vitamin D [1]. Less than 50 nmol/L indicates insufficiency, and less than 25 nmol/L is considered vitamin D
deficiency [2]. The blood’s ability to maintain calcium and phosphorus balance is significantly influenced by vitamin
D. Thus, it is essential for bone health, as a lack of vitamin D contributes to metabolic bone diseases that cause
osteomalacia in adults and rickets in youngsters. Inadequate intake of vitamin D is linked to an increased risk of
infection. Vitamin D is also crucial for the prevention of many chronic diseases, such as cancer, cardiovascular
disease, diabetes, metabolic syndrome, autoimmune diseases, and depression [3].
Additionally, it has been hypothesized that vitamin D has a beneficial immune-modulating effect that causes an
anti-inflammatory and anti-fibrogenic pattern in the liver. It is also crucial in preventing non-alcoholic fatty liver
disease (NAFLD) and colon cancer from developing and progressing [4]. Numerous causes, such as insufficient
vitamin D in the diet, malabsorption, and poor utilization, as well as increased needs, increased excretion, and
catabolism, are all associated with vitamin D insufficiency. In addition, there are various diseases that affect the
bioavailability of vitamin D, including gastrointestinal issues that limit absorption; and issues with the kidneys and
liver that can prevent the activation of parenteral vitamin D or affect its conversion to active metabolites.
Multiple sclerosis and other autoimmune illnesses like rheumatoid arthritis are linked to vitamin D deficiency.
Vitamin D insufficiency and the likelihood of developing chronic diseases are strongly correlated. According to
another study, people with vitamin D levels below 20 ng/mL have a 30%–50% higher chance of developing colon,
prostate, and breast cancers as well as a higher mortality rate from these diseases. The intensity of COVID-19-
related symptoms has recently been linked to vitamin D insufficiency [5]. South Asians are one of the population
groups most afflicted by vitamin D deficiency, according to mounting research that suggests it is becoming a global
epidemic. The main source of vitamin D is sunshine exposure. Oily fish, egg yolks, and dietary supplements for
vitamin D are some of the finest sources of vitamin D in the diet. South Asians continue to be one of the
demographics most susceptible to low vitamin D levels despite receiving enough of sunlight throughout the year in
their nations [6]. In light of this, educating the public on the necessity of vitamin D can help to significantly reduce
the health problems brought on by its insufficiency. The current study’s objective was to evaluate public knowledge
about vitamin D as well as attitudes and practices related to vitamin D deficiency.
Material and Methods
A survey study was carried out January 2023 to May 2023, both males and females were included in
study with age greater than 18 years. The online version of the questionnaire was used to reach a larger
number of people to assess their fundamental knowledge, attitudes, and actions toward vitamin D. The
necessary information was gathered over the course of five months, utilizing a Google Docs-created
online survey that was digitally disseminated over Twitter, Telegram, and WhatsApp. There were close-
ended multiple-choice questions in each of the three sections of the questionnaires. The participants’
age, gender, educational attainment were all discussed in Section A. Questions in Section B evaluated
sources of primary information about vitamin D, knowledge about significant sources of vitamin D, the
purpose and advantages of vitamin D, the daily recommended dosage of vitamin D, and the typical
amount of sun exposure needed to obtain adequate levels of vitamin D. Part C was created to assess
how people behave and think about sunlight, including how much time is spent outside in the sun, how
often it is exposed to them, whether they prefer to be outside during a particular season, how they
protect themselves by using sunscreen, whether they smoke, and how they can raise their vitamin D
levels.
Results
Study was conducted among 300 people, 55% of people were in the age group 18-39 years,
40.7% were in the age group 40-59 years, and 4.3% were in the age group > 60 years. 59%
of participants were female and 41% were male. 69.7% of participants were postgraduate,
14.3%, 10%, 3.3% 2.67% were graduate intermediate and illiterate respectively.
Knowledge and Awareness about vitamin D

The majority of the participants (92.7%) heard about vitamin D and 7.3% did not hear. 81.66%
of people heard about vitamin D from educational institutions, 8% from media, 4.66% from
primary health care center, and 5.66% from relatives and friends.
77 .7% of people knows the normal range of vitamin D as 20-50 ng/ml and 9.64% do not
know the normal range. 6.33% participants answered as <12ng/ml and <20ng/ml 6.33% of
participants.
72.7% people answered sun, milk and milk products, fatty fish, egg yolk, cod liver oil,
mushroom as essential sources of vitamin D and 16.7% reported sun as an important
source,4.33% milk and milk products,1% fatty fish, 0.66% egg yolk,1% cod liver oil,0.33 %
mushroom,3.33% as I don’t know.
79.3% people know that 10-20 minutes are required to be in sun to get enough vitamin D and
7% answered as 30-60 minutes,6.66% as < 10 minutes,1.66% as >1 hour,5% as I don’t know.
only 38% of participants know the daily requirement of vitamin D 600IU, 13.3% do not know
the daily requirement of vitamin D, 8.7%, 40%, answered daily requirement for vitamin D as
200IU, 800 IU respectively.
83% of people think taking calcium supplement helps in maintaining vitamin D levels in body,
10% did not know 7% people do not believe.
75.7% of the participants reported all the causes of vitamin D (genetics, less exposure to
sunlight, lack of food rich in vitamin D, kidney disease, respiratory infection.) 7.3% do not
know the cause of vitamin D deficiency,5% as genetics,7.67% as less exposure to
sunlight,4% as lack of food rich in vitamin D, 0.33% as kidney disease.
77% of people know the functions and effects of vitamin D(prevents osteoporosis, prevents
general weakness, prevents chronic disease, prevents cancer, aids in calcium absorption,
good for vision), 9% of people do not know function and effect of vitamin D and 6% reported
as prevention of osteoporosis as only function and effect of vitamin D.
78% of people knows the symptoms of vitamin D deficiency (joint and bone pain, delayed
tooth growth, walking delay in children, muscle pain, deformity of knee joint in children,
depression, alopecia) 12% answered as joint and bone pain as only symptoms of vitamin D
deficiency,2% reported as delayed tooth growth,0.33% as muscle pain,0.67% as deformity of
knee joint in children,0.33% as depression,1% as alopecia,5.67% do not know the symptoms.
81% people believe that vitamin D deficiency is associated with other disease such as CVD,
cancer, depression, celiac disease, multiple sclerosis.12.7% do not know and 6.3% do not
believe.
89% people do not have any disease causing vitamin D deficiency and 11% people have.
Attitude and practice towards vitamin D
53.3% people have checked their vitamin D levels and 46.7 % did not.
53.3% people always like to be in sun, 30% avoid sun exposure,9% rarely get the sun,7.7%
do not know.
62% people like to spend time in sun in early morning, 28.3% avoid sunlight, 1.33% in noon,
2.33% in afternoon, 6% do not know.
74.3% people are exposed to sun >3 times / week ,12% people 2-3 times/ week ,6.4%
people 0-1 times, 7.3% do not know.
38.3%of people exposure period in sun is 30-60 min,36.3% >1hour,10.3% within 15 minute,

7.3% do not known, 7.8%is 15-29 minute.
51% of people do not use protect ion, 36.3% use sunscreen,8.3% use scarf 4.4% use an
umbrella most often as a sunscreen.
41.3% of people use sunscreen with SPF >15, 49.7% do not use, 9% do not know.
51% people never used sunscreen, 40% uses sunscreen every time, 3.6% use sunscreen
rarely, 5.66% uses sunscreen sometimes.
88.7% of people were non-smokers, 6.3% were current smoker, 4.97 were former smoker.
41.7% of people expose their body to the sun to prevent vitamin D deficiency, 34.3% take
vitamin D supplements and 12.3% people do take vitamin D supplement, Drink 2 cups of milk,
not using sunscreen, including seafood in diet and do sun exposure as a measure to prevent
vitamin D deficiency, 34.33% take vitamin D supplements,5% participants drink 2 cups of
milk,0.33% don’t use sunscreen,1.33% include seafood in diet,5% participants don’t take
measures to improve vitamin D.
Discussion:
Knowledge and Awareness of vitamin D
The result indicates that participants heard about vitamin D (92.7%) and had good knowledge
about normal range of vitamin D(77.7%) which is in line with study [7] conducted in Jordan.
Educational institution was the main source of information for 81.6% of the participants in our
study contrary to the study conducted by [8], which was conducted where educational
institutions contributed only 2.3% in cases group and 11.3% in control group(8).Participants
had good knowledge about all the important sources of vitamin D(72.7%) which includes sun,
milk and milk products, fatty fish, egg yolk, cod liver oil, mushroom contrary to the study
conducted by [9] where only 9% male and 13% female students identified the correct sources
of vitamin D(9) . 79.3% people were aware of the time needed to spend in sun to get enough
vitamin D (10-20 minutes) similar to the study conducted by [10] where 77% of participants
know the time required to be in sun to get enough vitamin D(10).Despite good knowledge
about vitamin D only 38% of participants know the daily requirement of vitamin D(600IU)
Which is higher than the study conducted by [11] where only 13.9% were aware of daily
requirement of vitamin D(11).83% of people were aware about role of calcium supplement in
maintaining vitamin D levels in body. Participants had good knowledge about all the causes of
vitamin D deficiency (75.7%) in line with study conducted by [12]. Majority of the participants
77% had good knowledge about the function of vitamin D(prevents osteoporosis, prevents
general weakness, prevents chronic disease, prevents cancer, aids in calcium absorption,
good for vision),which is contrary to the study conducted by [13] in India where only 34
participants knows the benefits of vitamin D [14] .
participants had good knowledge (78%) about all the effects of vitamin D deficiency (joint and
bone pain, delayed tooth growth, walking delay in children, muscle pain, deformity of knee
joint in children, depression, alopecia). Majority of the participants (81%) had good knowledge
about vitamin D and its association with other disease (such as CVD, cancer, depression,
celiac disease, multiple sclerosis) which is higher to the study conducted in Kuwait by [15]
where 70.5% of participants were not aware of association of vitamin D with other diseases
[16].
Attitude and Practice of vitamin D
More than half of the surveyed participants (53.3%) had checked their vitamin D levels.
Majority of the participants had positive attitude towards spending time in sun particularly in
early morning around 30-60 minute > 3times/ week and more than half of participants avoids

the usage of sunscreen and their ingredients. Majority of participants were non-smoker
(88.7%) as majority of the participants were female. Almost all the participants include certain
practices to improve vitamin D levels of which exposing to sun was the most common practice
which is in line with study conducted in Jordan [17].
Table 1.1 Displays Age of the participants:-
S. No. Age Number (n) Percentage (%)
1 18-39 165 55
2 40-59 122 40.67
3 >60 13 4.33

18-3940-59>60
0
50
100
150
200
250

Age

Number(n)Percentage(%)

Table 1.2 Displays Gender of the participants:-
S.No Gender Number(n) Percentage (%)
1 Male 123 41
2 Female 177 59

Number(n)Percentage(%)

0
50
100
150
200
250
300
350

Gender

MaleFemale

Table 1.3 Displays Education of the participants
S. No Education Number (n) Percentage (%)
1 SSC 10 3.33
2 Intermediate 30 10
3 Graduate 43 14.33
4 Post graduate 209 69.67
5 illiterate 8 2.67

SscIntermediateGraduatePost graduateilliterate
0
50
100
150
200
250
300

Education

Number(n)Percentage(%)

Table 1.4 Displays whether they heard about vitamin D
S. No Heard Number Percentage
1 yes 278 92.7
2 no 22 7.3

numberpercentage

0
50
100
150
200
250
300
350
Heard about vitamin D

yesno

Table 1.5 Displays source of information about vitamin D
S.no source of information Number(n) Percentage %
1 Educational Institution 245 81.66
2 media 24 8
3 primary health care centers 14 4.66
4 relatives, friends 17 5.66

Educatioal
instituition

mediaprimary health
care centers

relatives,friends

0
50
100
150
200
250
300
350

Source of information

Number(n)Percentage %

Table 1.6 Displays knowledge about normal range of vitamin D among participants:-
S.no Normal range Number(n) Percentage%
1 <12 19 6.33
2 <20 19 6.33
3 20-50 233 77.7
4 I don’t know 29 9.64

<12<2020-50I don’t know
0
50
100
150
200
250
300
350

Normal range of vitamin D

Number(n)Percentage%

Table 1.7 Displays important sources of vitamin D of about vitamin D in of the
participants:
S.No sources Number(n) Percentage%
1 sun 50 16.66
2 Milk and milk products 13 4.33
3 fatty fish 3 1
4 egg yolk 2 0.66
5 cod liver oil 3 1
6 mushroom 1 0.33
7 all of the above 218 72.6
8 I don’t know 10 3.33

0
50
100
150
200
250
300
350

Sources of vitamin D

Number(n)Percentage%

Table 1.8 Displays knowledge about time required to be in sun to get enough vitamin
D among participants:-
S.no Time required Number(n) Percentage%
1 <10 min 20 6.66
2 10-20min 238 79.3
3 30-60min 21 7
4 >1hour 5 1.66
5 I don’t know 16 5

<10 min10-20min30-60min>1hourI don’t know
0
50
100
150
200
250
300
350

Time required to be in sun

Number(n)Percentage%

Table 1.9 Displays knowledge about daily requirement of vitamin D among
participants:-

S.no

Daily
requirement Number(n) Percentage%
1 200 26 8.7
2 600 114 38
3 800 120 40
4

I don’t know 40 13.3

200600800

I don’t know

0
20
40
60
80
100
120
140
160
180

numberpercentage

Table 1.10 Displays knowledge whether taking calcium supplements maintains
vitamin D among participants:

S.no Believe Number(n)

Percentage
%

1 yes 249 83
2 no 21 7
3 I don’t know 30 10

yesnoI don’t kow
0
50
100
150
200
250
300
350
Role of calcium supplements in

vitamin D

numberpercentage

Practices

Number(n)Percentage(%)

Conclusion
The current study Conducted amon g 300 participants indicate that
participants had Good knowledge about the normal range and important
sources of vitamin D, the Exposure period required to be in the sun, daily
requirement, causes, symptoms of vitamin D deficiency, and Positive Attitude
towards sun exposure and Practices among participants include sun
exposure, taking vitamin D supplements, drinking 2 cups of milk, including
seafood in diet, avoiding sunscreen. As Vitamin D deficiency is a global
epidemic awareness should be brought among people wherein pharmacists

plays a major role in educating the public as in this study only 4.6% of primary
health care providers we’re responsible for educating the public regarding
vitamin D.
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