 09
5. MATERIALS AND METHODS…………………………………. 10
i. TYPE OF STUDY………………………………………... 10
ii. PLACE OF STUDY ……………………………………… 10
iii. PERIOD…………………………………………………… 10
iv. SAMPLE SIZE……………………………………………. 10
v. SAMPLE TECHNIQUE…………………………………... 10
vi. SAMPLE SELECTION……………………………………. 10
vii. INCLUSION CRITERIA………………………………….. 10
viii. EXCLUSION CRITERIA…………………………………. 10
ix. MATERIALS……………………………………………… 10
x. METHODS………………………………………………… 11
xi. DATA COLLECTION PROCEDURE……………………. 12
xii. DATA ANALYSIS……………………………………….. 12
6. RESULTS………………………………………………………….. 13
7. DISCUSSION AND CONCLUSION……………………………... 18
8. REFERENCES…………………………………………………….. 20
9. ANNEXURE………………………………………………………. 23
 ACKNOWLEDGEMENT

First, I am thankful to Allah Almighty for his countless blessings. After that, I would like to
express my heartiest gratitude to my supervisor Muhammad Usman and my co-supervisor
Muhammad Bilal and Ma’am Sana Abbasi for their guidance, support and help at every step
of this research. Their teaching with patience helped to achieve this milestone of my
academic life. I am also thankful to all the other teachers who ever taught me. I will always
be indebted to all their efforts for my studies.

I am deeply grateful to all the academic and non-academic staff of College of Medical Lab
Technology for their continuous support and help in this research and in every other matter of
my academic life.

Last but not least, a heartfelt appreciation to my family and friends for giving me much-
needed love, support and encouragement through all this time.
ABSTRACT:

Background: Lack of knowledge concerning nutrition is one of the most important

reasons for nutritional problems and thus, poor nutritional practices can lead to a large
number of complications.

Aim: The aim of this study was to explain the knowledge, attitude, and practices regarding
Iron Deficiency Anemia (IDA) amongst educated people of Islamabad.

Methodology: A cross-sectional study was accomplished using a questionnaire for the

assessment of iron deficiency anemia among 200 students enrolled in Quaid-e-Azam
University, Punjab College, College of Medical Lab Technology and Residents of NIH
colony, Islamabad. Posters were also displayed in these places during this period of study.

Results: The results specified that 7% of the people could not tell if a person was having
anemia. About 44% of them were not aware of the consequences of IDA among pregnant
women and 48.50% had no knowledge of the causes of IDA. Also, 65% did not know which
iron-rich foods can be easily absorbed, while 51% did not know which foods lessen iron
absorption. Furthermore, 72.5% of the people usually eat citrus fruits and 34% of them did
not eat them on a daily basis. At the same time, 96% of the people usually consumed tea and
coffee, while 82.5% of them consumed these drinks daily. Also, 41% of the people
considered anemia as a serious condition, while 59% of them did not consider anemia to be a
serious condition or were unsure. Furthermore, 40.5% of the people liked the taste of iron-
rich food items.

Conclusion: Most people have good knowledge concerning iron deficiency anemia, its
causes, prevention, and management but they showed poor practice. Nutrition education
intervention should be implemented
INTRODUCTION:

Anemia is a condition that is defined by the decline in the total number of red blood
cells or total hemoglobin in the blood of a person. One of its most common types is iron
deficiency anemia (IDA) that occurs due to the absence of enough iron to produce normal red
blood cells. Iron deficiency anemia is caused by an inadequate intake of iron, constant blood
loss, or a combination of both. Iron deficiency anemia is the most common type of anemia in
the whole world (Clark, 2009) (Looker et al. 1997).

Iron is an important micronutrient required for the transport of oxygen, oxidative metabolism,
cellular proliferation, and physiological processes (Grantham, 2001). The lack of iron causes
the up-regulation of iron absorption and increases red blood cells production. Excess of iron
is caused by the down-regulation of its absorption due to inflammation. It is intervened by the
regulator of iron homeostasis that blocks iron release from enterocytes and macrophages
which results in anemia (Nairand, 2009).

The World Health Organization defines anemia as the hemoglobin level below 120g/L in
women, 130g/L in men and 110g/L in pregnant women (Sant et al. 2010) (Wiveka 2001).
Lack of iron can slow down normal motor functions during pregnancy, broaden the threat for
small or early (premature) babies, act as a root cause for tiredness in adults and influence
memory and other mental functions in teens (Christopher et al. 2012).

Colonization of Helicobacter pylori also causes iron deficiency anemia by spoiling the iron
uptake or intensifying the iron loss (Kattalin 2011). Iron deficiency anemia is one of the
substantial causes of low academic achievements and inferior health status in students. (Clark
2009). The common indicators of developing iron deficiency anemia are tiredness, lack of
appetite, irritability, headaches, and loss of concentration.

Iron deficiency anemia causes insignificant health situations that may lead to complex
diseases. Usually, the appraisal of the cause of anemia involves a complete blood cell count,
peripheral smear, reticulocyte count, and serum iron indices. The seriousness of anemia
depends on the patient's hematocrit or hemoglobin level. Iron deficiency anemia is
distinguished by microcytic, hypochromic erythrocyte. At first iron deficiency anemia can go
unnoticed. But as the iron level of the body drops, it aggravates the anemia and signs and
symptoms become severe (Kaushansky et al. 2016). Signs and symptoms of iron deficiency
anemia are paleness of skin, extreme tiredness, pain in the chest, fast heartbeat, cold hands
and feet, shortness of breath, headache, dizziness, poor appetite.
If the intake of iron is not enough or the loss of iron is too much, our body can't produce
hemoglobin, and eventually, iron deficiency anemia will develop. Loss of blood can cause
iron deficiency anemia. Iron is present within RBCs within our body. So with the loss of
blood, we also lose some iron. There is a high risk of developing IDA is in women with
heavy menstruation. Slow, continuing blood loss within the body (in peptic ulcer) can also be
a cause of iron deficiency anemia.

Our body acquires its supply of iron from the foods we eat. If our diet is poor in iron, with
time our body can become deficient in iron. Failure of proper iron absorption can also result
in anemia. Iron attained from food is absorbed into the blood in a small intestine. Any kind of
intestinal disease that disturbs its ability to work properly (i.e. absorb nutrients from digested
food) can cause iron deficiency anemia. Iron deficiency anemia is common in pregnant
women because their total blood volume increases and iron stores need to attend their own
increased blood volume as well as be a source of hemoglobin for a fetus (American Society
of Hematology, 2016).

Women are at higher jeopardy of iron deficiency anemia because of menstruation. Infants that
were born prematurely, who were born with low birth weight, who don’t get adequate iron
from breast milk may be at the risk of iron deficiency anemia. If a child is not getting a
healthy diet, he/she may be at risk of developing the disease. Blood donation can drain the
iron stores so the people who consistently donate blood may have elevated risk of iron
deficiency anemia.

If iron deficiency anemia is not severe, it doesn’t cause complications. But if left untreated
Iron deficiency anemia can cause severe health problems, which include heart problems,
problems during pregnancy and growth problems, etc. Iron deficiency anemia can cause a
fast or irregular heartbeat. When a person is anemic, his heart pumps more blood to
compensate for the lack of oxygen in his blood. This can cause enlargement of the heart
leading to heart failure. Premature births and low weight babies can be linked to iron
deficiency anemia in pregnant ladies. In children, anemia and delayed growth development
can occur due to iron deficiency. In addition, it’s also linked with elevated vulnerability to
infections.

Using Iron-rich foods can diminish the risk of developing iron deficiency anemia. Some iron-
rich foods are red meat, seafood, beans, dark green leafy vegetables, such as spinach, dried
fruit, such as raisins and apricots, iron-fortified cereals, bread and pasta, peas

Meat is the richest source of iron as the body absorbs more iron from meat than it does from
any other source. Foods comprising vitamin C also boost the absorption of iron (NIH, 2016).
 The normal reference range for mean hemoglobin concentration is 320-360g/l and for mean
cell volume is 800-100fL. When these values are lower than the normal range, the person's
cells are called microcytic and hypochromic. Note that, up to 41% of patients' with true iron
deficiency anemia will have normocytic erythrocytes (i.e. normal mean cell volume does not
preclude iron deficiency anemia) (Bermejo and Garcia, 2009). The worldwide prevalence of
anemia in children of age 6 months to 59 months is 44% and half is due to iron deficiency
anemia which is characterized by the hemoglobin level of less than 110g/L (Mclean et al,
2009).

The occurrence of anemia amidst young women was 58.81% during 2016. In 1990, its value
was 70.80% which was highest over the past 26 years and its lowest value was 56.30% in
2006 (WHO, 2007).

The value for the prevalence of anemia amidst non-pregnant women of age 15-49 years in
Pakistan was 52.20% in 2016. In 1990, it showed the highest value over the past 26 years
which was 54.10% while the lowest value was 48-90 during 2002. In pregnant women of
Pakistan, the value of occurrence of anemia was 51.30% during 2016. Over the past 26 years,
it reached a maximum value of 51.30% in 2016 and a minimum value of 47.40% in 2002.

AIMS AND OBJECTIVES:

The aim of this study was to check the awareness of people of Islamabad about iron
deficiency anemia. The main objectives of this study are;

 To estimate the level of knowledge, attitude, and practices in people regarding iron deficiency
anemia (IDA) among educated people.

 To improve knowledge of iron deficiency anemia among people.

MATERIALS AND METHODS:

Type of Study:

A cross-sectional survey/study

Place of Study:

Quaid-e-Azam University, Punjab College, College of Medical Laboratory Technology and

Residents of NIH colony, Islamabad.

Period:

3 months, started after the approval of synopsis.

Sample size:

200 people of age group 15-55.

Sampling technique:

Simple random sampling technique

Sample Selection:

A cross sectional study was accomplished using a questionnaire for the assessment of iron
deficiency anemia amongst the students registered in Quaid-e-Azam University, Punjab
college, College of medical lab technology and the residents of NIH colony, Islamabad.

Inclusion Criteria:

People of age 15-55 years

Exclusion Criteria:

Children and pregnant women

Materials:

Knowledge, Attitude, and Practices (KAP) questionnaire is a tool for determining what
people already know (Knowledge), how they feel (Attitude) and what they are doing
(Practices) concerning a specific matter (Macias 2014). The questions on attitude and
practices concerning iron deficiency anemia were used to check the level of the right attitude
and practices toward health (Miller and Lovler, 2014). The KAP data revealed what people
felt about iron deficiency anemia, if they were ready to defend themselves against iron
deficiency anemia and if the study sample was aware of the threat of iron deficiency anemia.
The category in the KAP questionnaire containing questions on practices gave a stance on
how people can defend themselves against iron deficiency anemia and if the study sample
was involved in any risky behavior.

Posters can expand knowledge, transform attitudes and change behaviors. Therefore, they
were used alongside the questionnaires to improve knowledge in the course of this study.

Methods:

Cross sectional study was achieved to check awareness concerning iron deficiency anemia in
educated people of Islamabad, Pakistan. To carry out the study, a questionnaire was
formulated. Questionnaires were distributed amongst 200 students presently enrolled in
Quaid-e-Azam University, Punjab College, College of Medical Lab Technology and
Residents of NIH colony, Islamabad. People from diverse families, different age groups,
different races, and different socio-economic status filled questionnaires. The filled
questionnaires comprised the demographic data of the students. The questionnaires were
divided into three parts named as knowledge, attitude, and practices. The total number of
questions was 21. The knowledge part contained 8 questions, the attitude part contained 6
questions and the last part contained 7 questions.

The questions in the knowledge part were multiple-choice questions. The answers to each
question were assessed as 'know' or 'do not know'. The purpose of the second part of the KAP
questionnaire, which contained six questions, was to estimate the attitude of the participants
towards perfect nutrition. Part three in the KAP questionnaire, which was the practice part,
contained three main subdivisions. The first subcategory was about iron intake. The second
subcategory was related to if the contributors generally eat citrus fruits, whereby the
contributors were needed to answer 2 questions in case their answer to the first question was
"Yes". On the contrary, if their answer to the first question was "No", the participants were
requested to skip the two questions.

My objective was to improve the knowledge of people regarding iron deficiency anemia so
that it can be prevented. The only problem that I encountered was how to circulate important
information to the public in an effective way. The goal was to make that idea stick in the
respondents’ minds. Posters concerning iron deficiency anemia were presented on the walls
and other places (white boards) within the universities and colleges of Islamabad. They
delivered a very brief impression of the topic.

Data Collection Procedure:

A cross-sectional study was accomplished using a questionnaire for the assessment of iron
deficiency anemia amongst students enrolled in Quaid-e-Azam University, Punjab college,
College of medical lab technology and residents of NIH colony, Islamabad.

Data Analysis:

A descriptive statistical data analysis method was used to relate the knowledge, attitude, and
practice in different demographic details. The data were examined using the Statistical
Package for Social Sciences (SPSS). The data, comprising variables such as age, gender,
educational status, knowledge, attitude, and practice were presented in the form of rates and
percentages.
RESULTS:

A total of 200 contributors were involved in this study of which most of the respondents age
ranges from 26 to 35. In KAP study majority of the respondents were female with 62% and
male with 38%. The majority of the respondents belonged to the graduate level of education
with 69%, 27% belonged to the secondary level, 4% belonged to the primary level. The
majority of the respondents were married (59%) and unmarried were 41%. The demographic
details are detailed in the table: 1.1.

Table 1.1: Percentage of age and gender distribution(n=200)

Sr. No. Frequency Percenta

Characteristics N ge
%
1. Age
15-25 44 22
26-35 82 41
36-45 54 27
46-55 20 10
2. Gender
Males 76 38
Females 124 62
3. Educational status
Primary 8 4
Secondary 54 27
Graduate 138 69
4. Marital status
Married 118 59
Unmarried 82 41
About 78% of the respondents knew about iron deficiency anemia .93% have stated that they
can distinguish someone who is pale, 48% respondents told about the complications of iron
deficiency anemia. 51.5% knew about the causes of the disease. 56% of them were aware of
the complications of iron deficiency anemia in pregnant women and 40% told that iron-rich
foods easily absorb in the body. 49% have knowledge about the foods that enhance the
absorption of iron in the body. Knowledge based questions are recorded in the table: 1.2.

Table 1.2: Knowledge based questions involved in KAP’s study of iron deficiency
anemia.

Sr. Characteristics N %
no
1 Have you heard about iron deficiency Yes 156 78
anemia? No 30 15
Don’t know 14 7
2 If yes, then what is your source of Family 19 9.5
information? Internet 130 65
Other 7 3.5
3 Can you recognize someone who is pale? Yes 186 93
No 14 7
Don’t know 0 0
4 Do you know about complications of iron Know 96 48
deficiency anemia? Don’t know 104 52
5 What are the causes of iron deficiency Know 103 51.5
anemia? Don’t know 97 48.5
6 Do you know about the complications of Know 112 56
IDA in pregnant women? Don’t know 88 44
7 Do you think iron-rich foods are easily Know 80 40
absorbed in the body? Don’t know 130 65
8 Do you know about the foods that increase Know 98 49
iron absorption? Don’t know 102 51
About 3% of the respondents expressed that they consider themselves iron deficient. 82%
identified that iron deficiency anemia is very serious, 91% respondents stated that it's good to
make a meal with iron rich foods. 23% said that they find it tough to make a meal with iron
rich foods. 26% of them were confident in making meals with iron-rich food and 81% stated
that they like the taste of iron-rich foods. Attitude based questions are detailed in the table:
1.3.

Table 1.3: Attitude based questions involved in KAP’s study of iron

deficiency anemia.

Sr. Characteristics N %
no
9 How likely do you think you’re iron deficient? Not likely 96 48
Likely 06 3
Not sure 98 49
10 How serious do you think iron deficiency Not serious 32 16
anemia is? Serious 82 41
Not sure 86 43
11 How good do you think it’s to prepare a meal Not good 02 1
with iron rich foods? Good 182 91
Not sure 16 8
12 How difficult it’s for you to prepare a meal Not Difficult 23 11.5
with iron rich foods? Okay 65 32.5
Difficult 112 56
13 How confident do you feel in preparing meals Not 105 52.5
with iron rich foods? confident
Okay 69 34.5
Confident 26 13
14 How much do you like the taste of iron rich Dislike 37 18.5
foods? Like 81 40.5
Not sure 82 41%

About 36% of the respondents responded that they take iron supplements. 72.5% replied that
they ingest vitamin c rich fruits. 96% of the respondents stated that they drink tea/coffee.
Practice based questions are detailed in the table: 1.4.

Table 1.4: Practice based questions involved in KAP’s study of iron

deficiency anemia.

Sr. Characteristics N %
no
Are you taking any iron therapy? Yes 72 36
15 No 128 64
Don’t know 0 0
16 Do you consume vitamin C rich fruits? Yes 145 72.5
No 32 16
Don’t know 23 11.5
16 Do you consume vitamin C rich fruits daily? Yes 132 66
No 68 34
(i)
16 When do you eat citrus fruits? Before meal 23 11.5
After meal 139 69.5
(ii) Other 38 19
17 Do you take tea/coffee usually? Yes 192 96
No 8 4
Don’t know 0 0
17 Do you take tea/coffee daily? Yes 165 82.5
No 35 17.5
(i) Don’t know 0 0
17 When do you usually drink tea/coffee? Before meal 25 12.5
After meal 128 64
(ii) Other 47 23.5
Overall 58.93% showed good results in knowledge and 41.06% were not very aware. 44.59%
showed good results in the attitude quota and only 37.5% showed good results in practices.

Table1.5: Knowledge, Attitude and Practice regarding iron deficiency

anemia.

CHARACTERISTI Good result Poor result

CS
Knowledge 58.93% 41.06%
Attitude 44.5% 55.5%
Practice 37.5% 62.5%

70.00%

62.50%
60.00% 58.93%
55.50%

50.00%
44.50%
41.06%
40.00% 37.50%
Series 1
Series 2
30.00%

20.00%

10.00%

0.00%
knowledge Attitude Pratcice

People showed a positive response to the information given to them through posters. These
posters encouraged the addressees to contribute and ask questions. The discussion was swiftly
formed and information spread at a faster rate.
 DISCUSSION:

Out of the 200 educated people, 78% had overheard about anemia and this percentage
was higher than the percentage (12.1%) in an Indian study (Kulkarni and Durge, 2011). In
contrast, this result was lower than the percentage in the latest study, where 91% of the
people had heard about anemia (Benoist et al. 2016). In this study, 93% of the contributors
knew how to categorize a person with anemia (or someone who is pale) and this result was
higher than the result acquired by a former study (12%)(Angadi and Ranjitha, 2016). This
percentage was also higher than the observation reported in two prior studies by 44.2% and
38% (Kotecha et al. 2009) (Chakma et al. 2013). The present study concluded that 41% of the
people knew that anemia was a serious health problem, whereas 73% of the people in a study
conducted in India recognized that anemia was a health problem (Benoist et al. 2008).

About 51% of the study sample did not know which foods were rich in iron and this result
was slightly lower than a study conducted in Sudan, which resolved that 73.4% of the
contestants did not know the sources of iron (Patimah et al. 2008). However, it was stated in
this study that about 25% of the study sample knew that tea and coffee reduce iron absorption
and this result was uneven with the result obtained by the prior study (43%)(Angadi and
Rajitha, 2016). On the other hand, 36% of the participants in the existing study answered that
vitamin C boosts iron absorption and this result was constant with the result reported in 2009
(37.3%)(Kotecha et al. 2009).

About 49% of the participants in the existing study knew that iron absorption could be
improved through the consumption of food. However, this result was varying with a recent
study conducted in India, which concluded that 59.0% of people knew about the foods that
improve iron absorption (Elhassan et al. 2013). The difference may have been due to the fact
that the majority of the contributors in this study sample covered females and only 38% were
males.

A study published in the Health Information and Libraries Journal established that the poster
presentations are some of the most generally used arrangements for communicating
information in educational and public health fields. Overall, people showed a positive
response to the information demonstrated at the posters.
CONCLUSION:

Anemia is a very communal health problem amongst people and leads to high
sickness and death rates among the population. Most people have good knowledge of the
topic of iron deficiency anemia, its causes, prevention, and management. The present study
was an endeavor to check the knowledge concerning iron deficiency anemia amongst
educated people. The overall outcomes of the study show that the attitude and practices of
people are moving in an objectionable direction. There is a need to improve healthcare
services, facilities and more importantly, knowledge on topics amongst people associated
with iron deficiency anemia and its prevention. More and more workers at the mass level
should be educated in this zone so that they can offer services at the primary level before the
start of an illness. Inclusive nutritional education knowledge regarding healthy dietary
behaviors should be broadcast. Extensive studies should be carried out in different countries
to get a precise picture of anemia and based upon that a concrete attitude should be
implemented to eradicate the problem.
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 QUESTIONNAIRE

Knowledge, Attitude, and Practices (KAP) regarding Iron Deficiency

Anemia among educated people of Islamabad, Pakistan

 Name: ____________________________

Female Male
 Gender?

15-25 26-35 36-45 46-55

 Age Group?

Primary Secondary Graduate

school school level
 Highest level of education you’ve completed?

Single Married Widowed Divorced

 Marital Status?

KNOWLEDGE:

1. Have you heard about iron deficiency anemia? Yes No

2. If yes, then what is your source of information? Internet Family/friend Other

3. Can you recognize someone who is pale? Yes No Don’t

know
 4. Do you know about complications of iron deficiency Know Don’t know -
anemia?

5. What are the causes of iron deficiency anemia? Know Don’t know -

6. Do you know about the complications of IDA in pregnant Know Don’t know -
women?

7. Do you think iron rich foods are easily absorbed in body? Know Don’t know -

8. Do you know about the foods that increases iron Know Don’t know -
absorption?

ATTITUDE:

9. How likely do you think you’re iron deficient? Not likely Likely Not sure

10. How serious do you think iron deficiency anemia is? Not Serious Not sure
serious

11. How good do you think it’s to prepare meal with iron Not good Good Not sure
rich foods?

12. How difficult it’s for you to prepare meal with iron rich Not Ok Difficult
foods? difficult

13. How confident do you feel in preparing meals with iron Not Ok Confident
rich foods? confident

14. How much do you like the taste of iron rich foods? Dislike Like Not sure

PRACTICES:

15. Are you taking any iron therapy? Yes No Don’t

know
16. Do you consume vitamin C rich fruits usually? Yes No Don’t
know

If answer to Q.16 is yes

16(i). Do you consume vitamin C rich fruits daily? Yes No Don’t

know

16(ii). When do you eat citrus fruits? Before After Other

meal meal

17. Do you drink tea or coffee usually? Yes No Don’

If answer to Q.17 is yes then;

17(i). Do you drink tea/ coffee daily? Yes No -

17(ii). When do you drink tea/ coffee usually? Before After Other
meal meal

POSTERS: