Knowledge, attitude, and practice of blood donation among college students in Puducherry.
Blood donation refers to the process of collection, testing, preparing, storing blood, and blood components.  Blood transfusion is an important concern for the society, as it is lifesaving for patients with bleeding disorders, accidents, surgeries, inherited/acquired hematological diseases, and malignancies.  Donating blood is an active way of helping others and the whole society. Donors are most commonly unpaid voluntaries but they may also be paid by commercial enterprise. Blood donation provides three different components each with its own role in treating patients, and hence, can help three different people and increase life expectancy.  In Africans and Americans people, 47% of blood donors are for "O" positive, 4% for "O" negative, 24% for "A" positive, 2% for "A" negative, 18% for "B" positive, 1% for "B" negative, 4% for "AB" positive, and 0.3% for "AB" negative. Asian people have 39% of blood donors for "O" positive, 1% for "O" negative, 27% for "A" positive, 0.5% for "A" negative, 25% for "B" positive, 0.4% for "B" negative, 7% for "AB" positive, and 1% for "AB" negative blood group. 
The criteria for donation is age between 18 and 60 years, weight should be 45 kg or above 45 kg, hemoglobin minimum of 12.5 g% and should not have donated blood three or more months earlier. The donar should be healthy not have suffered from malaria, typhoid or other transmissible disease in the recent past. A normal person can donate approximately 350 ml of blood in one donation, and those who weight more than 60 kg can donate 450 ml of blood.  "O" group blood is called "universal donar" as it can be given to any blood group person. The people of "AB" group can receive blood from any blood group person. Hence, people with this group blood are called "universal recipients." 
The numbers of potential donors were often reduced due to the strict selection criteria which were imposed to ensure the safety of the blood supplies. 
The shortage of blood in India is due to an increase in the demand, with fewer voluntary blood donors. One of its strategies is to take the appropriate decision and/or to introduce policy initiatives on the basis of the factual information, the operational research on various aspects such as transfusion-transmissible diseases, the knowledge, attitude, and practice (KAP) among donors, the clinical use of blood, etc.  A study on the knowledge, attitude, and the practice of the donors may prove to be useful in the successful implementation of the blood donation program. Our aim was to find the level of the KAP of blood donation among college students in Puducherry.
MATERIALS AND METHODS
The study was conducted in the Government Polytechnic College situated in the service areas of Indira Gandhi Medical College and Research Institute (IGMC & RI). The Urban Health Center (UHC) of IGMC & RI is the urban field practice area of IGMC & RI, Puducherry. It was decided to conduct the study among final year college students because it was felt that:
1. Students in 1st and 2nd year would not have attained 18 years.
2. Practice of blood donation was one component included in the study which might be applicable for students above 18 years.
Types of Study
Types of study were a cross-sectional study.
The study was conducted in Government Women's Polytechnic College, Lawspet, Puducherry, which is located in urban service area of IGMC & RI UHC, Lawspet. The participants were final year students of various Departments of Government Polytechnic College. The final year students were selected because they would have attained 18 years and would be eligible to answer questions on practice blood donation in the past.
The following was studied among all college students in the study: Age, gender, education, socioeconomic status. Further,
* Knowledge of blood donation,
* Attitude of blood donation,
* Practice of blood donation.
Tools and Techniques
A pretested structured self-administered questionnaire was used to collect the data.
The principals of the college selected from the service area were contacted, and the purpose of the study was explained to her in detail. Date and time was fixed for data collection. Total number of students enrolled in final year was 140 out of which 136 were present on the day of data collection. The questionnaire was first tested among five students of another college, not in the service area. After making a few modifications based on the responses obtained, the questionnaire was finalized and used for data collection. Convenient sampling was used to collect the data. There were four departments in the final year. The IIIrd semester MBBS students from IGMC & RI who were posted for community diagnosis posting were used for data collection. The purpose of the study was explained to them, and necessary instructions were given to participants. The pretested questionnaire was given individually to all the students in the study. They were assured that all the information provided by them would be kept confidential. There were 140 eligible students in the final year, and only 136 could be contacted on the day of data collection. By this, the attendance rate was 99%.
SPSS software version 22 and Microsoft Excel was used for date analysis. For summary statistics proportions, means and standard deviation were calculated.
The total number of respondents was 136. All the participants were females. The age distribution and socioeconomic status of the study population are shown in Table 1. Of the 136 respondents, 94.10% were more than 18 years. According to modified Kuppusamy's socioeconomic scale, 11% belong to lower middle (Class III).
The knowledge on the blood donation among the respondents has been stated in Table 2, which shows that 27 (19.9%) respondents knew that people could donate once in 3 months. The majority (90.4%) of them opined that blood donation could be started at 18 years of age. About, 78.7% stated that HIV patients could not donate blood. One-half (54.4%) knew prerequisite hemoglobin level for the blood donation and 61% did not know about the mandatory tests which were done on the donated blood. Only 30 (22%) knew the correct volume of blood that can be donated. Majority 84 (61.8%) knew the most common blood group. Only 62 (45.6%) knew the rarest group. About 43.3% said that TV/radio to be best source of knowledge on blood donation. Another 32.4% said that school or colleges could be the source of dissemination of blood donation.
The attitude toward the blood donation has been shown in Table 3, which shows that 60 (44%) felt that creating an opportunity for the donation was an important factor for motivating blood donation and 45 (33%) felt that lack of opportunity was the main reason for the hesitation of the donors in donating blood. Another 30 (22%) perceive that fear of getting infected to be the reason for not donating blood. A majority 102 (75%) perceive that TV/radio as the best way to disseminate message regarding blood donation.
The practice of the donors has been shown in Table 4. It was observed that 54 (39.7%) had donated blood for the first time. Two girls had donated blood more than twenty times. Remaining 80 (58.8%) had not donated blood. The majority, 56 (41.2%), were in the age group of 18-25 years. 28% students mentioned that they had voluntarily donated blood for the first time. Another 18 (13.2%) said that the reason for donating the first time was for their friends/relatives. Majority 54 (39%) were willing to become regular donors out of which 75.9% were ready to donate blood once in 6 months. More than half (53.6%) of the participants had a feeling of satisfaction after the blood donation. Another 16% of respondents expressed fear after blood donation.
The study was conducted among the final year students of Government Women's Polytechnic College, Lawspet, Puducherry. There were 136 students. About 94.1% were above 18 years. 61.8% of participants were coming underclass V of socioeconomic status. About 58.8% of participants have not donated blood. 41.2% of participants donated blood at 18-25 years. About 33.8% of participants belong to O positive blood group. Only 27 (19.7%) respondents knew that blood donation can be done once in 3 months. 90% of them knew that age to start blood donation is 18 years. The majority (78.7%) of participants said that HIV patient should not donate blood. 54% knew the prerequisite hemoglobin level for the blood donation. The majority (61%) did not know about the mandatory tests which were done on the donated blood. Only 30 (22.1%) knew that 350 ml of blood can be donated. More than half (61.8%) of them responded that the most common group is O positive. Only 45.3% of participants knew that the rare blood group is AB negative. About 44.1% respondents felt that creating an opportunity for the donation was an important factor for motivating the blood donation. The majority, 292 (55%), of them felt that the fear of pain was the main reason for not donating blood. 75% of participants said that TV/radio is the best way to disseminate message of blood donation. Only 28% students mentioned that they had voluntarily donated blood for the first time. 39.7% of participants are willing to become a regular donor in future. The majority (53.6%) of the participants had a feeling of satisfaction after the blood donation.
In our study, the participants were young adults who were in the age group of 18-25 years, with college level education, which was similar to the findings of the studies done by Allain et al.  and Hinrichs et al.  In contrast, Sampath et al. observed that 48.4% of the donors were in the age group of 26-50 years.  In our study, 51.5% said that blood can be donated every 6 months and 19.9% students knew correctly that the blood can be donated every 3 months. This was similar to the study by Nwogoh in Karachi who observed that 27% said that the minimum interval between donations was 6 month and only 21.5% said that it was 3 months.  In contrast, a cross-sectional study done by Uma  among the voluntary donors in Chennai observed that 57.2% donors knew that people could donate once in 3 months which was similar to the findings of the study done by Olaiya et al.  It was observed that 90.4% of students knew the correct age of donating blood was 18 years which was similar to the finding observed by Uma  In this study, 78.7% of students knew that HIV person cannot donate blood, 54.4% of students said that the required hemoglobin level to donate blood was 12.5 g% and 61% of students did not know the mandatory tests done on blood donation. Similarly, the cross-sectional study done by Uma among the voluntary donors in Chennai observed that 99.4% donors stated that HIV patients could not donate blood, 32% donors did not know the prerequisite hemoglobin level for blood donation, and 65% donors did not know about the mandatory tests which were done on donated blood.  It was observed that 22.1% of participants told correctly that 350 ml of blood could be donated on blood donation. The majority (61.8%) said that O positive is the universal donor and 45.6% replied that AB negative as the rarest blood group. Nwogoh conducted the cross-sectional study among voluntary healthcare workers in Karachi observed that 92.6% respondents had good knowledge on common blood group types.  Our study results showed that 50% of college students had good knowledge about the eligibility criteria, as in the study of Lischen and Marjorie.  There was a lack of knowledge among respondents with regard to the mandatory tests which were done after the blood collection, the amount of blood which can be donated. Hence, to create awareness, a clear and simple message must be delivered using health education materials to the target groups. In our study, it was observed that 44.1% accepted that creating opportunity to donate blood is a major motivating factor. Similar finding was found in a Chennai-based study by Uma who showed that 57% donors felt that creating an opportunity for blood donation was an important factor for motivating blood donation  which was similar with the findings of the study done by Olaiya et al.  It was observed that the students mentioned that 33% felt that lack of opportunity was the main reason for the hesitation to donate blood. Another 22% perceive that fear of getting infected to be the reason for not donating blood. Uma  in their study found that the main reason for their hesitation in donating blood was the fear of pain (55%), which were similar to the findings of a study which was done by Olaiya et al.  Nwogoh conducted a cross-sectional study among the health-care workers in Nigeria showed that 71.2% said blood donation may have adverse consequence, 5.5% said that donor may fall sick.  This study conducted among college students shows that 30.1% of students donated voluntarily and 13.2% donated blood for their friends and relatives. Another study conducted by Uma  in Chennai showed that 47.2% donated blood for the first time to their friends/relatives which was similar to the findings of the study done by Sojka and Sojka  Another cross-sectional study conducted in Pravara Institute of Medical Sciences revealed that 90.5% showed positive attitude toward blood donation.  Similar finding was observed in the study by Ahmed et al. among medical students in Karachi.  It was found in our study that 39.7% of students were willing to become regular donors, 41.9% students accepted that blood can be donated for every 6 months, 5.2% of students accepted that blood can be donated for every 4 months. It was observed that 39% were willing to become regular donors out of whom 75.9% were ready to donate blood once in 6 months. A cross-sectional study conducted by Nagatu among medical students in Ethopia shows that 23.6% has donated blood. From those who donated blood, 14.5% have donated before 1 year.  Devi et al. conducted a cross-sectional study among college students and observed that 13.9% of students have donated blood.  Among them, 75.6% have donated once. Gunsa conducted a cross-sectional study in health science college which shows that 28.5% have donated blood and in non-health science college 38.7% have donated blood.  According to 23.6%, the main reason for not donating blood was fear of pain. About 24.3% of students were satisfied on donating blood, 9.6% were in fear of donating blood. 47.8% of individuals which included the first time donors were willing to become regular donors. 74.4% of individuals were feeling satisfactory after blood donation. With regard to the impact of the blood donation, 53.6% of the participants had a feeling of satisfaction after the blood donation. Another 16% of respondents expressed fear after blood donation. This was similar to the finding of the study which was done by Uma and Sojka and Sojka. [11,14] In contrast, a study which was done by Hinrichs et al.  stated that 26.5% donors reported positive effects such as feeling happy and alert, feeling relaxed, 23.5% reported negative effects and 17.6% reported mixed effects. A study done at Abdulaziz Medical city shows that 76.8% strongly agreed that blood donation is a part of altruism, 71.3% agreed that blood donation is a religious duty, 74.2% agreed that blood donation is a national duty, and 81.9% agreed blood donation is a healthy habit. 
In our study, we were able to elicit that majority of the students had inadequate knowledge of blood donation. Most of the respondents in the study group opined that the motivating factors for the recruitment of more donors were creation of opportunities to donate and the need to be well-informed about the need of blood. We recommend that conducting awareness program about blood donation and blood donation camps will create more opportunity for blood donation to meet the blood demand in future. The main limitation of this study was it was questionnaire based study. One to one interview could have elicited an in-depth knowledge regarding the attitude of blood donation.
In our study, the majority of the students had inadequate knowledge of blood donation. Most of the respondents in the study group opined that the motivating factors for the recruitment of more donors were creation of opportunities to donate and the need to be well-informed about the need of blood. One-third of the students were willing to be regular donors. The majority of the blood donors showed positive effects like a sense of satisfaction after the donation. Creating opportunities for blood donations by conducting many blood donation camps may provide a solution for our blood demand.
Authors express my heartfelt gratitude to Mrs. G Rani, Principal of Government Women's Polytechnic College, Lawspet, Puducherry for having inspired, encouraged and helped in every aspect of this work. Authors should profusely acknowledge Mr. V Senthil Kumar, Red Ribbon club coordinator, Women's Polytechnic College for the constant help, guidance offered by him in all aspects to conduct this study. Authors sincere thank all the students of IIIrd semester MBBS, Pramila M, Hariprasadh D, Mahesari M, Mugesh T, Rojaramani P, Shalini T, Thueff Ahamed M, Vijayaraj S, for helping in data collection. Last but not the least, authors would like to thank the all the students who participated in this study without which this study would not have been possible.
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Devi Kittu, Dhivyalakshmi G, Haritha P, Kavitha Vasudevan
Department of Community Medicine, Indira Gandhi Medical College and Research Institute, Puducherry, India
Correspondence to: Devi Kittu, E-mail: email@example.com
Received: May 15, 2017; Accepted: May 30, 2017
Table 1: Demographic details Variables N (%) Age group (years) <18 6 (5.90) >18 130 (94.10) Socioeconomic classification Upper lower (Class IV) 120 (88.2) Lower middle (Class III) 15 (11.1) Upper middle (Class II) 1 (0.7) Total 136 (100) Table 2: Knowledge of blood donation Variables N (%) Knowledge of blood donation intervals Every 6 months 70 (51.5) Every 3 months 27 (19.9) Once in a year 15 (11.0) Don't know 24 (17.6) Age of first donation 18 years 123 (90.40) Don't know 13 (9.60) Can HIV positive person donate blood No 107 (78.7) Yes 16 (11.8) Don't know 13 (9.6) Hemoglobin level to donate blood 12.5 g% 74 (54.4) 11.5 g% 27 (19.9) Don't know 35 (25.7) Mandatory test done on donated blood Know 59 (39) Don't know 77 (61) Volume of blood that can be donated (ml) 250 55 (40.4) 350 30 (22.1) 450 6 (4.4) Don't know 45 (33.1) Commonest blood group O positive 84 (61.8) A positive 34 (25.0) O negative 7 (5.1) Don't know 11 (8.1) Rarest blood group AB negative 62 (45.6) O negative 51 (37.5) AB positive 11 (8.1) Don't know 12 (8.8) Source of knowledge about blood donation TV/radio 59 (43.3) Schools/colleges 44 (32.4) Newspapers/magazines and advertisements 17 (12.5) Workshops/blood donation camps 8 (5.9) Heard from people 8 (5.9) Total 136 (100) Table 3: Attitude of blood donation Variables N (%) Motivating factors according participants Creating opportunity 60 (44.1) Asking personally to donate 40 (29.4) Information about need of blood donation 31 (15.4) Others 15 (11.0) Reason for not donating blood among participants No opportunity 45 (33.1) Fear of getting infected 30 (22.1) Getting sick 20 (14.7) Weakness 17 (12.4) Lack of awareness 9 (6.6) Fear of pain 7 (5.1) Didn't think of it 6 (4.4) Others 2 (1.5) Best way to disseminate message TV/radio 102 (75.0) Personal request 17 (12.5) Printers/banners 12 (8.8) Others 5 (3.6) Total 136 (100) Table 4: Practice of blood donation Variable N (%) Number of donations among participants Not donated 80 (58.8) First time 54 (39.7) >20 times 2 (1.5) Age of first donation among participants Not donated 80 (58.8) 18-25 years 56 (41.2) Reason for donating blood among participants Voluntarily 38 (28) Friends/relatives 18 (13.2) Not donated 80 (58.8) Willing to become regular donor Yes 54 (39.7) No 27 (19.8) Don't know 55 (40.5) Time interval for regular donation Every 6 months 41 (75.9) Yearly once 11 (20.4) Every 3 months 2 (3.7) Impact of blood donation Satisfactory 30 (53.6) Fear 9 (16.1) Relaxation/alertness 5 (8.9) Tired/fatigue 5 (8.9) Numbness 4 (7.1) Generally better 2 (3.6) Mixed feelings 1 (18) Total 56 (100)
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|Title Annotation:||Research Article|
|Author:||Kittu, Devi; Dhivyalakshmi, G.; Haritha, P.; Vasudevan, Kavitha|
|Publication:||International Journal of Medical Science and Public Health|
|Date:||Jul 1, 2017|
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