Knowledge and attitude among Indian medical students towards thalassemia: a study in Delhi NCR

Abstract

Background: Thalassemia can easily be prevented by awareness, education, screening, premarital genetic counselling and prenatal diagnosis. There are only a handful of articles on knowledge and awareness about thalassemia among general population or parents of thalassaemic children. Aims and objectives was to evaluate the level of awareness, knowledge and attitudes of medical students towards thalassemia as well as to analyse the differences if any between the first year and second year MBBS students and their correlation with various socio-demographic parameters.Methods: This was an institutional based cross sectional observational descriptive study regarding knowledge and attitude of first and second year MBBS students about thalassemia using a pre-designed, structured, self-administered questionnaire. Data was analyzed using SPSS software version 17. Values of p<0.05 were considered significant.Results: Mean knowledge scores of second year MBBS students compared to first year MBBS were 11.73±1.78 versus 10.8±1.92, the difference being statistically significant, however, the difference between mean attitude scores was not found to be significant. There was no effect of age, gender, region or Kuppuswamy’s socio-economic class on the knowledge or attitude of MBBS students towards thalassemia.Conclusions: Majority of the MBBS students had good knowledge and positive attitude towards thalassemia. To confirm the observations, large scale studies need to be conducted comprising of different study populations. Screening for thalassemia should be made mandatory, as part of medical examination, at entry to a medical college so that the medical college students are sensitized and can spread awareness among general population.

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International Journal of Research in Medical Sciences | October 2017 | Vol 5 | Issue 10 Page 4470
International Journal of Research in Medical Sciences
Pujani M et al. Int J Res Med Sci. 2017 Oct;5(10):4470-4477
www.msjonline.org
pISSN 2320-6071 | eISSN 2320-6012
Original Research Article
Knowledge and attitude among Indian medical students towards
thalassemia: a study in Delhi NCR
Mukta Pujani1, Varsha Chauhan1, Charu Agarwal1*, Deepshikha Rana1, Kanika Singh1,
Shivam Dixit2
INTRODUCTION
The dictum ‘Prevention is better than cure’ holds true for
most of the diseases, however, it is the only option for
most of the genetic diseases including
hemoglobinopathies. Hemoglobinopathies being a
significant cause of morbidity and mortality, impose a
great burden on global healthcare.
Thalassemia is the most common among these with an
overall prevalence of beta thalassemia approaching 3-4 %
in India with certain communities like Muslims, Sindhis,
Kutchi, some tribals etc having 8-10% prevalence of β
thalassemia trait (βTT).1 About 10% of the global
thalassemia children are born in India, every year.2
Mohanty el al (ICMR) conducted a multicentre study in
six cities of six states of India (Maharashtra, Gujarat,
1Department of Pathology, ESIC Medical College and Hospital, Faridabad, Haryana, India
2Department of Community medicine, ESIC Medical College and Hospital, Faridabad, Haryana, India
Received: 30 July 2017
Accepted: 28 August 2017
*Correspondence:
Dr. Charu Agarwal,
E-mail: dr.charu.ag@gmail.com
Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under
the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial
use, distribution, and reproduction in any medium, provided the original work is properly cited.
DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20174579
ABSTRACT
Background: Thalassemia can easily be prevented by awareness, education, screening, premarital genetic
counselling and prenatal diagnosis. There are only a handful of articles on knowledge and awareness about
thalassemia among general population or parents of thalassaemic children. Aims and objectives was to evaluate the
level of awareness, knowledge and attitudes of medical students towards thalassemia as well as to analyse the
differences if any between the first year and second year MBBS students and their correlation with various socio-
demographic parameters.
Methods: This was an institutional based cross sectional observational descriptive study regarding knowledge and
attitude of first and second year MBBS students about thalassemia using a pre-designed, structured, self-administered
questionnaire. Data was analyzed using SPSS software version 17. Values of p<0.05 were considered significant.
Results: Mean knowledge scores of second year MBBS students compared to first year MBBS were 11.73±1.78
versus 10.8±1.92, the difference being statistically significant, however, the difference between mean attitude scores
was not found to be significant. There was no effect of age, gender, region or Kuppuswamy’s socio-economic class
on the knowledge or attitude of MBBS students towards thalassemia.
Conclusions: Majority of the MBBS students had good knowledge and positive attitude towards thalassemia. To
confirm the observations, large scale studies need to be conducted comprising of different study populations.
Screening for thalassemia should be made mandatory, as part of medical examination, at entry to a medical college so
that the medical college students are sensitized and can spread awareness among general population.
Keywords: Attitude, Awareness, MBBS students, Knowledge, Thalassemia

Pujani M et al. Int J Res Med Sci. 2017 Oct;5(10):4470-4477
International Journal of Research in Medical Sciences | October 2017 | Vol 5 | Issue 10 Page 4471
West Bengal, Assam, Karnataka and Punjab) to
determine the prevalence of haemoglobinopathies in
different caste/ethnic groups using uniform
methodology.3 The prevalence of β-thalassemia trait
ranged from 1.48 to 3.64 % in different states while the
overall prevalence was 2.78 %. The prevalence of β-
thalassemia trait in 59 ethnic groups varied from 0 to 9.3
%.
Thalassemia can easily be prevented by awareness,
education, screening, premarital genetic counselling and
prenatal diagnosis. There have been studies in literature
on level of awareness about thalassemia among medical
students with variable results.4-6 On review of Indian
literature, we came across only a handful of articles on
knowledge and awareness about thalassemia, however,
these mainly focus on general population or parents of
thalassaemic children.7-9 Recently, there has been a single
study on Indian junior doctors in this regard.10 Selecting
medical students for testing the knowledge and attitudes
towards thalassemia has an advantage as they being at the
grass root level form an important part of healthcare
system, hence they will further help in creating awareness
in the community.
The aims and objectives of present study were to evaluate
the level of awareness, knowledge and attitudes of
medical students towards thalassemia as well as to
analyse the differences if any between the first year and
second year MBBS students and their correlation with
various socio-demographic parameters.
METHODS
This was an institutional based cross sectional
observational descriptive study regarding knowledge and
attitude about thalassemia. It was carried out over 3
months, January-March 2017. The study was approved
by the institutional ethics committee. First year and
second year MBBS students of the ESIC Medical college,
Faridabad formed the study group.
Inclusion criteria: All MBBS students who gave consent
to participate in the study were included.
Exclusion criteria: The MBBS students who did not give
consent and those students who did not completely fill
the questionnaire were excluded from the study.
The study tool was a pre-designed, structured, self-
administered questionnaire. Questionnaire was designed
by faculty from pathology in consultation with faculty
from community medicine. It was given to 30 randomly
selected MBBS students from first year and second year
to obtain their opinion and necessary modifications were
done. This group of 30 students was not included in the
study.
It comprised of three sections- Section I- Socio-
demographic data (age, gender, religion, occupation,
education and income). Section II- Questions pertaining
to participant’s knowledge about thalassemia (15 in
number). Section III- Questions related to attitude
towards thalassemia (9 in number).
Socio-demographic data was used to calculate the
updated Kuppuswamy socio-economic class (2014, May,
current price index).11 In the second part, student’s
knowledge about thalassemia was assessed across several
domains: (1) General knowledge about thalassemia (2)
Knowledge about inheritance (3) Knowledge about
diagnosis (4) Knowledge about treatment. The answers
were either in the form of multiple options provided or
Yes/No. Each correct answer was given a score of 1. So,
the maximum score was 15. The scores were graded into
excellent (13-15), good (10-12), average (7-9) and poor
(<6) based on the scores.
The third section of the questionnaire was designed to
assess the attitude of the participants towards thalassemia
and consisted of 9 questions. The answers were either
Yes/No/No response. Each correct response was marked
as 1. So, a score more than or equal to 5/9 was considered
as a positive attitude while a score less than 5/9 was taken
as negative attitude.
Data was analyzed using SPSS software version 17.
Values of p<0.05 were considered significant.
Descriptive statistics such as mean, median, SD were
calculated wherever required. The chi square test was
used to test the significance of differences in percentages
between the two groups.
RESULTS
Questionnaires were distributed to a batch of first year
and second year MBBS students (100 each), but a total of
143 students completed and returned the questionnaire.
The 30 students who participated in the pilot study were
not included. The incompletely filled questionnaires were
not included in the analysis. So, the study group
comprised of 74 first year MBBS students (Group I) and
69 second year MBBS students (Group II).
Among the Group I (first year MBBS students), 59.46%
(44/74) were males while 40.54% (30/74) were females.
Majority of the 1st year MBBS students, 54.05% were in
the 18-19 years age group with a mean age group of
18.93 (SD=1.15). 74.32% (55/74) 1st year students
belonged to urban population. The most common source
of information about thalassemia was during MBBS
study (53.5%), followed by mass media (16.67%). On
analysis of scores based on knowledge 67% students had
an above average knowledge about thalassemia. The
characteristics of study population are depicted in Table
1.
Among the Group II (second year MBBS students), the
Male:Female distribution was more or less uniform
(47.83% versus 52.17%). The mean age was 19.89 years

Pujani M et al. Int J Res Med Sci. 2017 Oct;5(10):4470-4477
International Journal of Research in Medical Sciences | October 2017 | Vol 5 | Issue 10 Page 4472
with SD 2.62. Similar to first year MBBS students, the
most common source of information about thalassemia was during MBBS study (79.49%).
Table 1: Comparison of various parameters between MBBS first years and second years.
Variable
Status
No. of first year MBBS
students (percentage) (n=74)
No. of second year
MBBS Students
(percentage) (n=69)
P value
Age
<19 years
45 (60.81%)
24 (34.78%)
0.001
>20 years
29 (39.18%)
45 (65.21%)
Gender
Male
44 (59.46%)
33 (47.83%)
0.163
Female
30 (40.54%)
36 (52.17%)
Religion
Hindu
71 (95.94%)
68 (98.55%)
0.62
Sikh
1 (1.35%)
1 (1.44%)
Christian
2 (2.7%)
0
Region
Rural
19 (25.67%)
22 (31.88%)
0.412
Urban
55 (74.32%)
47 (68.11%)
Kuppuswamy’s
socioeconomic class
Upper (I)
9 (13.04%)
8 (10.81%)
0.029
Upper-middle (II)
38 (55.07%)
49 (66.21%)
Lower-middle (III)
and Upper-lower (IV)
27 (38.37%)
12 (16.21%)
Source of information
about thalassemia
Mass media
14 (16.67%)
9 (11.54%)
0.024
Family/friends
10 (11.9%)
2 (2.56%)
During MBBS study
45 (53.57%)
62 (79.49%)
Healthcare providers
2 (2.38%)
1 (1.28%)
Score on knowledge based
questions
Excellent
17 (22.97%)
25 (36.23%)
0.008
Good
33 (44.59%)
36 (52.17%)
Average and poor
23 (32.43%)
8 (11.59%)
Mean knowledge
score±SD
10.8±1.92
11.73±1.78
0.003
Type of attitude based on
questionnaire
Positive
68 (91.89%)
67 (97.1%)
0.278
Negative
6 (8.1%)
2 (2.9%)
Mean attitude score±SD
6.83±1.87
7.27±1.23
0.097
Figure 1: Comparison of knowledge based scores of
MBBS I year and II-year students towards
thalassemia.
In the knowledge based questionnaire, excellent scores
were obtained by 36.23%, good scores by 52.17% and
average scores by 11.59% students. All but one student
was aware that thalassemia is a hereditary disease.
Although the hereditary nature was known but the
inheritance of thalassemia is not clear as many students
thought that marriage between normal person and
thalassemia minor can result in a thalassemia major child
(group 1 versus group 2: 32.43% versus 24.63%).
Moreover, many felt that marriage between 2 minor
thalassemia individuals was not permissible (group 1
versus group 2: 56.75% versus 60.86%). The details of
responses to various questions based on knowledge and
attitude are depicted in Tables 2 and 3. Comparison of
knowledge based scores of MBBS I year and II-year
students is depicted in Figure 1.
Mean knowledge scores of second year MBBS students
compared to first year MBBS were 11.73±1.78 versus
10.8±1.92, the difference being statistically significant.
There was no effect of age, gender, region or
Kuppuswamy’s socio-economic class on the knowledge
of both the MBBS first and second year students about
thalassemia (Table 4).

Pujani M et al. Int J Res Med Sci. 2017 Oct;5(10):4470-4477
International Journal of Research in Medical Sciences | October 2017 | Vol 5 | Issue 10 Page 4473
Table 2: Comparison of responses on knowledge based questionnaire among MBBS I year and II-year students.
Question
Options
MBBS 1st year response
MBBS 2nd year response
What is the etiology of thalassemia?
Malnutrition
1 (1.35%)
0
Hereditary
73 (98.6%)
69 (100%)
Infection
0
0
Lifestyle
0
0
No response
0
0
Do consanguineous marriages have
any role to play in the incidence of
thalassemia?
Yes
70 (94.5%)
66 (95.65%)
No
3 (4.05%)
3 (4.34%)
No response
1 (1.35%)
0
Should premarital screening for
thalassemia be compulsory in
consanguineous marriages?
Yes
63 (85.1%)
64 (92.75%)
No
6 (8.1%)
5 (7.24%)
No response
5 (6.75%)
0
Can the occurrence of thalassemia be
predicted?
Yes
60 (81.08%)
56 (81.15%)
No
11 (14.86%)
12 (17.39%)
No response
3 (4.05%)
1 (1.44%)
Can thalassemia be diagnosed by a
blood test?
Yes
48 (64.8%)
48 (69.56%)
No
18 (24.32%)
18 (26.08%)
No response
8 (10.81%)
3 (4.34%)
How can we prevent the occurrence
of thalassemia?
Hygiene
2 (2.7%)
0
Premarital isolation
1 (1.35%)
1 (1.44%)
Premarital screening
68 (91.89%)
68 (98.55%)
Dietary
2 (2.7%)
0
No response
2 (2.7%)
0
Is marriage between two persons with
minor thalassemia permissible?
Yes
26 (35.13%)
25 (36.23%)
No
42 (56.75%)
42 (60.86%)
No response
6 (8.10%)
2 (2.89%)
Can thalassemia minor patient, later
on in life develop thalassemia major?
Yes
24 (32.43%)
16 (23.18%)
No
44 (59.45%)
49 (71.01%)
No response
6 (8.10%)
4 (5.79%)
Can marriage between a normal
person and a minor thalassaemic
result in a major thalassemia child?
Yes
24 (32.43%)
17 (24.63%)
No
46 (62.16%)
49 (71.01%)
No response
4 (5.4%)
3 (4.34%)
What is the treatment of major
thalassemia?
Dietary
4 (5.12%)
0
Antibiotics
2 (2.56%)
0
Blood transfusion
61 (78.20%)
67 (97.1%)
Iron therapy
9 (11.53%)
2 (2.89%)
No response
2 (2.56%)
0
Do minor thalassaemic need any
treatment?
Yes
32 (43.24%)
17 (24.63%)
No
37 (50%)
48 (69.56%)
No response
5 (6.75%)
4 (5.79%)
What is the definite treatment for
major thalassemia?
Iron
3 (4%)
2 (2.89%)
Bone marrow transplantation
57 (76%)
55 (79.71%)
Blood transfusion
10 (13.33%)
15 (21.73%)
Iron chelators
1 (1.33%)
0
No response
4 (5.33%)
0
Patients with thalassemia minor are
protected against which parasitic
disease?
Malaria
64 (86.48%)
62 (89.85%)
Dengue
5 (6.75%)
4 (5.79%)
No response
5 (6.75%)
3 (4.34%)
Does splenectomy play a role in β
thalassemia?
Yes
44 (59.45%)
39 (56.52%)
No
18 (24.32%)
14 (20.28%)
No response
12 (16.21%)
16 (23.18%)
Are you aware of types of
thalassemia? Name them.
Yes
34 (45.94%)
55 (79.71%)
No
40 (54.05%)
14 (20.28%)

Pujani M et al. Int J Res Med Sci. 2017 Oct;5(10):4470-4477
International Journal of Research in Medical Sciences | October 2017 | Vol 5 | Issue 10 Page 4474
Table 3: Comparison of responses on attitude based questionnaire among MBBS I year and II-year students.
Question
Options
MBBS 1st year response
MBBS 2nd year response
Are you willing to undergo blood test for
thalassemia screening before marriage?
Yes
63 (85.13%)
61 (88.4%)
No
7 (9.45%)
7 (10.14%)
No response
4 (5.4%)
1 (1.44%)
If you come to know that the person you intend to
marry is suffering from thalassemia minor, would
you still marry him or her?
Yes
46 (62.16%)
40 (57.9%)
No
25 (33.78%)
25 (36.23%)
No response
3 (4.05%)
4 (5.79%)
Would you like to donate blood for a thalassemia
patient?
Yes
70 (94.59%)
60 (86.95%)
No
3 (4.05%)
8 (11.59%)
No response
1 (1.35%)
1 (1.44%)
If there was a major thalassemia patient in your
family, would you like to donate your bone
marrow for transplantation?
Yes
62 (83.78%)
55 (79.71%)
No
8 (10.81%)
13 (18.84%)
No response
4 (5.4%)
1 (1.44%)
Would you like to participate in thalassemia
awareness and prevention programs in the
community?
Yes
67 (90.54%)
62 (89.85%)
No
6 (8.10%)
7 (10.14%)
No response
1 (1.35%)
0 (4.34%)
In your opinion should cord blood banking be
promoted more to have a store of stem cell/bone
marrow?
Yes
68 (91.89%)
64 (92.75%)
No
3 (4.05%)
1 (1.44%)
No response
3 (4.05%)
4 (5.79%)
Should couples who are thalassaemic carriers have
children?
Yes
44 (59.45%)
42 (60.86%)
No
23 (31.08%)
26 (37.68%)
No response
2 (2.70%)
1 (1.44%)
Premarital screening for thalassemia is necessary
for general public?
Yes
66 (89.18%)
61 (88.4%)
No
7 (9.45%)
8 (11.59%)
No response
1 (1.35%)
0
Termination of pregnancy with thalassemia major
is necessary as it not only brings suffering to the
affected child, but it is a burden to the family,
community and country?
Yes
39 (52.7%)
55 (79.71%)
No
27 (36.48%)
13 (18.84%)
No response
3 (4.05%)
1 (1.44%)
Table 4: Effect of various parameters on knowledge about thalassemia among MBBS students.
Parameter
Status
Score
MBBS 1st year (n=74)
P value
MBBS 2nd year (n=69)
P value
Gender
Male
Excellent
8 (18.18%)
0.49
13 (39.39%)
0.48
Good
18 (40.9%)
15 (45.45%)
Average
18 (40.9%)
5 (15.15%)
Female
Excellent
9 (30%)
12 (33.33%)
Good
15 (50%)
21 (58.33%)
Average and poor
6 (20%)
3 (8.33%)
Age
<20 years
Excellent
12 (26.67%)
0.87
5 (20.83%)
0.128
Good
19 (42.22%)
16 (66.66%)
Average
14 (31.11%)
3 (12.5%)
≥20 years
Excellent
6 (20.68%)
20 (44.44%)
Good
13 (44.82%)
20 (44.44%)
Average and poor
10 (34.48%)
5 (11.11%)
Region
Rural
Excellent
4 (21.05%)
0.619
9 (40.90%)
0.705
Good
7 (36.84%)
10 (45.45%)
Average
8 (42.10%)
3 (13.63%)
Urban
Excellent
13 (23.63%)
16 (34.04%)
Good
26 (47.27%)
26 (55.31%)
Average and poor
16 (29.09%)
5 (10.63%)
Kuppuswamy’s
socioeconomic
class
Upper (I)
Excellent
1 (11.11%)
3 (37.5%)
Good
5 (55.55%)
4 (50%)
Average
3 (33.33%)
1 (12.5%)
Upper-middle (II)
Excellent
9 (23.68%)
18 (36.73%)
Good
19 (50%)
27 (55.10%)

Pujani M et al. Int J Res Med Sci. 2017 Oct;5(10):4470-4477
International Journal of Research in Medical Sciences | October 2017 | Vol 5 | Issue 10 Page 4475
Figure 2: Comparison of attitude of MBBS I year and
II-year students towards thalassemia.
On the basis of score obtained on attitude based
questions, most of the students in both the groups had a
positive attitude towards thalassemia (group 1 versus
group 2: 91.89% versus 97.10%). Comparison of Attitude
of MBBS I year and II-year Students towards thalassemia
is shown in Figure 2. However, the difference between
mean attitude scores was not found to be significant
(second year versus first year 7.27±1.23 versus
6.83±1.87).
Various parameters like age, gender, region and socio-
economic class did not have any impact on the attitude of
MBBS students in present study (Table 5). Correlation of
knowledge and attitude scores is shown in Table 6.
Table 5: Effect of various parameters on attitude towards thalassemia among MBBS students.
Table 6: Correlation of knowledge and attitude scores among MBBS first year and second year students.
Status
Attitude
MBBS 1st year (n=74)
MBBS 2nd Year (n=69)
Excellent
Positive
17 (100%)
25 (100%)
Negative
0
0
Good
Positive
31 (93.90%)
34 ((94.44%)
Negative
2 (6.06%0
2 (5.55%)
Average
Positive
19 (82.60%)
8 (100%)
Negative
4 (17.39%)
0
Poor
Positive
1 (100%)
0
Negative
0
0
Average and poor
10 (26.31%)
0.587
4 (8.16%0
0.602
Lower-middle
(III) and
upper-lower (IV)
Excellent
7 (25.92%)
4 (33.33%)
Good
9 (33.33%)
5 (41.66%)
Average
11 (40.74%)
3 (25%)
Parameter
Status
Attitude
MBBS 1st year (n=74)
MBBS 2nd year (n=69)
Gender
Male
Positive
38 (86.36%)
32 (96.96%)
Negative
6 (13.63%%)
1 (3.03%)
Female
Positive
30 (100%)
35 (97.22%)
Negative
0
1 (2.77%)
Region
Rural
Positive
18 (94.73%%)
21 (95.45%)
Negative
1 (5.26%)
1 (4.54%)
Urban
Positive
50 (90.90%)
46 (97.87%)
Negative
5 (9.09%)
1 (2.12%)
Kuppuswamy’s
socioeconomic class
Upper (I)
Positive
7 (77.77%)
7 (87.5%)
Negative
2 (22.2%)
1 (12.5%)
Upper-middle (II)
Positive
37 (97.36%)
48 (97.95%)
Negative
1 (2.63%)
1 (2.04%)
Lower-middle (III) and
upper-lower (IV)
Positive
24 (88.88%)
12 (100%)
Negative
3 (11.11%)
0

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International Journal of Research in Medical Sciences | October 2017 | Vol 5 | Issue 10 Page 4476
DISCUSSION
In the present study, 75.25% (111/143) MBBS students
had good knowledge about thalassemia which was
comparable to study by Chatterjee et al on Indian junior
doctors.10 On the contrary, various other authors in the
literature like Mirza et al (Pakistan; study on young
people), Moghaddam M et al (Iran; study on school
students) and Pausiri et al (Thailand; study on pregnant
women) found much lower values.12-14 While Haque et al
found that almost 90% future health care providers of
Malaysia had good knowledge about thalassemia.6 The
reason for such a disparity could be that knowledge of
general population relies predominantly on mass media,
health care providers, awareness programs etc. while
medical students have an advantage over the rest of the
study population (school children, pregnant women,
general population etc) as thalassemia is taught as part of
MBBS curriculum. Further, differences in the studies
based on medical students could be due to the number of
years spent in the medical field. This was evident in the
present study as the difference in knowledge scores
among first year students and second year MBBS
students was statistically significant. We did not come
across any study in the literature regarding the
comparison of knowledge among MBBS students of
different years.
Almost all the participants in present study were aware of
the hereditary nature of thalassemia, however some were
unclear about the exact nature of inheritance as was
depicted from the responses to specify questions based on
transmission of the disease. Chatterjee et al found out that
85.11% of junior doctors had correct knowledge about
the inherited nature of the disease.10 Murthy et al revealed
66.3% medical students knew about the familial nature of
thalassemia compared with 36.7% of non-medical
students.4
67.13% (96/143) of the MBBS students in the present
study were aware that thalassemia could be diagnosed by
a blood test which is much lower compared to junior
doctors (91%) in study by Chatterjee et al.10
89.51% (128/143) of the MBBS students in the present
study knew that regular blood transfusion was the therapy
for thalassemia. However, 7.6% also opted for iron
therapy as an additional treatment option, possibly
confusing it with iron chelation. Similarly, 93% of the
participants in the study by Chatterjee et al responded
correctly about the treatment.10 However, the knowledge
about treatment was poor as observed by Haque et al.6
95.10% (136/143) of the MBBS students were aware that
occurrence of thalassemia can be prevented through
premarital screening in collaboration with studies by
Chatterjee et al and Mirza et al.10,12
In the present study, there was no effect of age, gender,
region or Kuppuswamy’s socio- economic class on the
knowledge of both the MBBS first and second year
students about thalassemia. This is in accordance with the
study by Murthy et al.4 While Chatterjee et al found a
significant correlation between knowledge, age and
marital status.10 Although in the present study, the female
MBBS students had better knowledge scores, the
difference was not statistically significant, similar to
Chatterjee et al but unlike Haque et al.6,10
In the present study, 94.4% MBBS students had a
positive attitude (135/143) towards thalassemia. The
mean attitude scores of 1st year versus 2nd year MBBS
students were 6.83±1.87 versus 7.27±1.23, although the
difference was not statistically significant. Moreover,
90.2% of the MBBS students were willing to participate
in thalassemia awareness and prevention programs in the
community. This is higher than that observed by several
other authors like Chatterjee et al, Haque et al, Murthy et
al etc.4,6,10 This is a promising observation in present
study as the enthusiasm and positive energies of these
future healthcare providers can be channelized towards
various programs to create awareness in community
regarding thalassemia and its prevention.
Around 89% (127/143) of MBBS students in present
study were in favour of premarital screening being made
mandatory for general public. This is quite similar to a
study by Chatterjee et al and Murthy et al.4,10 In contrast,
Mirza et al observed that only 59.4% of university
students (Pakistan) were of this view point.12
We observed that the knowledge about thalassemia had a
positive influence on the attitude. The students with good
knowledge about thalassemia proportionately displayed a
good attitude as well. This is in accordance with findings
of Chatterjee et al.10 However, on the contrary, Haque et
al concluded that level of knowledge was not directly
proportional to the level of attitude.6
Various parameters like age, gender, region and socio-
economic class did not have any impact on the attitude of
MBBS students in present study. However, in several
other studies some of the parameters correlated with
attitude, like study by Haque et al (age and gender
affected the attitude) and Chatterjee et al (age, marital
status and education correlated with attitude).6,10
90.90% of MBBS students were willing to donate blood
for a thalassemia patient while 81.81% (117/143) were
even willing to donate bone marrow for bone marrow
transplantation of a family member if required. Similar
findings were obtained by Chatterjee et al among junior
doctors.10
The limitation of the present study was the small sample
size. Therefore, large scale multi-centre studies need to
be conducted on knowledge and awareness of medical
students towards thalassemia. This would help in
obtaining important insights towards planning national
strategies for prevention of thalassemia in our country.

Pujani M et al. Int J Res Med Sci. 2017 Oct;5(10):4470-4477
International Journal of Research in Medical Sciences | October 2017 | Vol 5 | Issue 10 Page 4477
CONCLUSION
The study fulfilled the objective to evaluate knowledge
and attitude about thalassemia among MBBS students
and compare the two groups. Majority of the MBBS
students had good knowledge and positive attitude
towards thalassemia. The difference in the mean
knowledge scores was statistically significant between
first and second year MBBS students. The key areas
which we need to focus on are the inheritance pattern of
thalassemia so that these future healthcare providers can
impart correct knowledge to the community and conduct
premarital counseling to allay doubts of the general
public.
To confirm the observations, large scale studies need to
be conducted comprising of different study populations.
Mass media (print, TV and movies) needs to contribute
towards thalassemia awareness as they have a great
impact on the mindset of the youth. Screening for
thalassemia should be made mandatory, as part of
medical examination, at entry to a medical college so that
the medical college students are aware and can spread
awareness about it. In a phased manner, it can then be
extrapolated to all other colleges and universities and
ultimately to the entire population.
Funding: No funding sources
Conflict of interest: None declared
Ethical approval: The study was approved by the
Institutional Ethics Committee
REFERENCES
1. World Health Organization. Guidelines for the
Control of Haemoglobin Disorders: Report of the 6th
Annual Meeting of the WHO Working Group on
Haemoglobinopathies, Cagliari, Sardinia, 8-9 April.
Geneva, Switzerland: WHO; 1989. p. 2. Available
at http://www.apps.who.int/iris/
bitstream/10665/66665/1/WHO_HDP_HB_GL_94.
1.pdf.
2. Bashyam MD, Bashyam L, Savithri GR,
Gopikrishna M, Sangal V, Devi AR. Molecular
genetic analyses of beta-thalassemia in South India
reveals rare mutations in the beta-globin gene. J
Hum Genet. 2004;49:408-13.
3. Mohanty D, Colah RB, Gorakshakar AC, Patel RZ,
Master DC, Mahanta J, et al. Prevalence of ß-
thalassemia and other haemoglobinopathies in six
cities in India: A multicentre study. J Community
Genet. 2013;4:33-42.
4. Vasudeva Murthy CR, Asraf Bin Zulkeflle MZ,
Venkateswaran SP, Barua A. Knowledge,
Awareness and participation of medical and non-
medical students in the Malaysia national
thalassemia prevention programme. Int J Hum
Genet. 2015;15(2):61-72.
5. Naveed S, Dilshad H, Hashmi F, Khan A,
Salahuddin N. Awareness about thalassemia: a
survey report. Mintage J Pharmace Med Sci.
2014;3(2):18-19.
6. Haque ATME, Puteh FA, Osman NL, Mohd Zain
ZA, Haque M. Thalassaemia: level of awareness
among the future health care providers of Malaysia.
J Chemical Pharmace Res. 2015;7(2):896-902.
7. Basu M. A study on knowledge, attitude and
practice about thalassemia among general
population in outpatient department at a tertiary care
hospital of Kolkata. J Preventive Med Holistic
Health. 2015;1(1):6-13.
8. Behera SK, Panja S, Adak DK. Thalassemia control
by awareness: a study among the educated
Bengalese populations of South 24 parganas district,
West Bengal, India. Int J Ind Psychol.
2016;3(2):156-65.
9. Goyal JP, Hpapani PT, Gagiya H. Awareness
among parents of children with thalassemia major
from Western India. Int J Med Sci Public Health.
2015;4:1356-9.
10. Chatterjee S, Mondal TK, Ahamed A, Sarkar I,
Sarkar K, Shahbabu B, et al. Knowledge, attitude,
and practice of budding doctors in prevention of
thalassemia. Int J Prevent Public Health Sci.
2016;2(4):18-24.
11. Kohli C, Kishore J, Kumar N. Kuppuswamy’s
socioeconomic scale-update for July 2015. Int J
Preven Curat Comm Med. 2015;1(2):26-8.
12. Mirza A, Ghani A, Pal A, Sami A, Hannan S,
Ashraf Z, et al. Thalassemia and premarital
screening: Potential for implementation of a
screening program among young people in Pakistan.
Hemoglobin. 2013;37:160-70.
13. Miri-Moghaddam E, Motaharitabar E, Erfannia L,
Dashipour A, Houshvar M. High school knowledge
and attitudes towards thalassemia in Southeastern
Iran. Int J Hematol Oncol Stem Cell Res. 2014;8:24-
30.
14. Pauisri S, Saksiriwuttho P, Ratanasiri T. Knowledge
and attitude of pregnant women at risk for having a
fetus with severe thalassemia after genetic
counselling at Srinagar hospital. Thai J Obstet
Gynaecol. 2011;19:193-9.
Cite this article as: Pujani M, Chauhan V, Agarwal
C, Rana D, Singh K, Dixit S. Knowledge and attitude
among Indian medical students towards thalassemia:
a study in Delhi NCR. Int J Res Med Sci
2017;5:4470-7.