Regular sunlight exposure increases the serotonin levels in the body, making it more active and alert. The most important advantage of exposure to sunlight is the ability to boost your body's vitamin D supply [
Studies suggest that achieving and maintaining an adequate vitamin D blood serum level, as determined by a 25-hydroxyvitamin D (25(OH)D) blood test, is essential to the prevention and treatment of autoimmune diseases such as multiple sclerosis and type 1 diabetes. Additionally, vitamin D appears to play a protective role in cardiovascular health, various types of cancer, Autism, depression, schizophrenia, and respiratory conditions such as cystic fibrosis [
Recent knowledge suggests that the risk of some chronic diseases could be reduced if vitamin D intake and sun exposure of the population were increased. In some developed countries, the prevalence of rickets in the general population diminished after the emergence of dietary supplementation. However, in such countries, vitamin D deficiency rickets has re-emerged in recent years, particularly among groups with limited exposure to UVB-containing sunshine [
Previous studies indicate that insufficient exposure of sunshine was an important cause of rickets in children [
Evidence shows that many people have low vitamin D levels and also there is a well-documented relationship between low vitamin D levels and poor bone health [
Nutritional rickets are gaining the attention of public health professionals and individual clinicians worldwide as the disease remains an endemic problem in many developing countries and has re-emerged in a number of developed countries [
In middle east vitamin D deficiency and rickets continue to be a public health problem despite all year sunshine. In some parts of Asia, such as the northern parts of China (including Tibet), Mongolia, and Afghanistan rickets appears to be mainly due to vitamin D deficiency associated with the high latitude, cold winters, and limited skin exposure [
Vitamin D deficiency and nutritional rickets are still health problems in developing countries. Despite Turkey being in a geographical location with abundant sun light exposure, vitamin D deficiency continues to be a major health problem. Yearly incidence rates of vitamin D deficiency revealed in Turkey vary from 1.67% to 19%. Thus, sunning for bone development is still being advised [
In Ethiopia, its prevalence was in the order of 30% in the 1950s and does not seem to have changed over the years. The main cause of nutritional rickets in Ethiopian children is lack of exposure to sunshine and not adequate intake of vitamin D. Lack of awareness and traditional beliefs are major causes for not exposing infants to sunshine [
A retrospective study in jimma university specialized hospital revealed that the prevalence of rickets was 10.5% [
Institutional based cross-sectional study design was conducted.
The survey was done from February 15, up to March 25, 2018, in Farta district, Amhara regional state. Farta district is located in the northwest part of Ethiopia and about 667 km from Addis Ababa and 99 km from Bahir Dar. The area is found at the altitude, which ranges from 2000 to 2500 meters above sea level and it consists of four major agro-ecological zones: 25% low land, 45% medium highland, 24% highland, and 6% gorge. The annual temperature ranges between 9 and 25 degree Celsius and the rainfall varies from 1250 mm in the lowlands to 1500 mm in the highland areas during summer.
All lactating women whose child’s age was less than 1 year and attended all health institutions of the Farta district for health care and immunization.
All lactating women whose child’s age was less than 1 year and attended selected health institutions of the Farta district for health care and immunization during the study period.
Inclusion criteria—All women who were lactating with a child less than 1 year.
Exclusion criteria—Mothers who were unable to communicate were excluded.
To determine the sample sizes required existence of estimated prevalence rates is compulsory’s the prevalence of knowledge, attitude, and practice of sunlight exposure was 38.8% of Jimma university specialized hospital with an absolute precisions of ±5% and a statistical confidence of 95% [
The sample size is computed using the following formula.
where,
The total number of infants in Farta district is 4973. Since this figure is below 10,000.
Use the following adjustment formula for the sample size:
where,
Taking 5% [
The sampling method employed in this study was a systematic sampling method. That means proportional numbers of mothers were included into the sample from each selected health facility to make up a total sample size. Each study participant was selected using the systematic sampling technique in which every second client was interviewed in each health facility.
Proportional allocation of the study subjects of the four health facilities were as follows:
where,
nt = Total sample size
Knowledge, attitude, and practice of sunlight exposure of infant.
Age, occupation, income, educational status, no. of sibling and culture, place of delivery, antenatal care, and postnatal care.
A semi structured pre-tested questionnaire was prepared and translated into Amharic by an expert to ensure its consistency. A pretest study was also carried out in other health center to gain some useful feedbacks.
To ensure quality data collection, one day training was provided to data collector to make sure good interviewing techniques. The training was focused on how to complete the questionnaire, proper interview techniques, and proper asking. Through the data collection process, the researcher was closely supervised and checked for consistency and reliability of the data collected by interviewers.
Data entry formats were designed by defining the variables and labeling values for categorical variables. Specifically coding of the questions and data entry format was prepared and made ready before the data was collected. The data were entered and analyzed using computerized SPSS version 20 software. The raw data were edited and checked to control entry. Table and figures were used to present the finding.
Ethical clearance was first obtained from the research and publication office of Bahir Dar University. Ethical permission was also secured from, regional health bureau, South Gondar zonal health department & Farta district health office. Participation in the study was voluntary, and data were collected after obtaining permission from each participant.
Among the 357 mothers identified in the study, 339 (95%) responded to the interview, nearly all 323 (95.3%) were married. More than half, 176 (52%) of the women were in the age group 20–29. Almost all, 332 (98%) of respondents were orthodox and majority, 132 (38.8%) of child’s age were under 4 months. More than two-thirds, 241 (71.1%) of maternal educational status were illiterate. More than half, 312 (91.9%) of their occupations were farmer. Almost all (70%) of respondents incomes were above five hundred Birr (Table
Socio demographic characteristics of respondents whose child age was less than 12 months in Farta district, Northwest Ethiopia, 2018.
Item | Category | Number | % |
---|---|---|---|
Age of mother mean = 28.8, SD = 6.2 | <19 years | 11 | 3.1 |
20–29 years | 176 | 52 | |
30–39 years | 91 | 26.8 | |
40–49 years | 61 | 18 | |
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Age of child in months mean = 5.99, SD = 3.25 | <4 | 132 | 38.8 |
5–8 | 113 | 33.4 | |
9–12 | 94 | 27.8 | |
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Gender of child | M | 184 | 54.3 |
F | 155 | 44.7 | |
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Number of children | 1 | 72 | 21.2 |
2–5 | 218 | 64.3 | |
6–10 | 49 | 14.5 | |
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Religion of the mother | Orthodox | 332 | 98 |
Muslim | 5 | 1.6 | |
Protestant | 2 | .4 | |
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Marital status | Single | 0 | .6 |
Married | 323 | 95.2 | |
Windowed | 4 | 1.2 | |
Divorced | 12 | 3.5 | |
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Educational status of the mother | Unable to read & write | 241 | 71.1 |
Able to read & write | 54 | 15.9 | |
Primary school(1–8) | 32 | 9.4 | |
Secondary school and above | 12 | 3.5 | |
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Husband educational status | Unable to read & write | 195 | 60.5 |
Able to read & write | 54 | 16.7 | |
Primary school(1–8) | 49 | 15.2 | |
Secondary school and above | 25 | 7.7 | |
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Monthly income | <500 | 102 | 30 |
500–1000 | 143 | 42.3 | |
>1000 | 94 | 27.7 | |
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Maternal occupation | Farmer | 288 | 85 |
Civil servant | 4 | 1.2 | |
Merchant | 5 | 1.5 | |
Daily laborer | 6 | 1.8 | |
House wife | 36 | 10.6 | |
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Husband occupation | Farmer | 275 | 85.2 |
Civil servant | 12 | 3.7 | |
Merchant | 15 | 4.6 | |
Daily laborer | 9 | 2.8 | |
Other | 12 | 3.7 | |
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Mass media | Yes | 190 | 55.9 |
No | 149 | 44.1 | |
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Type of mass media | Radio | 161 | 84.9 |
Television | 26 | 15.1 |
Most, 306 (90.3%) of respondents had ANC follow up and the remaining 33 (9.7%) had no follow up. Among respondents who had ANC follow up, 113 (37%) of having four and above visit, only low proportion, 26 (8.6%) of women had one time visit. More than half, 180 (53%) of the mothers delivered at the health center. One hundred eighty eight (55.4%) of respondents had PNC follow up .Among respondents who had PNC follow up 79 (42%) of 188 respondents have a 1st PNC visit and 60 (32%) had three visits (Table
Obstetric history of women whose child age was less than 12 months in Farta woreda, Northwest Ethiopia, 2018.
Item | Category | Number | % |
---|---|---|---|
ANC visit | Yes | 306 | 90.3 |
No | 33 | 9.7 | |
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Number of visit | One | 26 | 8.6 |
Two | 97 | 31.7 | |
Three | 70 | 22.9 | |
Four and above | 113 | 37 | |
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Place of delivery | Home | 54 | 15.9 |
Health post | 40 | 11.8 | |
Health center | 180 | 53 | |
Hospital | 65 | 19.2 | |
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PNC visit | Yes | 188 | 55.4 |
No | 151 | 44.6 | |
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Number of visit | One | 79 | 42 |
Two | 29 | 15.4 | |
Three | 60 | 32 | |
Four | 20 | 10.6 |
Nearly half (49.9%) of the respondents had knowledge of sunlight exposure to their infant. Of 183 respondents, 84 (46%) had knowledge of sunlight exposure every day and 39 (11.4%) two times per week. Nearly three quarters, 134 (73.2%) of 183 respondents had knowledge of sunlight exposure to infants before four hours and the remaining, 7 (2.2%) after four hours. Similarly, more than three quarters, 68 (29.8%) of 183 respondents had knowledge of sunlight exposure of infant in less than 30 min and the remaining, 29 (11.9%) for more than 30 min. More than half, 183 (53.98%) of respondents had information about sunlight exposure of infant and most of the respondents, 120 (54.6%) had got the information from a health professional (Table
Knowledge of respondents on sunlight exposure of infant in Farta district, Northwest Ethiopia, 2018.
Item | Category | Number | % |
---|---|---|---|
Mentioned as they knew the importance of sunlight exposure | Yes | 183 | 53.98 |
No | 156 | 46.02 | |
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Number of day of sunlight exposure per week | Every day | 84 | 46 |
2 | 39 | 11.4 | |
3–4 | 48 | 26 | |
5–6 | 12 | 5 | |
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Starting day of sunlight exposure | Within 5 days | 17 | 9.3 |
5–10 days | 20 | 8.3 | |
10–15 days | 91 | 37.9 | |
After 15 days | 55 | 46.7 | |
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Time of sunlight exposure | Before 16:00 h | 134 | 73.2 |
16:00–19:00 h | 38 | 3.3 | |
19:00–22:00 h | 11 | .8 | |
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Duration of sunlight exposure | <15 min | 49 | 26.7 |
15–20 | 40 | 21.9 | |
20 min–1 h | 54 | 29.5 | |
Above 1 h | 35 | 19.1 | |
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Information on sunlight exposure | Yes | 183 | 53.98 |
No | 156 | 46 | |
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Source of information on sunlight exposure | Mass media | 12 | 5 |
Health professional | 100 | 54.6 | |
Neighbor | 68 | 36.6 | |
Parents | 3 | 1.1 |
Less than half of the participants (45.7%) were exposed their infants to sunlight. Only, 37 (15.7%) of 176 respondents started to expose their child to sunlight before 10 days and the remaining, 198 (84.3%) were after 10 days. Out of 176 respondents, about 80 (45.7%) participants exposed their child to sunlight every day and the remaining 96 (54.3%) were 5 up to 6 times a week and less. Most of, 169 (75%) of respondents covered their infant’s body when they exposed (Table
Practice of respondents on sunlight exposure of infant in Farta woreda, Northwest Ethiopia, 2018.
Item | Category | Number | % |
---|---|---|---|
Do you expose your child for sunlight | Yes | 176 | 51.98 |
No | 163 | 48.02 | |
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Number of day of sunlight exposure per week | Every day | 80 | 45.7 |
2 | 28 | 15.9 | |
3–4 | 43 | 24.4 | |
5–6 | 25 | 10.6 | |
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Starting day of sunlight exposure | Within 5 days | 17 | 7.2 |
5–10 days | 20 | 8.5 | |
10–15 days | 91 | 38.7 | |
After 15 days | 107 | 45.5 | |
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Time of sunlight exposure | Before 4 h | 129 | 73 |
4–7 h | 38 | 21.5 | |
7–10 h | 9 | 5.5 | |
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Duration of sunlight exposure | <15 min | 59 | 33.5 |
15–20 | 38 | 21.5 | |
20 min–1 h | 69 | 38.5 | |
Above 1 h | 10 | 5.7 | |
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Do you cover the infants body when you exposed | Yes | 169 | 75 |
No | 56 | 25 | |
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Reason for you cover | To prevent skin damage | 44 | 19.3 |
To prevent from evil eye | 98 | 55.7 | |
Other | 27 | 25 | |
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Reason of respondents for not exposing | Fear of blackness | 4 | 2.4 |
Lack of knowledge | 76 | 46.6 | |
Fear of evil eye | 59 | 36.2 | |
Fear of pneumonia | 5 | 3.1 | |
Lack of time | 5 | 3.1 |
Of the total respondents, 46% agreed with an advantage of sunlight exposure of their infants. More than half, 176 (51.98%) of respondents were happy when they exposed/if they exposed their child to sunlight and the remaining, 163 (48%) felt anxiety and other. About 156 (46%) of respondents perceived consequences after they exposed or if they exposed their child to sunlight were to become strong and the remaining, 183 (54%) were to be healthy, helps to sleep, and others (Table
Attitude of respondents on sunlight exposure of infant in Farta Woreda, Northwest Ethiopia, 2018.
Item | Category | Number | % |
---|---|---|---|
Sunlight exposure is Advantageous | Agree | 139 | 41 |
Disagree | 155 | 45.7 | |
Strongly agree | 17 | 10.98 | |
Strongly disagree | 28 | 2.3 | |
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Feeling of respondents while they expose their child | Happy | 176 | 51.98 |
Anxiety | 80 | 23.6 | |
Angry | 3 | .9 | |
Other | 80 | 23.6 | |
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Perceived consequence of respondents on sunlight exposure of infant | To become healthy | 60 | 17.7 |
To become strong | 156 | 46 | |
Helps to sleep | 3 | .9 | |
Exposes my child to cold/pneumonia | 94 | 27.7 | |
Others | 26 | 7.7 | |
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Thought that sunlight exposure cause skin cancer | Yes | 203 | 60 |
No | 136 | 40 | |
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Thought that sunlight exposure cause nappy rash | Yes | 237 | 70 |
No | 102 | 30 |
The aim of our study was to assess knowledge, practice, and attitude of sunlight exposure of lactating mothers to their infants in Farta district. Currently the government of Ethiopian gives emphasis to decreasing child morbidity and mortality. Therefore, assessing the knowledge, practice, and attitude of lactating mothers regarding exposing their infants to sunlight is one important aspect in maintaining children’s health.
The proportion of respondents who reported that they had the information (knowledge) about sunlight exposure was 53.98%; the same studies done in Turkey and jimma town showed that 86.4% and 100% of mothers had information about sunlight exposure, respectively [
Out of the total respondents who responded to the question “is sunlight exposure beneficial?”, 75.98% mentioned sunlight exposure was beneficial; our finding was lower than the study done in jimma town which was 99.68% [
Regarding the practice of sunlight exposure, 51.98% of mothers exposed their infants to sunlight. This finding is lower than the same study done in sakarya, which was 87.5% of mothers exposed their infants to sunlight [
This study showed that 15.7% of mothers started sunlight exposure of their babies between 0–15 days. This was lower than the study done in jimma town, 42.04% and debre markos town, 23.4% [
In our study, 73.2% of mothers exposed their infants to sunlight in the range of time from 8 to 10 AM in the morning and 21.9% of participants exposed their infants with time duration of 15–20 min. It was lower than the study done in debre markos [
About 36.5% of respondents had feared to expose their infants to sunlight. Among these 15.2% of participants not exposed their infants to sunlight due to fear of the evil eye. This finding was higher than the study done in debre markos town which was 11.9% [
For the current study, feeling of lactating women while they exposed their children, 53.98% were happy, 0.3% angry, 18.4% feel anxiety and 4.8% were other which was higher than with ethio-swedish children’s hospitals. Respondents perceived consequences while they exposed their child to sunlight, 17.7% were makes healthy, 75% were made strong, 0.9 were helped to sleep, 27.7% were exposé the infant to cold (pneumonia), and 1.8 other which was higher than the result of ethio-swedish children’s hospital [
However, this study does have some inherent limitations. Though there are wide ranges of factors which affect rickets among mothers attending governmental health institutions, only knowledge, attitude, and practice about sunlight exposure were addressed in this study. Hence, taking into consideration factors from the different contributors like calcium deficiency would have been important.
According to our study, participants had not good knowledge, practice, and attitude regarding sunlight exposure of infants. Therefore, health education focusing on the importance of sunlight exposure is important to improve knowledge, practice, and attitude of mother’s sunlight exposure of their infants.
The datasets generated during the current study are available from the corresponding author on reasonable request.
The authors declare that they have no conflicts of interest.
All authors participated in proposal conception and designing the proposal, data collection and analysis, and wrote the manuscript. Finally, the paper was approved by all authors.
We would like to express our deepest appreciation and heartfelt thanks to Bahir Dar University for giving the chance of doing this project. We also thank the Farta district health officer and community for their cooperation and their valuable information for this work. Last but not the least, we would like to express our heartfelt thanks to all data collectors and supervisor for their valuable contribution.