Mediterranean Journal of Pharmacy & Pharmaceutical Sciences
www.medjpps.com ISSN: 2789-1895 online ISSN: 2958-3101 print
Original article
Knowledge, attitude and practice of Libyan medical students
about vitamin D deficiency
Mustafa A. Alssageer1* , Naser M. Alaasswad2 , Amna I. Jebril1, Hajir A. Ahmed1 and Roqaia S. Almahdi1
1
Department of Pharmaceutical care, Faculty of Pharmacy, Sebha University, Sebha, Libya
2
Department of Clinical Biochemistry, Faculty of Medical Technology, Sebha University, Sebha, Libya
*
Author to whom correspondence should be addressed
Received: 09-09-2022, Revised: 22-09-2022, Accepted: 27-09-2022, Published: 30-09-2022
Copyright © 2022 Alssageer et al. This is an open access article distributed under the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
HOW TO CITE THIS
Alssageer et al. (2022) Knowledge, attitude and practice of Libyan medical students about vitamin D deficiency.
Mediterr J Pharm Pharm Sci. 2 (3): 46 - 56. https://doi.org/10.5281/zenodo.7115292
Keywords: Attitude, knowledge, Libya, medical student, vitamin D deficiency
Abstract: The prevalence rate of vitamin D deficiency over the last decades has grown up rapidly worldwide
among young adults. Therefore, the aim of this study is to explore knowledge, attitude and practice of Libyan
medical students of Sebha University regarding vitamin D deficiency. Out of a total of 200 questionnaires,
148 completed questionnaires were returned (74.0% response rate). The majority of respondents did not
measure their vitamin D levels (62.1%). Participants who indicated they exposing to sunlight for less than 15
min were 47.2% while 74.9% exposing to less than 30 min with highly significant difference in gender (p <
0.001). All the males did not use sunscreen creams compared with females (43.5%). Nearly two-thirds of the
participants (61.4%) denied drink milk almost daily with significant differences based on the gender (p <
0.005) while 56.0 % of the participants reported eat fish, 60.8% of the students denied eating fast food and
74.3% eating eggs daily or weekly. However, 49.3% of the students are usually drinking of tea and coffee
after meals, and do not usually practice exercise (53.3%), however, disagreed that their food has a low amount
of calcium (30.4%). Most of the students agreed with the benefits of vitamin D (72.0%). Based on the
assessment of awareness of the participants about vitamin D information, the average of correct answers
percentage of the respondents was 47.1%. The most frequent sources of vitamin D information were the
internet which accounted for 49.3%, followed by relatives and friends (31.7%). Some of the respondents
(58.7%) reported that unawareness is the main cause of vitamin D deficiency. This study highlights the lack
of awareness about the importance of vitamin D among medical students. This finding provides the institutions
of medical education in Libya with an evidence base for a deficit knowledge regarding young health which
could be utilized it to draw a strategy to correct health behaviors of students and community through medical
education programs.
Introduction Vitamin D is unique because it can be made in the
skin from exposure to the sunlight [2]. Deficiency
Vitamin D is essential for intestinal calcium
of vitamin D, or hypovitaminosis most commonly
absorption and it plays a central role in maintaining
occurs in people when they have inadequate
calcium homeostasis and skeletal integrity [1].
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Mediterranean Journal of Pharmacy & Pharmaceutical Sciences
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sunlight exposure (particular sunlight with awareness, knowledge, attitude and practice of
adequate ultraviolet B rays, UVB, and reducing in healthy medical students toward vitamin D
taking of foods with rich in vitamin D [3, 4]. deficiency in Libya.
Vitamin D deficiency has several complications
which they associate with increases in mortality Materials and methods
and adverse effects such as cardiovascular This is a cross-sectional study designed to
diseases, type 2 diabetes mellitus, obesity, determine vitamin D status among healthy young
metabolic syndrome, immune disorders and medical students at Sebha University, Sebha,
various types of cancer and mortality [5 - 7]. Libya. It was carried out between January and
Individuals such as the elderly may have a high risk April, 2020. All the medical students attending
of vitamin D deficiency since they have concurrent Sebha medical school were asked to participate
other factors related to vitamin D deficiency,
voluntarily in the study (n = 200). The
including decreased sunlight exposure, reduced questionnaire was based on previous studies [13 -
intake of vitamin D in diet and decreased vitamin 15]. The survey contained 34 item questions that
D absorption from sunlight due to decreasing in required varied response types. Most of the
their skin thickness [8]. However, the prevalence questions required specific categorical answers but
rate of hypovitaminosis D is not restricted to the some questions included other box to allow for
elderly and hospitalized population. Modernization
more expressive answers. The questionnaire was
has also brought the changes in the lifestyle and translated to Arabic language form in order to
food habits of the young generation which may clearly express for the participants. Verbal and
contribute to low dietary intake of vitamin D. The written explanation of the study was provided
prevalence rate of vitamin D deficiency has grown when needed to the students for more detail
up rapidly worldwide in adults during the past expression. All the students were informed about
decades [9, 10]. In addition, some studies have the study and were required to read informative
reported a high prevalence rate of vitamin D brochure to explain the purpose of the survey and
deficiency among healthy, young adults [9 - 11]. the research. The investigator requested
Thus, in a Boston study, nearly two thirds of participant's verbal and written consent. They have
healthy, young adults were found to be vitamin D also been informed that the questionnaire was
insufficient at the end of winter [11]. anonymous and should be deposited in a box
In Libya due to modernization and sudden rise in located in front of the classroom, in order to
temperature, the numbers of hours spent outdoors guarantee confidentiality. An ethics approval
have been decreased and sedentary way of working action for the study was obtained from the Sebha
is most appreciated among urban people. Among University Research Ethics Committee (2/2020).
Libyan population including young students may Statistical analysis: All analysis were carried out
have a high risk of vitamin D deficiency. Recently, by using Microsoft Office excel 2013 and SPSS
Alaasswad and others examined vitamin D status statistical package the generated data presented
among pharmacy students of Sebha University into percentage, variant increase and decrease,
which conducted concurrent with this study and mean and standard deviations were calculated.
some participant involved in this study [12]. The Paired t-test was used to compare between the
majority of pharmacy students in male and female individual groups. A probability value of less than
blood donors have low vitamin D levels which 0.05 was considered as a level of significance
represent 87.0% [12]. Inadequate awareness
difference.
regarding vitamin D deficiency or non-adherence
to the daily practice of the acquired knowledge or Results
inappropriate exposure to the sun may also be the
influential causes of deficiency of vitamin D. In this study, the questionnaires were handed to all
Therefore, this study was undertaken to explore the students who attended first years of pharmacy,
Alssageer et al. (2022) Mediterr J Pharm Pharm Sci. 2(3): 46-56. 46-56
Mediterranean Journal of Pharmacy & Pharmaceutical Sciences
www.medjpps.com ISSN: 2789-1895 online ISSN: 2958-3101 print
medicine and dentistry faculties. The returned proportion of the participants reported that bone
questionnaires were 148 out of 200 which weakness is their family history (males: 29.1% and
represents a response rate of 74.0% with notably females: 45.1%). 62.1% did not measure their
more females than males, 83.7%, 16.3%, vitamin D levels compared with 35.1% who
respectively. The majority of participants were declared did. Only 02.7% did not answer the
female and aged between 18 and 20 years old question. An equal rate of male and female students
accounted for 96.6%. Most of the participants who reported did not measure their vitamin D
denied to have diabetes mellitus (97.2%). A great levels, 62.5% and 62.4%, respectively.
Table 1: Data about responses of the medical students for factors related to vitamin D
Drinking of milk Chi-square
Yes No Total P - value
Male 12 (50.0%) 12 (50.0%) 0 024
Female 45 (36.2%) 79 (63.7%) 0 124 0.209
Total 57 (38.5%) 91 (61.4%) 0 148
Using sunscreen cream
Male 00 (00.0%) 24 (100%) 0 024
Female 54 (43.5%) 70 (56.4%) 0 124 0.000
Total 54 (36.4%) 94 (63.5%) 0 148
Eating fast foods
Male 11 (45.8%) 13 (54.1%) 00 (00.0%) 024
Female 45 (36.2%) 77 (62.0%) 02 (01.6%) 124 0.327
Total 56 (37.8%) 90 (60.8%) 02 (01.3%) 148
Eating fish
Male 16 (66.6%) 07 (29.1%) 1 024
Female 67 (54.0%) 05 (04.0%) 0 124 0.459
Total 83 (56.0%) 64 (43.2%) 1 148
Eating eggs daily or weekly
Male 22 (91.6%) 02 (08.3%) 00 (00.0%) 024
Female 88 (70.9%) 34 (27.4%) 02 (01.6%) 124 0.035
Total 110 (74.3%) 36 (24.3%) 02 (01.3%) 148
Drinking tea and coffee after meals
Male 16 (66.6%) 08 (33.3%) 0 024
Female 57 (45.9%) 67 (54.0%) 0 124 0.060
Total 73 (49.3%) 75 (50.6%) 0 148
Doing physical exercise
Male 18 (75.0%) 06 (25.0%) 00 (00.0%) 024
Female 48 (38.7%) 73 (58.8%) 03 (02.4%) 124 0.001
Total 66 (44.5%) 79 (53.3%) 03 (02.0%) 148
Diabetes mellitus
Male 01 (04.1%) 023 (95.8%) 0 024
Female 01 (00.8%) 121 (97.5%) 0 124 0.099
Total 02 (02.7%) 144 (97.2%) 0 148
Poverty of food with calcium source
Male 05 (20.8%) 13 (54.1%) 06 (25.0%) 024
Female 71 (57.2%) 32 (25.8%) 21 (16.9%) 124 0.009
Total 76 (51.3%) 45 (30.4%) 27 (18.2%) 148
Family history of bone weakness
Male 07 (29.1%) 16 (66.6%) 01 (04.1%) 024
Female 56 (45.1%) 54 (43.5%) 14 (11.2%) 124 0.542
Total 63 (42.5%) 70 (47.2%) 15 (10.1%) 148
Family history of vitamin D deficiency
Male 11 (45.8%) 09 (37.5%) 04 (16.6%) 024
Female 70 (56.4%) 35 (28.2%) 19 (15.3%) 124 0.471
Total 81 (54.7%) 44 (29.7%) 23 (15.5%) 148
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Mediterranean Journal of Pharmacy & Pharmaceutical Sciences
www.medjpps.com ISSN: 2789-1895 online ISSN: 2958-3101 print
Almost half of the participants (47.2%) have eggs whether daily or weekly (74.3%). This habit
exposure to sunlight less than 15 mints per day and was more dominant in males (91.6%) than females
74.9% have exposure to less than 30 min. On the (70.9%) with a significant difference of p < 0.035.
contrary, 24.9% reported to expose to light for About half of the students (49.3%) usually drinking
more than 30 min. Thus, an analysis by Chi-square tea and coffee after meals but 66.6% of the males
test revealed high significant difference between reported yes and half of females denied do that
males and females to exposure to sunlight (p < regularly (54.0%).
0.01). Half of the females declared to usually
In Figure 1, male students (54.1%) denied their
expose to sunlight (52.4%) for less than 15 minutes
food has a poor quantity of calcium compared with
compared with males (20.8%). 36.4% of the total
25.1% of females. 30.4% disagreed that their food
participants used sunscreen products. However, all
has a low amount of calcium. This difference is
the male students did not use sunscreen creams
significant between genders (p < 0.01). Table 1
compared with 43.5% of female students who
shows that three quarters of male students do
declared using sunscreen products (Table 1). In
regular exercise. Thus, students do not usually
Table 1, 61.4% denied drink milk every day.
practice physical exercise (53.3%) with highly
Female students have a higher rate of drinking of
significant difference (p < 0.001). Family history of
milk than males, 63.7% and 50.0%, respectively.
vitamin D deficiency was found to be 54.7%.
Females who denied drinking almost every day
Females were more likely to have a family
were as double as the males with no significant
deficiency of vitamin D than males (56.4% and
difference. 60.8% denied eating fast food. Female
45.8%, respectively). Most of the students’
students were less likely to eat fast foods compared
answers that agreed that vitamin D is used for the
with males. In the same way, 45.8% of the males
treatment of bone disorders and rickets (71.6%)
declared eating fast foods compared with females
and only 02.7% disagreed, but 25.6% do not know
(37.8%). 56.0% eat fish and males eating more than
in their answers.
females, 66.6% and 54.0%, respectively. The
majority of male and female students usually eat
71.6 70.9 72.2 69.5
80 66.2
70
60
50
40 25.6 28.3
23
30 18.2
20 9.4 7.4 5.4
2.7 0 3.37
10
0
does the vit D use vit D important in Does the vit D Does the Vitamin D Does the Vitamin D
for treatment of save of calcium & important for enhance the improve the muscle
bone & rickets Phosphate protection of bone immunity? strength?
and teeth
Yes No IDN
Figure 1: Libyan Medical participant's responses to benefits of vitamin D
Figure 1 shows the respondents agree that vitamin vitamin D can enhance the body's immunity. 70.9%
D is important of save the level of calcium and of females slightly more agreed on the statement
phosphate. However, only 03.37% disagreed and compared with 62.5% males with 23.0% could not
all of them were solitary females. Three quarters of answer this question. Also, in Figure 1, 66.2%
the respondents agreed that vitamin D can protect agreed that vitamin D can improve muscle strength
the bone and teeth compared with 09.4% who compared to who disagreed (05.4%) and 28.3%
disagreed (female students). 69.5% agreed that could not answer this question.
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Mediterranean Journal of Pharmacy & Pharmaceutical Sciences
www.medjpps.com ISSN: 2789-1895 online ISSN: 2958-3101 print
Table 2: Knowledge of the Libyan participants about vitamin D deficiency
Questions Yes No IDN
Do you agree that the incidence of vitamin D deficiency 42 (28.3%) 21 (14.1%) 85 (57.4%)
in Libya more than other countries
Does the sun is the main source of vitamin D 130 (87.8%) 09 (06.0%) 09 (06.0%)
Does the Osteoporosis is one of the symptoms of vitamin D 111 (75.0%) 13 (08.7%) 24 (16.2%)
deficiency?
Can vitamin D deficiency be replenished by eating dairy products? 52 (35.1%) 41 (27.7%) 55 (37.1%)
Does the vitamin D deficiency cause depression? 86 (58.1%) 11 (07.4%) 51 (34.4%)
Dose the level of vitamin D in the body differ by change in time 64 (43.2%) 08 (05.4%) 76 (51.3%)
and seasons?
Does the vitamin D sources are found in animals but not in 15 (10.1%) 83 (56.0%) 50 (33.8%)
Vegetables and fruits?
Are the people who live in cloudy areas more susceptible 87 (58.7%) 13 (08.7%) 48 (32.4%)
to vitamin D deficiency?
Does frequent exposure to the sun not lead to vitamin D toxicity? 27 (18.2%) 43 (29.0%) 78 (52.7%)
Could the use of sunscreen be a cause of vitamin D deficiency? 34 (22.9%) 41 (27.7%) 73 (49.3%)
Could a fat-free diet be a cause of vitamin D deficiency? 46 (31.0%) 31 (20.9%) 71 (47.9%)
Dark skin more susceptible to vitamin D deficiency than light skin? 18 (12.1%) 54 (36.4%) 76 (51.3%)
Can vitamin D toxicity cause hypercalcemia? 29 (19.5%) 17 (11.4%) 102 (68.9%)
In the case of vitamin D deficiency, taking pharmaceutical
preparations containing vitamin D is more effective compared
to foods, diet and exposure to sunlight. 75 (50.6%) 37 (25.0%) 36 (24.3%)
Taking vitamin D supplements (medications) is wrong unless 107 (72.2%) 20 (13.5%) 21 (14.1%)
prescribed by a doctor.
Taking vitamin D supplements is necessary to treat vitamin D 90 (60.8%) 19 (12.8%) 39 (26.3%)
deficiency, but not to prevent it.
Average percentage of correct answers of the respondents is 47.1%.
In Table 2, 57.4% did not know the incidence of compared with only 07.4% who disagreed. Over
vitamin D deficiency in Libya more than in other half of the respondents could not answer the
countries while 28.3% agreed with this statement question that levels of vitamin D differ by time and
compared with 14.1% who disagreed. 87.8% seasons changes. 05.4% disagreed with the
believed that sun is the main source of vitamin D statement. 10.1% agreed with the statement that
compared with 06.0% in each of those who vitamin D is found in animal sources rather than
disagreed with the statement and those who could vegetable or fruit sources while 56.0% contradict
not answer the question. Also, in Table 2, the with this statement, but 33.8% could not answer the
majority agreed that osteoporosis is one of the question. 58.7% agreed with the statement that
symptoms of vitamin D deficiency compared only people who live in cloudy areas are more
08.7% who disagreed. However, 16.2% chose they susceptible to vitamin D deficiency compared with
do not know. Furthermore, 35.1% agreed with the 08.7% who disagreed and 32.4% could not answer
statement that vitamin D can be replenished by this question. Only 12.1% agreed with the
eating dairy products compared with 27.7% who statement that dark skin is more susceptible to
disagreed. 58.1% agreed with the statement vitamin D deficiency than light skin compared with
vitamin D deficiency can cause depression 36.4% who disagreed with the same statement and
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Mediterranean Journal of Pharmacy & Pharmaceutical Sciences
www.medjpps.com ISSN: 2789-1895 online ISSN: 2958-3101 print
36.4% could not answer this question. As shown in rate of source of information among respondents
Table 2, 50.6% agreed on the question that taking was the internet which accounted for 49.3%
pharmaceutical preparation is more effective than followed by relatives and friends (31.7%). To less
foods, diet and exposure to sunlight and they extent, respondents chose medical providers and
represent as double as respondents (25.0%) who media by 16.2% and 10.1%, respectively. 12.1%
disagreed with this statement with 24.3% could not would not receive information about vitamin D
answer this question. Furthermore, 72.2% agreed compared with 82.4% who would like to get this
with the statement that vitamin D supplements is information. Also, in Figure 2, respondents who
wrong unless prescribed by a physician while a disagreed in males more than females (25.0% and
minority of respondent disagreed and could not 09.6%, respectively). The highest rate of causes
answer the question represented by 13.5% and reported by respondents (58.7%) was unawareness
14.1%, respectively. 60.8% agreed that a vitamin D of the risk of vitamin D deficiency followed by
supplement is necessary to treat vitamin D medication (53.3%). To less extent, imbalance in
deficiency rather than to prevent. 76.3% knew the nutrition was represented by 34.4%. Thus, Figure
disease of vitamin D deficiency while 16.2% did 2 shows respondents reported a lifestyle and less
not have knowledge about this disease. Females exposure to sun rays, concomitant disease and
(77.4%) were more declared that have knowledge others reported by 11.5%, 07.4% and 10.1%,
about the disease than males (70.8%) and 07.4% respectively.
were unable to answer this question. The highest
70
60
58.7
50 53.3
40
30 34.4
20
10
7.4 11.5 10.1
0
Concomitant Imbalance in Unawareness Life style and medications others
diseases nutrition about risk of Vit less exposure to
D deficiency sun rays
Figure 2: Causes of prevalence of vitamin D deficiency among Libyan participants
Discussion have exposure to sunlight for less than 30 minutes.
Vitamin D can be made in the skin from exposure Males had a higher average compared with females
to sunlight [16]. The major source of vitamin D is exposing themselves to sunlight. In a Chinese
due to synthesis of vitamin D from skin exposure study, 62.3% declared do not like going in the sun
to ultraviolet B radiation which leads to the [15]. Exposure peripherals as legs and arms for 15
conversion of 7-dehydrocholesterol to pre-vitamin min twice a week was reported to be enough for an
D3 and rapidly converted to vitamin D3 [17]. adequate sun-induced cutaneous vitamin D
Regarding its role, it suggests a low prevalence of synthesis in adolescents [17]. In veiled Arab
vitamin D deficiency in Mediterranean Sea women, vitamin D deficiency is a result of a
countries. This study reports the medical students combination of limitations in sunlight exposure and
Alssageer et al. (2022) Mediterr J Pharm Pharm Sci. 2(3): 46-56. 46-56
Mediterranean Journal of Pharmacy & Pharmaceutical Sciences
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low oral intake of vitamin D [18]. The current activity in outdoor environment with sun exposure
evidence showed wearing concealing clothes is would provide benefits from the physical work
associated with vitamin D deficiency irrespective itself and from vitamin D synthesis and action in
of race or strength of solar radiation [18, 19]. The the body [32]. This finding is slightly higher in
influence of clothing style on vitamin D status was Libyan study in which reported that 44% of the
the subject of several previous studies [20 -22]. All adults do not get sufficient exercise [18]. Women
Libyan females wearing hijabs. Thus, cover most are inclined to follow a sedentary lifestyle
of the body when women get outdoor activities, can compared with men where they spend much time
decrease skin opportunity to exposure to direct at home [33]. Physical inactivity among other
sunlight. Hypovitaminosis of vitamin D less factors such as obesity, low vitamin D dietary and
prevalence among individuals who staying indoor supplement intake are major modifiable predictors
more time, wearing clothes cover wide area of the of low vitamin D status [34].
skins and their skin pigmentation is darker [23]. In Vitamin D deficiency relates to diseases as diabetes
Sudan, one third of female medical students used mellitus [35]. A meta-analysis study indicated risk
sunscreen [24]. Using of sunscreens could result in of developing diabetes mellitus decreases by
vitamin D deficiency since they have a protective 04.0% with each 10 nmol/L increase in 25(OH) D
effect against ultraviolet B. Using sunscreen with [36]. Nutrition examination survey reported an
sun protection factor of 30 reduces vitamin D
inverse relationship between 25(OH) D and
synthesis in the skin [3, 25]. This differs from glycated hemoglobin (HbA1c) levels aged people
China’s study which reveals 85.0% of the (35 - 74 years) with no history of diabetes mellitus
participants used some sun protection and 33.0% of [37]. Previous studies have revealed genetic
males used sunscreen compared with females [26]. variants related to vitamin D hemostasis and
Reason behind this variation could be related to the strongly depend on endogenous vitamin D
difference in geographical, socioeconomic and production, which influenced by genetic
educational factors. A finding of study of medical determinants [38]. Twin and family studies have
students in Pakistan was in accord with our study, shown high vitamin D heritability [39, 40]. Ethnic
in which the female students have greater differences in prevalence of common genetic
proportion using sunscreen than males [14]. This polymorphisms are another likely explanation for
could be elucidated that males believe that low vitamin D in African Americans [41]. Among
sunscreen is not for masculine and it is a product the ethnic groups in Malaysia, Malay and Indian
intended for feminine since they are not highly females were six fold times more to have vitamin
concerned with skincare as remarkable with D deficiency compared to Chinese females [38].
females [12]. Healthy young adults may develop The majority of students agreed that vitamin D use
vitamin D deficiency when vitamin D intake is for treatment of bone disorders and rickets,
below the recommended intake [28]. The intake of importance of save the level of calcium and
diet rich in vitamin D is important for maintaining phosphate, protect the bone and teeth, enhance the
body vitamin D hemostasis. Dietary supplements body immunity and improve the muscle strength.
are useful to prevent and treat this deficiency [29, This is in good line with Babelghaith et al. [42].
30]. The present study revealed the participants’ The high awareness toward benefits vitamin D
consumption frequency of some foods rich in deficiency could be related to university students
vitamin D was low and participants denied usually and particularly medical students which might
drink milk. The UK retail study showed vitamin D3 behave higher education in health subjects. Brand
and 25(OH)D3 concentrations of eggs were et al. [43] reported older age appeared to be
significantly different depending on egg associated with a lower perception of risk of
production systems [31]. Evidence demonstrated vitamin D deficiency. Many health-care
that vitamin D in eggs is increased in birds exposed professionals are not fully aware of the benefits of
to ultraviolet radiation [31]. Performing physical vitamin D to public health [44]. A similar trend is
Alssageer et al. (2022) Mediterr J Pharm Pharm Sci. 2(3): 46-56. 46-56
Mediterranean Journal of Pharmacy & Pharmaceutical Sciences
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reported in Pakistan and Australia studies [45, 46]. toxicities and pharmacokinetics of vitamin D
This awareness about benefits of vitamin D is management. Over quarter of respondents rejected
important to encourage people and university the statement that exposure to the sun leads to the
students to influence their behaviors toward toxicity of vitamin D. A minority of respondents
vitamin D practice. Over three quarters of the disagreed with the same statement can vitamin D
participants knew vitamin D deficiency disease toxicity causes hypercalcemia. Lack of awareness
which is similar to previously published study [47]. will increase this problem while adequate
This could be elucidated that the respondents knowledge about vitamin D deficiency and its
received some information but were still prevention can cause potential decrease in the
unsatisfied with the amount of information they disease burden. Similarly, in Sudan, half of female
have. This aligned with study conducted in Bahrein medical students stated sunscreen does not
on the adult population [48]. The majority had interfere with vitamin D synthesis in the skin [24].
heard about vitamin D despite the low level of The highest rate of causes of hypovitaminosis D
awareness of sources and the role of vitamin D among the Libyan population was unawareness of
[15]. This poor knowledge could be due to people about the risk of vitamin D deficiency. This
conflicting information available from various consistency with finding that lack of awareness
sources about vitamin D. In contrast, 02.0% about importance of vitamin D, its health benefits
reported that internet is the source of their and prevention of deficient states across
knowledge and information about calcium and populations as important factors for the spread of
vitamin D [49]. In UK, the most common source of vitamin D deficiency [52, 53]. Lack of knowledge
vitamin D information is the media followed by about vitamin D and negative attitude toward
friends and family [50]. In Saudi Arabia, sunlight exposure is prevalent among university
information source was healthcare providers students [45, 54]. Ironically, in this study, a
followed by friends [42]. It is not surprising that lifestyle and less exposure to sunlight can causes
evidence also reported that healthcare workers lack vitamin D deficiency which is in contrast to the fact
a high knowledge of vitamin D deficiency [51]. that the worldwide pandemic of hypovitaminosis D
The knowledge of medical students with regard to mainly is attributed to lifestyle and environmental
some direct and simple questions generally scored factors that reduce exposure to sunlight [55]. As
as good knowledge. For example, the majority consequence, the sedentary lifestyle of individuals
believed that sun is the main source of vitamin D who has fewer physical activities such as female
and recognize the influence of vitamin D gender due to sociocultural or indoor job be liable
deficiency can cause osteoporosis. This finding is to exposure to sunlight at a lower rate since they
in line with Indian study conducted on female have limited time for outdoor activities.
medical students that the majority of the
participants correctly pointed out the effect of
vitamin D on bone health [13]. The statement that Conclusion: This study presents poor practice,
vitamin D is found in animal sources but not in inadequate knowledge and low awareness of the
vegetable or fruit sources was high in our study. importance of vitamin D deficiency among medical
However, fruits were the main source of vitamin D students of the University. The majority have an
among university students followed by vegetables adequate understanding of the benefits of vitamin
participants [45]. 20.0% of pharmacy students D. This study provides Libyan institutions of
failed to mention at least one vitamin D rich medical education an evidence for a deficit
product [49]. Over half of respondents agreed that knowledge which could be utilized as a strategy to
taking pharmaceutical preparation is more correct the health behaviors through medical
effective than foods, diet and exposure to sunlight. education programs.
However, participants had poor knowledge about
Alssageer et al. (2022) Mediterr J Pharm Pharm Sci. 2(3): 46-56. 46-56
Mediterranean Journal of Pharmacy & Pharmaceutical Sciences
www.medjpps.com ISSN: 2789-1895 online ISSN: 2958-3101 print
Acknowledgments: The authors would like to thank all the participants for their corporation that facilitates this study.
Author contributions: All the authors substantially contributed to the conception, compilation of data, checking and approving
the final version of the manuscript and agreed to be accountable for its content.
Author declarations: The authors confirm that all relevant ethical guidelines have been followed and any necessary IRB and/or
ethics committee approvals have been obtained.
Conflict of interest: The authors declare that the research was conducted in the absence of any commercial or financial
relationships that could be construed as a potential conflict of interest.
Data availability statement: The raw data that support the findings of this article are available from the corresponding author
upon reasonable request.
Ethical issues: Including plagiarism, informed consent, data fabrication or falsification and double publication or submission
have completely been observed by authors.
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