Final Thesis 30.1.2023

KNOWLEDGE, ATTITUDE AND PRACTICES
AMONG BLOOD DONORS AND NON-

DONORS REGARDING IRON DEFICIENCY
RELATED LOW HEMOGLOBIN
+++++
THESIS
SUBMITTED IN PARTIAL FULFILMENT OF REQUIREMENT

FOR THE DEGREE OF
M.D. (TRANSFUSION MEDICINE)
OF
POSTGRADUATE INSTITUTE OF MEDICAL EDUCATION AND
RESEARCH, CHANDIGARH
DEC, 2022 DR. BINEETA AWASTHI

ACKNOWLEDGEMENT
It is a great bliss for me to acknowledge the contributions of all those who have been
helpful in the successful completion of my thesis work.
First and forever, i would like to be grateful to god for giving me courage and strength
to complete this study, without his blessings this study would have been incomplete.
“A life of joy and happiness is possible only on the basis of knowledge and science.” -
Dr. Sarvepalli Radhakrishnan as the proverb quotes I want to utilize this opportunity for
expressing my sincere gratitude to my esteemed teacher and my Chief Guide Dr. Suchet
Sachdev, Associate Professor, Department of Transfusion Medicine, PGIMER, Chandigarh. I
am indebt and grateful for working under his guidance. As you always say “love your work
and do your work with happiness”, I am indeed thankful for these valuable words. I am be
thankful for his dedication, interest and above all his overwhelming attitude to help his
student. His timely advice, meticulous scrutiny, scholarly advice and scientific approach have
helped me to a very great extent to accomplish this task (thesis work) on time. It’s a great
privilege to work with you throughout this journey and for sharing your invaluable
knowledge and experience. It has been my profound privilege to be his student.
I must thank the participants who answered all the questions patiently and
contributed data because without their participation, this thesis could never have been
completed.
The mediocre teacher tells. The good teacher explains. The superior teacher
demonstrates. The great teacher inspires. – William Arthur Ward
As proverb quotes I would like to express my sincere gratitude to my Co-Guide Dr.

Ratti Ram Sharma, Professor and Head, Department of Transfusion Medicine, PGIMER
who has always been a constant source of inspiration for me, and his valuables principles for
work and his determination are always motivating and we are thankful for that.
I owe a deep sense of gratitude to my Co-Guide Dr. Sangeeta Kumari, Assistant
Professor, Department of Transfusion Medicine, PGIMER, Chandigarh for her keen interest
in me at every stage of my research. Her prompt inspirations, timely suggestions with
kindness, enthusiasm and dynamism enabled me to complete my thesis. “I am obliged for your
constant support, encouragement and motivation throughout hardships which were
encountered throughout this study.”
“Good teachers know how to bring out the best in students” – Charles Kuralt, as the
proverb quotes, thankyou ma’am for always being a supporting pillar, a mentor and bringing
out more output till end of study.
I would like to thank my Co-Guide Dr. Kamal Kishore, Assistant Professor,
Department of Biostatistics, PGIMER, Chandigarh for his valuable inputs and suggestions
throughout the study, his timely response and guidance for statistics and evaluation at every
single step of my thesis. I shall extend my gratitude for my other Co-Guides, Dt. Deepika
Puri, Department of Dietetics and Dr. Sandeep Grover, Professor, Department of Psychiatry,
PGIMER, Chandigarh.
I would also like to extend my gratitude to Dr. Ashish Jain, Dr. Rekha Hans, Dr.
Lakhwinder Singh, Dr. Divjot Singh Lamba, Dr. Sheetal Malhotra, for their kind support
and encouragement throughout the study. I wish to express my sincere thanks to Senior
Residents Dr. Nippun Prinja, Dr. Apalak Garg, Dr. Deepika Aggarwal, Dr. Sirat Kaur, Dr.
Gurpreet Thiara, Dr. Mehakdeep Kaur, Dr. Simranjeet Kaur, Dr. Manpreet Kataria, and
Dr. Gurika Copra, Dr. Anuradha Kalra, Dr. Anita and Dr. Preeti Paul who were always
there and supported me in my hard times and helped for the completion of this study. I would
like to thank my seniors Dr. Sharanya Ramakrishnan, Dr. Namrata Dutta, Dr. Thajri
Fatima, Dr. Ranjana, Dr. Manvi Talwar, and Dr. Aarushi Sahni, Dr. Prateek Srivastava,
Dr. Vasanthakumar Gounder, Dr. Garima Siwach, Dr. Manisha Roy for always being
constant support and not only giving me guidance but always helped me in completion of my
study. I would like to express thanks to my batchmate Dr. Anubhav Gupta for being there
with me throughout this journey and helping in all possible ways. I shall also like to extend
my sincerest gratitude and thanks to all of my juniors Dr. A. Arun Kumari, Dr. Sindhu
Bhargavi (my roommate and constant moral support in this journey), and Dr. Suvetha, Dr.
Shabeel P, and Dr. Aishwarya Sharma for their help in my thesis on many occasions so that
I could complete my study on time. My special thanks to the entire staff of Department of
Transfusion Medicine who helped me.
It is my privilege to thank my father Late. Mr. Jagdish Prasad Awasthi who always
believed in me and gave wings to my dreams and my mother Mrs. Mithlesh Awasthi for the
endless love and support she has given me throughout my life. Thank you for teaching me
respect, confidence, proper etiquettes, patience and for letting me find my own way.
This will be incomplete without thanking to my brothers (Mr. Ajay Awasthi, Mr.
Vijay Awasthi), sisters (Mrs. Sunita Awasthi, Mrs. Anita Awasthi, Ms. Sangeeta Awasthi),
brother-in-law (Mr. Neeraj Shukla) for being understanding when I have not answered
messages or returned phone calls. Your prayer and moral support for me was what sustained
me this far.
Finally, I would like to thank everybody who was important to the successful
realization of thesis, as well as expressing apology that I could not mention personally one
by one.
At the very top of that my special thanks to PGIMER, Chandigarh as I am part of
this prestigious institute I am forever grateful for being student of this reputed institute.
Thank you.
December, 2022 Dr. Bineeta Awasthi

ABBREVIATIONS:
BTS Blood Transfusion Services
CVI Content Validity Index
CVR Content Validity Ratio
DCA Drugs and Cosmetic Act
DIID Donation Induced Iron Deficiency
DMT1 Divalent Metal Transporter1
ID Iron Deficiency
IDA Iron Deficiency Anemia
ISBT International Society of Blood Transfusion
IEC Information, Education and Communication
KAP Knowledge, Attitude and Practices
NACO National AIDS Control Society
NBTC National Blood Transfusion Council
NBP National Blood Policy
NHP National Health Policy
NFHS National Family Health Survey
RBC Red Blood Cells
SI Serum Iron
TIBC Total Iron Binding Capacity
UHC Universal Health Coverage
VNRDs Voluntary Non-Remunerated Donors
WHO World Health Organization

CONTENTS
S. No. Contents Page Number
1. Introduction 1‐3
2. Review of literature 4‐10
3. Aims and Objectives 11
4. Materials and Methods 12‐21
5. Results 22‐83
6. Discussion 84‐93
7. Summary 94‐99
8. Conclusion and Recommendation 100‐101
9. Strength of the Study 102
10. Limitation 103
11. Bibliography 104‐109
12. Appendices
Annexure 1: Informed Consent Form
Annexure 2: Participant Information Sheet
Annexure 3: Questionnaire
Master Chart
Plagiarism
Ethical Clearance Certificate

INTRODUCTION
An important component in the endeavor towards the goal of universal health

coverage (UHC) is to ensure access to sufficient and secure supplies of blood,
blood components and blood products to strengthen the delivery of safe
transfusion services as part of a strong healthcare delivery system. However,
despite the progress over the last decade, it is clear that the goal of universal
access to safe blood, blood components and blood products could not be achieved
in many countries. [1]
The voluntary non-remunerated donations (VNRDs) of blood and blood

components donated by regular blood donors from low-risk populations lays the
foundation of robust and safe national blood transfusion services (BTS) to ensure
sustainability sufficiency, and security of national blood supplies. An effective
blood donor programme lays emphasis on sustainable public education for
ensuring donor motivation, followed by recruitment, mobilization and retention
programmes, that are sided by safe blood collection process, based on evidence-
based donor selection and/or deferral, and donor care, notification, counselling,
and referral for early management of any infection and/or abnormal laboratory
finding such as a low hemoglobin (Hb). [2]
The International Society of Blood Transfusion (ISBT) code of ethics defines the
responsibility of the blood transfusion professional towards the blood donor. [3,4]
The principles include autonomy, dignity, non-maleficence, beneficence and
justice.
Blood is accepted as a medicinal product of human origin, the availability of
which is dependent on the donation of the source material from a donor, who
donates blood for the benefit of others with the expectation of no physical benefit
to her/himself, and on a similar note without any undue physical harm to
1
her/himself. Thus, the donor be exposed to as little harm as possible, in line with
the principle of non-maleficence. [3,4]
The BTS has moral and ethical responsibility to safeguard the health of the blood
donor. This is put in practice through a structured process of donor recruitment
which involves pre-donation information, pre-donation counselling, pre-donation
interview and a brief physical examination of pulse, blood pressure and screening
for Hb.
Most common cause of donor deferral in a developing country like India is
[5]
anemia. Nutritional anemia is the most common cause of anemia. The major
reason of nutritional anemia is Iron deficiency anemia (IDA), accounting for 50%
of anemia. IDA has the highest prevalence in developing countries like India.
IDA is attributed to almost a million deaths annually worldwide. Asia and Africa
bear 71% of global burden of mortality due to IDA. [6]
National Family Health Survey 4 and 5 (NFHS-4 and NFHS-5) reported that
22.7% and 25% of men (15–49 years) and 53.1% and 57% of women (15–49
years) are anemic in India. [7]
Pre-clinical iron deficiency and IDA can occur due to blood donation, especially
in regular blood donors who are the best source of safe blood. Problem of
donation induced iron deficiency can be overcome by either decreasing the
frequency of blood donation or supplementing iron or changing the dietary habits
of the donors. Limiting donation frequency will result in depletion of the already
scarce blood supply. [8] Therefore to prevent iron deficiency in blood donors, iron
supplementation and change in dietary habits of the donor seems to be a better
option. Knowledge and awareness among donors regarding causes, prevention
and management of IDA can change their attitude to obtain and maintain the
optimum level of Hb thus will help us to maintain a quality donor pool. For this,
we should understand knowledge and attitude with respect to iron among the
potential blood donor population.
2
Only one study on this topic on blood donors was available from India. The need
to conduct such a study in the regional potential donor population becomes was
recognized, since the region has a base of regular repeat blood donors.
This study focused to increase understanding of the sometimes-overlooked link

between blood donation and iron deficiency and outline strategies for prevention
of the same. [9]
The present study was planned in line with the objective 4 and objective 7 of the
National Blood Policy (NBP) of India. [10]
The objective 4 of NBP, is “To launch extensive awareness programmes for

donor information, education, motivation, recruitment and retention in order to
ensure adequate availability of safe blood”.
The objective 4 of NBP, is “To encourage Research & Development in the field
of Transfusion Medicine and related technology”.
The findings of this study will be used to formulate material for Information,
Education and Communication (IEC) with the potential blood donor base to raise
awareness on the importance of iron and protein in diet to obtain and maintain
Hb levels, when they plan to donate blood on a regular basis. This will help to
translate the moral and ethical responsibility of the BTS towards the noble blood
donors, in order to protect them from donation induced iron deficiency, the less
appreciated long term adverse effect of regular blood donation.
3
REVIEW OF LITERATURE
IRON METABOLISM AND STORAGE
The standard body iron is around 3.5 g for men and 2.5 g for women. Hb contains
approximately 80% of functional body iron. As there is no regulatory pathway
for iron excretion, regulation of dietary iron absorption is the only way to
maintain iron balance. [6]
As the amount of iron loss by shedding of mucosal and epithelial cells is around
1to 2 mg/day, therefore the daily biological requirement of an individual is around
1 mg of elemental iron. An iron deficient individual can absorb up to 5–10% of
the iron present in a vegetarian diet and up to 20% of the iron in a non-vegetarian
diet. [6]
Iron is absorbed in the duodenum. At the apical membranes of enterocytes ferric

form is reduced by duodenal cytochrome B (ferric reductase) into ferrous. The
transport of ferrous form is mediated through the apical membrane through
divalent metal transporter (DMT1). Transport of heme iron through the apical
membranes is mediated by heme transporters. Iron inside the cell is either
transported to plasma or is stored as ferritin. A fraction of the iron is released
from enterocytes into the plasma through a transporter ferroportin-1 at the
basolateral membrane in ferrous form. Into the plasma ferrous oxidizes into ferric
form in presence of hephaestin which is located on the basolateral membrane.
Ferric is bound to apotransferrin and form transferrin which is transported into
various tissues. When an individual is replete with iron stores, the majority of
iron is bound to ferritin and excreted through the shedding of mucosal cells.
Transfer to plasma ferritin is increased in case of low iron store and ineffective
erythropoiesis. Erythropoietic activity is more important in comparison to iron
stores in regulation of iron absorption. [11]
4
Etiology of IDA:
Increased Iron demand:

Infancy or adolescence
Pregnancy
Increased loss of Iron:

Chronic blood loss
Menses
Acute blood loss
Blood donation
Decreased iron absorption or intake:

Inadequate diet
Malabsorption from disease (Sprue, Crohn's disease)
Malabsorption from surgery (post-gastrectomy)
Acute or chronic inflammation
Symptoms of anemia:
In general
Fatigue
Loss of stamina (reduced exercise capacity)
Pallor
Breathlessness
Tachycardia (particularly with physical exertion)
Particular to IDA
Cheilosis
Pica
Koilonychia
5
Diet —Dietary factors which impair iron absorption such as tannates, phosphates,
phytates of grains and cereals and foods high in calcium. Iron absorption is
decreased around 50% by phytates and phosphates. Dietary factors which
promote iron absorption such as ascorbic acid, heme iron (non-vegetarian diet).
Nearly 1% to 2% of non-heme iron and 20% of heme iron are absorbable. The
normal daily non-vegetarian diet contains 10 to 20 mg of iron. In the developing
countries, the most frequent causes of IDA are low intake and poor bioavailability
because most of population are vegetarian. [6]
Worm infestation
The main parasites causing blood loss which results in IDA are whipworm,
hookworm and schistosomiasis. Ancylostoma duodenale Hookworm can cause
blood loss upto 0.2ml per day (so a patient infected with 100 worms can lose up
to 20 ml of blood per day). Necator americanus worm can cause a blood loss upto
0.03ml per day. Ancylostoma duodenale can cause blood loss around 10 times
more than Necator americanus. Majority of these infections occur in in
developing nations where persons excrete outside and/or utilize excreta as
fertilizer (“night soil”). Penetration of skin by larvae or consumption of ova can
transmit the infection. Most intestinal tapeworm infections in humans are
obtained after consuming incompletely cooked meat of intermediate host. [12]
GLOBAL OVERVIEW OF BLOOD COLLECTION
During the reporting period, blood donations are thought to have been made in
171 countries in the amount of 118.5 million. 12.4 million of these were apheresis
donations, while 106.1 million of these were whole blood donations.
6
FIGURE 1: WHOLE BLOOD DONATION PER 1000 POPULATION, 2018
In 2018, sixty nations reported receiving fewer than 10 donations of whole blood
per 1,000 people annually. As depicted in figure above, 34 of these are located in
the WHO's African Region, four are in the Americas Region, five are in South-
East Asia, four are in Europe, four are in the Eastern Mediterranean, and nine are
in the Western Pacific. [13]
CURRENT SCENARIO OF BLOOD DONATION IN INDIA
Joy et al from Vellore, India reported 13.1 million whole blood units (1% of 1.3
billion population) are needed to meet India’s blood demand following the 1% of
population is sufficient to meet minimum nations basic blood requirement,
advocated by the WHO. However, in 2019-20, the annual collection of blood in
India was 12.5 million as per the annual report of the National AIDS Control
[14]
Organization (NACO), MoHFW, GoI.
They estimated that 34.3 of 1000 eligible population (3.43% of eligible

population) must donate blood at least once in a year to meet estimated clinical
demand. But the supply per 1000 population was 31.9 per 1000 eligible
7
population (3.19% of eligible population). Therefore, an additional 3 per 1000
population, is required to donate blood to address the actual clinical demand in
India. [14]
STUDIES ON IRON LOSS WITH BLOOD DONATION
Mittal et al [2016] from Chandigarh, India reported that “blood donation can
result in iron deficiency which is more frequent among repeat blood donors as
compared to first time donors and more frequent among female donors as
compared to male donors”. Iron deficiency is more frequent among donors who
donated at short intervals compared to donors with higher numbers of total
donation but donating with longer intervals. A healthy blood donor can donate at
an interval of every three months i.e., upto four times a year as within this time
period body iron stores get repleted.[15]
The risk of iron deficiency after blood donation is vary due to different frequency
of blood donation, dietary iron intake, presence of iron deficiency among all study
[16]
population, the use of supplemental iron and menstrual iron loss in females.
Iron lost from a blood donation for male is average 242 + 17 mg in males and 217
+ 11 mg in females. This may be replaced in about 3 months males by enhanced
[16]
absorption of dietary iron, but may take almost 1.5 year in female. Hb drop
after a blood donation reaches its lowest level 1 to 2 weeks after donation and it
takes on an average 3-4 weeks to reach pre-donation levels. [16]
The essential part of every country’s National Health Policy (NHP) is to provide
safe and adequate blood. VNRDs can only make this feasible. Therefore,
protecting the health and well-being of the VNRDs assumes utmost importance.
It is well known that regular VNRDs can cause iron deficiency anemia. [17-19] It is
also well known that a low Hb is one of the most common reasons for the deferral
[20-25]
of a prospective blood donor. For this reason, blood transfusion services
have a liability to protect blood donors from developing anemia. [26]
8
Iron-deficiency anemia has been established as the last stage in the pathogenesis
of depletion in body iron stores, and it is evident that Hb levels alone is not an
adequate data for identification of potential blood donor population with iron
deficiency without anemia. [27]
STUDIES BLOOD DONOR POPULATION
Shah et al from Gujarat, India in 2015 conducted “KAP survey with respect to
IDA and megaloblastic anemia among blood donors. They reported anemia in
general was known to only 60% blood donors. 42% and 31.6% donors were
having knowledge of IDA and Vitamin B12 deficiency respectively. Only 20%
blood donors had knowledge of the minimum acceptable Hb level for donating
the blood. Awareness on the importance of iron, folic acid and vitamin B12 for
maintaining normal Hb level was 42%. Most (82.7%) of repeat blood donors
wanting to get education with respect to iron, folic acid and vitamin B12. [28]
STUDIES IN OTHER POPULATION
Nivedita et al from Puducherry, India in 2016 reported that 40% of the population
of the study were aware of anemia. 54% were having knowledge that anemia is
more common in pregnant women as compared to non-pregnant. There was poor
knowledge about iron rich food among the study population. 1/5th of the study
population had not received education with respect to anemia. Attitude towards
the dietary habits and iron supplementation was good among the study
population.[29]
Singh et al from Delhi, India in 2019 reported that only 29% of participants had
knowledge of anemia. 25% of participants understood that anemia is a health
problem. Only few participants were aware about the symptoms, treatment and
prevention of anemia. Majority of participants (81%) used soap for hand washing
after defecation. Only 52% of girls used soap for hand wash before having a meal.
76% participants practiced cutting of nails regularly.[30]
9
Reddy et al from Telangana, India in 2021 reported anemia is more common
(96.5%) among teenagers who are in school. Only 10% were aware of anemia.
Only 20% believed that a drop in red blood cells is the cause of anemia. The
majority were unaware of which mineral deficiency anaemia is caused by. Almost
10% of respondents claimed that Hb is measured to determine anemia. Only 25%
believed that significant blood loss during menstruation can lead to anemia.
Nearly 50% of respondents said anemic people are weak, short of breath, and
more susceptible to infectious infections. Less than 10% of survey participants
were aware of foods high in iron. Only 5% of people were aware that vitamin C
improves and coffee, tea, and milk inhibit iron absorption. About half of them
were aware that severe episodes of anemia can be life-threatening and necessitate
blood transfusions. The programme for anaemia prophylaxis was only 20%
known to them. [31]
10
AIMS AND OBJECTIVES
To assess the knowledge, attitude and practices among blood donors and non-
donors regarding iron deficiency related low Hb.
OBJECTIVES
1. To study knowledge among donors and non-donors with respect to

relationship between blood donation and Hb and iron levels in them.
2. To study the attitude of donors and non-donors with respect to the need
for iron intake of iron and protein in diet or from pharmacological sources
during the tenure of blood donation.
3. To study the practices with regard to efforts to enhance and maintain iron
and protein in diet during their tenure of blood donation.
11
MATERIAL AND METHODS
STUDY DESIGN: Cross-sectional study, conducted at the Department of
Transfusion Medicine, Postgraduate Institute of Medical Education and Research
(PGIMER), Chandigarh from June 2022 to October 2022 after the approval by
the Institute Ethics Committee (Intramural) vide Letter no. INT/IEC/2021/SPL-
1437 dated 28th September 2021.
STUDY POPULATION: Potential blood donor population.
SAMPLE SIZE: The sample size was calculated using OpenEpi® software,
which was 816. This was calculated with an assumed prevalence of 50% level of
knowledge, based on the results of the previously published study. This was at
99% confidence levels with a margin of error at 5% after taking into account a
20% missingness or data related issues such as language barrier, empty or half-
filled, and electronic communication.
SAMPLING TECHNIQUE: Convenience sampling strategy was used to enroll

study participants.
STUDY TOOL: Pilot tested, pre-validated, self-administered structured
questionnaire.
Questionnaire: The initial draft of the questionnaire was made by the study
group, consisting of the chief guide, co-guides and the student after reviewing
literature. It was a set of forty items as part of a questionnaire divided into six
sections comprising demographic details, general questions, knowledge
12
questions, attitude questions, practice questions and questions to assess the
impact of study. For the content and construct validation the questionnaire was
distributed among five subject experts, which includes four from clinical
branches - representing the major users of blood with expertise on iron deficiency
anemia such as Clinical Hematology, Gynecology & Obstetrics and one from
Transfusion Medicine. Experts were asked to score every question for
importance, representation and clarity. A separate segment for comment section
was given below each question to get input from subject experts. The comments
from subject experts were discussed by the study group who prepared initial draft
of questionnaire, for further validation of questionnaire and drafting
questionnaire in easy language so that it can be locally understood. The
questionnaire was finalized after two rounds of revisions using Delphi technique.
After this the questionnaire was distributed among fifteen persons from general
population and same were interviewed to take feedback about the ease of
understanding and flow of questions to tide over any communication gap between
the experts and the study participants. All the feedback responses were carefully
incorporated to obtain the best possible response from study participants. Finally,
a validated, pilot tested, structured questionnaire with five sections was created.
13
ALGORITHM OF QUESTIONNAIRE VALIDATION
Initial draft of 40 items – study group
Delphi technique
Experts for content and construct validation – Clinical Haematology,

Gynaecology & Obstetrics and Transfusion Medicine
Validation parameters - Importance, Representation and Clarity of the

items in the questionnaire
Two rounds of revision and incorporation/rebuttal to the comments obtained

from experts
Draft after subject experts’ opinion – 26 items
Pilot testing in 15 participants with interview to incorporate/rebut the comments

of the participants
Finally, a validated, tested, structured questionnaire with five sections and 26

items
The preliminary questionnaire for the study had following parts to capture:
1. Participant’s demographic details such as age, gender, education,
occupation, residence and dietary habits.
14
2. General questions: The spectrum included 3 general items to assess and
delineate
2.1 Donor and/or non-donor status of the participant,
2.2 Whether the participant had heard about Hb- if any participant has not
heard about Hb, then questionnaire would not open further and these
participants were excluded from result analysis. This was done to obviate
bias from the study, as these participants response to further items would
not be reliable.
2.3 Whether the participant had ever been tested for Hb from any laboratory,
other than that done during the blood donors’ selection in case of donors.
This was done to ascertain whether the participants had ever got a
quantitative Hb done from a laboratory, because most of the blood
services test Hb qualitatively. In case on non-donors, it was to ascertain
the status of Hb testing in general.
3. Knowledge: The spectrum included 12 items related to assess knowledge

regarding
3.1 Hb eligibility criteria for blood donation,
3.2 Change in Hb and iron after blood donation,
3.3 Minimum interval between two blood donations for Male and female,
3.4 Indicator of low Hb,
15
3.5 Dietary elements required for Hb formation,
3.6 Iron, protein and Vitamin-C rich food items,
3.7 Food items that increase or decrease iron absorption
4. Attitude: The spectrum includes 4 items to assess attitude towards
4.1 Post donation decrease in Hb and iron,
4.2 Blood donation by a vegetarian - As less absorption of non-heme iron (1-
2%) from vegetarian diet as compared to heme iron (10-20%) from non-
vegetarian diet and lack of Vitamin B12 in vegetarian diet.
4.3 Blood donation by the female gender - As volume of blood loss in menstrual
cycle per year is equal to 1.5 -2 units of whole blood (350 ml) and total body
iron is lower in females (2.5 gms) as compared to males (4 gms).
5. Practice: This section opened only for blood donors. The spectrum included
6 items to assess
5.1 Whether participant received counseling on dietary practices,
5.2 Whether participant took extra care to increase iron, protein and vitamin-C
rich food items and decrease tea and coffee in their diet.
6. Impact of study: This section assessed number of participants who were
willing to adopt good dietary habits like increase iron, protein and vitamin-C
16
rich food items and decrease tea and coffee in their diet to become a regular
blood donor by virtue of being participant of this study.
Detailed set of finalized questionnaires is in ANNEXURE 3
STUDY METHOD
After the validation process, the questions were put into google form and the link
was prepared. In addition, a QR code for the questionnaire was generated. The
participant information sheet and electronic informed consent form were
incorporated into the Google Form. After the participant could read PIS, the
option to give informed consent was provided. The form was only opened to the
participants if they agreed to the electronic consent. The blood donors and the
non-donors present at the venue of blood donation were informed about the study,
the need of the study and after obtaining verbal consent from them they were
asked to either scan the QR code, or the link of the Google form was sent to them
on email and/or WhatsApp phone number provided by them.
The QR code and link to the Google form was also circulate among the registered
database of voluntary blood donation camp organizers for them to take part in the
study. They were further requested to share the same among their donors and no-
donor contacts for covering a representative donor and non-donor population.
17
Scoring Pattern of Questionnaire Validation:
Measure CVR (Content Validity CVI (Content Validity
Ratio) Index)
Character Importance Representative Clarity
s
Scoring 1- Not necessary 1- Not 1 – Not clear
2- Useful Representative 2 – Need major
3- Essential 2- Need major revisions to be clear
revisions to be 3 – Need minor
representative revisions to be clear
3- Need minor 4 – Clear
revisions to be
representative
4- Representative
Formula CVR = (NE – CVIR = NR / N CVIC = NC / N

N/2) / (N/2) where, where,
where, CVIR =CVI for CVIC = CVI for Clarity
representativeness
NE = Number of
experts who rated NC = Number of
an item as NR = Number of Experts who rated an
essential experts item as clear (3 or 4) N
rated an item as = Total number of
representative (3 or 4) experts
N = Total
number of
experts N = Total number of
experts
# Criteria: CVI >0.8 to retain individual item in questionnaire
18
DATA COLLECTION AND ANALYSIS:
Statistical analysis was done using Stata 15 (StataCorp. 2017. Stata Statistical
Software: Release 15. College Station, TX: StataCorp LLC). Data was
summarized by donor and non-donor using percentages. If the data was
qualitative, P-values were calculated using a Chi square test for non-continuous
data and rank-sum test for continuous data. Student t-test was used for comparing
means of the quantitative Hb between donors and non-donors. Mann Whitney
rank sum test was used for comparison of scores of knowledge, attitude and
practice respectively.
For data analysis, participants of the study were classified as donor and non-donor
and were compared.
Donor:- who had donated blood at least one time previously.
Non-donor:- who had never donated blood.
Knowledge analysis - A score of 1 was given against correct answer. For

questions with multiple correct options, score of 1 was given against each correct
response.
Score of “0” was given to the participants who did not answer or wrongly
answered or answered, “don’t know”.
Grading of knowledge was done as detailed below:
Adequate knowledge: - A score ≥50% was classified as “ADEQUATE”

knowledge
Inadequate knowledge: - A score 0-49% was classified as “INAEQUATE”

knowledge
Attitude analysis- For analysis, participants were classified as having positive

attitude if they were not concerned, as having negative attitude if they were
19
highly, moderately or even mildly concerned and as having neutral attitude if they
were not sure. A score of “1” was given against positive attitude. Score of “0”
was given to participants who had negative attitude or neutral attitude.
Practice analysis- Only donor participants were asked whether they received or
not received counseling on dietary practices for regular blood donation. Based on
response of above question, donor participants were further categorized in
counselled and non-counselled group. For analysis, score of “1” was given to the
study participants who reported answer as “Yes” and score “0” was given to the
study participants who reported answer as “No or Not Sure”.
Impact analysis- whether participants were got motivated to take care of their
diet to become a regular donor after participating in the present study. For
analysis, the score of 1 was given to the study participants who reported answers
as “yes” and were classified as “motivated”. Score of “0” was given to the study
participants who reported answer as “No or Not Sure” and was classified as “not
motivated”
https://docs.google.com/forms/d/e/1FAIpQLSfOXxZ9xkWkdRws‐
xsfCtCx5K_7q8o5se4JcpYxvhIVnUps0A/viewform?usp=sf_link
FIGURE 2: GOOGLE LINK OF QUESTIONNAIRE
20
FIGURE 3: QR Scan
21
OBSERVATION AND RESULTS
A: DETAILS OF STUDY PARTICIPANT RECRUITMENT
Overall, 1075 total participants attempted the questionnaire in the study, among
them, 8 (0.74%) participants were excluded as they did not provide the consent
for the study and were thereby automatically excluded from any further
participation in the questionnaire as per the inbuilt mechanism in the Google
Forms. Out of the remaining 1067 participants, 93 (8.65%) had never heard about
Hb, they were also excluded as per the inbuilt mechanism in the Google Forms.
Finally, only 975 participants were recruited in the study as depicted in Figure 4
(A).
The study included 710 (72.8%) donor participants and 265 (27.2%) non-donor
participants as depicted in Figure 4 (B).
22
FIGURE 4 (A): DETAILS OF STUDY RECRUITMENT
STUDY RECRUITMENT DETAILS
8
93
975
Disagree Excluded Total
FIGURE 4 (B): DONOR AND NON-DONORS IN THE STUDY
DONORS AND NON-DONORS IN THE STUDY
265
710
Donors Non-donors
23
B: DEMOGRAPHIC DISTRIBUTION OF STUDY PARTICIPANTS
The demographic characteristics of the study participants are depicted in Table 1.

TABLE 1: DEMOGRAPHIC DISTRIBUTION OF STUDY PARTICIPANTS
Variables Total (N=975) Donor (n=710) Non-donor (n=265) P-value
Age range (years)

18 – 24 306 (31%) 187 (26%) 119 (45%)
25 – 49 609 (63%) 473 (67%) 136 (51%) 0.001*
50 – 65 60 (6%) 50 (7%) 10 (4%)
Gender
Female 261 (27%) 79 (11%) 182 (69%)
0.001*
Male 714 (73%) 631 (89%) 83 (31%)
Education
College* 809 (83%) 589 (83%) 220 (83%)
NS
School** 166 (17%) 121 (17%) 45 (17%)
Occupation
Service 564 (58%) 432 (61%) 132 (50%)
Student 294 (30%) 179 (25%) 115 (43%) 0.001*
Business 93 (9%) 83 (12%) 10 (4%)
Others# 24 (3%) 16 (2%) 8 (3%)
Residence
Urban 758 (78%) 544 (77%) 214 (81%)
NS
Rural 217 (22%) 166 (23%) 51 (19%)
Dietary Habits
Vegetarian 559 (57%) 394 (55%) 165 (62%)
NS
Non-Vegetarian 416 (43%) 316 (45%) 100 (38%)
*Graduate and postgraduate both included
**All levels of school education included
#Others: Street vendors, Daily wagers, Contractual workers
NS: Not significant (P > 0.05)
24
TABLE 2: AGE DISTRIBUTION OF STUDY PARTICIPANTS
Age Range Total Donor Non-donor
P-value
(years) (N=975) (n=710) (n=265)
18 – 24 306 (31%) 187 (26%) 119 (45%)
25 – 49 609 (63%) 473 (67%) 136 (51%) 0.001*
50 – 65 60 (6%) 50 (7%) 10 (4%)
Out of total 975 participants, 306 (31%) were in the age group of 18-24 years,
609 (63%) were in the age group of 25-49 years and 60 (6%) were in the age
group of 50-65 years. Among 710 donors, 187 (26%) were in age group of 18-24
years, 473 (67%) were in age group of 25-49 years and 50 (7%) were in the age
group of 50-65 years. Among 265 non-donors, 119 (45%) were in age of 18-24
years, 136 (51%) were in age of 25-49 years and 10 (4%) were in the age group
of 50-65 years as depicted in Table 2, Figure 5 (A) and Figure 5 (B).
FIGURE 5 (A): AGE DISTRIBUTION AMONG STUDY PARTICIPANTS
AGE DISTRIBUTION
67%
70% 63%
60%
51%
45%
50%
40% 31%
26%
30%
20%
6% 7%
10% 4%
0%
18‐24 25‐49 50‐65
Total Donor Non Donor
25
FIGURE 5 (B): AGE DISTRIBUTION AMONG DONOR PARTICIPANTS
TABLE 3: GENDER DISTRIBUTION OF STUDY PARTICIPANTS

Non-donor
Gender Total (N=975) Donor (n=710) P-value
(n=265)
Female 261 (27%) 79 (11%) 182 (69%)
0.001*
Male 714 (73%) 631 (89%) 83 (31%)
Out of total 975 participants, 261 (27%) were females and 714 (73%) were males.
Among 710 donors, 79 (11%) were females and 631 (89%) were males. Among
265 non-donors, 182 (69%) were females and 83 (31%) were males as depicted
in Table 3, Figure 6 (A) and Figure 6 (B).
26
FIGURE 6 (A): DISTRIBUTION OF STUDY PARTICIPANTS WITH
RESPECT TO GENDER
GENDER DISTRIBUTION
89%
90%
73%
80% 67%
70%
60%
50%
40% 31%
27%
30%
11%
20%
10%
0%
Female Male
FIGURE 6 (B): DISTRIBUTION OF DONOR PARTICIPANTS WITH

RESPECT TO GENDER
DISTRIBUTION OF DONOR PARTICIPANTS WITH RESPECT TO GENDER
27
TABLE 4: EDUCATIONAL LEVEL OF STUDY PARTICIPANTS
Education Total (N=975) Donor (n=710) Non-donor (n=265) P-value
College* 809 (83%) 589 (83%) 220 (83%)

NS
School** 166 (17%) 121 (17%) 45 (17%)
*Graduate and postgraduate both included
**All levels of school education included
Out of total 975 participants, 809 (83%) reported education up to college level
and 166 (17%) reported education up to school level. Among 710 donors, 589
(83%) reported education up to college level and 121 (17%) reported education
up to school level. Among 265 non-donors, 220 (83%) reported education up to
college level and 45 (17%) reported education up to school level as depicted in
Table 4, Figure 7 (A) and Figure 7 (B).

RESPECT TO EDUCATIONAL STATUS
DISTRIBUTION OF STUDY PARTICIPANTS WITH RESPECT TO

EDUCATION STATUS
83% 83% 83%

90%
80%
70%
60%
50%
40%
30% 17% 17% 17%
20%
10%
0%
College School
28
RESPECT TO EDUCATIONAL STATUS
DISTRIBUTION OF DONOR PARTICIPANTS WITH RESPECT TO EDUCATION STATUS
COLLEGE SCHOOL
TABLE 5: OCCUPATIONAL DISTRIBUTION OF STUDY PARTICIPANTS

Occupation Total (N=975) Donor (n=710) Non-donor P-value
(n=265)
Service 564 (58%) 432 (61%) 132 (50%)

Student 294 (30%) 179 (25%) 115 (43%)
0.001*
Business 93 (9%) 83 (12%) 10 (4%)
Others# 24 (3%) 16 (2%) 8 (3%)
#Others: Street vendors, Daily wagers, Contractual workers
Out of total 975 participants, 564 (58%) reported to be in service, 294 (30%) were
students, 93 (9%) reported to be in business and 24 (3%) were classified in others
category. Among 710 donors, 432 (61%) reported to be in service, 179 (25%)
were students, 83 (12%) reported to be in business and 16 (2%) were classified
in others category. Among 265 non-donors, 132 (50%) reported to be in service,
115 (43%) were students, 10 (4%) reported to be in business and 8 (3%) were
classified in others category as depicted in Table 5, Figure 8 (A) and Figure 8 (B).
29
RESPECT TO OCCUPATION

OCCUPATION
70% 61%
58%
60%
50%
50% 43%
40%
30%
25%
30%
20%
12%
9%
10% 4% 3% 2% 3%
0%
Service Student Business Others

RESPECT TO OCCUPATION
DISTRIBUTION OF DONOR PARTICIPANTS WITH RESPECT TO OCCUPATION
30
TABLE 6: RESIDENCE OF STUDY PARTICIPANTS
Residence Total (N=975) Donor (n=710) Non-donor (n=265) P-value
Urban 758 (78%) 544 (77%) 214 (81%)

NS
Rural 217 (22%) 166 (23%) 51 (19%)
Out of total 975 participants, 758 (78%) reported to be residing in urban area and
217 (22%) reported to be residing in rural area. Among 710 donors, 544 (77%)
reported to be residing in urban area and 166 (23%) reported to be residing in
rural area. Among 265 non-donors, 214 (81%) reported to be residing in urban
area and 51 (19%) reported to be residing in rural area as depicted in Table 6,
Figure 9 (A) and Figure 9 (B).

RESPECT TO RESIDENCE
DISTRIBUTION OF STUDY PARTICIPANTS WITH RESPECT TO RESIDENCE
90% 81%
78% 77%
80%
70%
60%
50%
40%
22% 23%
30% 19%
20%
10%
0%
Urban Rural
31
RESPECT TO RESIDENCE
DISTRIBUTION OF DONOR PARTICIPANTS WITH RESPECT TO RESIDENCE
TABLE 7: DIETARY HABIT OF STUDY PARTICIPANTS

Dietary Habits Total (N=975) Donor (n=710) Non-donor (n=265) P-value
Vegetarian 559 (57%) 394 (55%) 165 (62%)

0.05*
Non-Vegetarian 416 (43%) 316 (45%) 100 (38%)
Out of total 975 participants, 559 (57%) were vegetarians and 416 (43%) were
non-vegetarians. Among 710 donors, 394 (55%) were vegetarians and 316 (45%)
were non-vegetarians. Among 265 non-donors, 165 (62%) were vegetarians and
100 (38%) were non-vegetarians as depicted in Table 7, Figure 10 (A) and Figure
10 (B).
32
RESPECT TO DIETARY HABIT

DIETARY HABIT
62%
70% 57% 55%
60%
43% 45%
50%
40%
30% 19%
20%
10%
0%
Vegetarian Non‐Vegetarian

RESPECT TO DIETARY HABIT
DISTRIBUTION OF DONOR PARTICIPANTS WITH RESPECT TO DIETARY

HABIT
33
KNOWLEDGE QUESTIONS
TABLE 8: KNOWLEDGE REGARDING HB REQUIRED TO DONATE BLOOD
Hb required to donate blood Total Donor Non-donor P-value
(N=975) (n=710) (n=265)
Correct response 792 (81%) 572 (81%) 220 (83%) NS
Wrong response 183 (19%) 138 (19%) 45 (17%)

Out of the total 975 participants, 792 (81%) were correctly knowing the Hb
required to donate blood and 183 (19%) were not knowing the Hb required to
donate blood. Among 710 donor participants, 572 (81%) were correctly knowing
the Hb required to donate blood and 138 (19%) were not knowing the Hb required
to donate blood. Among 265 non-donor participants, 220 (83%) were correctly
knowing the Hb required to donate blood and 45 (17%) were not knowing the Hb
required to donate blood. The difference in knowledge on Hb required to donate
blood between donors and non-donors was not statistically significant as depicted
in Table 8 and Figure 11.
FIGURE 11: DISTRIBUTION OF STUDY PARTICIPANTS WITH RESPECT

TO KNOWLEDGE REGARDING HB REQUIRED TO DONATE BLOOD
KNOWLEDGE REGARDING MINIMUM LEVEL OF HB
81% 81% 83%

90%
80%
70%
60%
50%
40%
19% 19% 17%
30%
20%
10%
0%
Correct Wrong
Total Donor Non‐Donor
34
TABLE 9: KNOWLEDGE REGARDING CHANGE IN HB AFTER
BLOOD DONATION AMONG STUDY PARTICIPANTS
Change in Hb after blood donation Total Donor Non-donor

P-value
(N=975) (n=710) (n=265)
Correct response 252 (26%) 175 (25%) 77 (29%)
NS
Wrong response 723 (74%) 535 (75%) 188 (71%)
Out of the total 975 participants, 252 (26%) were knowing that Hb decreases after
blood donation and 723 (74%) were not knowing that Hb decreases after blood
donation. Among 710 donor participants, 175 (25%) were knowing that Hb
decreases after blood donation and 535 (75%) were not knowing that Hb
decreases after blood donation. Among 265 non-donor participants, 77 (29%)
were knowing that Hb decreases after blood donation and 188 (71%) were not
knowing that Hb decreases after blood donation. The difference in knowledge on
that Hb decreases after blood donation between donors and non-donors was not
statistically significant as depicted in Table 9 and Figure 12.
FIGURE 12: DISTRIBUTION OF STUDY PARTICIPANTS WITH

RESPECT TO CHANGE IN HB LEVEL AFTER BLOOD DONATION
KNOWLEDGE REGARDING CHANGE IN HB AFTER

BLOOD DONATION
74% 75%
71%
80%
70%
60%
50%
26% 29%
40% 25%
30%
20%
10%
0%
Correct Wrong
35
TABLE 10: KNOWLEDGE REGARDING INDICATORS OF LOW HB
AMONG STUDY PARTICIPANTS
Total Donor Non-donor

Indicators of low Hb
(N=975) (n=710) (n=265) P-value
Weakness
Yes 716 (73%) 503 (71%) 213 (80%)

0.03*
No 259 (27%) 207 (29%) 52 (20%)
Dizziness
Yes 581 (60%) 421 (59%) 160 (60%)

NS
No 394 (40%) 289 (41%) 105 (40%)
Shortness of breath
Yes 369 (38%) 278 (39%) 91 (34%)

NS
No 606 (62%) 432 (61%) 174 (66%)
Fast heartbeat
Yes 300 (31%) 231 (33%) 69 (26%)

0.05*
No 675 (69%) 479 (67%) 196 (74%)
Urge to eat non-edible items
Yes 93 (10%) 69 (10%) 24 (9%)

NS
No 882 (90%) 641 (90%) 241 (91%)
Average

NS
Wrong response 563 (58%) 410 (58%) 154 (56%)
Overall, on an average, 412 (42%), 300 (42%) and 111 (42%) of the total
participants, donors and non-donors were aware of the indicators of low Hb from
the items provided in the questionnaire such as weakness, dizziness, shortness of
breath, fast heartbeat and urge to eat non-edible items (pica) collectively as
depicted in Table 10.
36
Out of total 975 participants, 716 (73%), 581 (60%), 369 (38%), 300 (31%) and
93 (10%) were aware of weakness, dizziness, shortness of breath, fast heartbeat
and urge to eat non-edible items (pica) as indicators (symptoms) of low Hb
respectively. Among 710 donor participants, 503 (71%), 421 (59%), 278 (39%),
231 (33%) and 69 (10%) were aware of weakness, dizziness, shortness of breath,
fast heartbeat and urge to eat non-edible items urge to eat non-edible items as
indicators (symptoms) of low Hb respectively. Among 265 non-donor (265)
participants, 213 (80%), 160 (60%), 91 (34%), 69 (26%) and 24 (9%) were aware
of weakness, dizziness, shortness of breath, fast heartbeat and urge to eat non-
edible items as indicators (symptoms) of low Hb respectively. The knowledge
regarding fast heartbeat as an indicator of low Hb was statistically significantly
higher in donors as compared to non-donors. However, contrary to the
expectation, the knowledge regarding weakness as indicator of low Hb was
statistically significantly higher among non-donors as compared to donors as
depicted in Table 10 and Figure 13.
37
FIGURE 13: DISTRIBUTION OF STUDY PARTICIPANTS WITH
RESPECT TO CHANGE IN HB LEVEL AFTER BLOOD DONATION
INDICATORS OF LOW HB
80%
80% 73% 71%
70%
60%
59% 60%
60%
50%
38% 39%
40% 34%
33%
31%
26%
30%
24%
20%
10% 10%
10%
0%
WEAKNESS DIZZINESS SHORTNESS OF FAST HEARTBEAT URGE TO EAT NON-
BREATH EDIBLE ITEMS
TOTAL (%) DONOR (%) NON -DONOR (%)
38
TABLE 11: STRATIFICATION OF KNOWLEDGE REGARDING
INDICATORS OF LOW HB WITH RESPECT TO THE NUMBER OF
CORRECT RESPONSES
Non-donor
Indicators of low Hb Total (N=975) Donor (n=710)
(n=265)
5/5 61 (6%) 48 (7%) 13 (5%)
4/5 174 (18%) 135 (19%) 39 (15%)
3/5 148 (15%) 101 (14%) 47 (18%)
2/5 184 (19%) 123 (17%) 61 (23%)
1/5 246 (25%) 173 (25%) 73 (27%)
0/5 162 (17%) 130 (18%) 32 (12%)

5/5: Participant correctly answered all 5 items out of the 5 items in the options
0/5: Participant correctly answered none out of the 5 items in the options
Out of total 975 participants, 61 (6%), 174 (18%), 148 (15%), 184 (19%), 246
(25%) and 162 (17%) were knowing 5, 4, 3, 2, 1 and none of the indicators of
low Hb respectively. Among 710 donor participants, 48 (7%), 135 (19%), 101
(14%), 123 (17%), 173 (25%) and 130 (18%) were knowing 5/5, 4/5, 3/5, 2/5,
1/5 and 0/5 indicator of low Hb. Among non-donor (265) participants, 13 (5%),
39 (15%), 47 (18%), 61 (23%), 73 (27%) and 32 (12%) were knowing 5, 4, 3, 2,
1 and none of the indicators of low Hb as depicted in Table 11 and Figure 14
respectively.
39
FIGURE 14: DISTRIBUTION OF STUDY PARTICIPANTS REGARDING
KNOWLEDGE OF INDICATORS FOR LOW HB WITH RESPECT TO THE
NUMBER OF CORRECT RESPONSES
PERCENTAGE OF CORRECT RESPONSES

0% 5% 10% 15% 20% 25% 30%
6%
5/5 7%
5%
18%
4/5 19%
15%
15%
3/5 14%
18%
19%
2/5 17%
23%
25%
1/5 25%
27%
17%
0/5 18%
12%
40
TABLE 12: KNOWLEDGE REGARDING INTER-DONATION INTERVAL FOR
MALE GENDER AMONG STUDY PARTICIPANTS
Inter-donation interval for Total Donor Non-donor P-value

males (N=975) (n=710) (n=265)

0.001*
Wrong response 262 (27%) 158 (22%) 104 (39%)
Out of total 975 participants, 713 (73%) were correctly knowing the minimum
inter-donation interval for male gender and 262 (27%) were not knowing the
minimum inter-donation interval for male gender. Among 710 donor participants,
552 (78%) were correctly knowing the minimum inter-donation interval for male
gender and 158 (22%) were not knowing the minimum inter-donation interval for
male gender. Among 265 non-donor participants, 161 (61%) were correctly
knowing the minimum inter-donation interval for male gender and 104 (39%)
were not knowing the minimum inter-donation interval for male gender. The
difference in knowledge regarding inter-donation interval for males was
statistically significantly higher among donors as compared to non-donors as
depicted in Table 12 and Figure 15.
41
KNOWLEDGE OF INTER-DONATION INTERVAL FOR MALES
INTER -DONATION INTERVAL FOR MALE GENDER
78%
73%
80%
61%
70%
60%
50% 39%
40% 27%
22%
30%
20%
10%
0%
Correct Wrong
TABLE 13: KNOWLEDGE REGARDING INTER-DONATION

INTERVAL FOR FEMALE GENDER AMONG STUDY PARTICIPANTS
Inter-donation interval for Total Donor Non-donor P-value

females (N=975) (n=710) (n=265)

NS
Wrong response 726 (74%) 531 (75%) 195 (74%)
Out of total 975 participants, 246 (26%) were knowing the minimum inter-
donation interval for female gender and 726 (74%) were not knowing the
minimum inter-donation interval for female gender. Among 710 donor (710)
participants, 179 (25%) were knowing the minimum inter-donation interval for
female gender and 531 (75%) were not knowing the minimum inter-donation
interval for female gender. Among 265 non-donor participants, 70 (26%) were
knowing the minimum inter-donation interval for female gender and 195 (74%)
were not knowing the minimum inter-donation interval for female gender. The
42
difference in knowledge regarding inter-donation interval for females was not
statistically significant between donors as compared to non-donors as depicted in
Table 13 and Figure 16.

KNOWLEDGE OF INTER-DONATION INTERVAL FOR FEMALES
INTER DONATION INTERVAL FOR FEMALE GENDER
74% 75% 74%

80%
70%
60%
50%
40% 26% 26%

25%
30%
20%
10%
0%
Correct Wrong
TABLE 14: KNOWLEDGE REGARDING ELEMENT DECREASING

AFTER BLOOD DONATIONS
Decrease in element (iron) Total Donor Non-donor P-value

after regular blood donations (N=975) (n=710) (n=265)

0.001*
Wrong response 566 (58%) 443 (62%) 123 (46%)
Out of total 975 participants, 409 (42%) were knowing the element (iron)
decreasing after regular blood donations and 566 (58%) were not knowing the
element decreasing after regular blood donations. Among 710 donor participants,
267 (38%) were knowing the element decreasing after regular blood donations
and 443 (62%) were not knowing the element decreasing after regular blood
donations. Among 265 non-donor participants, 142 (54%) were correctly
43
knowing the element decreasing after regular blood donations and 123 (46%)
were not knowing the element decreasing after regular blood donations. The
difference in knowledge regarding the element decreasing after regular blood
donations was statistically significantly higher among non-donors as compared
to donors as depicted in Table 14 and Figure 17.

KNOWLEDGE OF THE ELEMENT DECREASING AFTER BLOOD DONATION
ELEMENT DECREASING AFTER BLOOD DONATION
70% 62%
58%
54%
60%
42% 46%
50% 38%
40%
30%
20%
10%
0%
Correct Wrong
44
TABLE 15: KNOWLEDGE REGARDING DIETARY ELEMENTS
REQUIRED FOR FORMATION OF HB
Dietary elements required Total Donor Non-donor P-value

for the formation of Hb (N=975) (n=710) (n=265)
Iron
Yes 711 (73%) 499 (70%) 212 (80%)
0.002*
No 264 (27%) 211 (30%) 53 (20%)
Folic acid
Yes 380 (39%) 277 (39%) 103 (39%)

NS
No 595 (61%) 433 (61%) 162 (61%)
Vitamin B12
Yes 309 (32%) 220 (31%) 89 (34%)

NS
No 666 (68%) 490 (69%) 176 (66%)
Protein
Yes 242 (25%) 196 (28%) 46 (17%)

0.001*
No 733 (75%) 514 (72%) 219 (83%)
Average

NS
Wrong response 565 (58%) 412 (58%) 152 (57%)
participants, donors and non-donors were aware of the dietary items required for
Hb formations from the items provided in the questionnaire such as iron, folic
acid, vitamin B12 and proteins collectively as depicted in Table 15.
Out of total 975 participants, 711(73%), 380 (39%), 309 (32%) and 242 (25%)
were aware that iron, folic acid, vitamin B12 and protein are dietary elements
required for formation of Hb respectively. Among 710 donor participants, 499
(70%), 277 (39%), 220 (31%) and 196 (28%) were aware that iron, folic acid,
vitamin B12 and protein are dietary element required for formation of Hb
45
respectively. Among 265 non-donor participants, 212 (80%), 103 (39%), 89
(34%) and 46 (17%) were aware that iron, folic acid, vitamin B12 and protein are
dietary element required for formation of Hb respectively.
Knowledge regarding requirement of protein for formation of Hb was

significantly higher among donors as compared to non-donors. However,
contrary to the expectation the knowledge regarding requirement of iron for
formation of Hb was statistically significantly higher among non-donors as
compared to donor participants whereas respectively as depicted in Table 15 and
Figure 18.
FIGURE 18: DISTRIBUTION AMONG STUDY PARTICIPANTS REGARDING

KNOWLEDGE OF THE DIETARY ELEMENTS REQUIRED FOR FORMATION OF
HB
DIETARY ELEMENTS REQUIRED FOR FORMATION OF HB

80%
80% 73%
70%
70%
60%
50%
39% 39% 39%
40% 32% 31% 34%
28%
30% 25%
17%
20%
10%
0%
IRON FOLIC ACID VITAMIN B12 PROTEIN
TOTAL (%) DONOR (%) NON ‐DONOR (%)
46
TABLE 16: STRATIFICATION OF KNOWLEDGE REGARDING DIETARY
ELEMENTS REQUIRED FOR FORMATION OF HB WITH RESPECT TO THE
Dietary elements required for the formation Total Donor Non-donor

of Hb (N=975) (n=710) (n=265)
4/4 86 (9%) 66 (9%) 20 (8%)
¾ 157 (16%) 115 (16%) 42 (16%)
2/4 242 (25%) 172 (24%) 70 (26%)
¼ 343 (35%) 239 (34%) 104 (39%)
0/4 147 (15%) 118 (17%) 29 (11%)

Out of total (975) participants, 86 (9%), 157 (16%), 242 (25%), 343 (35%) and
147 (15%) were knowing 4, 3, 2, 1 and none of the dietary elements required for
the formation of Hb respectively. Among 710 donor participants, 66 (9%), 115
(16%), 172 (24%), 239 (34%) and 118 (17%) were knowing 4, 3, 2, 1 and none
of the dietary element required for the formation of Hb respectively. Among 265
non-donor participants, 20 (8%), 42 (16%), 70 (26%), 104 (39%) and 29 (11%)
4, 3, 2, 1 and none of the dietary elements required for the formation of Hb in
respectively as depicted in Table 16 and Figure 19 .
47
DIETARY ELEMENTS REQUIRED FOR FORMATION OF HB WITH RESPECT TO
THE NUMBER OF CORRECT RESPONSES

0% 5% 10% 15% 20% 25% 30% 35% 40% 45%
9%
4/4 9%
8%
16%
3/4 16%
16%
25%
2/4 24%
26%
35%
1/4 34%
39%
15%
0/4 17%
11%
48
TABLE 17: KNOWLEDGE REGARDING PROTEIN RICH FOOD
ITEMS AMONG STUDY PARTICIPANTS
Protein-rich foods Total Donor Non-donor P-value
(N=975) (n=710) (n=265)
Dals
Yes 760 (78%) 542 (76%) 218 (82%)
0.05*
No 215 (22%) 168 (24%) 47 (18%)
Soyabean
Yes 736 (75%) 528 (74%) 208 (78%)

NS
No 239 (25%) 182 (26%) 57 (22%)
Non-vegetarian items
Yes 621 (64%) 442 (62%) 179 (68%)

NS
No 354 (36%) 268 (38%) 86 (32%)
Channa
Yes 611 (63%) 441 (62%) 170 (64%)

NS
No 364 (37%) 269 (38%) 95 (36%)
Nuts
Yes 444 (46%) 304 (43%) 140 (53%)

0.005*
No 531 (54%) 406 (57%) 125 (47%)
Makhana
Yes 308 (32%) 227 (32%) 81 (31%)

NS
No 667 (68%) 448 (68%) 184 (69%)
Mushroom
Yes 300 (31%) 231 (33%) 69 (26%)

0.05*
No 675 (69%) 479 (67%) 196 (74%)
Average

NS
Wrong response 435 (45%) 322 (45%) 113 (43%)
49
participants, donors and non-donors were aware of the food items that are rich in
protein provided in the questionnaire such as Dals, Soyabean, Non-vegetarian
dietary items, Channa, Nuts, Makhana and Mushroom collectively as depicted in
Table 17.
(46%), 308 (32%) and 300 (31%) were aware that Dals, Soyabean, Non-
vegetarian dietary items, Channa, Nuts, Makhana and Mushroom are sources of
protein rich food items respectively. Among 710 donor participants, 542 (76%),
528 (74%), 442 (62%), 441 (62%), 304 (43%), 227 (32%) and 231 (33%) were
aware that Dals, Soyabean, Non-vegetarian dietary items, Channa, Nuts,
Makhana and Mushroom are sources of protein rich food items respectively.
Among 265 non-donor participants, 218 (82%), 208 (78%), 179 (68%), 170
(64%), 140 (53%), 81 (31%) and 69 (26%) were aware that Dals, Soyabean, Non-
vegetarian dietary items, Channa, Nuts, Makhana and Mushroom are sources of
protein rich food items respectively. Knowledge regarding Mushroom as protein
rich food items was statistically significantly higher among donors as compared
to non-donors. However, contrary to the expectation the knowledge regarding
Dals and Nuts as protein rich food items was statistically significantly higher
among non-donors as compared to donors as depicted in Table 17, Figure 20.
50
KNOWLEDGE OF PROTEIN-RICH FOOD ITEMS
PROTEIN RICH FOOD ITEMS

76%
90% 82% 74%
78%
80% 75% 78% 62%
68% 62%
70% 64% 63% 64%
53%
60% 43%
46%
50%
32%
33%
40% 32% 31% 31%
26%
30%
20%
10%
0%
DALS SOYABEAN NON‐ CHANNA NUTS MAKHANA MUSHROOM
VEGETARIAN
DIETARY
ITEMS
TABLE 18: STRATIFICATION OF KNOWLEDGE REGARDING

PROTEIN RICH FOOD ITEMS WITH RESPECT TO THE NUMBER OF
CORRECT RESPONSES
Protein-rich foods Total (N=975) Donor (n=710) Non-donor (n=265)
7/7 137 (14%) 101 (14%) 36 (14%)
6/7 81 (8%) 57 (8%) 24 (9%)
5/7 182 (19%) 124 (17%) 58 (22%)
4/7 186 (19%) 136 (19%) 50 (19%)
3/7 129 (13%) 91 (13%) 38 (14%)
2/7 91 (9%) 72 (10%) 19 (7%)
1/7 112 (11%) 85 (12%) 27 (10%)
0/7 57 (6%) 44 (6%) 13 (5%)

51
(13%), 91 (9%), 112 (11%) and 57 (6%) were knowing 7, 6, 5, 4, 3, 2, 1 and none
of the food items rich in protein respectively. Among 710 donor participants, 101
(14%), 57 (8%), 124 (17%), 136 (19%), 91 (13%), 72 (10%), 85 (12%) and 44
(6%) were knowing were knowing 7, 6, 5, 4, 3, 2, 1 and none of the food items
rich in protein respectively. Among 265 non-donor participants, 36 (14%), 24
(9%), 58 (22%), 50 (19%), 38 (14%), 19 (7%), 27 (10%) and 13 (5%) were
knowing 7, 6, 5, 4, 3, 2, 1 and none of the food items rich in protein respectively
as depicted in Table 18, Figure 21.

KNOWLEDGE OF PROTEIN-RICH FOOD ITEMS WITH RESPECT TO THE

0% 5% 10% 15% 20% 25%
14%
7/7 14%
14%
8%
6/7 8%
9%
19%
5/7 17%
22%
19%
4/7 19%
19%
13%
3/7 13%
14%
9%
2/7 10%
7%
11%
1/7 12%
10%
6%
0/7 6%
5%
52
TABLE 19: KNOWLEDGE REGARDING IRON RICH FOOD ITEMS
AMONG STUDY PARTICIPANTS
Iron-rich food items Total (N=975) Donor (n=710) Non-donor P-value
(n=265)
Chukandar
Yes 638 (65%) 455 (64%) 183 (69%)
NS
No 337 (35%) 255 (36%) 82 (31%)
Anaar
Yes 637 (65%) 457 (64%) 180 (68%)

NS
No 338 (35%) 253 (36%) 85 (32%)
Hari Patidar Sabzi
Yes 629 (65%) 448 (63%) 181 (68%)

NS
No 346 (35%) 262 (37%) 84 (32%)
Khajoor
Yes 482 (49%) 349 (49%) 133 (50%)

NS
No 493 (51%) 361 (51%) 132 (50%)
Gur
Yes 460 (47%) 330 (46%) 130 (49%)

NS
No 515 (53%) 380 (54%) 135 (51%)
Channa
Yes 361 (37%) 252 (35%) 109 (41%)

NS
No 614 (63%) 458 (65%) 156 (59%)
Average

NS
Wrong response 440 (45%) 328 (46%) 112 (42%)
participants, donors and non-donors were aware of the iron rich food items among
that provided in the questionnaire such as Chukandar, Anaar, Hari Patidar sabzi,
Khajoor, Gur and Channa collectively as depicted in Table 19.
53
Out of total (975) participants, 635 (65%), 637 (65%), 629 (65%), 482 (49%),
460 (47%) and 361 (37%) were aware that Chukandar, Anaar, Hari Patidar sabzi,
Khajoor, Gur and Channa are sources of iron rich food respectively. Among 710
donor participants, 455 (64%), 457 (64%), 448 (63%), 349 (49%), 330 (46%) and
252 (35%) were aware that Chukandar, Anaar, Hari Patidar sabzi, Khajoor, Gur
and Channa are sources of iron rich food respectively. Among 265 non-donor
participants, 183 (69%), 180 (69%), 181 (68%), 133 (50%), 130 (49%) and 109
(41%) were aware that Chukandar, Anaar, Hari Patidar sabzi, Khajoor, Gur and
Channa are sources of iron rich food respectively. The knowledge of dietary items
that are rich sources of iron was in general more in non-donors as compared to
donors, but the difference was not statistically significant as depicted in Table 19,
Figure 22.

KNOWLEDGE OF IRON-RICH FOOD ITEMS
IRON RICH FOOD ITEMS

69% 68% 68%
70% 65% 64% 65% 64% 65%
63%
60%
49% 49% 50% 49%
47% 46%
50%
41%
37%
40% 35%
30%
20%
10%
0%
CHUKANDAR ANAAR HARI PATIDAR KHAJOOR GUR CHANNA
SABJI
54
TABLE 20: STRATIFICATION OF KNOWLEDGE REGARDING IRON
RICH FOOD ITEMS WITH RESPECT TO THE NUMBER OF
CORRECT RESPONSES
Iron-rich food Total (N=975) Donor (n=710) Non-donor (n=265)
6/6 172 (18%) 121 (17%) 51 (19%)

5/6 134 (14%) 93 (13%) 41 (15%)
4/6 135 (14%) 90 (13%) 45 (17%)
3/6 197 (20%) 153 (21%) 44 (17%)
2/6 129 (13%) 97 (14%) 32 (12%)
1/6 116 (12%) 87 (12%) 29 (11%)
0/6 92 (9%) 69 (10%) 23 (9%)
(13%), 116 (12%) and 92 (9%) were knowing 6, 5, 4, 3, 2, 1, none of the food
items rich in iron respectively. Among 710 donor participants, 121 (17%), 93
(13%), 90 (13%), 153 (21%), 97 (14%), 87 (12%) and 69 (10%) were knowing
6, 5, 4, 3, 2, 1, none of the food items rich in iron respectively. Among 265 non-
donor participants, 51 (19%), 41 (15%), 45 (17%), 44 (17%), 32 (12%), 29 (11%)
and 23 (9%) were knowing 6, 5, 4, 3, 2, 1, none of the food items rich in iron
respectively as depicted in Table 20, Figure 23.
55
KNOWLEDGE OF IRON-RICH FOOD ITEMS WITH RESPECT TO THE NUMBER
OF CORRECT RESPONSES
PERCENTAGE OF CORRECT RESPNOSES

0% 5% 10% 15% 20% 25%
18%
6/6 17%
19%
14%
5/6 13%
15%
14%
4/6 13%
17%
20%
3/6 21%
17%
13%
2/6 14%
12%
12%
1/6 12%
11%
9%
0/6 10%
9%
56
TABLE 21: KNOWLEDGE REGARDING FOOD ITEMS THAT
DECREASE IRON ABSORPTION
Food decreasing iron Total (N=975) Donor (n=710) Non-donor (n=265) P-value
absorption
Tea
Yes 496 (51%) 352 (50%) 144 (54%)
NS
No 479 (49%) 358 (50%) 121 (46%)
Coffee
Yes 466 (48%) 327 (46%) 139 (52%)

NS
No 509 (52%) 383 (54%) 126 (48%)
Milk
Yes 250 (26%) 199 (28%) 51 (19%)

0.005*
No 725 (74%) 511 (72%) 214 (81%)
Average

NS
Wrong response 571 (59%) 417 (59%) 154 (58%)
participants, donors and non-donors were aware of the food items that decrease
iron absorption provided in the questionnaire such as tea, coffee and milk
collectively as depicted in Table 21.
Out of total 975 participants, 496 (51%), 466 (48%) and 250 (26%) were aware
that tea, coffee and milk decrease iron absorption respectively. Among 710 donor
participants, 352 (50%), 327 (46%) and 199 (28%) were aware that tea, coffee
and milk decrease iron absorption respectively. Among 265 non-donor
participants, 144 (54%), 139 (52%) and 51 (19%) were aware that tea, coffee and
milk decrease iron absorption respectively as depicted in Table 21 and Figure 24
respectively. Knowledge regarding tea as an inhibitor of iron absorption was
statistically significantly higher among donors as compared to non-donors as
57
KNOWLEDGE OF FOOD ITEMS THAT DECREASE IRON ABSORPTION
FOOD ITEMS THAT DECREASE IRON ABSORPTION
60% 51% 54% 52%

48% 50%
50% 46%
40%
26% 28%
30%
19%
20%
10%
0%
TOTAL DONOR NON‐DONOR
TEA COFFEE MILK
TABLE 22: STRATIFICATION OF KNOWLEDGE REGARDING FOOD

ITEMS THAT DECREASE IRON ABSORPTION WITH RESPECT TO
THE NUMBER OF CORRECT RESPONSES
Food-reducing iron absorption Total (N=975) Donor (n=710) Non-donor (n=265)
3/3 152 (16%) 119 (17%) 33 (12%)

2/3 262 (27%) 174 (25%) 88 (33%)
1/3 232 (24%) 173 (24%) 59 (22%)
0/3 329 (34%) 244 (34%) 85 (32%)
3/3: Participants correctly answered all 3 items out of the 3 items in the options
0/3: Participants correctly answered none out of the 3 items in the options
Out of total 975 participants, 152 (16%), 262 (27%), 232 (24%) and 329 (34%)
were knowing 3, 2, 1 and none of the food item that decrease iron absorption
respectively. Among 710 donor participants, 119 (17%), 174 (25%), 173 (24%)
and 244 (34%) were knowing 3, 2, 1 and none of the food item that decrease iron
absorption respectively. Among 265 non-donor participants, 33 (12%), 88 (33%),
59 (22%) and 85 (32%) were knowing 3, 2, 1 and none of the food item that
decrease iron absorption respectively as depicted in Table 22, Figure 25.
58
KNOWLEDGE OF FOOD ITEMS THAT DECREASE IRON ABSORPTION WITH
RESPECT TO THE NUMBER OF CORRECT RESPONSES

0% 5% 10% 15% 20% 25% 30% 35% 40%
16%
3/3 17%
12%
27%
2/3 25%
33%
24%
1/3 24%
22%
34%
0/3 34%
32%
59
TABLE 23: KNOWLEDGE REGARDING FOOD ITEMS RICH IN
VITAMIN C AMONG STUDY PARTICIPANTS
Food items rich in Total Donor Non-donor P-value
vitamin C (N=975) (n=710) (n=265)
Nimbu
Yes 787 (81%) 566 (80%) 221 (83%)
NS
No 188 (19%) 144 (20%) 44 (17%)
Amla
Yes 747 (77%) 539 (76%) 208 (78%)
NS
No 228 (23%) 171 (24%) 57 (22%)
Santra
Yes 744 (76%) 530 (75%) 214 (81%)
0.05*
No 231 (24%) 180 (25%) 51 (19%)
Guava
Yes 284 (29%) 203 (29%) 81 (31%)
NS
No 691 (71%) 507 (71%) 184 (69%)
Average

NS
Wrong response 334 (34%) 266 (36%) 84 (32%)
participants, donors and non-donors were aware of the food items that are rich
sources of Vitamin C among those provided in the questionnaire such as Nimbu,
Amla, Santra and Guava collectively as depicted in Table 23.
Out of total 975 participants, 787 (81%), 747 (77), 744 (76%) and 284 (29%)
were aware that Nimbu, Amla, Santra and Guava are rich in vitamin C. Among
710 donor participants, 566 (80%), 539 (76%), 530 (75%) and 203 (29%) were
aware that Nimbu, Amla, Santra and Guava are rich in vitamin C. Among 265
non-donor participants, 221 (83%), 208 (78%), 214 (81%) and 81 (31%) were
aware that Nimbu, Amla, Santra and Guava are rich in vitamin C. The knowledge
regarding Santra being rich in vitamin C is statistically significantly more in non-
donors as compared to donors as depicted in Table 23, Figure 26.
60
KNOWLEDGE OF FOOD ITEMS RICH IN VITAMIN C
FOOD ITEMS RICH IN VITAMIN C
90% 83%
81% 80% 81%
77% 76% 78% 76% 75%
80%
70%
60%
50%
40%
31%
29% 29%
30%
20%
10%
0%
NIMBU AMLA SANTRA GUAVA
TABLE 24: STRATIFICATION OF KNOWLEDGE REGARDING FOOD ITEMS

FOOD ITEMS RICH IN VITAMIN C WITH RESPECT TO THE NUMBER OF
CORRECT RESPONSES
Food items rich in
Total (N=975) Donor (n=710) Non-donor (n=265)
vitamin C
4/4 236 (24%) 167 (23%) 69 (26%)
3/4 416 (43%) 296 (42%) 120 (45%)
2/4 120 (12%) 92 (13%) 28 (11%)
1/4 130 (13%) 98 (14%) 32 (12%)
0/4 73 (8%) 57 (8%) 16 (6%)
4/4: Participants correctly answered all 4 items out of the 4 items in the options
0/4: Participants correctly answered none out of the 4 items in the options
Out of total 975 participants, 236 (24%), 416 (43%), 120 (12%), 130 (13%) and
73 (8%) were knowing 4, 3, 2, 1 and none of the food items rich in vitamin C
respectively. Among 710 donor participants, 167 (23%), 296 (42%), 92 (13%),
98 (14%) and 57 (8%) were knowing 4, 3, 2, 1 and none of the food items rich in
61
vitamin C respectively. Among 265 non-donor participants, 69 (26%), 120
(45%), 28 (11%), 32 (12%) and 16 (6%) were knowing 4, 3, 2, 1 and none of the
food items rich in vitamin C respectively as depicted in Table 24, Figure 27.

KNOWLEDGE OF FOOD ITEMS RICH IN VITAMIN C WITH RESPECT TO THE NUMBER
OF CORRECT RESPONSES
PERCENT OF CORRECT RESPONSES

0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50%
24%
4/4 23%
26%
43%
3/4 42%
45%
12%
2/4 13%
11%
13%
1/4 14%
12%
8%
0/4 8%
6%
62
TABLE 25: KNOWLEDGE REGARDING THAT VITAMIN C
INCREASES IRON ABSORPTION IN STUDY PARTICIPANTS
Vitamin (Vitamin C) Total Donor Non-donor
P-value
increasing iron absorption (N=975) (n=710) (n=265)
NS
Incorrect response 259 (27%) 195 (27%) 64 (24%)
Out of the total 975 participants, 716 (73%) were correctly knowing that vitamin
C increases the iron absorption and 259 (27%) were not knowing that vitamin C
increases the iron absorption. Among 710 donor participants, 515 (73%) were
correctly knowing that vitamin C increases the iron absorption and 195 (27%)
were not knowing that vitamin C increases the iron absorption. Among 265 non-
donor participants, 201 (76%) were correctly knowing that vitamin C increases
the iron absorption and 64 (24%) %) were not knowing that vitamin C increases
the iron absorption. The difference in the knowledge that Vitamin C increases
Iron absorption was not statistically significant between donors and non-donors
as depicted in Table 25 and Figure 28 respectively.
FIGURE 28: DISTRIBUTION OF STUDY PARTICIPANTS WITH RESPECT TO
KNOWLEDGE REGARDING VITAMIN INCREASING IRON ABSORPTION
VITAMIN INCREASING IRON ABSORPTION
73% 76%
73%
80%
70%
60%
50%
40% 27% 27%

24%
30%
20%
10%
0%
CORRECT WRONG
TOTAL DONOR NON DONOR
63
TABLE 26: LEVEL OF KNOWLEDGE REGARDING IRON
DEFICIENCY RELATED LOW HB
Knowledge Total (N=975) Donor (n=710) Non-donor (n=265) P-value
Adequate 425 (44%) 304 (43%) 121 (46%)

NS
Inadequate 550 (56%) 406 (57%) 144 (54%)
# Adequate >50%, Inadequate ≤49%
Overall, 425 (44%), 304 (43%) and 121 (46%) of the total participants, donors
and non-donors had adequate knowledge, whereas 420 (56%), 406 (57%) and 144
(54%) of the total participants, donors and non-donors did not have adequate
knowledge (inadequate) respectively. The difference in the level of knowledge
regarding iron deficiency-related low Hb between the donor and non-donor
participants was statistically not significant as depicted in Table 26 and Figure 29
respectively.
FIGURE 29: DISTRIBUTION OF STUDY PARTICIPANTS WITH RESPECT TO

LEVEL OF KNOWLEDGE REGARDING IRON DEFICIENCY RELATED LOW HB
GRADING OF KNOWLEDGE
56% 57%
54%
60%
46%
44% 43%
50%
40%
30%
20%
10%
0%
ADEQUATE INADEQUATE
64
TABLE 27: ATTITUDE OF STUDY PARTICIPANTS
Total Donor Non-donor
Variable and Attitude (N=975) (n=710) (n=265)
Decrease in Hb after blood donation
Positive 500 (51%) 377 (53%) 123 (46%)
Neutral 145 (15%) 105 (15%) 40 (15%)
Negative 330 (34%) 228 (32%) 102 (39%)
Decrease in iron after blood donation
Positive 471 (48%) 361 (51%) 110 (42%)
Neutral 169 (17%) 121 (17%) 48 (18%)
Negative 335 (34%) 228 (32%) 107 (40%)
Blood donation from vegetarians
Positive 654 (67%) 474 (67%) 180 (68%)
Neutral 101 (10%) 77 (11%) 24 (9%)
Negative 220 (23%) 159 (22%) 61 (23%)
Blood donation from females
Positive 550 (56%) 398 (56%) 152 (57%)
Neutral 166 (17%) 138 (19%) 28 (11%)
Negative 259 (27%) 174 (25%) 85 (32%)
Average
Positive 544 (56%) 403 (57%) 141 (53%)
Neutral 145 (15%) 110 (15%) 35 (13%)
Negative 286 (29%) 197 (28%) 89 (34%)
Overall, 544 (56%), 403 (57%) and 141 (53%) of the total participants, donors
and non-donors had positive attitude towards the items in the questionnaire such
as a decrease in iron and Hb post blood donation and the donations from
vegetarians and females collectively. Whereas 286 (29%), 197 (28%) and 89
(34%) of the total participants, donors and non-donors had negative attitude
towards the items in the questionnaire such as a decrease in iron and Hb post
blood donation and the donations from vegetarians and females collectively.
While 145 (15%), 110 (15%) and 35 (13%) of the total participants, donors and
non-donors had neutral attitude towards the items in the questionnaire such as a
decrease in iron and Hb post blood donation and the donations from vegetarians
and females collectively as depicted in Table 27.
65
Out of total 975 participants, 500 (51%), 145 (15%) and 220 (34%), were having
positive, neutral and negative attitude regarding decrease in Hb after blood
donation respectively. Among 710 donor participants, 377 (53%), 105 (15%) and
228 (32%) were having positive, neutral and negative attitude regarding decrease
in Hb after blood donation respectively. Among 265 non-donor participants, 123
(46%), 40 (15%) and 102 (39%) were having positive, neutral and negative
attitude regarding decrease in Hb after blood donation respectively as depicted in
Table 27.
Out of total 975 participants, 471 (48%), 169 (17%) and 335 (34%) were having
positive, neutral and negative attitude regarding decrease in iron after blood
donation respectively. Among 710 donor participants, 361 (51%), 121 (17%) and
228 (32%) were having positive, neutral and negative attitude regarding decrease
in iron after blood donation respectively. Among 265 non-donor participants, 110
(42%), 48 (18%) and 107 (40%) were having positive, neutral and negative
attitude regarding decrease in iron after blood donation respectively as depicted
in Table 27.
Out of total 975 participants, 654 (67%), 101 (10%) and 220 (23%), were having
positive, neutral and negative attitude regarding a blood donation from
vegetarians respectively. Among 710 donor participants, 474 (67%), 77 (11%)
and 159 (22%) were having positive, neutral and negative attitude regarding a
blood donation from vegetarians respectively. Among 265 non-donor
participants, 180 (68%), 24 (9%) and 61 (23%) were having positive, neutral and
negative attitude regarding a blood donation from vegetarians respectively as
Out of total 975 participants, 550 (56%), 166 (17%) and 259 (27%) were having
positive, neutral and negative attitude regarding a blood donation from females
respectively. Among 710 donor participants, 398 (56%), 138 (19%) and 174
(25%) were having positive, neutral and negative attitude regarding a blood
66
donation from females respectively. Among 265 non-donor participants, 152
(57%), 28 (11%) and 85 (32%) were having positive, neutral and negative attitude
regarding a blood donation from females respectively as depicted in Table 27 and
Figure 30.
67
FIGURE 30: ATTITUDE OF STUDY PARTICIPANTS
ATTITUDE OF STUDY PARTICIPANTS

67%
70% 68%
67%
56%
60% 57%
53% 56%
51%
51%
46% 48%
50%
42%
40%
39%
40%
34% 32%
32% 34%
32%
25%
30% 27%
22%
23% 23%
15% 19%
17%
20% 18% 17%
17%
15% 15%
11% 11%
10% 9%
10%
0%
Decrease in POSITIVE NEUTRAL NEGATIVE Decrease in POSITIVE NEUTRAL NEGATIVE Blood POSITIVE NEUTRAL NEGATIVE Blood POSITIVE NEUTRAL NEGATIVE
Hemoglobin Iron after donation donation
after blood blood from from
donation donation vegetarians females
TOTAL DONOR NON‐ DONOR
68
TABLE 28: GRADING OF NEGATIVE ATTITUDE
Variable and Grade of Negative Total Donor Non-donor

attitude measured as concern
Decrease in Hb after blood donation
N=330 n=228 n=102
High concern 98 (30%) 77 (34%) 21 (21%)
Moderate concern 90 (27%) 61 (27%) 29 (28%)
Mild concern 142 (43%) 90 (39%) 52 (51%)
Decrease in iron after blood donation
N=335 n=228 n=107
High concern 98 (29%) 78 (34%) 20 (19%)
Mild concern 143 (43%) 80 (35%) 63 (59%)
Blood donation from vegetarians
N=220 n=159 n=61
High concern 103 (47%) 82 (52%) 21 (34%)
Mild concern 61 (28%) 38 (24%) 23 (38%)
Blood donation from females
N=259 n=174 n=85
High concern 105 (40%) 84 (48%) 21 (25%)
Mild concern 85 (33%) 45 (26%) 40 (47%)
Table 28 and Figure 31 depict the grading of the negative attitude in total
participants, donors and non-donors on the items included in the study
questionnaire such as a decrease in iron and Hb post blood donations and the
attitude towards a blood donation from a vegetarian and females respectively.
However, no clear pattern of concordance was noted on this stratification.
69
FIGURE 31: DISTRIBUTION OF STUDY PARTICIPANTS WITH RESPECT TO GRADES OF NEGATIVE ATTITUDE
GRADES OF NEGATIVE ATTITUDE
60%
50%
40%
30%
20%
10%
0%
Decrease in HIGH MILD MODERATE Decrease in HIGH MILD MODERATE Blood HIGH MILD MODERATE Blood HIGH MILD MODERATE
Hemoglobin Iron after donation donation
after blood blood from from females
donation donation vegetarians
TOTAL DONOR NON ‐ DONOR
70
TABLE 29: HB TESTING AND INFORMATION ON QUANTITATIVE
HB VALUE IN STUDY PARTICIPANTS
Hb Total (N=975) Donor (n=710) Non-donor (n=265) P-value

Yes 767 (79%) 568 (80%) 199 (75%)
NS
No 208 (21%) 142 (20%) 66 (25%)
# Quantitative Hb done from a laboratory irrespective of the screening done during donor selection
NS: Not significant (P>0.05)
Out of total 975 participants, 767 (79%) had got their Hb tested and 208 (21%)
had never got their Hb tested and could not report the quantitative values. Among
710 donors, 568 (80%) had got their Hb tested apart from qualitative testing
which is a part of donor screening and 142 (20%) had never got their Hb tested
apart from qualitative testing which is a part of donor screening and could not
report the quantitative values. Among 265 non-donors, 199 (75%) had got their
Hb tested and 66 (25%) had never got their Hb tested and could not report the
quantitative values. The difference between donors and non-donors, analysis was
not statistically significant as depicted in Table 29 and Figure 32.
71
FIGURE 32: DISTRIBUTION OF DONOR AND NON-DONOR
PARTICIPANTS WITH RESPECT TO HB TESTING
CATEGORY BASED ON HB TESTED

79% 80%
75%
80%
70%
60%
50%
40%
21% 25%
30% 20%
20%
10%
0%
Hb Tested Hb Not Tested
TABLE 30: STRATIFICATION OF HB TESTING AND INFORMATION

ON QUANTITATIVE HB VALUE IN DONOR PARTICIPANTS BASED
ON STATUS OF COUNSELLING
Hb (N=710) Counselled (n=331) Non-counselled (n=379) P-value
Yes 278 (84%) 290 (77%)

0.01*
No 53 (16%) 89 (23%)
Among 331 donors who had been counselled, 278 (84%) had got their
quantitative Hb tested apart from qualitative testing which is a part of donor
screening whereas 53 (16%) had never got their Hb tested apart from qualitative
testing which is a part of donor screening and could not report the quantitative
values. Among 379 donors who had not been counselled, 290 (77%) had got their
quantitative Hb tested apart from qualitative testing which is a part of donor
screening whereas 89 (23%) had never got their Hb tested apart from qualitative
testing which is a part of donor screening and could not report the quantitative
72
values. Notably, the difference in the practice of getting Hb tested apart from the
qualitative testing that is usually done as part of donor selection between donor
who received counselling and donors who did not receive counselling was
FIGURE 33: DISTRIBUTION OF DONOR AND NON-DONOR

PARTICIPANTS WITH RESPECT TO COUNSELLING
DISTRIBUTION OF HB BASED ON COUNSELLING
84%
90% 77%
80%
70%
60%
50%
40%
23%
30% 16%
20%
10%
0%
Hb Tested Hb Not Tested
Counselled Non Counselled
Out of 767 study participants who got their Hb tested only 712 could report their
quantitative Hb and 55 could not report.
TABLE 31: HB AMONG STUDY PARTICIPANTS
Study participants Hb (g/dl) Mean ± SD P-value
Total participants (N=712) 13.11 ± 2.11
Donors (n=524) 13.71 ± 1.77

0.001*
Non-donors (n=188) 11.45 ± 2.10
Out of total 712 participants who had got their Hb tested and could report the
quantitative values, 524 were donors and 188 were non-donors. The mean Hb of
73
total participants, donor and non-donor participants was 13.11 ± 2.11 g/dl, 13.71
± 1.77 g/dl and 11.45 ± 2.10 g/dl respectively. The mean Hb of non-donors was
significantly higher compared to donors as depicted in Table 31.
TABLE 32: DISTRIBUTION OF HB AMONG DONORS BASED ON

COUNSELLING
Donors (N=524) Hb (g/dl) Mean ± SD P-value
Counselled (n=255) 14.03 ± 1.81

0.001*
Non-counselled (n=269) 13.40 ± 1.68
Out of total 524 donor participants who had got their Hb tested and could report
the quantitative values, 225 were counselled and 269 were non-counselled donors
respectively. The mean Hb of counselled and non-counselled donor participants
was 14.03 ± 1.81 g/dl and 13.40 ± 1.68 g/dl respectively. The mean Hb of
counselled blood donors was statistically significantly higher compared to non-
counselled donors as depicted in Table 32.
TABLE 33: HB DISTRIBUTION OF STUDY PARTICIPANTS BASED ON

DIETARY HABIT:
Dietary habit (N=712) Hb (g/dl) Mean ± SD P-value
Vegetarian (n= 419) 12.94 ± 2.16
Non-vegetarian (n= 293) 13.35 ± 2.01 0.01*
Out of total 712 participants who had got their Hb tested and could report the
quantitative values, 419 were vegetarian and 293 were non-vegetarians. The
mean Hb of vegetarian and non-vegetarian participants was 12.94 ± 2.16 g/dl and
13.35 ± 2.01 g/dl respectively. Mean Hb of non-vegetarians was statistically
significantly higher than vegetarians as depicted in Table 33.
74
TABLE 34: PRACTICES IN DONOR PARTICIPANTS
Total Donors Counselled Non-counselled

Variables P-value
(N=710) (n=331) (n=379)
Increase Iron rich items
Yes 460 (65%) 285 (86%) 175 (46%)

0.001*
No 250 (35%) 46 (14%) 204 (54%)
Increase Proteins rich items
Yes 532 (75%) 304 (92%) 228 (60%)

0.001*
No 178 (25%) 27 (8%) 151 (40%)
Increase Vitamin C rich items
Yes 491 (69%) 287 (87%) 204 (54%)

0.001*
No 219 (31%) 44 (13%) 175 (46%)
Decrease tea
Yes 458 (65%) 260 (79%) 198 (52%)

0.001 *
No 252 (35%) 71 (21%) 181 (48%)
Decrease coffee
Yes 468 (66%) 259 (78%) 209 (55%)

0.001*
No 242 (34%) 72 (22%) 170 (45%)
Average

0.001*
Wrong response 228 (32%) 52 (16%) 176 (46%)
Overall, 482 (68%), 279 (84%) and 203 (54%) of the total donors, counselled
donors and non-counselled donors adopted practices to increase iron, protein and
vitamin C rich items in diet and decrease tea and coffee in diet collectively.
Whereas 228 (32%), 52 (16%) and 176 (56%) of the total donors, counselled
donors and non-counselled donors did not adopted practices to increase iron,
protein and vitamin C rich items in diet and decrease tea and coffee in diet
collectively. Notably the difference of such practices between the practices to
optimize iron and Hb in diet were statistically significantly higher in counselled
donors as compared to non-counselled donors as depicted in Table 34.
75
Out of total 710 donor participants, 460 (65%) participants were taking extra care
to increase iron rich food in their diet and 250 (35%) were not taking extra care
to increase iron rich food in their diet. Among 331 counselled donors, 285 (86%)
donor participants were taking extra care to increase iron rich food in their diet
and 46 (14%) were not taking extra care to increase iron rich food in their diet.
Among 379 non-counselled donors, 175 (46%) donor participants were taking
extra care to increase iron rich food in their diet and 204 (54%) were not taking
extra care to increase iron rich food in their diet. Notably, the difference in
practice of taking extra care to increase iron rich food in diet was statistically
significantly higher in counselled donors as compared to non-counselled donors
as depicted in Table 34.
Out of total 710 donor participants, 532 (75%) were taking extra care to increase
protein rich food in their diet and 178 (25%) were not taking extra care to increase
protein rich diet in their diet. Among 331 counselled donors, 304 (92%) donors
were taking extra care to increase protein rich food in their diet and 27 (8%) were
not taking extra care to increase protein rich diet in their diet. Among 379 non-
counselled donors, 228 (60%) were taking extra care to increase protein rich food
in their diet and 151 (40%) were not taking extra care to increase protein rich diet
in their diet. Notably, the difference in practice of taking extra care to increase
protein rich diet in diet was statistically significantly higher in counselled donors
as compared to non-counselled donors as depicted in Table 34.
Out of total 710 donor participants, 491 (69%) were taking extra care to increase
vitamin C rich food in their diet and 219 (31%) were not taking extra care to
increase vitamin C rich food in their diet. Among 331 counselled donors, 287
(87%) were taking extra care to increase vitamin C rich food in their diet and 44
(13%) were not taking extra care to increase vitamin C rich food in their diet.
Among 379 non-counselled donors, 204 (54%) were taking extra care to increase
vitamin C rich food in their diet and 175 (46%) were not taking extra care to
76
increase vitamin C rich food in their diet. Notably, the difference in practice of
taking extra care to increase vitamin C rich diet in diet was statistically
Out of total 710 donor participants, 458 (65%) were taking extra care to decrease
tea intake in their diet and 252 (35%) were not taking extra care to decrease tea
intake in their diet. Among 331 counselled donors, 260 (79%) were taking extra
care to decrease tea intake in their diet and 71 (21%) were not taking extra care
to decrease tea intake in their diet. Among 379 non-counselled donors, 198 (52%)
were taking extra care to decrease tea intake in their diet and 181 (48%) were not
taking extra care to decrease tea intake in their diet. Notably, the difference in
practice of taking extra care to decrease tea intake in diet in diet was statistically
Out of total 710 donor participants, 468 (66%) were taking extra care to decrease
coffee intake in their diet and 242 (34%) were not taking extra care to decrease
coffee intake in their diet. Among 331 counselled donors, 259 (78%) were taking
extra care to decrease coffee intake in their diet and 72 (22%) were not taking
extra care to decrease coffee intake in their diet. Among 379 non-counselled
donors, 209 (55%) were taking extra care to decrease coffee intake in their diet
and 170 (45%) were not taking extra care to decrease coffee intake in their diet.
Notably, the difference in practice of taking extra care to decrease coffee intake
in diet in diet was statistically significantly higher in counselled donors as
compared to non-counselled donors as depicted in Table 34 and figure 34.
77
FIGURE 34: DISTRIBUTION OF PRACTICES IN DONOR PARTICIPANTS WITH RESPECT TO COUNSELLING
PRACTICES IN DONOR PARTICIPANTS
100%
92%
90% 86% 87%
79% 78%
80% 75%
69%
70% 65% 65% 66%
60%
60% 54% 55%
54% 52%
46% 48%
50% 46% 45%
14%
40% 21%
22%
40% 35% 13% 35% 34%
8% 31%
30% 25%
20%
10%
0%
TOTAL DONORS COUNSELLED NON ‐COUNSELLED
78
TABLE 35: IMPACT OF STUDY TOWARDS MOTIVATING DIETARY
MODIFICATION AMONG STUDY PARTICIPANTS
Motivation towards Total Donor Non-donor

dietary modification (N=975) (n=710) (n=265) P-value
Yes 849 (87%) 624 (88%) 225 (85%)

NS
No 126 (13%) 86 (12%) 40 (15%)
Out of total 975 participants, 849 (87%) got motivated towards dietary
modification for becoming a regular blood donor during the attempt of the present
questionnaire, whereas 126 (13%) did not get motivated towards dietary
questionnaire. Among 710 donor participants, 624 (88) got motivated towards
dietary modification for becoming a regular blood donor during the attempt of
the present questionnaire, whereas 86 (12%) did not get motivated towards
dietary modification for becoming a regular blood donor during the attempt of
the present questionnaire. Among 265 non-donor participants, 225 (85%) got
motivated towards dietary modification for becoming a regular blood donor
during the attempt of the present questionnaire, whereas 40 (15%) did not get
motivated towards dietary modification for becoming a regular blood donor
during the attempt of the present questionnaire. Overall, 849 (87%) total study
participants were motivated to take care of their diet by virtue attempting the
present survey. However, the difference between the motivation between donors
and non-donors regarding motivation towards dietary modification was not
79
FIGURE 35: DISTRIBUTION OF IMPACT OF STUDY AMONG STUDY
PARTICIPANTS TOWARDS MOTIVATION FOR DIETARY
MODIFICATION
MOTIVATION TOWARDS DIETARY MODIFICATION AMONG

STUDY PARTICIPANTS
87% 88% 85%
90%
80%
70%
60%
50%
40%
12%
30%
13% 15%
20%
10%
0%
MOTIVATED NOT MOTIVATED
TOTAL DONOR NON‐DONOR
80
TABLE 36: IMPACT OF STUDY IN MOTIVATING DIETARY
MODIFICATION STARTIFIED AMONG DONORS WITH REGARD TO
THE STATUS OF COUNSELLING
Motivation towards dietary Counselled Non-counselled
P-value
modification (n=331) (n=379)
Yes 318 (96%) 306 (81%)
0.001*
No 13 (4%) 73 (19%)
Out of total 331 counselled donors, 318 (96%) got motivated towards dietary
questionnaire, whereas 13 (4%) did not get motivated towards dietary
questionnaire. Among 379 non-counselled donors during their previous blood
donations, 306 (81%) got motivated towards dietary modification for becoming
a regular blood donor, whereas 73 (19%) did not get motivated towards dietary
questionnaire. Notably, the impact of the study measured in terms of being
motivated for taking care of their diet by virtue attempting the present survey was
statistically significantly higher in the donors who had also been previously
counselled on such aspects during their previous blood donations as compared to
non-counselled donor participants as depicted in Table 36 and Figure 36
respectively.
81
FIGURE 36: DISTRIBUTION OF IMPACT OF STUDY IN DONOR PARTICIPANTS
TOWARDS MOTIVATION FOR DIETARY MODIFICATION WITH RESPECT TO
COUNSELLING
MOTIVATION TOWARD DIETARY MODIFICATION WITH REGARD

TO THE STATUS OF COUNSELLING AMONG DONORS
96%
100% 81%
90%
80%
70%
60%
50%
40%
19%
30%
20% 4%
10%
0%
MOTIVATED NOT MOTIVATED
COUNSELLED DONOR NON COUNSELLED DONORS
TABLE 37: KNOWLEDGE AND ATTITUDE SCORES IN STUDY

PARTICIPANTS
Donor Non-donor
Score Total (N=975)
(n=710) (n=265) P-value
(Mean ±SD)
Knowledge 16 ± 7.04 16 ± 7.26 17 ± 6.41 NS

Attitude 2 ± 1.59 3 ± 1.62 2 ± 1.52 NS
The mean of knowledge score was 16 ± 7.04, 16 ± 7.26 and 17 ± 6.41 in total
participants, donors and non-donors respectively. The difference in mean of
knowledge score was not statistically significantly different in donors as
compared to non-donors as depicted in Table 37.
The mean of attitude score was 2 ± 1.59, 3 ± 1.62 and 2 ± 1.52 in total participants,
donors and non-donors respectively. The difference in mean of attitude score was
not statistically significantly different in donors as compared to non-donors as
82
TABLE 38: PRACTICES SCORES AMONG COUNSELLED AND NON-
COUNSELLED DONOR PARTICIPANTS
Score Total Donor Counselled Non-counselled

P-value
(Mean ±SD) (N=975) (n=710) (n=265)
Practice 5 ± 2.00 5 ± 2.04 4 ± 1.86 0.001*
The mean of practice score was 5 ± 2.00, 5 ± 2.04 and 4 ± 1.86 in total donors,
counselled donors and non-counselled donors respectively. The difference in
adoption of healthy practices to increase iron, protein and vitamin C rich items in
diet and decrease tea and coffee in diet collectively was statistically significantly
higher in counselled donors as compared to non-counselled donors as depicted in
Table 38.
83
DISCUSSION
Voluntary non-remunerated regular donors are the cornerstone of BTS.

Therefore, BTS emphasize on retention of voluntary blood donors. At the same
time, the well-being and health of the donor are the responsibility of BTS.
Donation induced iron deficiency (DIID) is a well-known, but less appreciated
long-term adverse effect of regular blood donation. In consonance with the ISBT
code of ethics for blood donations of non-maleficence, the BTS should take
measures to prevent/mitigate DIID. The endeavour is to assess the knowledge,
attitude, and practice regarding iron deficiency low Hb among donors and
potential blood donors, is the first step towards the formulation of interventions
to prevent/mitigate DIID.
The present study included 975 participants, including 710 (72.8%) donors and
265 (27.2%) non-donors. The mean age was 31.6±10.1, 32.5±9.9, and 28.3±9.9
years among total participants, donors and non-donors respectively. There were
261 (27%), 79 (11%) and 182 (69%) females and 714 (73%), 631 (89%) and 83
(31%) males among total participants, donors and non-donors respectively.
Education upto college was in 809 (83%), 589 (83%) and 220 (83%), and upto
schooling was in 166 (17%), 121 (17%) and 45 (17%) among total participants,
donors and non-donors respectively. Service class constituted 564 (58%), 432
(61%) and 132 (50%), students were 294 (30%), 179 (25%) and 115 (43%),
business class were 93 (9%), 83 (12%) and 10 (4%) whereas 24 (3%), 16 (2%)
and 8 (3%) were classified in others category among total participants, donors
and non-donors respectively. Vegetarians constituted 559 (57%), 394 (55%) and
165 (62%) whereas non-vegetarians constituted 416 (43%), 316 (45%) and 100
(38%) among total participants, donors and non-donors respectively. Urban
residents constituted 758 (78%), 544 (77%) and 214 (81%) whereas 217 (22%),
166 (23%) and 51 (19%) were rural residents among total participants, donors
and non-donors respectively.
84
Notably, the percentage of females is quite low in donors (approximately 30%
only), whereas it is quite high in non-donors (approximately 70%). The actual
donations may be even less as there are many factors responsible for the low
number of donor presentations such as a lower body weight, lower Hb levels,
higher chances of deferral due to menstruation and/or breastfeeding, a recent
child birth and/or abortion. One published study from PGIMER, Chandigarh
reports only 1493 (1.3%) of donations from females out 1,17,768 total donations
over 9 years, however, the study reports blood donations from the blood donation
centre and may not represent total female donor participations as donors may
donate at the outdoor camps. [25]
Overall, 81% participants, 81% donors and 83% non-donors were aware of on
Hb required to donate blood respectively. This is in sharp contrast and
significantly higher to the 20% reported by Shah et al, however, the study was
carried out in 2015 and on blood donors at a rural hospital in western India. [28]
The difference in knowledge on Hb required to donate blood between donors and
non-donors in the present study was not statistically significant. Therefore, there
is apparently no increase in knowledge on Hb required to donate blood by virtue
of being a blood donor in reference to the context of the results obtained in the
present study.
Overall, 26% of participants, 25% donors and 29% non-donors were knowing
that Hb decreases after blood donation. The difference in knowledge on that Hb
decreases after blood donation between donors and non-donors was not
statistically significant. Therefore, there is apparently no increase in knowledge
that Hb decreases after blood donation by virtue of being a blood donor in
reference to the context of the results obtained in the present study.
85
Overall, on an average, 42%, 42% and 42% of the total participants, donors and
non-donors were aware of the indicators of low Hb from the items provided in
the questionnaire such as weakness, dizziness, shortness of breath, fast heartbeat
and urge to eat non-edible items (pica) collectively. Contrary to the expectation,
the knowledge regarding weakness as indicator of low Hb was statistically
significantly higher among non-donors as compared to donors. Therefore, there
is apparently no increase in knowledge on the aspect by virtue of being a blood
donor in reference to the context of the results obtained in the present study. This
is similar to the reported knowledge of 42% in donors regarding indicators of
IDA by Shah et al from Gujarat, India in 2015. [28] Whereas Reddy et al reported
that 50% of adolescent girls knew about weakness and shortness of breath as
symptoms of low Hb from Telangana, India in 2021. [31] Only 7% of donors knew
all indicators of low Hb among the options provided in the questionnaire, whereas
18% donors did not know even a single indicator of low Hb among the options
provided in the questionnaire. Therefore, counselling regarding signs and
symptoms of low Hb to donors may aide early recognition of DIID.
Overall, 73% & 26% of participants, 78% & 25% donors and 61% & 26% non-
donors were aware of the inter-donation interval for male and female gender
respectively. The difference in knowledge regarding inter-donation interval for
males was statistically significantly higher among donors as compared to non-
donors. Mishra et al reported that 75% donors and 59% non-donors were aware
of the inter-donation interval, they did not report it separately because at the time
of the study the inter-donation interval was not separately specified in India. [32]
The separate notification for inter-donation interval with respect to the gender of
the donor was in the Guidelines for blood donor selection of the National Blood
Transfusion Council (NBTC), MoHFW, GoI in 2017 and the Drugs and
Cosmetics Act in 2020. [33,34]
86
Overall, 42% of participants, 38% donors and 54% non-donors were knowing
that iron levels decrease after blood donations. The difference in knowledge on
that iron levels decrease after blood donations between non-donors and donors
was statistically significant. Therefore, there is apparently no increase in
knowledge that iron levels decrease after blood donations by virtue of being a
blood donor in reference to the context of the results obtained in the present study.
These findings bring out the need to inform, educate potential blood donors (at
present non-donors) on this aspect and explain that, may occur after regular blood
donation specially if dietary practices do not include food items rich in iron, and
facilitators of iron absorption and avoidance of inhibitors of iron absorption.
Therefore, potential blood donors need not harbour any fear that his/her iron will
in any case fall after blood donations.
non-donors were aware of the dietary items required for Hb formations from the
items provided in the questionnaire such as iron, folic acid, vitamin B12 and
proteins collectively This finding in donors is similar to the report by Shah et al
that 42% donors knew importance of both iron vitamin-B12 for formation of Hb
from Gujarat, India in 2015. [28] Knowledge regarding requirement of protein for
formation of Hb was significantly higher among donors as compared to non-
donors. Contrary to the expectation, knowledge regarding requirement of iron for
formation of Hb was statistically significantly higher among non-donors as
compared to donors. Only 9% of donors knew all dietary elements required for
the formation of Hb among the options provided in the questionnaire, whereas
17% of donors did not know even a single dietary element required for the
formation of Hb among the options provided in the questionnaire. Therefore,
counselling regarding dietary element required for the formation of Hb to donors
may aide mitigation of DIID.
87
non-donors were aware of the food items that are rich in protein provided in the
questionnaire such as Dals, Soyabean, Non-vegetarian dietary items, Channa,
Nuts, Makhana and Mushroom collectively. The knowledge of Mushroom as a
rich source of protein was statistically significantly higher among donors as
compared to non-donors. However, contrary to the expectation, knowledge
regarding Dals and Nuts as protein rich food items was statistically significantly
higher among non-donors as compared to donors. Only 14% of donors knew all
source of protein rich food item among the options provided in the questionnaire,
while 6% of donors did not know even a single source of protein rich food item
among the options provided in the questionnaire. Therefore, counselling
regarding dietary protein rich food items required for the formation of Hb to
donors may aide mitigation of DIID.
non-donors were aware of the iron rich food items among that provided in the
questionnaire such as Chukandar, Anaar, Hari Patidar sabzi, Khajoor, Gur and
Channa collectively. This finding in donors is higher to the report by Shah et al
that 31.6% had correct knowledge of iron rich food from Gujarat, India in 2015.
[28]
Whereas Reddy et al report that less than 10% of adolescent girls know about
iron rich food from Telangana, India in 2019. [31] Contrary to the expectation, the
knowledge of dietary items that are rich sources of iron was in general more in
non-donors as compared to donors, the difference was not statistically significant.
Only 17% of donors knew all source of iron rich food item among the options
provided in the questionnaire, while 10% of donors did not know even a single
source of iron rich food item among the options provided in the questionnaire.
Therefore, counselling regarding dietary iron rich food items required for the
formation of Hb to donors may aide mitigation of DIID.
88
non-donors were aware of the food items that decrease iron absorption provided
in the questionnaire such as tea, coffee and milk collectively. Whereas Reddy et
al report that 5% of adolescent girls know about food items which decrease
absorption iron rich food from Telangana, India in 2019. [31] Knowledge regarding
milk as food item that decreases iron absorption was statistically significantly
higher among donors as compared to non-donors. Only 17% of donors knew all
food item that decrease iron absorption among the options provided in the
questionnaire, while 34% of donors did not know even a single food item that
decreases iron absorption among the options provided in the questionnaire. This
has been described in literature due to the presence of tannins in tea, they act as
chelators and bind minerals and thereby inhibit intestinal absorption apart from
the polyphenols and phytates. The polyphenols in coffee reduce the iron
absorption of non-heme iron due to the presence of chlorogenic acid (binds and
hinders absorption), apart from the tannins and phytates. Clusters of
phosphoserine residues in cow milk casein binds iron with high affinity and
inhibits the absorption apart from the effect of calcium in milk. Calcium inhibits
absorption of both nonheme iron and heme iron, probably by acting at enterocyte
[35-42]
iron transporter proteins. To compound the issue both tea and coffee are
predominantly made with milk in India. Therefore, counselling regarding food
item that decreases iron absorption in donors may aide mitigation of DIID.
non-donors were aware of the food items that are rich sources of Vitamin C
among those provided in the questionnaire such as Nimbu, Amla, Santra and
Guava collectively. Whereas Reddy et al report that only 5% of adolescent girls
know about the facilitation of iron in food by vitamin C from Telangana, India in
[31]
2019. The knowledge regarding Santra being rich in vitamin C was
statistically significantly more in non-donors as compared to donors. Only 23%
89
of donors knew all food items rich in vitamin C among the options provided in
the questionnaire, while 8% of donors did not know even a single food items rich
in vitamin C among the options provided in the questionnaire. The ability to
reduce ferric to ferrous iron and chelate iron largely are responsible for the
facilitation of iron absorption in presence of vitamin C. It also has potential to
negate or overcome the inhibitory influence of phytates, polyphenols and
calcium. [35-40] Therefore, counselling regarding food items rich in vitamin C in
donors may aide mitigation of DIID.
Overall, 73%, 73% 76% of the total participants, donors and non-donors were
aware that vitamin C increases iron absorption respectively. The difference in the
knowledge that Vitamin C increases iron absorption was not statistically
significant between donors and non-donors.
Overall, 44%, 43% and 46% of the total participants, donors and non-donors had
adequate knowledge about iron and Hb with respect to blood donations and the
sources of iron, protein, vitamin B12 and vitamin C rich sources in diet and the
facilitators and inhibitors of iron absorption in diet, whereas 56%, 57% and 54%
of the total participants, donors and non-donors did not have adequate knowledge
(inadequate) respectively. The difference in the level of knowledge regarding iron
deficiency-related low Hb between the donor and non-donor participants was
statistically not significant.
The findings of the present study emphasize that the IEC activity needs to focus
more on blood donation factors that affect Hb and iron, dietary requirements and
habits to maintain or increase iron and Hb to increase awareness among donors
so that DIID, the less appreciated long term adverse effect of regular blood
donation can be prevented and donors can be retained to ensure safe and adequate
supply of blood.
90
Overall, on an average 56%, 57% and 53% of the total participants, donors and
non-donors had positive attitude towards the items in the questionnaire such as a
decrease in iron and Hb post blood donation and the donations from vegetarians
and females collectively. Whereas only 29%, 28% and 34% of the total
participants, donors and non-donors had negative attitude towards the items in
the questionnaire such as a decrease in iron and Hb post blood donation and the
donations from vegetarians and females collectively. While 15%, 15% and 13%
of the total participants, donors and non-donors had neutral attitude towards the
items in the questionnaire such as a decrease in iron and Hb post blood donation
and the donations from vegetarians and females collectively.
Further no clear pattern of concordance could be noted upon the grading of the
negative attitude in total participants, donors and non-donors on the items
included in the study questionnaire such as a decrease in iron and Hb post blood
donations and the attitude towards a blood donation from a vegetarian and
females respectively.
Overall, on an average 68%, 84% and 54% of the total donors, counselled donors
and non-counselled donors adopted practices to increase iron, protein and vitamin
C rich items in diet and decrease tea and coffee in diet collectively. Whereas 32%,
16% and 56% of the total donors, counselled donors and non-counselled donors
did not adopted practices to increase iron, protein and vitamin C rich items in diet
and decrease tea and coffee in diet collectively. Notably the difference between
the practices to optimize iron and Hb in diet such as increasing iron, protein,
vitamin C in diet and decrease tea, coffee and milk simultaneously with diet were
statistically significantly higher in counselled donors as compared to non-
counselled donors was statistically significant.
Overall, the mean knowledge score was 16±7.04, 16±7.27 and 17±6.40 in total
participants, donors and non-donors respectively. There difference between
91
donors and non-donors in term of knowledge about iron deficiency related low
Hb was not statistically significant.
Overall, the mean attitude score was 2 ± 1.6, 3 ± 1.6 and 2 ± 1.5 in total
participants, donors and non-donors respectively. However, the mean of
difference in attitude between donors and non-donors with respect to a decrease
in Hb and/or iron post blood donation and the blood donation from vegetarians
and females was not statistically significant.
Overall, the mean practice score was 5 ± 2, 5 ± 2 and 4 ± 1.86 total donors,
counselled donors and non-counselled donors respectively. The difference in
mean practice scores was statistically significantly higher in counselled donors in
comparison to non-counselled donors. This suggest that counselled donors were
able to adopt healthy practice for intake and facilitation of absorption of iron and
protein in diet by the virtue of being counselled during their previous blood
donations.
Overall, 79% participants got their quantitative Hb tested from a laboratory. The
difference in the practice between donors and non-donors was not statistically
significant. However, worth mentioning that the difference in practice of getting
a quantitative Hb test done from laboratory was statistically significantly higher
among counselled as compared to non-counselled donors.
Overall, the mean Hb values of vegetarian participants (12.94 ± 2.16 gm/dl) was
statistically significantly lower as compared to non-vegetarian participants (13.35
± 2.01gm/dl). This is in consonance with literature. [43,44]
Overall, the mean Hb of donors (11.45 ± 2.10 gm/dl) was statistically

significantly lower as compared to non-donor participants (13.71 ± 1.77 gm/dl).
This is also in consonance with literature. [27,45,46]
The mean Hb of counselled donors (14.03 ± 1.81gm/dl) was statistically

significantly higher as compared to non-counselled donor (13.40 ± 1.68 gm/dl).
92
This finding is unique to the present study. Findings of present study reiterate that
counselling plays an important role to motivate donors to adopt good dietary
habits and may one of the strategies to prevent DIID as well as in maintaining Hb
levels in regular donors.
93
SUMMARY
 The present cross-sectional study was done to assess the knowledge,

attitude and practices among blood donors and non-donors regarding iron
deficiency related low Hb.
 Knowledge and awareness among donors regarding causes, prevention
and management of IDA can change their attitude to obtain and maintain
the optimum level of Hb thus will help BTS to maintain a quality donor
pool.
 Pilot tested, pre-validated, self-administered structured questionnaire was
used as study tool.
 DEMOGRAPHIC DISTRIBUTION OF STUDY PARTICIPANTS
- The present study included 975 participants, including 710 (72.8%) donors
and 265 (27.2%) non-donors.
- The mean age was 31.6±10.1, 32.5±9.9, and 28.3±9.9 years among total
participants, donors and non-donors respectively.
- There were 261 (27%), 79 (11%) and 182 (69%) females and 714 (73%),
631 (89%) and 83 (31%) males among total participants, donors and non-
donors respectively.
- Education upto college was in 809 (83%), 589 (83%) and 220 (83%), and
upto schooling was in 166 (17%), 121 (17%) and 45 (17%) among total
- Service class constituted 564 (58%), 432 (61%) and 132 (50%), students
were 294 (30%), 179 (25%) and 115 (43%), business class were 93 (9%),
83 (12%) and 10 (4%) whereas 24 (3%), 16 (2%) and 8 (3%) were
classified in others category among total participants, donors and non-
donors respectively.
94
- Vegetarians constituted 559 (57%), 394 (55%) and 165 (62%) whereas
non-vegetarians constituted 416 (43%), 316 (45%) and 100 (38%) among
total participants, donors and non-donors respectively.
- Urban residents constituted 758 (78%), 544 (77%) and 214 (81%) whereas
217 (22%), 166 (23%) and 51 (19%) were rural residents among total
- Notably, the percentage of females is quite low in donors (approximately
30% only), whereas it is quite high in non-donors (approximately 70%).
 RESULTS
- Overall, 81% participants, 81% donors and 83% non-donors were aware of
on Hb required to donate blood respectively. The difference in knowledge
on Hb required to donate blood between donors and non-donors in the
present study was not statistically significant.
- Overall, 26% of participants, 25% donors and 29% non-donors were
knowing that Hb decreases after blood donation. The difference in
knowledge on that Hb decreases after blood donation between donors and
non-donors was not statistically significant.
- Overall, on an average, 42%, 42% and 42% of the total participants, donors
and non-donors were aware of the indicators of low Hb from the items
provided in the questionnaire such as weakness, dizziness, shortness of
breath, fast heartbeat and urge to eat non-edible items (pica) collectively.
- Only 7% of donors knew all indicators of low Hb among the options
provided in the questionnaire, whereas 18% donors did not know even a
single indicator of low Hb among the options provided in the questionnaire.
- Overall, 73% & 26% of participants, 78% & 25% donors and 61% & 26%
non-donors were aware of the inter-donation interval for male and female
gender respectively. The difference in knowledge regarding inter-donation
interval for males was statistically significantly higher among donors as
compared to non-donors.
95
- Overall, 42% of participants, 38% donors and 54% non-donors were
knowing that iron levels decrease after blood donations. The difference in
knowledge on that iron levels decrease after blood donations between non-
donors and donors was statistically significant.
and non-donors were aware of the dietary items required for Hb formations
from the items provided in the questionnaire such as iron, folic acid,
vitamin B12 and proteins collectively.
- Only 9% of donors knew all dietary elements required for the formation of
Hb among the options provided in the questionnaire, whereas 17% of
donors did not know even a single dietary element required for the
formation of Hb among the options provided in the questionnaire.
and non-donors were aware of the food items that are rich in protein
provided in the questionnaire such as Dals, Soyabean, Non-vegetarian
dietary items, Channa, Nuts, Makhana and Mushroom collectively. The
knowledge of Mushroom as a rich source of protein was statistically
significantly higher among donors as compared to non-donors. However,
contrary to the expectation, knowledge regarding Dals and Nuts as protein
rich food items was statistically significantly higher among non-donors as
compared to donors. Only 14% of donors knew all source of protein rich
food item among the options provided in the questionnaire, while 6% of
donors did not know even a single source of protein rich food item among
the options provided in the questionnaire.
and non-donors were aware of the iron rich food items among that provided
in the questionnaire such as Chukandar, Anaar, Hari Patidar sabzi,
Khajoor, Gur and Channa collectively.
96
- Only 17% of donors knew all source of iron rich food item among the
options provided in the questionnaire, while 10% of donors did not know
even a single source of iron rich food item among the options provided in
the questionnaire.
and non-donors were aware of the food items that decrease iron absorption
provided in the questionnaire such as tea, coffee and milk collectively.
- Knowledge regarding milk as food item that decreases iron absorption was
statistically significantly higher among donors as compared to non-donors.
Only 17% of donors knew all food item that decrease iron absorption
among the options provided in the questionnaire, while 34% of donors did
not know even a single food item that decreases iron absorption among the
options provided in the questionnaire.
and non-donors were aware of the food items that are rich sources of
Vitamin C among those provided in the questionnaire such as Nimbu,
Amla, Santra and Guava collectively.
- Only 23% of donors knew all food items rich in vitamin C among the
options provided in the questionnaire, while 8% of donors did not know
even a single food items rich in vitamin C among the options provided in
the questionnaire.
- Overall, 73%, 73% 76% of the total participants, donors and non-donors
were aware that vitamin C increases iron absorption respectively. The
difference in the knowledge that Vitamin C increases iron absorption was
not statistically significant between donors and non-donors.
- Overall, 44%, 43% and 46% of the total participants, donors and non-
donors had adequate knowledge about iron and Hb with respect to blood
donations and the sources of iron, protein, vitamin B12 and vitamin C rich
sources in diet and the facilitators and inhibitors of iron absorption in diet,
97
whereas 56%, 57% and 54% of the total participants, donors and non-
donors did not have adequate knowledge (inadequate) respectively. The
difference in the level of knowledge regarding iron deficiency-related low
Hb between the donor and non-donor participants was statistically not
significant.
- Overall, on an average 56%, 57% and 53% of the total participants, donors
and non-donors had positive attitude towards the items in the questionnaire
such as a decrease in iron and Hb post blood donation and the donations
from vegetarians and females collectively. Whereas only 29%, 28% and
34% of the total participants, donors and non-donors had negative attitude
towards the items in the questionnaire such as a decrease in iron and Hb
post blood donation and the donations from vegetarians and females
collectively. While 15%, 15% and 13% of the total participants, donors and
non-donors had neutral attitude towards the items in the questionnaire such
as a decrease in iron and Hb post blood donation and the donations from
vegetarians and females collectively.
- Overall, on an average 68%, 84% and 54% of the total donors, counselled
donors and non-counselled donors adopted practices to increase iron,
protein and vitamin C rich items in diet and decrease tea and coffee in diet
collectively. Whereas 32%, 16% and 56% of the total donors, counselled
donors and non-counselled donors did not adopted practices to increase
iron, protein and vitamin C rich items in diet and decrease tea and coffee
in diet collectively. Notably the difference between the practices to
optimize iron and Hb in diet such as increasing iron, protein, vitamin C in
diet and decrease tea, coffee and milk simultaneously with diet were
statistically significantly higher in counselled donors as compared to non-
counselled donors was statistically significant.
- Overall, the mean knowledge score was 16±7.04, 16±7.27 and 17±6.40 in
total participants, donors and non-donors respectively.
98
- Overall, the mean attitude score was 2 ± 1.6, 3 ± 1.6 and 2 ± 1.5 in total
- Overall, the mean practice score was 5 ± 2, 5 ± 2 and 4 ± 1.86 total donors,
counselled donors and non-counselled donors respectively. The difference
in mean practice scores was statistically significantly higher in counselled
donors in comparison to non-counselled donors.
- Overall, 79% participants got their quantitative Hb tested from a
laboratory.
- Overall, the mean Hb values of vegetarian participants (12.94 ± 2.16
gm/dl) was statistically significantly lower as compared to non-vegetarian
participants (13.35 ± 2.01gm/dl).
- Overall, the mean Hb of donors (11.45 ± 2.10 gm/dl) was statistically
significantly lower as compared to non-donor participants (13.71 ± 1.77
gm/dl).
- The mean Hb of counselled donors (14.03 ± 1.81gm/dl) was statistically
significantly higher as compared to non-counselled donor (13.40 ± 1.68
gm/dl).
99
CONCLUSION AND RECOMMENDATION
Findings of present study bring out important aspects on the baseline information
on knowledge attitude and practices in the potential and present blood donor base.
The mean practice scores with regard to adoption of healthy dietary practices was
statistically significantly higher in counselled donors in comparison to non-
counselled donors. The practice of getting a quantitative Hb test done from
laboratory was statistically significantly higher among counselled donors as
compared to non-counselled donors. The mean Hb of counselled donors was
higher than that of non-counselled donors. The mean Hb of non-vegetarians was
higher than that of vegetarians. The mean Hb of non-donors was higher than that
of donors. There was no difference in the knowledge, attitude and practices scores
in donor and non-donors. Notably, more than 50% of the total study participants
and the donors and non-donors did not have adequate knowledge on the iron
deficiency related low Hb items in the questionnaire. There was no difference in
the mean of difference in attitude between donors and non-donors with respect to
a decrease in Hb and/or iron post blood donation and the blood donation from
vegetarians and females. There was no difference in adoption of healthy dietary
practices between donors and non-donors.
Therefore, based on the results obtained in the present study, there is a need to
inform, educate and motivate (counsel) the potential blood donors on knowledge
of iron deficiency related low Hb and the existing donors on the donation induced
iron deficiency to bring forth a change in the attitude, for the translation of
positive attitude to practice over a period of time. The IEC activities need to be
tailor made to suit the local socio-economy and demography of the regional
potential and existing blood donor population. The central dogma of public
health, that prevention is better than cure appears the most suitable strategy as the
first step towards the “donor blood management” because regular blood donors
are predisposed towards DIID related low Hb in the era where there is a lot of
100
focus on “patient blood management”. Optimization of both donor and patient
blood management shall help bridge the gap between the blood supply and
demand in due course of time. Role of trained blood centre counselors in
proportion to the magnitude of blood collection shall appears to be the most
important human resource towards the donor blood management initiative.
101
STRENGTH OF PRESENT STUDY
There is only one such previous study on this topic among blood donors from
India. The sample size of the previous study was 500, whereas the present study
included 975 participants. The content and construct validity and pilot testing of
the questionnaire in the previous study has not been adequately addressed in the
manuscript. The present study has used a pilot tested, pre-validated structured
questionnaire that was validated using Delphi methodology to assess knowledge,
attitude and practices with regard to iron deficiency related low Hb in both donors
and non-donors. The previous study only assessed knowledge, whereas the
present study assessed the attitude and practices and most importantly assessed
the impact of the survey itself in motivation towards adoption of healthy practices
in addition as a unique feature.
102
LIMITATIONS
The study was done using online survey modality and there may be a bias in terms
of the proper understanding and comprehension of the survey tool items in some
participants as there was no option to get the doubts between the expectation of
the study team and the comprehension and response from the participant.
The questionnaire was self-administered by the participants, so there is a chance

that the participants of the study did not thoroughly understand all the items asked
in the questionnaire.
Finally, randomization was not employed for study participant recruitment. This
generates scope for further studies on such aspects in blood donors and non-
donors.
103
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109
APPENDICES
ANNEXURE 1: INFORMED CONSENT FORM
INFORMED CONSENT FORM (ICF) (was inbuilt into the google form)
TITLE: KNOWLEDGE, ATTITUDE AND PRACTICES AMONG
DONOR AND NON-DONORS REGARDING IRON DEFICIENCY
RELATED LOW HB
Subject’s Name: ______________ Date of Birth / Age: _________________
Participant's initial _____________
1. I confirm that I have read and understood the information sheet dated _ _ _ _
for the above study and have had the opportunity to ask questions.
2. I understand that my participation in the study is voluntary and that I am free
to withdraw at any time, without giving any reason, without my medical care
or legal rights being affected.
3. I understand that the Ethics Committee/regulatory authorities will not need my
permission to look at my health records both in respect of the current study
and any further research that may be conducted in relation to it, even if I
withdraw from the study. I agree with this access. However, I understand that
my identity will not be revealed in any information released to third parties or
published.
4. I agree not to restrict the use of any data or results that arise from this study
provided such use is only for scientific purpose(s)
5. I agree to take part in the above study
6. I have read the participant information sheet and understood fully and I have
opportunities to clear all doubts and now I am voluntarily to participate in this
study.
Signature (or Thumb impression) of the Subject/Legally Acceptable
Representative: ____________
Date: _____/_____/______
Signatory’s Name: ________________________________________
Signature of the Investigator: ____________________________
Date: ____/_____/______
Study Investigator’s Name: ___________________________________

सूिचत सहमित फॉम (ICF)
अ यन शीषक:
अ यन सं ा (यिद कोई हो):
िवषय का नाम: ______________ ज ितिथ / आयु: _________________
ितभागी का ारं िभक: _____________
1. म पु ि करता ं िक मने उपरो अ यन के िलए िदनां िकत _ _ _ _ सूचना प
को पढ़ा और समझा है और मुझे पूछने का अवसर िमला है ।
2. म समझता ं िक अ यन म मे री भागीदारी ै क है और म िबना िकसी कारण
के, िबना िकसी िचिक ीय दे खभाल या कानूनी अिधकारों के भािवत ए, िकसी
भी समय वापस लेने के िलए तं ं।
3. म समझता ं िक वतमान अ यन के संबंध म नैितकता सिमित और िनयामक
अिधका रयों को मे रे ा रकॉड को दे खने के िलए मेरी अनुमित की
आव कता नहीं होगी और इसके संबंध म िकए जाने वाले िकसी भी आगे के
अनुसंधान, भले ही म परी ण से वापस लेता ं । म इस प ं च से सहमत ं । हालाँ िक,
म समझता ँ िक मेरी पहचान तीसरे प को जारी िकसी भी सूचना म या कािशत
नहीं की जाएगी।
4. म इस अ यन से उ िकसी भी डे टा या प रणामों के उपयोग को ितबंिधत
नहीं करने के िलए सहमत ं , बशत ऐसा उपयोग केवल वै ािनक उ े के िलए
हो।
5. म उपरो अ यन म भाग लेने के िलए सहमत ं ।
6. मने ितभागी सूचना प को पढ़ा है और पूरी तरह से समझा है और मे रे पास सभी
संदेहों को दू र करने के अवसर ह और अब म े ा से इस अ यन म भाग ले ने
के िलए ं ।
िवषय / कानूनी प से ीकाय के ह ा र (या अंगूठे का िनशान)
ितिनिध: ____________
िदनांक: _____/_____/______
ह ा रकता का नाम: ________________________________________
अ े षक का ह ा र: ____________________________
िदनांक: ____/_____/______
अ यनकता का नाम: ___________________________________

ANNEXURE 2: (PARTICIPANT INFORMATION SHEET)
PARTICIPANT INFORMATION SHEET (PIS) (was inbuilt into the google
form)
Name of the participant:
TITLE: KNOWLEDGE, ATTITUDE AND PRACTICES AMONG
DONOR AND NON-DONORS REGARDING IRON DEFICIENCY
RELATED LOW HB
You are invited to be a part in this research study. The information in this
document is meant to help you decide whether or not to take part. Please feel free
to ask if you have any queries or concerns. You are being asked to participate in
this study being conducted in Department of Transfusion Medicine (PGIMER)
because you satisfy our eligibility criteria. You will be one of the 820 participants
whom we plan to recruit in this study.
What is the purpose of research?
The purpose of the research is to assess the Knowledge, attitude and practices
with respect to iron deficiency related low Hb among potential blood donors.
What is the study design?

The participant will be issued with a questionnaire through online which contains
41questions. The response to those questions will be collected back and used for
the study.
Possible risk:
This study is a kind of question and answer study. So, no risk is involved in this
study.
Possible benefits:
The participant will not get any added benefits through this study, since this study
is entirely voluntary.
Cost to the participant:
You will never be asked to pay/provide anything during this study.
Confidentiality of the information obtained from you:
You have the right to confidentiality regarding the privacy of your medical
information (personal details and your medical history). By signing this
document, you will be allowing the research team investigators, other study
personnel, Institute Ethics Committee and any person or agency required by the
law like Drug Controller General of India to view your data, if required. The
information from this study, if published in scientific journals or presented at
scientific meetings, will not reveal your identity.
Can you decide to stop participating in the study once you start?
The participation in this research is purely voluntary and you have the right to
withdraw from this study at any time during the course of study without giving
any reasons. Though advisable that you give the investigators the reason for
withdrawing, it is not mandatory.
Right to new information:
If the research team gets any new information during this research study that may
affect your decision to continue participating in the study, or may raise some
doubts, you will be told about that information.
Contact persons:
For further information / questions, you can contact us at the following
address:
Principal Investigator
Dr Bineeta Awasthi
Junior Resident
Dept. of Transfusion Medicine, PGIMER Chandigarh
Mobile:9118063443, Email: bineetaawasthi05@gmail.com
CHIEF GUIDE
Dr. Suchet Sachdev
Associate professor
Dept. of Transfusion Medicine, PGIMER Chandigarh
Suchet.sachdev@gmail.com
In case of conflicts, you can contact the chairperson (convener) of out
institutional ethics committee at the following address:
Dr. Nandita Kakkar
Department of Histopathology
Convener/Chairperson, Institutiional Ethics Committee
PGIMER, Chandigarh
Telephone: 1072-2755141, 7087888141

ANNEXURE 3 (QUESTIONNAIRE)
QUESTIONNAIRE
Title: Knowledge, attitude and practices among the blood donors and non-
donors regarding iron deficiency-related low Hb.
A) Participant Details
Age
Gender Male Female
Education Postgraduate
Graduate
Senior Secondary School (Up to 12th class)/ Diploma
High School (Up to 10th class)
Primary School (< 6th class)
No schooling
Occupation Government job
Private job
Business (large scale/small scale/shop etc.)
Student
Agriculture
Others (Street vendors, Daily wagers, Contractual workers

etc.)
Residence Urban
Rural
Dietary Habits Vegetarian
Non-Vegetarian
B) General questions
1. How many times have you donated blood?
2. Have you heard about Hb?
Yes/No
3. Have you ever tested for Hb? Yes/No
If yes, then what is your most recent Hb level? …………grams/dl

C) Knowledge items
4. What is the minimum level of Hb required to donate blood?

 12 g/dl
 12.5 g/dl
 13 g/dl
 13.5 g/dl
 Don’t know
5. What is the change in Hb after donation?
 Decreases
 No change
 Don’t know
 Increases
6. What are the indicators of low Hb? (Select as many)
 Shortness of breath
 Dizziness
 Fast heartbeat
 Weakness
 Increase capacity of concentration
 Urge to eat non-edible items
 Don’t know
7. What should be the minimum gap between two blood donations for males?
 3 months
 4 months
 5 months
 6 months
 Don’t know
8. What should be the minimum gap between two blood donations for females?
 3 months
 4 months
 5 months
 6 months
 Don’t know
9. Which of the following element decreases with regular blood donations?
 Sodium
 Calcium
 Iron
 Potassium
 Don’t know
10. What dietary elements are required for formation of Hb? (Select as many)
 Folic acid
 Vitamin D
 Protein
 Vitamin B12
 Iron
 Don’t know
11. Which of the following are protein-rich foods? (Select as many)
 Non-vegetarian diet
 Dals
 Channa
 Soya Bean
 Makhana
 Mushroom
 Vegetables
 Nuts
 Don’t know
12. Which of the following are iron-rich foods? (Select as many)
 Chukandar
 Khajoor
 Hari Patidar Sabzi
 Gur
 Anaar
 Saboo dana
 Chana
 Don’t know
13. Which of the following foods can reduce iron absorption? (Select as many)
 Milk
 Tea
 Coffee
 Lemon water
 Don’t know
14. Which of the following food items are rich in vitamin C? (Select as many)
 Amla
 Nimbu
 Santra
 Guava
 Watermelon
 Don’t know
15. Which of the vitamin increase iron absorption?
 Vitamin C
 Vitamin D
 Vitamin E
 Vitamin K
 Don’t know
D) Attitude items {High concern, Moderate concern, Mild concern, No
concern, not sure}
16. Are you concerned that blood donation can decrease Hb?
17. Are you concerned that blood donation can decrease iron?
18. Are you concerned to donate blood because you are vegetarian?
19. Are you concerned with regard to blood donation from the female gender?
E) Practice {Yes/No/ not sure}
20. Did you receive counseling on dietary practices for regular blood donation?
21. Do you take extra care to increase Iron-rich food in your diet?
22. Do you take extra care to increase Protein-rich food in your diet?
23. Do you take extra care to increase Vitamin-C-rich food in your diet?
24. Do you take extra care to decrease tea in your diet?
25. Do you take extra care to decrease coffee intake in your diet?
F) Impact of the present study (Yes/No/not sure)
26. Does this study motivate you to take care of your diet for regular blood
donation?
Master chart
Plagiarism report
Ethical committee clearance letter

Final Thesis 30.1.2023

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KNOWLEDGE, ATTITUDE AND PRACTICES

AMONG BLOOD DONORS AND NON-

SUBMITTED IN PARTIAL FULFILMENT OF REQUIREMENT

M.D. (TRANSFUSION MEDICINE)

DEC, 2022 DR. BINEETA AWASTHI

As proverb quotes I would like to express my sincere gratitude to my Co-Guide Dr.

December, 2022 Dr. Bineeta Awasthi

BTS Blood Transfusion Services

CVI Content Validity Index

CVR Content Validity Ratio

DCA Drugs and Cosmetic Act

DIID Donation Induced Iron Deficiency

DMT1 Divalent Metal Transporter1

IDA Iron Deficiency Anemia

ISBT International Society of Blood Transfusion

IEC Information, Education and Communication

KAP Knowledge, Attitude and Practices

NACO National AIDS Control Society

NBTC National Blood Transfusion Council

NBP National Blood Policy

NHP National Health Policy

NFHS National Family Health Survey

RBC Red Blood Cells

UHC Universal Health Coverage

VNRDs Voluntary Non-Remunerated Donors

WHO World Health Organization

S. No. Contents Page Number

2. Review of literature 4‐10

3. Aims and Objectives 11

4. Materials and Methods 12‐21

8. Conclusion and Recommendation 100‐101

9. Strength of the Study 102

10. Limitation 103

11. Bibliography 104‐109

Annexure 1: Informed Consent Form

Annexure 2: Participant Information Sheet

Ethical Clearance Certificate

An important component in the endeavor towards the goal of universal health

The voluntary non-remunerated donations (VNRDs) of blood and blood

This study focused to increase understanding of the sometimes-overlooked link

The objective 4 of NBP, is “To launch extensive awareness programmes for

IRON METABOLISM AND STORAGE

Iron is absorbed in the duodenum. At the apical membranes of enterocytes ferric

Increased Iron demand:

Increased loss of Iron:

Decreased iron absorption or intake:

GLOBAL OVERVIEW OF BLOOD COLLECTION

CURRENT SCENARIO OF BLOOD DONATION IN INDIA

They estimated that 34.3 of 1000 eligible population (3.43% of eligible

STUDIES ON IRON LOSS WITH BLOOD DONATION

STUDIES BLOOD DONOR POPULATION

STUDIES IN OTHER POPULATION

1. To study knowledge among donors and non-donors with respect to

and protein in diet during their tenure of blood donation.

STUDY DESIGN: Cross-sectional study, conducted at the Department of

Transfusion Medicine, Postgraduate Institute of Medical Education and Research

the Institute Ethics Committee (Intramural) vide Letter no. INT/IEC/2021/SPL-

1437 dated 28th September 2021.

STUDY POPULATION: Potential blood donor population.

filled, and electronic communication.

SAMPLING TECHNIQUE: Convenience sampling strategy was used to enroll

STUDY TOOL: Pilot tested, pre-validated, self-administered structured

sections comprising demographic details, general questions, knowledge

Transfusion Medicine. Experts were asked to score every question for