Assessment of Knowledge, Attitude and Practice towards Obesity among Medical Students in Jalalabad City, Afghanistan

doi:10.21203/rs.3.rs-4959799/v1

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Research Article

Assessment of Knowledge, Attitude and Practice towards Obesity among Medical Students in Jalalabad City, Afghanistan

https://doi.org/10.21203/rs.3.rs-4959799/v1

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Background

Obesity is a global public health concern affecting individuals of all ages, sexes, and socioeconomic groups. It is generally linked to a greater risk of disability. Therefore, the present study aimed to determine the knowledge, attitudes, and practices of medical students toward obesity in Jalalabad city, Afghanistan.

METHODS

This institution-based, cross-sectional survey was conducted with 463 public and private medical university students in Jalalabad city, Afghanistan, from June 2023 to September 2023. The study participants were chosen via a nonprobability convenience sampling technique, and data were collected through structured questionnaires completed by all participants.

RESULTS

In this study, a total of 463 participants were enrolled. A total of 86.2% of them were male, and 13.8% were female. The majority (98.9%) had heard of term obesity. Body mass index (BMI) is the technique most commonly used to identify obesity. Ninety-five percent of the respondents were aware that obesity leads to cardiovascular diseases and diabetes mellitus. The participants’ attitudes toward obesity were satisfactory. Obesity was viewed as a disease by 86.6% and weight loss as a necessity by 99.1% of the participants. Only 24.6% of the respondents believed that obesity was inherited and could not be reduced. Among the respondents, 23.8% walked every day, and 28% participated in sports. Over half (53.6%) of the participants had never attempted to lose weight, and 43.2% reported eating junk food on a daily basis.

CONCLUSION

Most participants were aware of obesity and agreed that obesity is a serious health problem; however, they had inadequate practices compared with their knowledge and attitudes.

knowledge

attitudes

practices

obesity

medical students

Afghanistan

Obesity is a complex and chronic medical condition characterized by abnormal or excessive accumulation of body fat, which can cause adverse health effects. Several methods are commonly used to assess obesity, including body mass index (BMI), waist circumference (WC), and the waist‒to-hip ratio (WHR). Among these, BMI is a commonly used measure to categorize individuals as underweight, normal weight, overweight, or obese. Obesity is typically determined by BMI, which is calculated by dividing a person’s weight in kilograms by the square of their height in meters (BMI = kg/m²).(1) (2)

Obesity is a global public health concern that affects individuals of all ages, sexes, and socioeconomic groups. In 2016, it was estimated that, globally, there were 1.9 billion adults who were overweight, with a BMI of ≥ 25 kg/m². Additionally, over 650 million adults were classified as obese with a BMI of ≥ 30 kg/m². By 2020, the estimated number of children under the age of 5 who were overweight had risen to 39 million. According to the 2016 data from the Global Database launched on the WHO website, over 340 million children and adolescents are overweight or obese. In 2019, an estimated 38.2 million children under the age of five were overweight or obese.² Obesity is the fifth leading cause of death(3), estimated to be associated with 5.02 million deaths and 160 million disability–adjusted life years (DALYs) globally in 2019.(4) Obesity is generally linked to a greater risk of disability, such as type 2 diabetes, dyslipidemia, cardiovascular diseases (including high blood pressure, coronary heart disease, and stroke), biliary tract disease, certain malignancies, and nonfatal diseases such as gout, osteoarthritis, and infertility. Owing to social discrimination against fatness, obesity has significant adverse effects on mental health as well.(2, 5, 6) In a study conducted in 1997 among three-year-old children, the proportion of overweight children was 4%.(7) Another study conducted in Badghis province of Afghanistan in 2002 revealed that the prevalence of obesity and overweight in the 15–49-year-old female group was 1.8% and 11.5%, respectively, while the mean BMI was 21.1 kg/m².(8) According to a study conducted by Saeed Khawaja Mir Islam in Kabul, the overall prevalence of obesity was 31.2%. The main risk and protective factors independently associated with obesity are age, sex, diabetes status, blood pressure, central obesity, and frequency of walking per week.(2, 9)

Knowledge of obesity can only be used to identify the disease; however, a positive attitude and consistent behavior can help prevent the disorder and reduce associated complications.(6)

Understanding the knowledge, attitudes, and practices (KAPs) of medical students toward obesity is crucial for addressing the growing obesity epidemic and equipping future healthcare professionals with the necessary skills to manage this complex condition effectively. Medical students play key roles in promoting healthy lifestyles, providing patient education, and implementing evidence-based strategies to prevent and treat obesity. The KAP of medical students toward obesity can be assessed through surveys. The findings from such assessments provide valuable insights into educational needs and areas for improvement in medical training programs. They can guide curriculum development, instructional strategies, and the integration of obesity-related content into medical education, ensuring that future doctors are well equipped to address the multifaceted challenges of obesity.

However, studies investigating the knowledge, attitudes, and practices related to obesity among medical students in Jalalabad city, Afghanistan, are lacking. Thus, the current study aimed to assess the knowledge, attitudes, and practices toward obesity among medical students in Jalalabad, Afghanistan.

Study Setting and Design

This institution-based, cross-sectional survey was conducted with 463 public and private medical university students in Jalalabad city, Afghanistan, between June 2023 and September 2023. The inclusion criteria were as follows: 1) public or private medical universities registered with the Ministry of Higher Education and located in Jalalabad city, Afghanistan; 2) students with first-, second-, and third-year MD; and 3) students studying at public and private medical universities who were willing to participate in the study; and 3) aged 18 years or older. The exclusion criteria were as follows: 1) incomplete questionnaires; 2) fourth- and fifth-year medical degree (MD) degree; and 3) unwillingness to complete the questionnaire.

Sample size and sampling technique

All the participants who fulfilled the inclusion criteria were invited to participate. The sample size for nonprobability convenience sampling was calculated via a single population proportion formula ($\:\text{n}=\text{z}2\text{*}\text{p}(1-\text{p})/$d2), where n is the sample size, p is the expected prevalence of the outcome, assumed to be 50%, d2 is the margin of error, set at 5% (0.05), and Z is the standard normal z value corresponding to a 95% confidence interval (CI), which is 1.96. The minimum required sample size, calculated via this formula, was 385 participants.

Calculation:

$$\:\text{n}=\frac{{\text{z}}^{2}\times\:\text{p}(1-\text{p})}{{\text{d}}^{2}}=\frac{{\left(1.96\right)}^{2}\times\:0.5(1-0.5)}{{\left(0.05\right)}^{2}}=\:384$$

To account for the potential statistical nonresponse rate and increase the study’s statistical power, the minimum required sample size of 384 was increased by 15%. This additional 15% equals 57.6, which was rounded to 58. Therefore, the total number of participants to be selected for the study was 384 + 58 = 442.

Data collection and patient characteristics

In the absence of a validated, standardized questionnaire, the survey questionnaire was first developed in English in a similar study conducted in Faisalabad, Pakistan. (1) The questionnaire was translated into the national language Pashtu and used after minor changes were made according to the context to meet our study objectives. Data were collected through individual interviews with trained data collectors via a pretested structured questionnaire. The questionnaire contains 23 questions that assess medical university students’ knowledge, attitudes, and practices toward obesity. The questionnaire consisted of four parts: the first part included the sociodemographic characteristics of the medical students (such as age, sex, marital status, residence, university, and year of MD), whereas the remaining three sections included the level of KAP (knowledge, attitudes, and practices) regarding obesity among medical university students. The knowledge section consisted of five questions; the attitude and practice sections comprised six questions each.

Pilot Study

The questionnaire was pretested on a small sample of 50 participants for one day to confirm its validity and reliability. Expert researchers reviewed the questionnaires for content validity, and the authors of this study considered the comments of the experts. The reliability of the questionnaire was tested via Cronbach’s alpha. The results were 0.75 for every questionnaire section, which indicates the acceptable reliability of the questionnaire. The observations from the pilot study were excluded from the final analysis.

Ethical Approval and Consent

This research study received ethical approval (IRB No. 155, dated 5/06/2023) from the Department of Research at the Faculty of Medicine, Nangarhar University. All participants provided written informed consent before taking part in the study. The study was conducted in accordance with the principles outlined in the Declaration of Helsinki.

Statistical analysis

The initial data were entered into an Excel spreadsheet and then exported to SPSS version 28.0 for analysis. The distribution of the quantitative data was tested for normality via the Shapiro‒Wilk test. For variables with approximately normal distributions, the data are summarized as the means ± SDs. For continuous variables with skewed distributions, the data are summarized as medians and interquartile ranges (IQRs). All qualitative data were recorded as the number (n) and percentage (%) of responses for each variable to provide a clearer representation of the distribution of responses within each variable.

Sociodemographic characteristics of the study participants

This study included a total of 463 participants, with the majority (86.2%) being male and a small proportion (13.8%) being female. The median age of the study subjects was 21 (23–21) years (range, 18–47). The detailed sociodemographic distribution of the participants is presented in Table 1.

Table 1

Sociodemographic characteristics of the study participants [N = 463]
Variables	Frequency	Percentage
Demographic characteristics
Age (years)*	21	(23 − 20)
Age category (years) n (%) - 18–27 - 28–37 - 38–47	447 15 1	96.5 3.2 0.2
Gender n (%) - Male - Female	399 64	86.2 13.8
Marital status n (%) - Married - Unmarried	91 372	19.7 80.3
Residence n (%) - Dormitory - Out of dormitory	180 283	38.9 61.1
University n (%) - Public - Private	193 270	41.7 58.3
Year of MD n (%) - First year - Second year - Third year	191 161 111	41.3 34.8 24
Notes: Data presented as number, percentage, or median (interquartile range). Abbreviations*: MD, Medical doctor

Knowledge of Obesity among students

Among the 463 participants, 98.9% had heard of term obesity. The most widely used technique for identifying obesity is BMI. Ninety-five percent of the respondents were aware that obesity might lead to cardiovascular diseases and diabetes mellitus, whereas social and psychological problems were less well known. With respect to the causes of obesity, eating too much fat and not exercising enough were more frequently mentioned than were hormone disorders and depression. Only 44.9% of the participants correctly identified a normal BMI range. Table 2 shows the respondents’ levels of knowledge.

Table 2

Knowledge regarding obesity among the participants [N = 463].
Variables	Frequency	Percentage
Have you ever heard the word obesity n (%) - Yes - No	458 5	98.9 1.1
Have you ever heard of the following methods of determine obesity? n (%) - BMI - Waist hip ratio - Waist Circumference	282 181 185	60.9 39.1 39. 96
Have you ever heard of the following ill effects of obesity n (%) - Cardiovascular diseases - Diabetes Mellitus - Social Problems - Psychological problems	440 435 220 200	95 93.92 47.5 43.18
Have you ever heard about the following causes of obesity n (%) - Eating too much fat - Hormonal disorders - Insufficient physical activity - Genetic factors - Depression - High socioeconomic status	429 408 423 414 360 350	92.7 88.16 91.40 89.45 77.79 75.62
What is the normal BMI range (kg/m^2) n (%) - 18.5 - 18.5–24.9 - 25-29.9 - Never heard of it	35 208 9 211	7.6 44.9 1.9 45.6
Notes: Data presented as number, percentage, or median (interquartile range). Abbreviations*: BMI, Body Mass Index;

Attitudes of students regarding obesity

The students’ opinions on obesity are shown in Table 3. Most statements reflected positive attitudes. Nonetheless, 24.6% of the respondents believed that obesity was inherited and could not be addressed.

Table 3

Attitudes regarding obesity among the participants [N = 463].
Variables	Frequency	Percentage
Obesity is a disease n (%) - Agree - Disagree	410 53	86.6 11.4
Normal weight is important for health n (%) - Agree - Disagree	459 4	99.1 0.9
Medical students should maintain normal weight n (%) - Agree - Disagree	462 1	99.8 0.2
Small weight loss can produce important health benefits n (%) - Agree - Disagree	419 44	90.5 9.5
Obese people must try to lose weight n (%) - Agree - Disagree	459 4	99.1 0.9
Obesity is linked to inheritance and it cannot be reduced n (%) - Agree - Disagree	114 349	24.6 75.4
Notes: *Data presented as number, percentage, or median (interquartile range).

Practices of students regarding obesity

The obesity practices of the participants are summarized in Table 4. Among the students, 72.4% chewed after meals. In addition, 8.2% of the individuals did not engage in any sports. Only 23.8% of the participants preferred to walk daily.

Table 4

Practices regarding obesity among the participants [N = 463].
Variables	Frequency	Percentage
Demographic characteristics
How frequently do you check your body weight? n (%) - Every 1–3 months - Every 4–6 months - Every 7–9 months - Every 10–12 months	102 260 23 78	22 56.2 5 16.8
Frequency of eating junk food n (%) - Daily - Weekly - Monthly	200 209 54	43.2 45.1 11.7
Frequency of eating sweets after food n (%) - Daily - Weekly - Monthly	317 88 58	68.5 19 12.5
Do you have a habit of munching between meals n (%) - Yes - No	128 335	27.6 72.4
Do you participate in sport? n (%) - Yes - Sometimes - No	130 85 248	28 18.4 53.6
How often do you prefer going for walk n (%) - Daily - Twice a week - Once a week - Monthly	110 93 94 166	23.8 20 20.3 35.9
Notes: *Data presented as number, percentage, or median (interquartile range).

Obesity is generally linked to a greater risk of disability, including type 2 diabetes, dyslipidemia, cardiovascular diseases (including high blood pressure, coronary heart disease, and stroke), biliary tract disease, certain malignancies, and nonfatal diseases such as gout, osteoarthritis, and infertility. Owing to social discrimination against fat, obesity has significant adverse effects on mental health.(2, 5, 6)A crucial aspect of multidisciplinary obesity treatment is physician involvement. Because medical students will become doctors in the future, it is necessary to assess their knowledge, attitudes, and practices regarding obesity. According to the results of this study, 98.9% of the total 463 participants had heard of term obesity. The most frequently used technique for identifying obesity is BMI measurement. The majority of the study respondents were aware that obesity can lead to cardiovascular diseases and diabetes mellitus, but they were less knowledgeable about the potential social and psychological problems associated with obesity. The most commonly identified factors contributing to obesity are overeating fatty foods, a lack of physical activity, genetic predisposition, and hormonal disorders. Participants were less likely to identify depression and high socioeconomic status as potential factors leading to obesity. The findings of this study are in line with the findings of previously published studies. (1, 10, 11) This can be attributed to the fact that our study population belonged to a medical society. Regarding the normal BMI range, 45.6% of the students were unaware of the normal BMI range. This knowledge gap can be attributed to the mismatch between the skills acquired through education and practical implementation. This finding was also reported by authors who conducted a study on Malaysian and Indian medical students.(11, 12) However, considering that one-third of the study participants were unfamiliar with waist circumference and the waist‒hip ratio, emphasis should be placed on enhancing students’ understanding of the measurements used to determine obesity. These findings are in agreement with those of a previous study.(1) The attitudes of the participants toward obesity were satisfactory. The majority of participants (86.6%) reported that obesity is an illness; 99.1% agreed that maintaining a healthy weight is crucial for good health; 99.8% stated that controlling and preventing disease requires maintaining a healthy body weight; and 90.5% claimed that even a small amount of weight loss could have significant health benefits, such as lowering the risk of developing diabetes mellitus and cardiovascular disease. Most participants stated that those who were obese should make an effort to reduce their weight, with only 24.6% believing that obesity was inherited and could not be prevented. The findings of this study are comparable to those of studies conducted among medical students in Pakistan, which revealed that the overall responses in the attitude section were satisfactory.(1) Our study revealed that 43.2% of the participants consumed junk food daily. The findings of the current study were slightly greater than those from similar studies conducted by other authors.(1, 13, 14) The findings of the present study indicate that the frequency of eating sweets after eating food was somewhat greater than those reported in similar studies among Malaysian, Indian, and Pakistani medical students(1, 11, 13), whereas the habit of munching between meals was comparable in both studies.(11) Our study revealed that more than half of the respondents did not participate in sports regularly, and 23.8% went for walks daily. These results agree with those of a previously published study.(1, 2)

This study had several shortcomings. First, the small and unequal sample size comprised more male participants; a larger sample size could have resulted in more accurate reporting of knowledge, attitudes, and practices toward obesity among adult populations. Second, the convenience sampling method employed in our study is another limitation, as some high-risk students may have opted out of the study because of the implications following the identification of obesity. Third, during the current study, the majority of the data were self-reported, which is susceptible to social desirability bias. Furthermore, our study was confined to medical students only; therefore, it does not provide the true prevalence of knowledge, attitudes, and practices in the total population.

There is insufficient information available to combat the disease, despite advances in our understanding of obesity and its causes. The obesity of young people can be prevented by adopting a positive attitude toward obesity and healthy habits, which can be fostered by inspiration, education, and an emphasis on making lifestyle changes. Although our study concluded that the majority of respondents were aware of obesity and agreed that obesity is a serious health problem, they had inadequate practices compared with their knowledge and attitudes. It is crucial to translate students’ knowledge and attitudes into deliberate and proper practices through lifestyle modifications.

Ethics approval and consent to participate

Approval of the research protocol: This research study received ethical approval from the Department of Research, Faculty of Medicine, Nangarhar University. This study complied with the principles of the Declaration of Helsinki (as revised in Fortaleza, Brazil, October 2013).

Informed consent: Written informed consent was obtained from all the participants prior to their participation in the study.

Approval date of Registry and the Registration No. of the study: 5/06/2023, No.155.

Consent for publication

All authors agreed to submit the article and published versions.

Availability of data and material

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Competing interests

The authors declared no conflict of interest with respect to the research, authorship, and/or publication of this article.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Authors' contributions

I/we declare that we made significant contributions to the research study, including (AS, MS, QZ, and MZ) conceptualizing the topic, drafting the protocol, and designing the questionnaires. AJ, MA, and HM contributed to the data collection. AS and MS did the statistical analysis and wrote the first draft of the manuscript. AS and QZ edited the second draft and made critical comments. All authors agreed to submit the article and published versions.

Acknowledgements

The authors would like to acknowledge and thank the students for participating in the study.

Authors' information

Not applicable

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No competing interests reported.

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You are reading this latest preprint version

Assessment of Knowledge, Attitude and Practice towards Obesity among Medical Students in Jalalabad City, Afghanistan

Status:

Version 1

Abstract

Background

METHODS

RESULTS

CONCLUSION

INTRODUCTION

MATERIAL AND METHODS

Study Setting and Design

Sample size and sampling technique

Calculation:

Data collection and patient characteristics

Pilot Study

Statistical analysis

Results

Sociodemographic characteristics of the study participants

Knowledge of Obesity among students

Attitudes of students regarding obesity

Practices of students regarding obesity

DISCUSSION

CONCLUSION

Declarations

References

Additional Declarations

Status:

Version 1