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© 2024 Journal of Education and Health Promotion | Published by Wolters Kluwer - Medknow 1
Knowledge-related iron deciency
anemia among undergraduate nursing
female students in the University of
Baghdad
Massara A. Najm, Ali Hussein Alek Al-Ganmi, Ahmed Fleih Hassan
Abstract:
BACKGROUND: Globally, iron deciency anemia is a problematic nutritional deciency health-
related issue that impacts early-adulthood people such as university students. The aim was to asses
female nursing students’ knowledge concerning iron deciency anemia in the College of Nursing,
University of Baghdad.
MATERIALS AND METHODS: A cross-sectional survey was carried out from the period of June 18,
2023 to December 20, 2023. Nonprobability (purposive) samples of 100 female nursing students were
selected from the second, third, and fourth stages in the College of Nursing, University of Baghdad.
Data collection included students’ sociodemographic characteristics, and students’ knowledge
questionnaire consists of “20” constructed questions, which included the students’ knowledge about
iron deciency. The knowledge questionnaire has been developed through reading textbooks and
review of the literature for the related topic. The data have been analyzed through the application of
descriptive and inferential analysis and using SPSS version 26.
RESULTS: The nding of the study revealed that the level of female students’ knowledge regarding
iron deciency anemia based on the total mean score of M(SD) = 1.33 (0.39) showed a poor level.
Also, there is a signicant association between students’ age and academic stage with their level of
knowledge of iron deciency anemia, P = 0.028.
CONCLUSION: The female nursing students at the University of Baghdad had a poor level of
knowledge about iron deciency anemia, and this can be attributed to their academic stage in the
College of Nursing. There is a signicant association between students’ age and academic stage
with their iron deciency anemia knowledge. Faculty of nursing should increase female students’
health awareness and their understanding, knowledge, motivation, and perception regarding iron
deciency and how to prevent it.
Keywords:
Iron deciency anemia, knowledge, undergraduate nursing students
Introduction
Worldwide, anemia due to iron deciency
is the most common hematologic
disorder.[1] Anemia is a global public health
problem impacting over 1.62 billion people
globally, accounting for approximately 25%
of the global population.[2]
A recent study from Saudi Arabia stated
that the majority of female Saudi students
who attended colleges have anemia. Iron
deciency anemia is common, indicating
that these students get this sickness very
often with a prevalence ranging from 20%
to 39.9%.[3] According to the World Bank’s
report, 38% of pregnant women in Iraq were
estimated to have anemia.[4] A recent cross-
sectional study conducted in Iraq stated that
Department of Adult
Nursing, College of
Nursing, University of
Baghdad, Baghdad, Iraq
Original Article
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DOI:
10.4103/jehp.jehp_422_24
How to cite this article: Najm MA, Al-Ganmi AH,
Hassan AF. Knowledge-related iron deciency
anemia among undergraduate nursing female
students in the University of Baghdad. J Edu Health
Promot 2024;13:498.
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Address for
correspondence:
Dr. Ali Hussein Alek
Al-Ganmi,
Department of Adult
Nursing, College of
Nursing, University of
Baghdad, Baghdad, Iraq.
E-mail: ali.h@conursing.
uobaghdad.edu.iq
Received: 04-03-2024
Accepted: 09-05-2024
Published: 28-12-2024
Najm, et al.: Undergraduate nursing student knowledge about Iron deciency anemia
2 Journal of Education and Health Promotion | Volume 13 | December 2024
anemia affects 56% of the female population.[5] A lack of
iron can have a number of negative effects on the adults
since iron is essential for the delivery of oxygen to tissues
and the elimination of carbon dioxide.[6] In Iraq, anemia
poses a serious challenge to public health, necessitating
more government intervention in the form of targeted
health education campaigns.[7]
Iron deciency anemia is the most prevalent nutritional
illness around the world, affecting women and girls of
reproductive age of the increased iron requirements
associated with pregnancy and menstruation, particularly
in those who have heavy menstrual bleeding.[8] Iron is
one of the important minerals in the human body,
and it has a major role in the process of transporting
oxygen from the lungs to all parts of the body by means
of hemoglobin, which is found in red blood cells, and
constitutes two-thirds of the source of iron within the
body. Hence, iron deciency affects the various functions
of the body, starting from brain functions and the end
of the immune system and its ability to ght infection.[9]
Often, anemia is the presenting sign of a more serious
underlying condition which if left untreated can generate
consequent morbidity. It is crucial for women, especially
those who are young, to have knowledge about anemia
and related information on the signicance of nutrition
and self-efcacy to enhance their awareness about the
disease.[10]
Knowledge decit can lead to unfavorable or negative
attitudes and behaviors among females, which can
be reected in unhealthy eating habits in day-to-day
life, making it one of the risk factors for anemia.[11] A
recent descriptive study conducted in 2023 found that
92.9% of young women with anemia in Yemen have
knowledge decit regarding iron deciency.[12] Another
community-based study conducted in Pakistan among
medical female students indicated that 52% of them
were having adequate knowledge on iron deciency
anemia.[13] Nonetheless, there have been limited studies
regarding nursing student knowledge on iron deciency
anemia in Iraq, specically focused on female students
who are in the stages of physiological, nutritional, and
behavioral changes that may directly affect their health.
To our knowledge, there are no studies that have been
conducted in Iraq to assess the knowledge of iron
deciency anemia among university students despite
the high prevalence. Hence, this study aimed to assess
knowledge about iron deciency anemia among female
nursing students in Baghdad City, Iraq.
Materials and Methods
Study design and setting
A descriptive cross-sectional survey design to assess
knowledge about iron deciency anemia among female
students who are attending the College of Nursing,
University of Baghdad, Iraq, between June and December
2023.
Study participants and sampling
A nonprobability (purposive) sampling of 100 female
students in the second, third, and fourth stages who
are attending the College of Nursing, University of
Baghdad, was conducted. Participants aged 18 years
old and above and those who wished to take part in the
study were included after accepting and signing the
informed consent form. The study excluded those who
cannot communicate or comprehend due to any medical
illnesses and who refused to participate and sign the
informed consent.
Data collection tools and technique
A structured paper-based self-report questionnaire
was used for data collection and administered via an
interviewing technique by the researchers/interviewers.
All survey questionnaires were completed through face-
to-face interviews. The questionnaire was designed,
developed, and constructed by researchers after reviewing
the related literature. The questionnaire was written in
simple Arabic language and contained two parts. The
first part included participants’ sociodemographic
characteristics such as age, marital status, level of
education, family history of anemia, housing, and
sources of information. Part 2 included the female
students’ knowledge about iron deciency anemia. The
content validity of the instrument format is established
through the jury opinion of the panel of experts in the
nursing field who were the faculty members in the
College of Nursing, University of Baghdad. They were
asked to review the questionnaire and whether they were
multiple choice questions (20 items). The questionnaire
consisted of 20 questions divided into two levels,
scored as (correct = 2, wrong = 1). A scoring system was
followed to assess knowledge of female students about
iron deciency anemia. The questionnaire contained 20
points and categorized into two level as follows. Each
correct answer was given 2 points, and the incorrect
answers were given 1 point. It was considered that ≥50%
(21:40 grades) indicated a satisfactory level of knowledge.
<50% (1:20 grades) indicated an unsatisfactory level of
knowledge. The self-report of the questionnaire and
interview took approximately 10–15 minutes for each
nurse. A 0.5 level of signicance was used as a standard
to determine if there was a signicant difference in the
student’s knowledge according to age, marital status,
level of education, family history of the student, housing,
and sources of information.
Ethical considerations
Data collection was started after getting approval from
the University of Baghdad, College of Nursing authority,
Najm, et al.: Undergraduate nursing student knowledge about Iron deciency anemia
Journal of Education and Health Promotion | Volume 13 | December 2024 3
and ethical approval was obtained from the Scientic
Research Ethical Committee of College of Nursing
authority, University of Baghdad, before starting the
study. In addition, oral approval was obtained from
each participant who agreed to share in this study.
Prior to data collection, participants were asked to sign
an informed consent form, indicating that they have
been informed about the study, its objectives, and their
rights to refuse or accept participation. Condentiality
of the participants’ information was respected, and
only the researchers and the ethics committees have
the right to access the data and reported as group data.
The questionnaire was anonymous, and the data were
analyzed groupwise, so there was no link between results
of this study and any of the individual participants. The
privacy of the respondents was maintained by preparing
and setting the place and time for data collection. Ethics,
values, cultural backgrounds, and beliefs were respected.
Data analysis
Data were analyzed through the use of the Statistical
Package of Social Sciences (SPSS) version 26.0.
Sociodemographic data were analyzed descriptively and
continuous data were presented as means and standard
deviation. The value of P < 0.05 was taken as statistically
signicant. Data were categorized, scored, tabulated,
and analyzed using the appropriate statistical methods.
Descriptive statistics was utilized, with frequencies,
means, standard deviations, and test of signicances.
Quantitative data were expressed as means and standard
deviations. Chi-square (χ2) test of signicance was used in
order to compare proportions between study variables.
A pilot study was conducted including ve older adults
within the inclusion criteria to check for clarity of the
questionnaire and time required. It was concluded that
no major changes were required in the questionnaire and
the participants were able to answer the questionnaire
without any major difculties. Data from the pilot study
were not included in the nal analysis.
Results
Table 1 shows that 75% of the study participants were
within the age ranging between 19 and 21 years, 93%
were unmarried, 40% were in the fourth stage, and
40% of them have family history of iron deciency. The
majority of students lived in the city of Baghdad, and
87% of them acquired their information from the Internet.
Table 2 shows that the level of students’ knowledge
regarding iron deciency was poor in most students’
knowledge items with the total mean score of M(SD) =
1.33 (0.39).
Table 3 indicates that there is a signicant association
between both students’ age and their academic stage
with their knowledge at P values of 0.028 and 0.029,
respectively. The study finding also revealed no
signicant association between participants’ age, family
history of iron deciency, housing, and information of
iron deciency and their knowledge at P value < 0.05.
Discussion
Throughout the period of analyzing the data of the
current study, the results showed that 75% of the study
participants were young. These ndings agreed with a
study reporting that the majority of participants were
between 20 and 26 years of age.[14] Another study from
Kuwait indicated that 55.7% of females were single and
had a signicant relationship with their knowledge
regarding iron deciency anemia.[15] Furthermore, the
current study reported that almost half of the female
students have a family history of iron deciency anemia.
This result is consistent with the results of AlSheikh[16]
ndings among university students from Saudi Arabia,
indicating that 45% of them have a family history of iron
deciency anemia. Moreover, the majority of female
students lived in the city capital. This nding agrees
with a descriptive study conducted in Egypt among
female nursing students, which found that 98.8% of these
students lived in city areas.[17]
The current study reported that the majority of students
have a poor and fair level of knowledge regarding iron
deciency anemia. Recent research revealed a similar
result that the majority of the medical students have
inadequate knowledge on anemia such as iron deciency
anemia and were unable to constantly update their
Table 1: Sociodemographic characteristics of the
female students
Student characteristics Frequency Percentage
Age (year)
19-21 75 75.0
22-24 25 25.0
Marital status
Single 93 93.0
Married 77.0
Academic stage
second stage 30 30.0
third stage 30 30.0
fourth stage 40 40.0
Family history
Yes 40 40.0
No 60 60.0
Residence
Urban 91 91.0
Rural 9 9.0
Information
Internet/social media 78 78.0
University 16 16.0
Other sources 6 6.0
Najm, et al.: Undergraduate nursing student knowledge about Iron deciency anemia
4 Journal of Education and Health Promotion | Volume 13 | December 2024
knowledge (P < 0.001).[18] A prospective, cross-sectional
study by Patharkar et al.[19] among undergraduate
medical students showed that they have a lack of
basic knowledge about anemia. On the other hand,
an opposite result of a cross-sectional study indicated
that nearly almost undergraduate medical students
from Chennai were knowledgeable about anemia.[20] A
Jordanian quasiexperimental study conducted among
young female students found that 52.4% of them have
adequate knowledge about iron deciency anemia due
to their engagement in healthy practice with a positive
attitude toward the disease.[21] The prevalence of anemia
is signicant among all ages, which are conrmed by
the available evidence, and future nurses having lack
of knowledge will be considered as an unmet medical
need.[22] The knowledge decit regarding iron deciency
anemia among nursing students in this study might be
attributed to the lack of a number of anemia courses
and disorganizing hospital-related training programs
on anemia in the government hospitals such as in-
service training programs at regular intervals after
graduation.[23]
The study results showed that there is a signicant
association between age of nursing female students
and their knowledge regarding iron deciency anemia.
This nding supported by Saudi cross-sectional study
performed among 450 adult female university students
revealed a signicant association between participants’
age and their level of knowledge concerning iron
deficiency anemia (P = 0.001).[24] A previous study
from Iraq reported that younger students were more
knowledgeable about premenstrual syndrome, which
indicate that age was significant factor for having
knowledge.[25] The authors suggested that younger
people have a high level of awareness about the iron
deciency anemia compared to older individuals. This
can be implied by the fact that single female students
have not experienced the physiological changes of
being old with the fact that their nutritional need also
changed. Younger students have more ability to adopt
knowledge and behaviors that protect them against
psychological and physical threats.[26] Hence, with their
experiences having iron deciency anemia, they acquired
the knowledge by the medical personnel and their peers
with the same diagnosed disease. Moreover, the study
results were consistent with other study ndings, which
revealed that the academic stage of undergraduate
nursing students was significantly associated with
their knowledge regarding iron deficiency anemia
(P < 0.001).[27-28] For example, students at 1st stage in the
college had experienced psychological problems, which
Table 2: Level of student knowledge concerning of iron deciency
Items Correct
answer
Incorrect
answer
Mean SD Ass.
What is the role of iron in the body 298 1.02 0.141 Poor
The normal level of iron in the blood 71 29 1.71 0.456 Good
The recommended amount of iron for adult women aged (19–50) years 66 34 1.66 0.476 Fair
Where is iron stored in the body 41 59 1.41 0.494 Fair
People most at risk of iron deciency 20 80 1.20 0.402 Poor
Which of the following foods does not contain iron 15 85 1.15 0.359 Poor
One of the following vitamins increases iron absorption 44 56 1.44 0.499 Fair
Foods that an iron-decient person should avoid 12 88 1.12 0.327 Poor
The causes of iron deciency anemia 18 82 1.18 0.386 Poor
Iron deciency affects sleep as it causes some complication 62 38 1.62 0.488 Fair
One of the following is not an iron deciency 17 83 1.17 0.378 Poor
One of the following tests diagnoses iron deciencies in the body 9 91 1.09 0.288 Poor
Blood transfusion help in chronic cases of iron deciency treatment or anemia in the body 12 88 1.12 0.327 Poor
What is recommended for patients with iron deciency 85 15 1.85 0.359 Good
The right time to take iron pills 64 36 1.64 0.482 Fair
One of the following helps to raise the level of iron in the body 14 86 1.14 0.349 Poor
The period of time for the iron level in the body to return to the normal limit after taking the treatment 26 74 1.26 0.441 Poor
Anemia is caused by iron deciency, which in turn can lead to some complication 18 82 1.18 0.386 Poor
One of the potential complications of iron deciency for pregnant women 82 18 1.82 0.386 Good
Total mean of score 707 1239 1.33 0.39 poor
M.S=Mean of score, SD=Standard deviations, Level of Knowledge = (1-1.33=poor, 1.34-1.66=fair, 1.67-2=good)
Table 3: Association between students’
sociodemographic characteristics and their
knowledge
Sociodemographic variables Chi‑square PSignicant
Age 24.331 0.493 0.028*
Marital Status 11.734a0.343 0.550
Academic stage 41.322a0.643 0.029*
Family history 17.071a0.413 0.196
Housing 10.285a0.321 0.670
Previous students’ information
on iron deciency anemia
34.071a0.584 0.694
*P<0.001
Najm, et al.: Undergraduate nursing student knowledge about Iron deciency anemia
Journal of Education and Health Promotion | Volume 13 | December 2024 5
might interrupt their study activities and might impact
their knowledge gaining.[29] These results demonstrated
that the differences were most likely caused by the
students’ general exposure to educational materials
and the amount of coursework they completed during
their studies in health science. However, the students’
individual learning styles, access to learning resources,
and hands-on experiences with the specic health issue
could also have an impact.
Conclusion
The current study highlighted crucial results, that is,
nursing female students were unknowledgeable about
iron deficiency anemia. An association was found
between the student level of knowledge about iron
deciency anemia and their age and academic stage.
The College of Nursing in the University of Baghdad
needs to implement regular orientation lectures between
courses among female nursing students for better
understanding of iron deficiency, which enhances
their health awareness, knowledge, motivation, and
perception.
Ethics approval and consent to participate
The College of Nursing Ethics Committee approval
and written informed consent were obtained from all
the participants before the conduct of study-related
procedure.
Patient consent for publication
Written informed consent was obtained from the
students for the publication of the present study and
any related information.
Financial support and sponsorship
Nil.
Conicts of interest
There are no conicts of interest.
References
1. Stahl-Gugger A, de Godoi Rezende Costa Molino C, Wieczorek M,
Chocano-Bedoya PO, Abderhalden LA, Schaer DJ, et al. Prevalence
and incidence of iron deficiency in European community-
dwelling older adults: An observational analysis of the DO-
HEALTH trial. Aging Clin Exp Res 2022;34:2205-15.
2. Alzaheb RA, Al-Amer O. The prevalence of iron deficiency
anemia and its associated risk factors among a sample of female
university students in Tabuk, Saudi Arabia. Clin Med Insights
Womens Health 2017;10:1179562X17745088.
3. Almasmoum HA, Iqbal MS, Aljaadi A, Ghafouri K, Qasem AH,
Azhar W, et al. Prevalence of undiagnosed iron deciency anemia
and associated factors among female undergraduate medical
students in Makkah, Saudi Arabia. Cureus 2023;15:e50046.
4. World Bank. Prevalence of Anemia among pregnant women, Iraq.
Available from: https://data.worldbank.org/indicator/SH.PRG.
ANEM?locations=IQ. [Last accessed on 2023 Jul 11].
5. Abdulraheem AL, Rashid MY, Faraj RK, Darwish RQ,
Amin GSH, Muhialdin AJ, et al. Evaluation of prevalence and
severity of anemia among non-pregnant women of reproductive
age in Garmian province, Iraqi Kurdistan region. Iraqi J Sci
2023;64:5000-10.
6. Chaudhry G-e-S, Akim AM, Sung YY, Sifzizul TMT. Iron
deciency amongst university graduate; prevalence, diagnosis,
and iron consumption. Arch Pharm Pract 2023;14:44-50.
7. Hussain AM, Hussain NA. Prevalence of anaemia in a sample
of pregnant women in Babylon Governorate, Iraq. Revista
Latinoamericana de Hipertension, 2020;15:275-9.
8. MacLean B, Sholzberg M, Weyand AC, Lim J, Tang G, Richards T.
Identication of women and girls with iron deciency in the
reproductive years. Int J Gynecol Obstetr 2023;162:58-67.
9. Roth DE, Abrams SA, Aloia J, Bergeron G, Bourassa MW,
Brown KH, et al. Global prevalence and disease burden of vitamin
D deciency: A roadmap for action in low- and middle-income
countries. Ann N Y Acad Sci 2018;1430:44-79.
10. Sudirman J, Rosdianah R, Anjani QK, Wangi K, Iskandar AM,
Bachri N. Increasing knowledge, self-efcacy and hemoglobin
levels in pre-conception women through nutrition assistance
program. Al-Sihah Public Health Sci J 2023;15:33-43.
11. Huong C, Chua JL, Ng RY, Panse DK, Misra S, Sumera A.
Knowledge, attitude and practices (KAP) towards anaemia among
female university students in Malaysia: A cross-sectional survey.
Mal J Nutr 2022;28:203-15.
12. Al-Rabeei NA, Al-Khuleidy SA, Abo taleb, A-u-Y, Ghalb, SM.
Knowledge, attitudes and practices of pregnant women regarding
iron deciency anemia, Sana’a-Yemen. Al-Razi Uni J Med Sci
2023;7:156.
13. Khan I, Ghulam M, Gul S, Khan MAY, Ullah N, Idrees T, et al.
Knowledge of health hazards of iron deciency anemia amongst
those women of higher education (above F. Sc) and those women
of lower education (below F. Sc) in Hayatabad, Peshawar.
J Biomed Sci 2022;4. doi: 10.38125/OAJBS.000520.
14. Mahdi SM, Khairi SH. Effectiveness of an educational program
on female students’ practices toward premenstrual syndrome at
secondary schools in third Al-Rusafa education directorate. Iraqi
National Journal of Nursing Specialties 2022;34:39-58.
15. Al-Sejari MM. Anemia and its main risk factors: A sociocultural
study of a sample of Kuwaiti University students. Annals of Arts
and Social Sciences/Hawliyyat Kulliyyat al-adab 2020;41:5.
16. AlSheikh MH. Prevalence and risk factors of iron-deciency
anemia in Saudi female medical students. Saudi J Health Sci
2018:7:148-52.
17. Ali RMA, AbdEl-Aziz NA, Sayed SA. Life style of female students
nurses with iron deciency anemia. Egyptian J Health Care
2022;13:982-96.
18. Kuş C, Çakar E, Gümüştakim RŞ. Evaluation of the knowledge
and awareness of anemia in medical faculty students and family
physicians. (in en). Kahramanmaraş Sütçü İmam Üniversitesi Tıp
Fakültesi Dergisi 2022;17:140-8.
19. Patharkar J, Sattigeri B, Amane H, Brahmbhatt S. Comparative
study to evaluate the awareness about anemia and its
complications, among undergraduate and post-graduate medical
students - A cross sectional survey study. Int J Res Med Sci
2016;4:2692.
20. Malay KK, Duraisamy R, Mp B, Kumar MPS. Awareness
regarding anemia among 1st year dental undergraduate students.
Drug Inven Today 2018;10:1463-7.
21. Abu-Baker NN, Eyadat AM, Khamaiseh AM. The impact
of nutrition education on knowledge, attitude, and practice
regarding iron deficiency anemia among female adolescent
students in Jordan. Heliyon 2021;7:e06348.
22. Shander A, Goodnough LT, Javidroozi M, Auerbach M, Carson J,
Ershler WB, et al. Iron deciency anemia—bridging the knowledge
and practice gap. Transfus Med Rev 2014;28:156-66.
Najm, et al.: Undergraduate nursing student knowledge about Iron deciency anemia
6 Journal of Education and Health Promotion | Volume 13 | December 2024
23. Natour N, Al Tell M, Shakhshir M. Knowledge on anemia
causes and associated risks improve with education and better
socioeconomic standards among students of medicine, pharmacy,
nursing and other allied health professions in Palestinian
territories; 2022. doi: 10.21203/rs.3.rs-1442578/v1.
24. Mohammad SM, Algahtni, MS, Alsharif AA, Alshehri RH,
Ghali KNB, Al-Almaei HMF, et al. Awareness of iron deciency
anemia among the adult population in Riyadh, Saudi Arabia.
International Journal of Medicine in Developing Countries.
2020;4:2259-66.
25. Mansoor S and Khairi S., "Effectiveness of an Educational Program
on Female Students’ Knowledge toward Premenstrual Syndrome
in Secondary Schools in Third Al- Rusafa Education Directorate,
Iraq," Iraqi National Journal of Nursing Specialties 2020;33:66-75.
26. Shubib H, Muhammad Q. Q. Effectiveness of Education Program
on High School Males Students’ Knowledge about Smoking. Iraqi
National Journal of Nursing Specialties 2023;36:99-107.
27. Lock YS. Evaluation of knowledge and attitude related to anemia
among female utar undergraduate students: A cross-sectional
study. UTAR; 2023. Available from: http://eprints.utar.edu.my/
id/eprint/6156.
28. Alkasab HE, Aziz AR. Assessment of dietary habits for
adolescent girls diagnosed with iron deciency anemia in Kirkuk
secondary schools. Iraqi National Journal of Nursing Specialties
2023; 36:137-49.
29. Ibrahim M, Hasan R, Fadhil S. Assessment of Levels of
premenstrual psychological and physical Problems (Premenstrual
Syndrome-PMS) of Students of the Colleges of Bab Al-Mua’dham
Complex/ University of Baghdad. Iraqi National Journal of
Nursing Specialties 2017;30:25-34.