The National Ribat Universityrepository.ribat.edu.sd/public/uploads/upload/repository...V regarding...
Transcript of The National Ribat Universityrepository.ribat.edu.sd/public/uploads/upload/repository...V regarding...
1
The National Ribat University
Faculty of Graduate Studies and Scientific Research
Assessment of Knowledge, Attitude and Practices (KAP) of Medical
Student Regarding the use of Carbonated Drinks at The National Ribat
University 2016
A Thesis Submitted in Partial Fulfillment of the Requirements of the
master Degree in Human Nutrition and Dietetics
By: Razan Abdul Monem Mohamed Ali
Supervised by: Dr. Mofida Yousif Elkhalifa
January 2017
II
ــةاآلي
ٹ ٹ
ڃ ڃ ڃ چ چ ى ى ىې ې ې ېۋ ۋ ۅ ۅ ۉ ۉ ٴۇۇ ۇ ۆ ۆ ۈ ۈچ
ى ى ىى ى ى ى ى ى ى ى ى ى ى ىى
ى ى ى ى ى ىى ى ى ى ى ىىی ی ي ی ى
چ ى ى
صدق هللا العظيم
٢٨٦سورةالبقرة:
DEDICATION
Every challenging work needs self-efforts as well as guidance of elders especially
those who were very close to our heart.
My humble effort I dedicate to my sweet and loving
Mother& Father, Whose affection, love, encouragement and prays of days and night
III
make me able to get such success and honor.
My Mother
A strong and gentle soul who taught me to trust in Allah, believe in hard work and
that so much could be done with little.
My Father
For earning an honest living for us and for supporting and encouraging me to believe
in myself.
My Brothers:
For thinking of me and for always walking beside me for each day and night.
My Friends
For being who you are and for helping me be me and for making me smile always.
ACKNOWLEDGMENTS
In The Name of Allah, the Most Gracious, the Most Merciful
Foremost, I would like to express my special appreciation and thanks to my
advisor Dr.Mofida Yousif Al-Khalifa
Have been a tremendous
IV
Mentor for me. I would like to thank her for her patience, motivation,
enthusiasm, and
Immense knowledge.Her guidance helped me in my research, allowing me to
grow as a research scientist. her advice on both research as well as on
my career have been
Priceless. Her influence on my life will continue through my entire life, as
one of my role models.
ABSTRACT
Excess consumption of carbonated drink has been associated with many
adverse health effects.
This research conduct to assess the knowledge, attitudes and practices of students
V
regarding carbonated drinks, a cross sectional study was conducted at National Ribat
University – Faculty of Medicine. A total of 300 students were selected randomly
and included in the study. Self-structured pretested questionnaire was used for
collection of data. Out of all students, 77% of the students reported that they had
started taking carbonated drinks when they were less than 16 years of age. Most of
the medical students thought that carbonated drinks are associated with ill effects
that included: osteoporosis (50%), and obesity (30%). Up to (30%) among these
students were not aware of the ill-effects of carbonated drinks.
Finally, to encounter the problems which are caused by consumption of
carbonated drinks, focus on various aspects of primary prevention like Health
education has to be done.
البحث ملخص
لتقییم أجري هذا البحث ارتبط االستهالك الزائد من المشروبات الغازية بالعديد من اآلثار السلبیة على الصحة.
جامعة كلیة الطب سلوك وممارسة الطالب بخصوص المشروبات الغازية، أجريت دراسة مقطعیة فيومعرفة
طالب تم اختیارهم بشكل عشوائي. تم جمع البیانات عن طريق استبیان 300 مل هذا البحث الرباط الوطني . ش
. يعتقد معظم ةسن 16لغازية قبل عمر تناول المشروبات ا بدءوا% من الطالب 77 موجه يمأل بواسطة الطالب.
VI
%( 30%( ، والسمنة )50: هشاشة العظام ) بأضرار صحیة منهاالمشروبات الغازية مرتبطة إنطالب الطب
غیر مضرة بالصحة . المشروبات الغازية بأن %( من الطالب30) يعتقد . بینما
والرعاية الصحیة األولیة التركیز على الوقاية و المشروبات الغازيةلتناول المصاحبة اإلشكالیات،تحديد ختاما
التثقیف الصحي .و
TABLE OF CONTENTS
List of content Page
I إستهالل
Dedication II
VII
Acknowledgment III
Abstract in English IV
Abstract in Arabic )الملخص( V
List of Contents VI
List of Tables VIII
List of Abbreviations X
Carbonated Drinks Definition xi
CHAPTER ONE
Introduction
Introduction 1
1-1-Backgranoud 1
1-2- Problem Statement 2
1-3-Justification
1-4-objectives 2
A-general objective 2
B-specific objectives 2
CHAPTER TWO
Literature Review
2.1.Carbonated Drinks Ingredients 3
2.2.TheMain Types 4
2.3. Nutritional Value 4
VIII
2.4. Carbonated Drink Damage on The Body 5
2.5. Carbonated Drink Risks 10
CHAPTER THREE
Methodology
3.1. Study Design 15
3.2. Study Population 15
3.3. Sample Method 15
3.4. Sample Size 15
3.5. Study Duration 15
3.6. Study Tools 15
3.7. Statistical Analysis 16
3.8. Ethical Consideration 16
CHAPTERFOUR
Result, discussion, Conclusion & Recommendation
4.1.Result 17
4.2. Discussion 30
4.3. Conclusion 33
4.4. Recommendation 34
4.5. References 35
LIST OF TABLES
Table No Title Page No
Table(1) Gender Distribution of Study Population 17
Table(2) Recurring Age Distribution of Study Population 17
Table(3) Class Level of Study Population 18
Table(4) Distribution of Study Population By Family Income 18
Table(5) Mother Education of Study Population 18
IX
Table(6) Father Education of Study Population 19
Table(7) Student Expenditure Per Day 19
Table(8) Daily Financial Family Supported Distribution of Study
population
19
Table(9) Place of Residence of Study Population 20
Table(10) Way of Transportation of Study Population 20
Table(11) Disease Conditions among Distribution of Study Population 20
Table(12) Student Knowledge of Carbonated Drinks 21
Table(13) Knowledge of Components of Carbonated Drinks among Study
Population
21
Table(14) Student Knowledge of Calories Contents of Carbonated Drinks
(500ml) 21
Table(15) Student Knowledge about the Ill Effects of Carbonated Drinks 22
Table(16) Student Knowledge about the Ill Effects Associated with
Carbonated Drinks 22
Table(17) Student Knowledge about the Prolonged Effect of Consumption
and Health 22
Table(18) Student Knowledge about Using Pepsi for digestion of Foods 23
Table(19) Student Knowledge about Using Seven Up for relieving
abdominal pain 23
Table(20) Student Knowledge about Bread and Pepsi Calories 23
Table(21) Student Feeling Regarding Drink Pepsi carbonated Drink 24
Table(22) Student Feeling Regarding Others People When They Are
Drinks Pepsi 24
Table(23) Preferring of student Regarding Soft Drinks 25
Table(24) Students age when they are starting taking Carbonated Drinks
(Years) 25
Table(25) Consumption of Carbonated Drinks Per Litter 26
Table(26) Student Consumption of Carbonated Drink Per Day 27
Table(27) Preferable Consumed Carbonated Drinks 27
Table(28) Reason behind Consuming Carbonated Drinks 28
Table(29) Students Daily Coffee Consumption 28
Table(30) Sleep Disturbance at Night 28
Table(31) BMI 29
Table(32) Height 29
X
LIST OF ABBREVITIONS
NRU: National Ribat University
KAP: Knowledge, Attitude and Practices.
SPSS: Statistical Package for the Social Sciences.
BMI: Body Mass Index.
XI
HTN: Hypertension (HTN or HT), also known as high blood pressure (HBP).
DM: Diabetes mellitus.
SDG: Sudanese pound.
XII
The term Carbonated Drinks in this report refers to
carbonated beverages. If no adjective is used, then the term
refers to regular or sugar-sweetened carbonated drinks’. In
Sudan, the sugar added is sucrose.
However, some of the literature uses the term
carbonated drinks rinks to include artificially sweetened or
diet carbonated beverages. Where this is the case, we have
clarified meaning in the surrounding text. Other
terminology includes sugary drinks or sugar-containing
drinks — terms which encompass carbonated sugar-
sweetened carbonated drinks as well as fruit juices, fruit
drinks, cordials, sports drinks, energy drinks and iced teas.
Throughout this report, amounts of soft drinks are
expressed in milliliters (1mL = approximately 1 gram)
- 13 -
Chapter One
Introduction
1.1. Background:
The soft drinks have been consumed since hundred years, but many
of their deleterious health effects have not been well studied or known.
There is a growing concern about the harmful effects associated with
carbonated soft drinks.Many academic studies have shown that there is
nothing healthy about carbonated drinks or soda. The term soft drink refers
to non-alcoholic water based flavoring agents that are optionally
sweetenedcoloring compounds, acidifiers, preservatives, caffeine might be
added. Carbonated drinks may contain fruit juice or pulp, salts; and their
flavor may be derived from vegetable extracts or other aromatic
substances. Carbonated drinks was invented in the 18th century and widely
used in recent decades.
The increasing consumption of carbonated drinks and carbonated water all
over the world and in market, as well as the growing diversity of carbonated drinks,
show the importance of evaluating the overall impact of carbonated drinks to
consumers’ health. When one consumes carbonated beverages instead of milk, juice
and water, body will not get some of the nourishment as per the needs.
Most people view soft drink consumption as fairly innocuous and its consumption
is not as harmless as generally believed; however, there are a number of serious
health issues associated with regular consumption of soft drinks .Scientific studies
have shown how as few as one or two soft drinks per day can increase one’s risk for
numerous health problems such as obesity, tooth decay, osteoporosis, heart disease,
diabetes, many neurological disorders and nutritional deficiencies.
- 14 -
1.2. Problem Statement:
Althoughmultiplestudieshavebeen carried out globally relatedto soft
drinkconsumption, researchonthisbehalfinSudanseriouslylacking
.Anexhaustiveevaluation of the issue is fundamental to disentangle the more
profound complexities of the issue. At exactly that point, can any intercessions be
relied upon to fruitful this study undertaken in order to determine the level of soft
drink consumption and the level of knowledge about health impact of drink of soft
drinks among the medical students of (NRU).
1.3. Justification:
To suggest satiable recommendation for the health permeation andraising the
awareness of the sugar content of various carbonated drinks and potential health
problem associated with their consumption was considered important for achieving
better health for all individuals.
1.4. Objectives:
a. General Objectives:
To asses Knowledge, Attitude and Practices (KAP) regarding
Carbonated Drinks of faculty Medical students in National Ribat University.
b. Specific Objectives:
(1) To identify the Knowledge of Medical students regarding carbonated drinks.
(2) To identify the attitudes of students towards consumption of carbonated
drinks.
(3) To determine the practices of students regarding consumption of carbonated
drinks.
- 15 -
Chapter Two
Literature Review
2.1. Carbonated Drinks Ingredients:
Water constitutes about 85% of the carbonated drinks. Sugar, and it is one
of the most important carbonated drinks components because it gives them
the desired taste, can add sucrose by two methods, the first in the form of a
concentrated solution, and the second through a solid condition. Usually a
percentage of sugar in carbonated drinks about 8% - 13%, Acids, many types
of acids are added in the preparation of carbonated drinks, among them
phosphoric acid, citric acid, tartaric acid. Smell and taste materials, uses many
of the characteristic taste of material to give a carbonated drink taste
distinctive, and different bait materials from drink to drink, and the reason that
each drink contains a taste of a particular feature, and there are several types
of bait, among them natural materials such as citrus peel, or fruit pulp, or by
using the full fruits taking care to remove the seeds, and industrial materials
are very similar to the taste of natural fruit extent, but the price is inexpensive
compared to natural flavors, as well as mixtures of natural blends industrial
mixtures gathered, used in the preparation of several types of carbonated
drinks. Color materials, which are used to impart color to carbonated drinks,
caramel and is widely used in the coloring, and must ensure that the materials
used does not affect the taste and smell drinks, in addition to the non-use of
harmful chemicals. Carbon dioxide, and is one of the most important materials
used in carbonated drinks, is named carbonated drinks that name because they
contain a large proportion of carbon dioxide, and is second compressed carbon
dioxide pumped into the final carbonated drink after cool completely on the
temperature of 1-2 degrees Selicizah by devices called carbonation devices,
- 16 -
and there are several reasons to add carbon dioxide to carbonated drinks. The
reason that it gives a taste distinctive drink, it also prevents mold in carbonated
drinks, as well as it increases the acidity that prevent microorganisms from
growing. Caffeine, Which is made from kola nut material that gives a
distinctive flavor for carbonated drinks, caffeine and vary the proportion of
drink to another.(Mansho, 2006)
2.2. The Main Types:
One canister containing the equivalent of 10 teaspoons of sugar sufficient
to destroy vitamin B deficiency, which leads to poor digestion and poor
infrastructure nervousness, headaches, insomnia, depression, muscle spasms and
disorders. Carbonated drinks also vary depending on the flavor added to the
original components which is a drink, sugar, preservatives and gases, and these
flavors are
A. It Cola flavor additives for Pepsi and Coca-Cola.
B. Lemon and add to the ships in Seven Up and Sprit.
C. Orange and add to Miranda and Fanta.(Warner, 2007)
2.3. Nutritional Value:
All carbonated drinks are of low nutritional value, contains no protein or
fat, or vitamins and minerals, but is a means of containing large amounts of empty
sugars (i.e. non-nutritional value).A very small amount of salt, As for the
carbonated drinks for diabetes and diet (diet), similar to regular drinks is the
sugar substitute aspartame compound is a two welding aspartic acid and vinyl,
which generate the sweet taste when their union. This compound is not fit for a
class of people (who suffer from the disease vinyl ketene urea).(Mansho, 2006)
- 17 -
2.4. Carbonated Drink Damage on The Body:
2.4.1. Drought:
Water constitutes about 60% of body weight. According to the Mayo
Clinic reports that the drink is lost in different shapes and images, including
sweat, urination, breathing, so that the body continues to work properly, as it
should compensate the amount of fluids that are lost constantly. Some may
resort to other alternatives solutions such as drink and other wet liquids,
carbonated drink. But many of the carbonated drinks contain a high content
of caffeine which acts as a diuretic, and leads to increased urination and rid
the body of existing inside the fluid and the absence of the amount of fluid in
order to lead the body and its functions properly and healthy. In addition, some
Diet carbonated drinks contain a high content of sodium, which is based,
according to the drink from the cells and enhances the drought. (Warner, 2007)
2.4.2. High sugar content:
Many carbonated drinks contain large amounts of sugar. For example,
the, about 12 ounces of carbonated drinks contain 39 grams, the equivalent of
about 3.3 tablespoons sugar and consumption of these large quantities of sugar
leads to raise the sugar levels in the blood and increases the risk of heart
disease and blood vessels. In addition, many carbonated drinks containing
high fructose corn syrup and sugar longer is the primary ingredient. And thus
lead to damage to the pancreas and fluctuating blood sugar levels. It can when
the consumption of sugary carbonated drinks regularly, lead to diabetes type
II. (Patel, 2016)
- 18 -
2.4.3. Overweight:
Studies have shown that weight gain caused by the consumption of too
many calories and not burning the body. About 12 ounces of carbonated
drinks contain 140 calories, often called "empty calories because they do not
provide the body with no nutritional value. When you drink one can of cola a
day for four weeks, the equivalent of taking nearly 3920 calories and increase
one kilo in weight in the absence of the ability to burn calories. And when you
walk on the feet for 27 minutes about 3.5 miles per hour can burn calories in
one can of cola. According to report in May Kellnek about calories analysis
that if you do not burn calories, leads to an increase of 12 kg per year. In
addition, the carbonated drinks sweet disrupt signals of appetite and increased
cravings for sugary foods. (MaichlXorafe, 2005)
2.4.4. Obesity:
Obesity is a serious public health problem world over, which is
associated with high mortality and a major risk factor for cardiovascular
diseases, diabetes mellitus, osteoarthritis and cancers.Changes in lifestyle,
dietary habits, physical activity, and the socio cultural environment play an
important role in obesity.Changes in socioeconomic status have had a
significant effect on physical activity with the availability of easy transport,
the increase in electrical home appliances and more involvement in office
work, long periods in watching television and using the internet. (Kishore, 2009)
Now days, schools of affluent societies generally provide mostly fast
foods and beverages which are dense in calories. Children who eat fast food,
compared with those who do not, consume more total energy (calories), more
- 19 -
energy per gram of food, more total fat, more total carbohydrate, more added
sugar, more sugar sweetened beverages, less fiber, more milk and few fruits
and non-starchy vegetable, are vulnerable to develop obesity problem.Obesity
and associated diabetes rates are rising worldwide.1-3 More than 1.5 billion
people worldwide are now overweight, and at least1in 20 adults now have
diabetes.2,3 Globally, obesity has doubled since1980, such that most of the
world’s population now lives in countries where there are more deaths
attributable to being overweight than to being underweight.(Patel, 2016)
2.4.5. Osteoporosis:
Calcium from the base metals, which helps you get the teeth and bones
strong and consumption of high amounts of phosphoric acid, one of the
common elements in the carbonated drinks could lead to the absorption of
calcium from the body .lead to cases of osteoporosis and weak bones,
especially in women.
Osteoporosis is a systematic metabolic disease resulting in low bone
mass, and deteriorates of bone structure, which increases the risk of fracture
called “silent killer.(Oloyede, EO, 2009)
The impact of carbonateddrinks on calcium absorption showed that
consumption of carbonated drinks with food negatively affect the calcium from the
intestinal absorption due to the presence of phosphoric and citric acid who unite with
the calcium content in food in one man, and this can cause a decrease in the amount
of calcium that link to blood and thus to the bones, it is known the importance of
calcium in building bone and growth, especially in childhood and adolescence age,
or later age of forty when they start osteoporosis problems.(Doglas, 2003)
- 20 -
2.4.6. Heart disease:
Excessive weight gain to increase the operating risk of heart disease,
due to the ingredients found in soda drink. The Dr. Mary said that
McLaughlin, medical director of the Center for American heart health that the
sodium and caffeine in soda drink with dangers on the heart. That so health
because sodium leads to fluid retention, caffeine works to increase heart rate
and blood pressure. As stated in the analysis it was published in 2012 that
more than 42,000 men ate a single package of sugary carbonated drinks every
day. They had an increased risk of heart attack, compared with those who did
not take carbonated drinks at all.(Yancy CW, et al. 2013).
2.4.7. Diabetes:
Most individuals may find it difficult when you eat one cookie a day
for fear of sugar addiction. If you're dealing with carbonated drinks, you will
suffer from high blood sugar and the body's inability to produce insulin. High
blood sugar make you are looking for more material sugar and soda to
compensate. With the passage of time to become the body's resistance to
insulin is weak and is unable to metabolize sugar, resulting diabetes. Oivkr
doctor or disseminating that India dealt with 1:59 carbonated drinks a day
increases the risk of diabetes 2 by 26%, according to a report published in the
in 2010 in the Journal of diabetes care.(Warner, 2007)
2.4.8. Dental problems:
The Children prefer cola to milk and fruit juice. The excess
consumption on of these carbonated beverages is playing havoc in teenage
population on as it contains no essential al nutrients and harms their general
- 21 -
and oral health. If you prefer not to go to the dentist, try to limit the
consumption of carbonated drinks. This is because the bacteria found in the
mouth grow with sugar and feed it. And lead to the production of acids that
damage tooth enamel and leads to tooth decay. (Attin, 2004)
2.4.9. Gout:
Gout is a medical condition afflicting the body of increased uric acid,
which leads to swelling and inflammation of the joints. According to data
published in 2012 in the Journal of the American Medical that there was a
study done on about 80,000 women for 22 years caused eat one package a day
from cola to a significant increase in the risk of developing gout when
compared with those who rarely drank sugary drinks.(Roubenoff R. 2008)
2.4.10. Cause headaches:
Drink carbonated drinks may increase the risk of a headache because
of the artificial sweeteners because aspartame cause headaches and still
unknown effects on the body. The most patients who complain of migraines
may be to see that they consume carbonated drinks regularly.(Malik-
Kotru,G2004).
2.4.11. Bulge:
Carbonated drink can cause air bubbles in the stomach and cause
accumulation of air, can lead to loudly and sometimes cannot control it. Leads
to the accumulation of air bloated abdomen. In the case of carbonated drink
intake will constantly suffer from chronic bloating. The pain may lead resulting
from the Bulge.(R., Grasso, R., 2002)
- 22 -
2.5. Carbonated Drink Risks:
The danger of taking carbonated drinks is the low nutritional value of not
contain protein or fat, or vitamins and minerals, but it is a liquid containing large
amounts of free nutritional value sugars. Warning that carbonated drinks have
spread dramatically because of several key factors, in which the ad is playing a
major role in promoting this .As that carbonated drinks began to replace milk and
natural juices which represents a threat to the extent of damage to persons as a
result of drink such beverages, particularly young people category, also note that
all the meals eaten by children not devoid of carbonated drinks.(Doglas, 2003)
2.5.1. Iron Absorption:
The effect of carbonated drinks on the absorption of iron containing
carbonated drinks caffeine that negatively affect the absorption of iron,
thereby causing anemia, which is one of the health problems among children,
adolescents and cause them years vulnerable to health and the lack of activity
and lack of appetite. Caffeine also leads to increased heart rate and high blood
pressure and increase the acidity in stomach and increase the hormones in the
blood, which may cause inflammation and ulceration of the stomach, is also
working to weaken the pressure valve lower esophagus, which in turn leads
to reflux of food and acid from inside the stomach into the esophagus, causing
pain and inflammation.(Bukhari H, 2014)
2.5.2. Digestion:
For the argument that the carbonated drinks and help digestion made it
clear that it is erroneous beliefs are widespread among people that carbonated
beverages help digestion and this is not true, and can be explained by the
- 23 -
feeling that he feels his mustache and gases that leads them out after drinking
because of the gases contained in the drink itself and not as a result of the
digestion of food in your stomach, and carbonated drinks cause indigestion
because they contain a substance bicarbonate which is an alkaline substance,
so if you have been taken after meals cause reduced stomach acid, which plays
an important role in the process of digestion, as the carbonated drinks affect
the center of stomach acid as it interacts with all its sodium bicarbonate with
stomach acid, is produced by the reaction gases stomach opens doors to
forcibly push the food into the intestines before completing digest.(Mohamed, 2009)
2.5.3. Second gas and carbon dioxide
The containof carbon dioxide, which leads to the stomach of important
yeasts salivary deprived in the process of digestion gas and that when ingested
with food or after and lead to a reduction of the role of digestive enzymes
secreted by the stomach and thus impede the process of digestion and reduce
the advantage of the food.(Nelson, 2011)
2.5.4. Acidity rate:
The rate of acidity in carbonated drinks: for example, Pepsi-Cola or Coca-
Cola has a pH rate is 3.4 i.e. it is very acidic. PH by this strong can dissolve teeth
and bones! The human body stops building bone remodeling at the age of thirty.
After this age, depending on the amount of acidity in the food so that they affect
the overall functions and lead to be stones in them. (The proportions of these acids
are not dependent on the taste of our food, but depend on the proportion of each of
- 24 -
potassium, chlorine, manganese, and others to salts of phosphorous).Curzon,M.E.J.
(2004).
2.5.5. Protection
The best solution is to stay away from carbonated beverages and replace them
with natural juices, fresh fruit, and that had to be used, there are some tips for people
addicted to drink, namely:
Avoid carbonated drinks with food so as to prevent a bad influence on important
minerals such as calcium and iron absorption.
If you would like very much to drink, you can drink a glass at the most a week does
not harm you staying away from it completely.(Maichl, 2009)
2.5.6. Previous studies
A study by (Hattersley-2009), aiming at exploring the knowledge,
attitudes and behaviors regarding caloric soft drinks in a group of young
adults attending university and to identify opportunities for a health
promotion intervention aimed at reducing consumption. This study was
carried out in Sydney, Australia. They found that the social and
environmental cues, intrinsic qualities of beverages and personal health
beliefs were identified as important influences on consumption. Social cues
included settings in which drinks are usually consumed, socializing with
friends, and family influences. Environmental cues included purchasing of
fast foods, and ready availability, preferential pricing and promotion of
caloric beverages. Reinforcing intrinsic qualities of caloric soft drinks
included taste, sugar and caffeine content, and their association with treats
and rewards. Major gender differences as well as variations in individual
- 25 -
readiness for behavior change were observed. Raising awareness of the
sugar content of various beverages and the potential health impacts
associated with their consumption was considered important.
Another study of carried out by (ElSawy-2014), about the relationship
between carbonated drinks and osteoporosis. They reported that in several
observational studies, intake of carbonated drink was associated with reduced
bone mass, decreased calcium level in the blood, and increased fracture risk.
Carbonated drinks consumption has exploded over the past three decades,
demonstrating a per capita availability increase from 22 gallons to 52 gallons. In
the USA, carbonated soft drinks and milk are the two most popular non-alcoholic
beverages, accounting for 39.1% of total beverage consumption.
A recent study in Saudi Arabia in 5033 boys and 4400 girls aged
10 to 19 years on dietary intake and obesity showed that Sugar sweetened
carbonated drink consumption varied from 5.93 to 9.04 servings a week by age,
and was significantly higher than consumption of non-caloric sweetened "Diet"
carbonated drink, which varied between 0.92 and 1.52 servings per week. Thus,
obesity combined with poor dietary habits can increase osteoporosis”.
A study carried out by (Tahmassebi-2004) in the USA showed a positive
relationship between cumulative caries scores and the frequency of mealtime and
between-meal use of carbonated beverages. However, the strength of this
conclusion was weakened by the use of only a one-day diet analysis to represent
the foods and drinks used over the period of up to 20 years during which the
observed caries developed”.
Another study by (Kharde-2013) found that the consumption of high sugar contained
carbonated drinks is more prevalent among youngsters. The excess consumption of
carbonated drink has been associated with many adverse health effects.
- 26 -
Thus, out of all students 52 (48%) reported that they had started to drink carbonated drink
at the age less than 10 years. The majority of students consider obesity (28.2%) as side
effect associated with consumption of carbonated drink followed by bone decay (11%)
and dental caries (9%). They concluded that the health education and primordial
prevention would be the best way to adopt healthy life style and combat the problems
associated with the consumption of carbonated drinks.
A study by (Kishore -2009) investigating the knowledge, attitude and
practices of students regarding carbonated drinks,the study subjects comprised of
medical and nursing students at HIMS. Maximum of the medical students
responded gastritis (27.14%) specifically as the important ill-effects associated
with the consumption of the carbonated drinks for long period of time followed by
teeth and bone diseases (22.85%) and about 28.57% of the them were not aware of
the ill-effects of the same at all. About 39.65% of the nursing students responded.
- 27 -
Chapter Three
Methodology
The field study aims to get the parameters and indicators on the Knowledge,
Attitude and Practices (KAP) regarding carbonated drinks among students of
medical college of the national Ribat University from 15th October to 30th October
2016.
3.1. Study design:
This is a descriptive cross sectional study.
3.2. Study population:
Thestudy population was the students of the Faculty of Medicine of the
National University of Rabat.
3.3. Sample Method:
The sample of student was scientific selectionrandomly from the faculty of
Medicine.300 Questionnaires were distributed 300 students of the sampling
group.The researcher retrieved all the questionnaires (100%).
3.4. Study Duration:
This study started from Period of 15Oct to 15MAR.
3.5. StudyTools:
Self-administer questionnaire as a tool for data collection from the study
sample. It included questions about
- 28 -
1) The socio-demographic characteristics of the students (age, sex, residence,
parent’s education and occupation…etc.).
2) The practices of students towards carbonated drinks (how many cups they
daily consume, why, which types were preferred.
3) Knowledge of students towards the health effect of carbonated drinks, the
nutrient contents as well as other contents.
4) The attitudes of the students towards drinking of carbonated drinks.
3.6. Statistical Analysis:
Data was entered and analyzed using SPSS program. Descriptive statistics
was used including percentages and frequencies. Data was presented in the form
of tables.
3.7. Ethical Consideration:
The Main indicator of ethical Consideration that is a good conformation &
grantees for student of NUR that all information it be in highly secured and not
use for other purposes.
- 29 -
Chapter Four
Result and Conclusion
4.1. Result:
A. Socio Demographic Data:
Table(1) Gender Distribution of Study population:
gender Number Percentage%
Male 141 47%
Female 159 53%
Total 300 100%
Table(2) Age Distribution of Study population:
Percentage% Number Age
30% 90 16 – 20 years
59% 177 21 – 24 years
17% 51 > 24 years
100% 300 Total
- 30 -
Table(3) Class Level of Study population:
Percentage% Number Class
29% 87 Class One
23% 69 Class Two
19% 57 Class Three
15% 45 Class Four
14% 42 Class Five
100% 300 Total
Table(4) Distribution of Study Population By Family Income :
Percentage% Number Family Income
12% 36 less than2000SDG
48% 144 2000-5000 SDG
22% 66 5000-7000 SDG
18% 54 more than7000SDG
100% 300 Total
Table(5) Mother Education of Study population:
Percentage% Number Mother Education
44% 132 secondary school
56% 168 University
100% 300 Total
- 31 -
Table(6) Father Education of Study population:
Percentage% Number Father Education
22% 66 secondary school
88% 234 University
100% 300 Total
Table(7) Student Expenditure Per Day:
Percentage% Number Pocket
21% 63 less than25 SDG
49% 147 25-50SDG
30% 90 More than 50 SDG
100% 300 Total
Table(8) Daily Financial Family Supported Distribution of Study
population:
Percentage% Number The phrase
45% 135 Father
6% 18 Mother
41% 123 Both
5% 15 student him/herself
3% 9 Relatives
100% 300 Total
- 32 -
Table(9) Place of Residence of Study Population:
Percentage% Number Living
84% 252 Family
8% 24 Relative
9% 27 Boarding Houses
100% 300 Total
Table(10) Way of Transportation of Study Population:
Percentage% Number
Method
Transportation
64% 192 public Transportation
17% 51 Joint Transportation
18.33% 55 Vehicles
0.67% 2 Walking
100% 300 Total
Table(11) Disease Conditions among Distribution of Study
population:
Percentage% Number Disease
4% 12 Asthma
0.67% 2 HTN
0.33% 1 DM
95% 285 Free from Illness
100% 300 Total
- 33 -
B. Knowledge :
Table(12) Student Knowledge of Carbonated Drinks:
Percentage% Number Knowledge
93% 279 Knows
7% 21 Doesn’t knows
100% 300 Total
Table(13) Knowledge of Components of Carbonated Drinks Among
Study Population:
Percentage% Number Knowledge
51% 153 Knows
49% 147 Doesn’t knows
100% 300 Total
Table(14) Student Knowledge of Calories Contents of Carbonated
Drinks (500ml):
Percentage% Number Knowledge
80% 240 Knows
20% 60 Doesn’t knows
100% 300 Total
- 34 -
Table(15) Student Knowledge about the Ill Effects of Carbonated
Drinks:
Percentage% Number Knowledge
71% 213 Knows
29% 87 Doesn’t knows
100% 300 Total
Table(16) Student Knowledge about the Ill Effects Associated with
Carbonated Drinks:
Illness Number Percentage%
Obesity 90 30%
Bone decay 150 50%
Dental caries 21 7%
Other (DM, Hyperacidity) 39 13%
Total 300 100%
Table(17) Student Knowledge about the Prolonged Effect of
Consumption and Health:
Percentage% Number Effects
10% 30 Healthy
90% 270 Not Healthy
100% 300 Total
- 35 -
Table(18) Student Knowledge about Using Pepsi for digestionof
Foods:
Percentage% Number Case
84% 252 Believe
16% 48 Don’t Believe
100% 300 Total
Table(19) Student Knowledge about Using Seven Up for relieving
abdominal pain:
Percentage% Number Case
85% 255 Believe
15% 45 Don’t Believe
100% 300 Total
Table(20) Student Knowledge about Bread and Pepsi Calories:
Percentage% Number Case
69% 207 Pepsi 500ml> bread100gm
18% 54 bread 100> Pepsi 500ml
13% 39 Pepsi 500 ml= bread 100g
100% 300 Total
- 36 -
C. Attitude:
Table(21) Student Feeling Regarding Drink Pepsi carbonated Drink:
Percentage% Number Feeling
42% 126 Good
44% 132 Bad
14% 42 Unspecific
100% 300 Total
Table(22) Student Feeling Regarding Others People When They Are
Drinks Pepsi:
Percentage% Number Feeling
38% 114 Good
46% 138 Bad
16% 48 Unspecific
100% 300 Total
- 37 -
D. Practice:
Table(23) Preferring of student Regarding Soft Drinks:
Percentage% Number Drinks Type
79% 237 Natural Fruit Juice
21% 63 Carbonated Drinks
100% 300 Total
Table(24) Studentsage when they are starting taking Carbonated
Drinks (Years):
Percentage% Number Years
77% 231 ≥ 16 Years
23% 69 < 16 Years
100% 300 Total
- 38 -
Table(25) Consumption of Carbonated Drinks Per Litter :
Percentage% Number Average Group
26% 78 Less than 200ml
24% 72 200-350ml
33% 99 350-500ml
17% 51 More than 500ml
100% 300 Total
Table(26) Student Consumption of Carbonated Drink Per Day:
Percentage% Number Frequency
50% 150 Once
24% 72 twice
15% 45 3 Times
11% 33 more than 3 Times
100% 300 Total
- 39 -
Table(27) Preferable Consumed Carbonated Drinks:
Percentage% Number Carbonated Drink
51.67% 155 Pepsi
3% 9 Sprite
16% 48 Coca Cola
14% 42 Seven UP
5.33% 16 Miranda
2% 6 Stim
8% 24 Similar
100% 300 Total
Table(28) Reason behind Consuming Carbonated Drinks:
Percentage% Number Reason
39% 117 Satisfy Thirst
18% 54 To Gain Energy
43% 129 Habit
100% 300 Total
- 40 -
E. Lifestyle:
Table(29) Students Daily Coffee Consumption :
Percentage% Number Coffee Consumption
51% 153 Drinking Coffee
49% 147 Don’t Drinking Coffee
100% 300 Total
Table(30) Sleep Disturbanceat night :
Percentage% Number Sleep Disturbance
42% 126 Sleep Disturbance
58% 174 No Sleep Disturbance
100% 300 Total
F. Anthropometric Measures:
Table(31) BMI
Percentage% Number BMI
66% 198 ≥ 25
34% 102 < 25
100% 300 Total
- 41 -
Table(32) Height:
Percentage% Number Height
10% 30 ≥ 150cm
60% 180 151cm-160cm
18% 54 161cm-180cm
12% 36 More than 180cm
100% 300 Total
- 42 -
4.2. Discussion
In this study the majority of the students studied were females (53%). Most of
them (59%) belong to the age group from 21-24 years. Their families' income is
considered generally to be mordent, as (48%) have monthly incomesbetween2000
to 5000SDG. The majority of the students’ parents completed high levels of
education (university). Up to 49% of the students have dailyexpanses money
between 25 to 50 SDG. Which mainly come from the students'parents.The majority
of these students live with their parents (84%). The present study revealed that 93%
of the study sample had heard about carbonated drinks, and7% have never heard
about the term “carbonated drinks”. This is disagrees with Patel et al., (2016),
results that, 100% had heard about carbonated drink and 0% hadn’t heard about
carbonated drinks.
From the result we found that 51% knew the components of carbonated drinks,
and 49% didn’t know. This disagreed with Khardeet al., (2013), result that, 5.5%
knew about carbonated drinks, and 94.5% didn’t know.
In this study majority of students 80% knew the amount of calories in carbonated
drinks, and 20% didn’t know it. This disagreed with Khardeet al., (2013), result
that, most of the students didn’t know the amount of calories. That might be referred
to that not all students care about reading the ingredients that in label of bottle. Also
the participants of this study were medical school students who were probably
familiar with calories.
In the present study it was found that 71% knew about the bad effects of
carbonated drinks, and 29% didn’t know. This is close to the results reported by
Khardeet al., (2013), who showed that, 72.7% knew the bad effects and 27.3% didn’t
know it. This might be due to that these students prefer the taste of carbonated drinks
over the nutritional value and didn’t care about the consequences.
In the present study the opinions of the students associated with the ill effects of
carbonated drinks, was highest for bone decay 50%, obesity was 30%.This disagreed
with Patel et al., (2016) result that 11% had reported bone decay and agreed with
Khardeet al., (2013) that 28% of subjects in their study mentioned obesity.
- 43 -
In the present study subjects also viewed out the consequences of prolonged
consumption of carbonated drinks was found to be: bad for health (90%). This agrees
with (Kharde-2013) result who reported that 99% thought carbonated drinks were
bad for health. Also agrees with (Patel-2016) who found that 94% of subjects
thought carbonated drinks were bad for health.
This study also showed that 84% of the medical students thought that drinking of
Pepsi is good for food digestion. And 85% of subjects think that drinking Seven Up
is good for relievingabdominal pain. These were wrong believes. Thus, Soda, also
contain carbon dioxide which might generate more abdominal gases when they
break down during digestion and cause the belching and discomfort. There was also
wrong belief about carbonated drinks and their caloric contents. Thus, it was found
that up to 69% of the studied participants thought that Pepsi has more calories
compared to a whole piece of bread. These thought might encourage students to
substitute bread with drinking of Pepsi believing that they have taken the needed
amount of calories
The present study showed that up to 46% of the students felt badly for students
who drink one cup every day of carbonated drinks. And 42% felt good when they
drink it. This study also showed that most students prefer natural juices (79%) and
the carbonated drinks was preferred by 21%, these results were in line of the findings
of (Patel-2016), and they concluded that, preference for natural juices was reported
by 89.5% and the carbonated drinks by 10.4%. However, the natural juices aren’t
available and affordable as carbonated drinks especially in Sudan.
The majority of the medical students in this study started drinking carbonated
drinks since they were 16 years old or younger for up to 77%, and over 16 years old
for 23%. This disagrees with the results stated by (Kharde-2013), they reported that,
the age the students started to take carbonated drinks younger than the age of 16
years old was 84%, and over 16 years old was 16%. This might be due to the better
awareness of parents towards carbonated drinks as when student gain some sort of
independence as they grew up freedom for such choices is enhanced.
The results showed that the most common reason that encourage students to start
taking carbonated drinks was good taste by 49%, this agrees with the result stated
- 44 -
by (Patel-2016), who reported that among 45% and also (Kharde-2013), who
reported this among 30%..
In the present study it was found that Pepsi was the commonest carbonated drinks
students prefer to consume (51%) compared to other carbonated drinks. In That line
of findings of (Kishore-2009), they reported that higher intake of carbonated drinks
was a Pepsi by 49%. And with (Kharde-2013), who concluded that higher intake of
carbonated drinks was a Pepsi by 27%. This might be because Pepsi is the oldest
carbonated drinks and the most permanent produced one. The results show the body
mass indices of the studied students were equal or under 25 for 66%, and over 25 for
34%.That in agreement with the results reported by (Kharde-2013) that.The body
mass index of students fewer than 25 was 77%, and over 25 were 23%. From this
result we concluded the carbonated although for the students at the time of the study
are not a major cause of obesity probably if they continue in consuming it they will
probably suffer from obesity and its associated health associated disease.
- 45 -
4.3. Conclusion:
1. The knowledge of the students regarding the ill-effects of the consumption of
carbonated drinks is not convincing one. The attitudes of the students are
relatively better but their practices are neither preventive nor health
promoting.
2. A high number of university students take carbonated drinks on daily basis as
a refreshing preferable drink to get rid of thirst and dehydration, and the
majority of them knew that carbonated drinks leads to many health problems
including obesity, osteoporosis and diabetes.
3. The field study has shown that there is sufficient knowledge of the dangers of
carbonated drink intake by males and females, and in spite of that is addressed
in abundance.
4. Some of the study population believes that some carbonated drinks contribute
to the digestion of food, or as a treatment for abdominal pain.
5. 93% of study population knows about carbonated drinks while 77% started
drink carbonated drinks when they were less than 16 years of age.
- 46 -
4.4. Recommendations:
Based on previous results researcher recommends the following:
1. It is recommended that a holistic approach should be incorporated to combat the
problems associated with the consumption of carbonated drinks. There is a need of
Behavioral Change (BCC) for youngsters.
2. To develop nutritional education and designing more nutritional intervention
programs for the university students in general, specially focusing on the drink fresh
fruit juice and their benefits to the body, the consequences of high sugar
consumption from carbonated drink.
3. The need for awareness through seminars in schools and universities of the
harmful effects of carbonated drinks.
4. The importance of putting health warnings included the adverse effects of these
beverages in newspapers, radio and television bulletins and various social media, as
well as increased advertising of these drinks fees and attach a health warning is
mandatory.
5. Further studies on the short and long term dangers of drinking carbonated drink
on health are urgently needed.
6. Research on alternative nutritious, appealing and affordable drinks must be carried
out as to replace carbonated drinks.
7. Health education section for student regarding health effect of carbonated drink.
- 47 -
4.5. Reference:
1. Adults. Public Health Nutrition, 12(10): 1816–1822.
2. Attin T, Siegel S, Buchalla W, Lennon AM, Hannig C, Becker K. Brushing
abrasion of softened and remineralized dentin: an in situ study. Caries Res.
2004;38(1):62–66. doi: 10.1159/000073922.
3. Bamise, CT.; Kolawol, KA.; and Oloyede, EO. (2009).The Determinants And
Control Of Soft Drinks-Incited Dental Erosion. Rev ClínPesqOdontol, 5(2):141-
154
4. Carbonated water and bone health, Nelson, J.K., RD, MAYO CLINIC:
HEALTHY LIFESTYLE, 2011. http://www.mayoclinic.org/healthy-
living/nutrition-and-healthy-eating/expert-blog/carbonated-water/bgp-20056174
5. Doglas, S. Laboratory experiments on carbonated drink effects on osteoporosis,
United Kingdom.2003.
6. Effects of carbonated water on functional dyspepsia and constipation, Cuomo,
R., Grasso, R., et. al., EUROPEAN JOURNAL OF
GASTROENTEROLOGY& HEPATOLOGY 14: 1-9, 2002
7. ElSawy,N,; Bukhari,H.; Nada,I.;andAHeader,E. (2014). Obesity and
Osteoporosis among Students in Umm Al-Qura University Makkah, KSA.VRI
Bio Med Chem, 2(2):29-35.
8. James,J.; Thomas,P.; Cavan.;D And Kerr.;D.(2004).Preventing childhood
obesity by reducing consumption of carbonated drinks. Diabetes Primary Care
,4(3):9-75.
9. Hattersley,L.; Irwin1,M.; King,L.; and Allman-Farinelli,M.(2009). Determinants
and patterns of soft drink consumption in young.
10. Kharde,ADeshpande,J.; and Phalke,D.(2013).
- 48 -
11. Kishore, S.; Aggarwal, P.; and Muzammil, K. (2009). KAP Study
AboutCarbonated Drinks Among Medical and Nursing Students at Teaching
Hospital. J K Science, 11(4):196-199.
12. Knowledge, attitude and practice (KAP) regarding carbonated drinks among
medical students. International Journal of Medical Science and Public Health,
6(1).
13. Knowledge, Attitude and Practices (KAP) Regarding Carbonated Drinks Among
Student Of Medical College Of Western Maharashtra. International Journal
ofMedical Science and Public Health, 2(4):912-915.
14. Kumar P, Clark M, Clinical Medicine; 5th Edition.
15. MaichlXorafe, Gaseous material components through a medical perspective,
the National Library, New York, 2005.
16. Mansho, F. (2006) Carbonated drink experiments on Public Health,
University of Manchester,Manchester.
17. Mohamed Abu Eez, The effect of caffeine in organic materials for
carbonated drinks, Michigan University, 2009.
18. Patel,N.; Joshi,K.; Kumar,P.; Purani,S.; and Kartha,G.(2016).
19. Roubenoff R, Klag MJ, Mead LA, Liang KY, Seidler AJ, Hochberg MC.
Incidence and risk factors for gout in white men. JAMA 1991;266:3004-7.
20. Tahmassebi,J.F.; Duggal,M.S.; Malik-Kotru,G.; and Curzon,M.E.J.
(2004).Soft drinks and dental health. Journal of Dentistry, 0300-5712
Warner, D. (2007) Carbonated drinks manufacturing, the United States.
21. Yancy CW, et al. (2013). 2013 ACCF/AHA Guideline for the management
of heart failure: A report of the American College of Cardiology
Foundation/American Heart Association Task Force on Practice Guidelines.
Journal of the American College of Cardiology, 62(16): e147-e239.
- 49 -
The National Ribat University
Faculty of Post Graduate Studies & Scientific Research
Faculty of Medicine
Knowledge, Attitude And Practices (KAP) Regarding Carbonated Drinks
Among Students Of Medical College Of The National Ribat University from
15th October to 30th October 2016
Questionnaire
Please mark (√) on the corresponding item:
Serial No: ………………… Date ……………………
A.Socio Demographic data :
1) Gender:
Male ( ) Female ( )
2) Age:
16-20 ( ) 21-24 ( ) ≥24 ( )
3) Grade:.......
4) Family monthly income:
Less than 2000SDG ( ) 2000-5000SDG ( ) 5000-7000SDG ( ) More than
7000SDG ( )
5) How much is your pocket money /day?
<15 SDG ( ) 16-25 SDG ( ) 26-50 SDG ( )
6) Source of income
Father ) ( Mother ( ) Both ) (
Student him/herself ( ) Relative ) (
Other: specify…………………………………
7) Type of accommodation:
With family ) ( with relative ) (
Boarding Houses ( ) other: specify: ……………………….
8) Usually you get to university by:
- 50 -
Public transportation ( ) Joint Transportation ( ) Vehicles ( )
Walking ( )
9) Mother education level:
Illiterate ( ) Secondary school ( ) University ) (
10) Father education level:
Illiterate ( ) Secondary school ( ) University ) (
11) Do you have any chronic illness?
Yes ( ) No ( )
if yes: specify.........................
B.Knowledge :
1) Have You Heard about Carbonated Drinks?
Yes ( ) No ( )
2) Do you know the Ingredients of Carbonate Drink?
Yes ( ) No ( )
3) Do you Know how much calories of 500ml carbonate drink contains?
Yes ( ) No ( )
If yes how many calories? ml
4) Do you know about the Ill Effects?
Yes ( ) No ( )
5) Is carbonated drink associated with Ill Effects?
Obesity ( ) Bone decay ( ) Dental caries ( ) Belching ( )
Hyperacidity ( ) Diabetes type II ( ) Sleep Disturbance ( )
6) Prolonged Consumption and health?
Bad for health ( ) Good for health ( )
7) Do you think people may drink Pepsi because it helps in digesting the food?
Yes ( ) No ( )
8) Do you think people may drink seven up because it relieves abdominal
pain?
Yes ( ) No ( )
9) Which one of the following have more calories?
Pepsi 500ml> bread100gm ( ) bread 100> Pepsi 500ml ( ) Pepsi 500 ml=
bread 100gm ( )
C. Attitude:
- 51 -
1) What do you feel or think (feel good or feel bad or no specific feeling) about
yourself when you drink carbonated drinks?
a. One cup Every day ( )
2) What do you feel or think (feel good or feel bad or no specific feeling) about
the people who drink carbonated drinks?
a. One cup Every day ( )
D. Practice regarding carbonated drinks:
1) What would you prefer?
Natural Fruit Juice ( ) Carbonated Drinks ( ) other ( )
2) At which Age you started to take carbonated drinks (Years)?
≤16 ( ) >16 ( )
3) What encouraged you to start taking it?
Good taste ( ) Media Advertisement ( ) Easy access ( )
Appeal of drink ( ) Family influence ( )
Courtesy friends ( ) other ( )
4) What is Average Amount you usually consume?
<200ml ( ) 200-350ml ( ) 350-500ml ( ) >500ml ( )
5) How many times per day you drink carbonated drink?
Once ( ) twice ( ) third ( ) more than 3 ( )
6) What is the commonest carbonates drink you prefer to consume?
Pepsi ( ) Sprite ( ) coca cola ( ) seven UP ( )
Miranda ( ) steem ( ) Similar ( )
7) Why do you drink it?
Satisfy thirst ( ) To Gain energies ( ) habit ( )
E. Lifestyle:
1) Do you drink coffee on daily basis? Yes ( ) No ( )
2) Do you stay awake till late times at night?
Yes ( ) No ( )
F. Anthropometrics measures:
Weight ( ) kg Height ( ) cm