ORIGINAL ARTICLE

Who Donates More; Medical or Non-Medical Students

ABSTRACT
Objectives: To assess and compare the knowledge, attitude and practices regarding blood donation among medical and non-medical students of Karachi. Methods: Research Venue: The institutes included Dow Medical College (DMC), Sindh Medical College (SMC), NED, Karachi University (KU), IBA, Sir Syed University of Engineering &Technology (SSUET) and others. Subjects: The age of sample ranges between 18-25 yrs. Sample size was 500 students; 250 medical n 250 nonmedical. Study Design and Duration: A cross sectional study was conducted in various institutes of Karachi from 1st Oct, 2008 to 1st March, 2009; through apre-tested close-endedquestionnaire in English. Its designwas simple and aimed at student's level of understanding.The topics addressed included knowledge, attitudes and practices regarding blood donation. Results: Among 500 individuals, 38 out of 250 medical students (15.2%) while 50 out of 250 non-medical students (20%) were donors. Altogether 17.6% students were donors out of which 5.4%were regular donors. Major reasons for donation among medical students were 'humanity' (63%), family and friends; and among nonmedical students were humanity (46%), family and friends. Reasons for non-donation among medical students were 'no one ever asked me' (59.4%), "i'm too weak", "services not trustworthy" and "future weakness" and among non-medical students were 'no one ever asked me' (36%), "future weakness", "services not trustworthy", "afraid of needles". Source of motivation among medical student donors was "self" (47.3%) while among non-medical was "friends" (36%). Most medical donors donated at blood bank (42.1%), while non- medical at hospital (64%).15.9% donors faced complications after blood donation. Conclusion: There is lack of motivation and misconceptions regarding blood donation among the students. This needs encouragements regarding blood donation particularly through electronic media.

INTRODUCTION
Across the globe especially developing countries, many people die every year due to insufficient supply of blood and blood products. According to an estimate, over 80 million units of blood are donated all over the world every year. Unfortunately only 39% of this amount is collected in developing countries which provide accommodation to 82% of global population.1 Regarding blood donors, they are of 5 types: Voluntary unpaid, replacement, autologous, phaxesis & paid.2 It can also be remunerated or non-remunerated i.e. one who donates for payment and one who dont.3 It is a dilemma for developing countries that only 16% of blood supply is donated by voluntary non-remunerated low risk blood donors.4 It is highly needed in this regard to discourage commercial i.e. replacement and
1 Doctors.

paid blood donation system, which still meets 50% of total requirements of Pakistan.5 Realizing all the inadequacies regarding voluntary blood donations, the motivations and recruitment of students holds an issue of great significance. The specific orientation of students regarding blood donations, either through self-encouragement or society implied confrontations held an arena of great understanding to be analyzed in detail. In view of this, the prime motive behind this study is to assess knowledge attitude and practices regarding blood donations prevalent among medical and non-medical students and so to analyze the impact of knowledge in actual practices of blood donations. The information so obtained can be utilized in developing the appropriate messages to be used during recruitment campaign, creating and strengthening positive attitude towards blood donations and developing and implementing focused awareness program for meeting the demands of population.6 As a matter of fact, few local studies have been conducted to understand the scenario but due to inadequate information available especially regarding students, it is needed to explore further.7 However, a
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2 Department of Surgery, Dow University of Health Sciences and Civil Hospital Karachi, Pakistan. Correspondence: Dr. Urooj Fatimah Siddiqui, A-4, Gulistan-eKaleem, Model Colony, Karachi, Pakistan. Email: [email protected]

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Urooj Fatimah Siddiqui, AmmarahYasmeen, Nosheen Hina and Shams Nadeem Alam

large number of international studies done in Norway, Iran, Trinidad, Chile and Spain was conducted a few years back but the manipulated results were not pertinent to our people due to broadly classified differences in knowledge, belief ,trends, customs and practices.8

METHODOLOGY
A cross sectional study was conducted in various medical & non-medical institutes of Karachi from 1st Oct, 2008 to 1st March, 2009. The institutes included DMC, SMC, Liaqat National Medical College, Hamdard University, NED, KU, IBA, SSUET, Agha Khan Higher Secondary School, Islamia Degree, National collage, CAMS, Iqra, Sheikh Zaid Institute. The age of sample ranges between 18-25 yrs. Sample size was 500 students; 250 medical and 250 non-med students. The assessment of knowledge, attitude and practices was done through a pre-tested close-ended questionnaire with English as medium of questions. Its design was simple and aimed at student's level of understanding. In order to assess knowledge, attitude and practice, questions were asked about demographic characteristics, ethnicity, profession, donor and non-donor status, motivation, support, family concerns, number of donation experiences, regularity, reasons for donation and non-donation, complication after blood donation and sources of promoting awareness.

Most common reason for non-donation among medical and non-medical students was 'no one ever asked me' 59.4% and 36% respectively. Other common reasons included "I'm too weak", "services not trustworthy, "future weakness", no services available near me and "consider procedure unhygienic". The fears of needle, sight of blood and future weakness plus untrustworthiness in services were more common among non-medical. Commonest source of motivation among medical student donors was "self" (42%) whereas among nonmed it was friends (36%).Institutes too seemed to play a motivational part among medical donors.
Figure 1: Sources of Motivation Reported by Students 18 16 14 12 10 8 6 4 2 0
Self Family Friends Media Medical
.

Non Medical

No. of Students

Institute

RESULTS
Students were in the range of 18-25 yrs of age. Thirty eight out of two fifty medical students were donors (15.2%). Fifty out of 250 non-medical students were donors (20%). Further, among medical students 1 girl out of 125 (0.8%) and 37 boys out of 125 were donors (29.6%). However, among non-medical students 6 girls out of 125 (4.8%) and 44 boys out of 125 were donors (35.2%). Altogether 17.6% students were blood donors out of which 10% medical students and 0.4% non-medical students were regular donors. This shows more pronounced regularity among medical student-donors. Otherwise majority of students donated blood only when needed. The major reason for donation among medical and non-medical students was 'humanity' i.e; 63% and 46% respectively. Other commoner reasons were "family" and friends. While approximately 10% donated for incentives. Humanity was more common reason for donation among medical students. For family and friends reasons, non-med students had donated blood in comparatively larger number than medical students.
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Most medical student donors donated at blood bank (42.1%) and hospital (36.8%). While among nonmedical student donors, most of them donated at hospital (64%), blood bank (30%) and medical camps (20%). Nearly 16% of students faced complications after blood donation. The commonest of which was weakness (10.2%). Overall complications were more commonly complained by non-medical students. Upon asking how to encourage students to donate blood, 66% medical students and 51% non-medical students suggested "media awareness" as the major source of encouragement. The rest included organizing seminars, patients awareness, door to door campaigning, mobile clinics and family/friends.
Figure 2: Complications Received by the Students
Non Medical Medical

Others Infection/alle.. Weight... Change in BP Dizziness Weakness 0 1 2 3 4 5 No. of Students 6

Journal of the Dow University of Health Sciences Karachi 2012, Vol. 6 (1): 17-21

Who donates more; medical or non-medical students

DISCUSSION In this age of rapid advancement in more or less all fields, the worth of human life is epicenter of all in great concern. Increased demands as a result of increase in population and the number medical facilities need to be coped meticulously. Blood donations being vital aspect of many emergency and non-emergency situations always need to be emphasized at large scale.9 Due to this, students aptitude towards prioritizing the lifes most vital need appears to be a big issue. The impact of knowledge and understanding on practical act of donation clarifies the distinction of either awareness programs or donation campaigns in practice. Grossly this study depicts that 17.6% students are donors including 7.6% med and 10% non-med. Family orientation towards blood donation has been analyzed and found that 61.6% medical students families have donated blood mostly for family emergencies i.e. replacement type while 68.8% non-med families have donated blood for family emergency as well as welfare. Main factor, as stated by medical students for not donating blood, is no one ever asked them. Other reasons include weakness, non-trustworthy blood transfusion services, future weakness, consider procedure unhygienic, no info about near blood donation services, afraid of needles and infections. Few have also stated that being young they dont consider them eligible. Very few have stated that they are afraid of pain or influences of family/friends/community too restrict them. However among non-med students, the prime reason is same i.e. no one ever asked them. The other significant reasons are more or less the same. Differences lie in that they are more afraid of needles, pain and site of blood plus they consider themselves younger n weaker for this service. A study done by M. Giles (UK) also shows that four of the control beliefs, a fear of needles, a fear of fainting, a fear of catching some infection and a fear of being sick, are significantly discriminated.10 It reflects that there is primarily lack of motivation and secondarily lack of basic knowledge regarding blood donation, more prevalent among non-med students. According to national and international standards person must be 17 yrs old to donate blood.11 Since study is conducted for age group 18-25 yrs, no one is ineligibly young to donate blood. In spite of the average weight that is 66 kg in boys and 56 kg in girls, 13.6% (6.4% med n 7.4% non-med) students consider themselves weak enough to donate blood. Minimum donor weight of 50 kg (110 pounds) is recommended to donate usual 450+45 ml of blood because a 50 kg person has blood volume of approximately 3750 ml, donation of 405-495 ml would represent only 10-13% of donors volume.12 The symptoms of hypovolemia appear with loss of 15% or greater.13

Regarding motivation, a research Rajagopolan reported that donors and non-donors even in medically oriented population do not differ significantly in their sentiment towards blood donation but lack motivation.14 It is also highly needed that different fears regarding pain, needle and sight of blood plus mistrust in hospital and transfusion services must be dealt appropriately to motivate non- remunerated blood donation. It corresponds with a study of Ferguson which states that ...increasing non-donors and donors perceived abilities to cope with the stresses of donation prior to blood donation may, as with occupational career selfefficacy, motivate individuals to respond to future recruitment drives.15 One more study regarding motivations in voluntary donors state that service to society, self-actualization, need for power, emotional associations, autonomy and need for mutual support are presented as possible motivations for undertaking the voluntary role. Self-esteem, altruism and a generalized need for participation are additional factors possibly related to motivation to become and to remain involved in voluntary activity.16 Acknowledgment regarding blood bank following strict screening guidelines and eligibility requirement should be clarified among population. According to Pakistan Red Crescent Society, sterilized needle and bay is used for every individual, skin is cleared with pyodine and methylated spirit and needle is broken after use. Staff is trained and well experienced too.17 The donation process finishes in about 10 minutes for a pint in which liquid part replaces in few hours and blood cells in about 4-6 weeks.18 Regarding blood donation, this study reveals that out of 88 donors, 89% medical and 87% non-medical students are motivated for donating blood. It clearly reveals the strong influence of motivation on donating blood among students. Sources of motivation are mostly self-oriented 42% among medical donors and friendsoriented 36.7% among non medical donors. Other sources include family, media and institute. It reflects role of medical knowledge among student donors. Of all medical donars,68% used to donate regularly in contrast to 2% of non medical regular donors who mostly donate when needed. 63% med-students are found donating for humanitarian purpose while 47% non medical donating for same reasons. This clearly depicts influence of knowledge upon attitude regarding vital aspect of life. This study reveals few other reasons too for donating blood like family, friends, will be healthier, compulsion, regular donor etc. Different incentives also do play a significant role in blood donation. However in this study it is found that 4/38 med &5/50 non med has donated blood for
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Journal of the Dow University of Health Sciences Karachi 2012, Vol. 6 (1): 17-21

Urooj Fatimah Siddiqui, AmmarahYasmeen, Nosheen Hina and Shams Nadeem Alam

S. No. i ii iii iv v vi vii viii ix x xi xii xiii xiv xv xvi xvii xviii xix xx

REASONS OF NON-DONATION

Medical

Girls Boys No one ever asked me for blood donation 90 36 I m too weak 13 19 Blood transfusion services are not trustworthy 14 14 Future weakness 13 12 Consider procedure unhygienic 8 15 Infection 6 14 I am not permitted by elders/community/religion 8 9 Afraid of needles 10 5 Have no info about blood transfusion services near me 10 4 Other reasons 5 6 Afraid of pain 6 4 I m too young 8 1 Lack of knowledge or information 2 1 Afraid of sight of blood 0 3 I have a medical reason/disease 2 5 My family/friends doesnt donate blood 4 3 I went to donate blood but could not because 0 5 Weight gain 2 1 Bad donation experience 0 0 Because i have a rare blood group 2 0

TOTAL Non Medical Girls Boys 126 41 31 32 26 10 28 22 12 25 26 15 23 9 10 20 11 5 17 7 8 15 18 5 14 15 6 11 8 7 10 14 5 9 12 6 3 9 9 3 13 6 7 7 4 7 5 3 5 1 2 3 5 0 0 1 0 2 4 1

TOTAL 72 36 34 41 19 16 15 23 21 15 19 18 18 19 11 8 3 5 1 5

S. No. i ii iii iv v vi vii viii ix x xi xii

REASONS OF DONATION Family Friends Humanity Money Unique blood group My own surgery I will be healthier To lose weight Just a regular donor Compulsion by family/job/religion/community/others For mass disaster victims Other reasons

Medical Girls Boys 0 10 0 5 1 23 0 0 0 1 0 0 0 3 0 0 0 3 0 3 0 1 0 2

TOTAL Non Medical Girls Boys 10 4 14 5 0 17 24 2 21 0 0 1 1 0 0 0 1 0 3 1 0 0 0 0 3 0 2 3 0 4 1 0 0 2 0 0

TOTAL 18 17 23 1 0 1 1 0 2 4 0 0

incentives. It includes mostly extra leave, blood credit cards the rest are juices, sandwiches, money etc. This corresponds to a study in which issuance of blood donor certificate/blood credit card was claimed to be the best incentive. Another one was extra leave however no one agrees for payment of money as incentive.19 Regarding this practice, few questions are asked about donation place, experience and complications so forth. Forty two percent meds have donated at blood bank and 36% at hospitals whereas mostly non meds (65%) preferred hospital for donating blood. Most of them find their experience good. According to this study, all donors irrespective of med or nonmed are satisfied with hygienic conditions, proper equipments, precautions & expertise of staff regarding donation. As far as complications are concerned, only 5 meds
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and 9 non meds have complained significant effects, which include weakness in principal. The others are dizziness, changes inblood pressure, wt. gain/loss and infection/allergy. Generally, it has also been found that females participation is significantly less as compared to males. In the study, 1:1 ratio is maintained for females and males with sample distribution of 250 for either. Only 2.8 % (5/250) females have been found to be donors. This corresponds to a study conducted in YAZD (Iran) where it was found that attitude towards blood donation was high among women but their actual performance rate was low. In the light of this it is needed to increase the level of motivation and remove barriers to blood donation for women who comprise around half of the population.20

Journal of the Dow University of Health Sciences Karachi 2012, Vol. 6 (1): 17-21

Who donates more; medical or non-medical students

Regarding education, promotion and encouragement of people for donating blood, questions have been asked about the ways to do so. Most of the students have emphasized upon the role of media awareness and organizing seminars/workshops for mass awareness and motivations. The other mentioned ways include door to door campaigning, mobile clinics/sessions/ awareness of people, family, friends etc. This is in congruence with the research of Saudi medical journal, published in 2003, November which states that there is a need for dissemination of information regarding safe blood and voluntary blood donation particularly on electronic mass media.

Moore RJ. Promoting blood donation: a study of the social profile, attitude, motivation and experience of donors. Transfus Med 1991; 1: 201-207. (i) Irum Gilani, Ziyad Afzal Kayani, Muhammad Atique. Knowledge, attitude and practices (KAP) regarding blood donation prevalent in medical and paramedical personnel. J Coll Physicians Surg Pak Aug 2007; 17(8):473-6. (ii) Maqbool Alam, Mohammad Talha, Shafiq Ahmed. Perceptions about blood donation among army personnel. Pak Armed Forces Med J Sep 2006;56(3):311-5. (i) Abdul Majeed Al-Drees. Attitude, belief and knowledge about blood donation and transfusion in Saudi population. Pak J Med Sci January - March 2008 Vol. 24 No. 1 74-79. (ii) Javad zadeh Shahshahani H, Yavari MT, Attar M, Ahmadiyeh MH. Knowledge, attitude and practice study about blood donation in the urban population of Yazd, Iran, 2004.Transfus Med.2006 Dec;16(6):403-9. (iii) Hosain GM,Anisuzzaman M,Begum A. Knowledge and attitude towards voluntary blood donation among Dhaka University students in Bangladesh. East Afr Med J. 1997 Sep;74(9):549-53. Abdul Majeed Al-Drees. Attitude, belief and knowledge about blood donation and transfusion in Saudi population. Pak J Med Sci January - March 2008 Vol. 24 No. 1 74-79

CONCLUSION
It is concluded that there is a lack of motivation regarding blood donation among the students. Despite having the required knowledge, lesser percentage of medical students are found to donate blood, although there are more regular donors among them in contrast to non-medical students. Some misconceptions have also been found to be present.

RECOMMENDATIONS
The study revealed a number of shortcomings that are critical and need urgent attention. 1 Students should be motivated to donate blood through electronic media and seminars. 2 All students should be trained in information communication. In this way they will be able to provide appropriate information to the donors. Communication in terms of latest developments regarding blood donation should be a must. Acknowledgement: The authors are highly thankful to the group mates for their assistance, support and valuable suggestions regarding this research study. This includes Muhammad Adeel Rahat, Muhammad Babar, Danish Aftab, Anam Shamim, Faiza Fazal Khan, Hafsa Haroon, Fatima Sheikh, Sadaf Liaqat, Sofia Hanif, Sana Sehar and Zubair Ali Khuwaja.

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M. Giles, C. McClenahan, E. Cairns and J. Mallet. An application of the Theory of Planned Behaviour to blood donation: the importance of self-efficacy.Health Education Research Vol.19 no.4 2004. Theory & Practice Pages 380391. Pakistan Red Crescent Society FAQs ( http://www. prcs.org.pk/blood_faq.asp) Walker RH editor. Technical Manual of the American Association of Blood Banks. 11th ed. Bethesda (MD): American Association of Blood Banks; 1993. Rosvoll RV editor. Accreditation Requirements Manual of the American Association of Blood Banks. 3rd ed. Arlington (VA): American Association of Blood Banks; 1990. Rajagopalan M, Pulimood R. Attitudes of medical and nursing students towards blood donation. Natl Med J India 1998;11(1):12-3. Ferguson, E. (1996) Predictors of future behavior: a review of the psychological literature on blood donation. British Journal of Health Psychology, 1, 287308. John C.Anderson,Newyork state school of Industrial & labor relations, Cornell University& Larry F.Moore University of British Columbia,Journal of Voluntary Action Research,The Motivation to volunteer Nonprofit and Voluntary Sector Quarterly, Vol. 7, No. 3, 120-129 (1978) Pakistan Red Crescent Society FAQs ( http://www.prcs.org.pk/ blood_faq.asp) Pakistan Red Crescent Society ( http://www.prcs.org.pk /blood_procedure.asp) Maqbool Alam, Bourhanl Din Masalmeh Knowledge, attitudes and practices regarding blood donation among the Saudi population.. Saudi Medical Journal 2004; Vol. 25(3): 318-21 JavadzadehShahshahani H, Yavari MT, Attar M, Ahmadiyeh MH. Knowledge, attitude and practice study about blood donation in the urban population of Yazd, Iran, 2004.Transfus Med. 2006 Dec; 16(6):403-9

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REFERERNCES
1 2 3 Pakistan red crescent society: http://www.prcs.org. pk/blood_importance.asp Pakistan red crescent society: http://www.prcs.org.pk/ blood_types.asp Kalibatas V Payment for whole blood donations in Lithuania: the risk for infectious disease markers. Vox Sang.2008 Apr;94(3):209-15. Epub 2007 Dec 7 Report of the first meeting of the Global Collaboration FOR Blood Safety Geneva 14-17 Nov ember 2000;pg 6 Wake D, Cutting W. Blood transfusion in developing countries: Problems, priorities and practicalities. Trop Doct 1998; 28:4-8. 17 18 19

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