Vitamin D Deficiency in Saudi Women - Literature review Example

 Vitamin D Deficiency in Saudi Women Introduction Vitamin D deficiency is a growing problem in many parts of the world. Due to its widespread occurrence in many countries, cancer, arthritis and diabetes are rapidly growing particularly in the Middle East. There are various reasons that directly or indirectly increase the cases of vitamin D deficiency in Saudi Arabia. First, hijab, abayya, and other religious and cultural symbols which are mainly worn by the Saudi women also cause the problem of vitamin D deficiency. Consequently, inadequate sunlight exposure also triggers the problem of vitamin D deficiency. In the following parts of the literature review, first geographical background of Saudi Arabia has been provided in which local climate and temperature conditions have been provided. In the subsequent part, vitamin D description has been included in which types of vitamin D and its different sources have been made part. Subsequently, causes of vitamin D deficiency in Saudi women have been mentioned in which a range of important causes have been provided. Additionally, from a social perspective, some significant description has also been included. However, it is important to mention that the causes have been critically discussed. After this part, effects of vitamin D deficiency have been detailed, elaborating these effects on women particularly on the pregnant women as well. Before the chapter summary part, some remedies have been discussed in which cultural change, economic empowerment of women are some of the important factors that are highly essential. Moreover, the role of Saudi government has been mentioned in which it is expected that they can reduce this problem by spreading awareness of vitamin D deficiency problems. Saudi Arabia geography and female population Saudi Arabia has harsh, dry desert with extreme temperatures (Central Intelligence Agency, n.d). Most importantly, it is the largest state without a river but owns extensive coastline on Red Sea and the Persian Gulf (Central Intelligence Agency, n.d). And some reports also highlight that its temperature crosses 50 degree centigrade in summer season which is very harsh and difficult for avoiding the sun stroke and other health impacts. Moreover, mostly sunny weather is largely available throughout year, providing a maximum source for vitamin D (Alsuwaida, 2013). The female population was around 43 per cent in 2012, highlighting that the female population is around 50 per cent of the total population (Quandl, n.d). Based on the above information, it can be deduced that Saudi Arabia has hot and humid climate in which harsh weather conditions through heat are experienced by the local natives. In other words, sun exposure and its related health-related both positive and negative effects on human body cannot be undermined. In addition, these effects can create health and medical problems if the sun exposure is greater than the medically allowable level and this could be a serious health hazard for female population which is of a sizable part of overall Saudi population. However, the society of Saudi Arabia is largely religious in its nature where the fundamentals of the religion of Islam are strictly adhered to. And when it comes for Muslim women, the religious customs and laws are highly stringent in their nature. For example, the Saudi women are not allowed to walk with bare head but they are asked to cover their head with Hajib (a local term for covering body within the teachings of Islam). As a result, there are more chances that the Saudi women are rarely exposed to the sun, which is the main and biggest source of vitamin D, and they are at a higher level of consuming smaller or insufficient amount of Vitamin D through the sun exposure. Vitamin D Vitamin D is essential for smooth working of human body; it has two different types: cholecalciferol, known as vitamin D3, and ergocalciferol (vitamin D2) (Habib et al, 2014). Vitamin D3 is produced through the human skin when it is mainly exposed to the sun, which offers the natural way of forming vitamin D (Michael 2008; Combs, 1998; Misra et al., 2008). Based on the above provided information, it can be highlighted that the role of vitamin D is very fundamental and important for human body as it facilitates and enables the human body to perform its routine functions besides diminishing the risk of serious disease. In other words, Vitamin D has direct relationship with the immune system in which it not only retains its routine body protection function but also enables it to fight against all types of serious and common diseases (Donath and Amir, 2005). However, it is still important to argue that it has been claimed that vitamin D protects human body from malicious diseases but the ground reality is different as the reported cases of diabetes, cancer and arthritis are globally touching the new heights every year, making the claim baseless and irrelevant. For the sake of argument, even if it is assumed that the intake of vitamin D strengthens the immune system, the recent surge in the arthritis cases does not solidify the claims of Cauley. Causes of Vitamin D Deficiency in Saudi Women Vitamin D deficiency is medically defined as hypovitaminosis D (Habib et al., 2014). In this regard, Lips (2007) mentions that the problem of hypovitaminosis D is commonly prevalent across the state of Saudi Arabia but it causes have not been appropriately identified. Based on the findings of Lips (2007), it can be deduced that the Saudi women are at a higher level of risk because the field work or primary research on the issue has been rarely conducted and it is continued in that fashion, the possibility of this problem to becoming a national health hazard in Saudi Arabia cannot be ruled out. In this regard, it has been explained that apart from the sunlight exposure for receiving vitamin D, some food items also provide vitamin D, including egg yolk, mushroom, seafood and fortified Milk (Shamma, 2013; Mark, 2009). However, it has been observed that the natural food items containing vitamin D are not sufficient enough to satisfy the body requirement and it would be very risky to purely rely on the support and intake of food items for the purpose of vitamin D. Moreover, inadequate sun exposure, diet and skin pigmentation remain the major causes of vitamin D deficiency for Saudi women (Al Bathi et al., 2011). In this regard, it is important to contend that although Al Bathi et al. have highlighted the causes of vitamin D but they have not provided any standard benchmark highlighting the mix of taking vitamin D from the sun exposure and from the food items. at the same time, it can also be argued that the recent research also highlights that after a certain level, exposure to the sunlight may causes skin disease, sun stroke and even skin cancer as well(youl et al., 2009). keeping in view the harsh climate and severe weather patterns in Saudi Arabia, the Saudi women face dilemma in which they find it hard to determine and draw a line between the level of required sun exposure for developing vitamin D and the sunlight avoidance for protecting their skin from diseases and medical issues which are caused by the extreme sun exposures. Moreover, it is still important to signify that the Saudi women are not freely allowed for attending social events and other personal activities as is done in the western world; consequently, they are forced to remain at home most of day time which creates another problem for them to appropriately understand and satisfy their vitamin D requirements. Moreover, the society of Saudi Arabia is complex and it would not be incorrect to say that it is a clear reflection of male-dominated culture in which the decisions and wishes of male family members are strongly listened to and adhered to as well. In the Saudi society, women are not encouraged for studying or getting higher education instead they are forced to remain at home and they are only allowed to serve the family members. Consequently, the level of medical education and vitamin D awareness and knowledge is very limited or it would not be incorrect to say that they are even unable to read or write common words. In this strange situation, the Saudi women find it hard to improve their understanding and knowledge about the education, symptoms and other aspects relating to the issue of vitamin D deficiency. In a nutshell, the Saudi society also provides a cause for disallowing the Saudi women from getting proper understanding about vitamin D and its deficiency, causes, effects and remedies as well. Physical inactivity is also common among Saudi women (Al-Nozha et al., 2007; Al-Hazzaa and Hazzaa, 2007). In this regard, it has also been contended that the despite the fact that this problem is fastly growing among Saudi women, no public awareness from any relevant authority has been given to this serious social problem (Al-Nozha et al., 2007; Al-Hazzaa and Hazzaa, 2007). The gravity of this problem can be understood by the fact that in the Western countries, it is commonly believed that poor physical activity is linked with the low status of vitamin D (Hintzpeter and Mensink, 2007). If both findings are attached together, then it would be clearly evident that the Saudi women are at greater level of risk because they have limited tendency towards physical activity and that has a very serious implications for overall health of human body and brain as well. Knowledge and Awareness of Vitamin D: Effects of Vitamin D Deficiency on Saudi Women More than 30 per cent of young Saudi women face the vitamin D inadequacy problem (Sadat-Ali et al., 2008). And in this regard, some other findings reveal that the Saudi women has lower level of vitamin D status (Taha, 1996; Narchi et al., 2001; Fida, 2003).This is an important finding with regard to the Saudi women in which the ordinary Saudi women do not only the face the problem of vitamin D inadequacy but also encounter other medical issues, such as arthritis, diabetes, cancer and so on. In this regard, it is significant to highlight that Saudi Arabia is not a poor country but has a steady stream of money from religious tourism and other powerful economic indicators. Despite the fact that it has huge oil reserves and is among one of the leading oil producing and exporting countries, the health barometer is reflecting that 30 per cent women face the problem of vitamin D deficiency and that is considerably contrary to its economic prosperity. Consequently, in the widespread prevalence of vitamin D deficiency among Saudi women brings subsequent effects on the health of pregnant Saudi women. For them, this definition has multiple effects on their pregnancy because the similar effects of vitamin D deficiency are also experienced by child in mother’s womb and it would be very difficult to assess the effects of vitamin D deficiency on the child and what areas of human body and brain are going to be affected by the shortage of vitamin D is not very easy to examine because the child’s physical and mental growth continues throughout the pregnancy period till the time of birth. Some findings reveal a very startling reality about the current level of knowledge and awareness about vitamin D in the Saudi women. Habib et al., (2014) conducted research on this topic in which they found that around 14 per cent of the respondents had good knowledge about the benefits of vitamin D and they also revealed that 86 per cent of the respondents, who participated in the research activity as respondents, either had bad or fair understanding about vitamin D. Based on the findings of Habib et al. (2014), it can be argued that majority of the respondents did not know anything about vitamin D and its uses, benefits and other side-effects on human body and brain. In this regard, it is important to highlight that if the majority of the Saudi women are not aware of vitamin D, it has serious ramifications for overall Saudi society because in any such society, the role of women is highly important for the children nourishment. If the Saudi mothers are not aware of vitamin D, then there are chances that the similar effects can also be displayed by other members of the Saudi society as well. Moreover, the findings also demonstrate that the Saudi women are less inclined to increase their understanding about the medical and physical issues pertaining to the use of vitamin D. In the developed countries, the role of women is highly critical for child nourishment not only in terms of motherly care but also in terms of mental growth and development. For this purpose, mothers are provided six moth courses before they become able to nourish children. However, no such programs on government levels are arranged in Saudi Arabia; consequently, such gap creates the physical and mental problems for children and mother as well particularly after the period of pregnancy. Remedies for Vitamin D Deficiency Cultural change Based on the findings in the above-mentioned parts of this literature review, it can be deduced that the vitamin D deficiency is cultural and personal causes. Culturally, the society of Saudi Arabia is male-dominated where the role of women is subservient to the wishes of male member of family. So, in order to remedy the problem of vitamin D deficiency, it is highly essential to change the overall thinking of society in which some traditional and cultural thinking must not be allowed to remain the same but some changes should be introduced for addressing the overall issues pertaining to the Saudi women. In this regard, education, religious knowledge from the Holy Quran and the Sunnah can be used for changing attitude toward women and their sign fiancé and role in the overall growth and development of the Saudi society. For example, the male members must be educated regarding the domestic and personal rights of women and those rights are given and provided in the Holy Quran as well. If the male members are convinced concerning the rights of women, then there are more chances that women would be given opportunity to think and carry out their thinking and understanding about their physical and mental well being. In this regard, it is important to mention that such rights should be given to women within the ambit of the religion of Islam and no western or other theories should be allowed to extend freedom to the Saudi women. However, some may disagree with this notion and may argue that what type of freedom and level of freedom should be given to the Saudi women and it has been seen that such freedom has been only exploited inappropriately and no proper use has been observed till this point of time. Economic empowerment for Saudi women Economic empowerment can also reduce the miseries pertaining to vitamin D and other health-related issues. It is no more a hidden fact that the Saudi women are not allowed to earn for their living but they are required to rely on their male family members to support them throughout their life. Before marriage, father and brothers are legally and religiously allowed to facilitate them and after the marriage, she would be her husband’s responsibility and she would be getting money and other assistance from the husband. In other words, throughout her life, she has no personal economic freedom but reliance on male family members is largely visible. Under this condition, the Saudi women would not be in a position to avail economic rights and economic empowerment. In this regard, it is important to mention that the Saudi women are largely relying on other male members to support them. Consequently, they become too reliant to think about those medical and other issues that are highly critical for physical and mental health. For example, if she is required to buy anything, individually she cannot buy it because without getting money from male family member, access to that item remains an impossible reality. From this example, it can be deduced that even for a small piece of purchase, she is required to receive the financial support from male family members, and satisfying medical and physical requirements, including avoiding vitamin D deficiency, would be a monumental task for them. The role of Saudi Arabia and the Gulf states to raise awareness about vitamin D The role of Saudi government and other Gulf States is very crucial as well. For this purpose, they can arrange different seminars, walks, social gathering programs and they can also use both print and electronic media for spreading the awareness regarding vitamin D and its importance for the physical and mental stability. For example, through government funded programs, the Saudi government can arrange vitamin D awareness seminars in which only women are encouraged to participate and understand the significance of the vitamin D. In such programs, only importance of vitamin D should be emphasised besides highlighting main advantages and disadvantages should provide further information about vitamin D. Moreover, it is also significant that such programs must be held regularly because this would enable the authorities to track the performance and level of awareness about vitamin D in the Saudi women. Chapter Summary The problem of vitamin D deficiency in Saudi Arabia is common among women. More than 30 per cent young females are directly affected by the vitamin D deficiency. This deficiency is mainly caused by the range of factors including inadequate sunlight exposure and diet is among the most prominent causes. Moreover, physical inactivity which is mainly and commonly found in Saudi women also increases the chances of vitamin D deficiency. And the effects of vitamin D deficiency are not only faced by women but also children as well because during the period of pregnancy, a vitamin D deficient mother transfers the effects to the child as well. For reducing the effects, number of measures needs to be taken including cultural change, economic empowerment of women and the seminars and other social program through the support of Saudi government would reduce the causes of vitamin D deficiency in Saudi women. References Al Bathi BA, Al Zayed KE, Qenai AI (2011). Makboul,G El-Shazly MK. Knowledge, attitude and practice of patients attending primary care centers toward vitamin D in Kuwait, Alexandria Journal of Medicine, 4 (8), 5-35 Al-Hazzaa, Hazzaa M, (2007) Health-enhancing Physical Activity Among Saudi Adults Using the International Physical Activity Questionnaire (ipaq), Public Health Nutrition, 10.1 Al-Nozha MM, Al-Hazzaa HM, Arafah MR, Al-Khadra A, Al-Mazrou YY, AlMaatouq MA, Khan NB, Al-Marzouki K, Al-Harthi SS, Abdullah M, Al- Shahid MS, (2007) Prevalence of physical activity and inactivity among Saudis aged 30- 70 years, A population-based cross-sectional study, Saudi Medical Journal.;28(4):559-568. Alsuwaida, AO, Farag, YM, Al Sayyari, AA, Mousa, DH, Albejaili, FF, Al-Harbi, AS, Housawi, AA, Mittal, BV, & Singh, AK, (2013), Prevalence of vitamin D deficiency in Saudi adults, Saudi Medical Journal, 34 (8), 814-818 Central Intelligence Agency, (n.d.), Middle East: Saudi Arabia, Available: https://www.cia.gov/library/publications/the-world-factbook/geos/sa.html Accessed: 8 June, 2014 Combs, GF, (1998), The Vitamins: Fundamental Aspectsin Nutrition and Health, 2nd Edn., New York, Academic Press, pp: 155-182 Donath, SM, and Amir, LH (2005), Breastfeeding and the introduction of solids in Australian infants: Data from the 2001 National Health Survey Australia, New Zeeland Journal of Public Health, 29: 171-175. Fida NM, (2003), Assessment of nutritional rickets in Western Saudi Arabia, Saudi Medical Journal, 24:337–40 Habib, FM, Al-Motairi, AA, Al-Mutairi, WM, (2014), Vitamin D Deficiency: Knowledge and Practice among Adult Saudi Females, Global Advances Research Journal of Medicine and Medical Science, 3 (5), 095-101 Lips P (2007), Vitamin D status and nutrition in Europe and Asia, Journal of Steroid Biochemistry and Molecular Biology, 103: 620–625 Mark A Moyad (2009), Vitamin D: A Rabid Review. Dermatology Nursing 21(1):25-30 Hintzpeter B, Mensink GB, Thierfelder W, (2007), Vitamin D status among German adults, European Journal of Nutrition, 62(9):1079. Michael F Holick, Tai C Chen (2008), Vitamin D deficiency: a worldwide problem with health consequences American Journal of Clinical Nutrition, 87(4):1080S– 1086S Misra, M, Pacaud, D, Petryk, A, Collett-Solberg, FP, Kappy, M (2008)Vitamin D deficiency in children and its management: review of current knowledge and recommendations. Pediatrics, 122: 398-417 Narchi, H, El, JM, & Kulaylat, N (2001), Symptomatic rickets in adolescence, Archives of Disease in Childhood, 84, (6), 501-503 Sadat-Ali, M, A.H Al-Elq, H.A Al-Turki, F.A Al-Mulhim, and A.K Al-Ali (2008), "25- hydoxyvitamin D Levels Among Healthy Saudi Arabian Women, Saudi Medical Journal, 29(12), 1765-1768 Shamma JM, (2013), Vitamin D deficiency among healthy adolescents in Al Ain, United Arab Emirates Quandl, (n.d), Saudi Arabia: Population Data, Available: http://www.quandl.com/saudi-arabia/saudi-arabia-population-data Accessed: 8 June, 2014 Taha AK,(1996) Proceeding of Workshop on Prevention and Control of Micronutrient Deficiencies in the Arab Gulf Cooperation Council Countries, Kuwait, 30 June-2 July. Youl, P.H, M Janda, and M Kimlin, (2009), Vitamin D and Sun Protection: the Impact of Mixed Public Health Messages in Australia, International Journal of Cancer, 124(8), 1963-1970 Read More