|Year : 2021 | Volume
| Issue : 1 | Page : 43-47
Effect of health education on knowledge and awareness of sickle cell disease among adolescents
Osita U Ezenwosu1, Barth F Chukwu1, Ikenna K Ndu2, Ndubuisi A Uwaezuoke1, Ifeyinwa L Ezenwosu3, Ifechukwu M Udorah4, Anthony N Ikefuna1, Ifeoma J Emodi1
1 Department of Paediatrics, Faculty of Medical Sciences, College of Medicine, University of Nigeria, Ituku/Ozalla, Nigeria
2 Department of Paediatrics, Enugu State University Teaching Hospital, Enugu, Enugu State, Nigeria
3 Department of Community Medicine, University of Nigeria Teaching Hospital, Ituku/Ozalla, Nigeria
4 Department of Paediatrics, Annunciation Specialist Hospital, Emene, Enugu State, Nigeria
|Date of Submission||03-Feb-2020|
|Date of Decision||04-Apr-2020|
|Date of Acceptance||03-Jun-2020|
|Date of Web Publication||31-Mar-2021|
Dr. Osita U Ezenwosu
Department of Paediatrics, Faculty of Medical Sciences, College of Medicine, University of Nigeria, Ituku/Ozalla Campus, Enugu
Introduction: Majority of Nigerians are not aware of their personal genotype, and the knowledge about sickle cell disease is quite low. We hypothesize that health education will improve the knowledge and awareness of sickle cell genotype among adolescents. This study aimed to determine the effect of health education on knowledge and awareness of sickle cell genotype among adolescents. Materials and Methods: Adolescent students of Federal Government College were recruited, and necessary data on sociodemography, knowledge, and awareness of sickle cell were obtained through a pretested sickle cell knowledge assessment questionnaire. Following health education, the same questionnaire was re-administered to the participants for assessment of any change in knowledge. Results: Majority (58.1%) of the respondents heard about sickle cell during lessons in class, while mass media was the next common source (16.5%) of knowledge and awareness. Following health education, there was an improvement in all the specific knowledge questions, especially the prevalence of sickle cell trait in Nigeria (28.1% vs. 75.2%) and the probability of carrier couple having a child with sickle cell anemia (SCA) (10.3% vs. 48.2%). There was a statistically significant increase in mean knowledge score (t = −14.203, P < 0.001), as well as a significant increase in high knowledge level (χ2 = 105.13, P < 0.001) after education. Conclusion: Health education improved the knowledge and awareness of sickle cell among adolescents in secondary schools, especially the chances of having children with SCA in carrier couples. Inculcating health education on sickle cell in secondary school curriculum will help in informed decision on marriage and birth, ultimately reducing the birth of children with SCA.
Keywords: Awareness, health education, knowledge, sickle cell
|How to cite this article:|
Ezenwosu OU, Chukwu BF, Ndu IK, Uwaezuoke NA, Ezenwosu IL, Udorah IM, Ikefuna AN, Emodi IJ. Effect of health education on knowledge and awareness of sickle cell disease among adolescents. Sahel Med J 2021;24:43-7
|How to cite this URL:|
Ezenwosu OU, Chukwu BF, Ndu IK, Uwaezuoke NA, Ezenwosu IL, Udorah IM, Ikefuna AN, Emodi IJ. Effect of health education on knowledge and awareness of sickle cell disease among adolescents. Sahel Med J [serial online] 2021 [cited 2021 Apr 15];24:43-7. Available from: https://www.smjonline.org/text.asp?2021/24/1/43/312743
| Introduction|| |
Sickle cell anemia (SCA) is the most common life-threatening monogenic disorder which affects millions of people throughout the world and particularly sub-Saharan Africa, India, the Mediterranean, and the Middle East. , Globally, it is estimated that about 305,000 newborns are born annually with SCA, and the global burden has been shown to be on the increase with about 20–25 million people currently affected worldwide. In Nigeria, the prevalence is about 2% (about 3.6 million) and more than 150,000 children are born each year with SCA. Current modeling projects a 50% increase over present levels of annual SCA births in Nigeria by the year 2050. The increasing number will continue to have a major impact, particularly on healthcare services and financing.
SCA is inherited in an autosomal recessive pattern through simple Mendelian fashion. Therefore, a child with SCA inherits both genes from heterozygous parents who are both carriers of the sickle cell trait (SCT). Thus, only carrier parents can transmit the genes. It follows then that to reduce the high prevalence of SCA, the target should be to affect a decline in the union between potential spouses with SCT. However, the SCT (HbAS) is carried by as many as 100 million individuals worldwide including an estimated 2.5 million Americans. In Nigeria, the prevalence of SCT is estimated at 24%, as more than 40 million individuals are carriers of the SCT. , This indicates the need to identify methods to increase awareness and education levels related to SCT and SCA. This can be effectively achieved mainly through education.
Health education is any combination of learning experiences designed to help individuals and communities improve their health by increasing their knowledge or influencing their attitudes. The primary purpose of health education is to influence antecedents of behavior so that healthy behaviors develop in a voluntary fashion without coercion. Health education on sickle cell will potentially improve knowledge and allow the informed individuals with SCT to make informed decision on marriage and birth which will ultimately reduce the birth of children with SCA. It will also increase the proportion of individuals who have knowledge and awareness of their genotype in line with the Healthy People 2020 priority objective. Despite the high burden of SCA and high prevalence of SCT, studies have shown that majority of Nigerians are not aware of their personal genotype. , Furthermore, the knowledge about sickle cell has been shown to be quite low. This study was designed to determine the effect of health education on knowledge and awareness of sickle cell genotype among adolescents in a secondary school. We hypothesize that health education improves the knowledge and awareness of sickle cell genotype among adolescents.
| Materials and Methods|| |
This is a cross-sectional descriptive study conducted at Federal Government College among students in the senior secondary classes. Following clearance from the school authority, students were recruited for the study. The subjects were those who gave assent to participate in the study, and they were recruited consecutively. They were met in a quiet environment in the school where the study and its purpose were explained in English language, and written assent was obtained before administering a structured questionnaire. Necessary data (including age, sex, tribe, religion, class, parental education and occupation, awareness of genotype, and knowledge of SCT and SCA) were obtained through a pretested sickle cell knowledge assessment questionnaire used before. Thereafter, health education on the prevalence of SCA, its inheritance, pathogenesis, pathophysiology, manifestations, predisposing factors, diagnosis, treatment, and preventions were given to the students using a PowerPoint presentation over 1½ h. Following the health education, the same questionnaire was re-administered to the participants for assessment of any change in knowledge.
The knowledge scores were summed on a binary basis with 1 point assigned for a correct answer while 0 was given for an incorrect response. The scores of 3–6 were graded as low SCA knowledge, the scores of 4–6 were referred to as average, while the scores of 7 and 8 were considered to be an indicator of high SCA knowledge.
Socioeconomic class was determined using the occupation and educational attainment of both parents or their substitutes proposed by Oyedeji, as described by Ikefuna and Emodi.
The Health Research Ethics Committee of the University of Nigeria Teaching Hospital (UNTH), Enugu approved the study (Protocol number UNTH/CSA/329/OL.5 of December 11, 2017), and the school authority gave clearance before the study was carried out. Data were entered into the SPSS statistical windows, version 22.0 (IBM Corp, Armonk, NY) for analysis. Means were compared using Student's t-test while frequencies were compared with Chi-squared test. The level of significance was set at P < 0.05.
All the procedures were carried out as per the guidelines given in the Declaration of Helsinki 2013.
| Results|| |
Out of 584 students in the senior class, 409 students participated in the study, with a participation rate of 70%. There were 206 (50.4%) males and 203 (49.6%) females, with a male: female ratio of approximately 1:1. The age range was between 12 and 18 years, with a mean and standard deviation of 14.07 ± 0.95. Most of the students in this study, i.e., 88.5%, belonged to the high socioeconomic class. Two hundred and twenty-six students participated in the posteducation intervention as 183 willingly withdrew from continuing and were not coerced to continue.
As shown in [Table 1], vast majority of the respondents (97.6%) have heard about sickle cell disease (SCD). In the follow-up question about the source of their knowledge, most (58.1%) were during lessons from class teachers. Mass media (16.5%) was the next common source. Class teachers and mass media combined accounted for about three-quarters (74.6%) of the source of awareness and knowledge of SCD.
[Table 2] shows the responses to specific questions on knowledge of SCA and the changes in responses to the same questions after education. Before health education, out of the questions to assess knowledge, only a few respondents correctly answered the questions on similarity of SCT and disease, prevalence of SCT in Nigeria, and chances of inheritance of SCD from carrier parents (10%, 28.1%, and 10.3%, respectively). Following health education, there was an improvement in the questions to 38.1%, 75.2%, and 48.2%, respectively.
The mean (standard deviation) of the total knowledge scores was 5.08 ± 1.09 before the health education and 6.46 ± 1.15 after the health education. The difference was statistically significant (t = −14.203, P < 0.001).
The frequency distribution of levels of knowledge of the respondents before and after the health education is shown in [Table 3]. Twenty-seven (6.6%) and 3 (1.3%) had a low level of knowledge before and after education, respectively. The percentage of students with high knowledge before health education (7.3%) was lower when compared to the percentage after education (54.0%). The differences were statistically significant (χ2 = 105.13, P < 0.001).
|Table 3: Distribution of levels of knowledge of students before and after health education|
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[Figure 1] shows the effect of health education on the level of knowledge of sickle cell among the students. There were a significant reduction in the proportion of participants with low level of knowledge (6.6% vs. 1.3%) and a statistically significant increase in the number with high level of knowledge (7.3% vs. 54.0%) before and after the delivery of health education, respectively (χ2 = 105.13, P < 0.001).
|Figure 1: Effect of health education on level of knowledge of the students|
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| Discussion|| |
The high awareness of SCD noted in this study may be explained by the high prevalence of the condition in Nigeria where about 2%–3% of the 200 million population are affected by SCD.,, Furthermore, of approximately 315,000 babies born annually with the condition worldwide, Nigeria contributes about half of the incidence. The burden of SCD in Nigeria constitutes a major public health problem indicating need for studies in the area. The finding of high awareness in this study is consistent with the findings of other studies across the country.,,, Most of the awareness about SCD in the present study came from school lessons, followed by various forms of media. Similarly, Ameen et al. in Ilorin documented the sources of information for majority of their subjects as schools and media. Orish et al. in Ghana also reported that school lessons had the highest influence in this regard. Although Adewoyin et al. in Benin reported that the main channel of information was through health talks, the findings of all the studies underscore the importance of health information dissemination through different channels.
Unfortunately, awareness of SCA does not necessarily translate to knowledge which application helps to achieve the desired goal of prevention, as Nigeria continues to bear the highest burden of the disease in the world. , This is in agreement with our study where despite the high level of awareness reported, only a few of the respondents to the pretested sickle cell knowledge assessment questionnaire demonstrated comprehensive knowledge of mode of inheritance and other features of SCD. This is similar to a study in Benin, which showed that only 17.8% of the respondents had a good knowledge of SCD despite high level of awareness (98.4%).
However, after the health education, the postintervention data revealed a statistically significant improvement in knowledge levels and in mean knowledge scores. Several studies have demonstrated similar findings. , Olatona et al. in Lagos showed that there was a significant overall knowledge gain of 64.1% after intervention. These findings demonstrate that health education as an interventional tool was effective in increasing the knowledge of the respondents. Communication is key in any form of education, and the Health Belief Model (HBM) has been suggested as an explanatory framework in communication research. The HBM posits that messages will achieve optimal behavior change if they successfully target perceived barriers, benefits, self-efficacy, and threat. , This information would be useful to effectively channel health education interventions toward motivating individuals to pursue healthy behavior. One of the important improvements following education in this study was on the chance of SCT couples having a child with SCA. This is because this knowledge will help informed individuals with SCT to make informed decision on marriage and birth which will ultimately reduce the birth of children with SCA.
Following education, though there were improvements in knowledge concerning prevalence of SCT in Nigeria and chances of SCT couples having SCA child, many participants still failed to provide right response for the questions. There may be less understanding in the affected questions possibly due to the technicality of the questions. However, this observation highlights the need for repeated and frequent education toward the consistent and persistent progression of understanding of the public health priority nature of the condition. This may likely be achieved through the introduction of the subject in schools as most of the target population in Nigeria are in secondary schools.
| Conclusion|| |
We hypothesized that health education improves the knowledge and awareness of sickle cell genotype among adolescents. This study shows that health education of the students was effective in improving their level of knowledge of SCA. Therefore, there is a need for the inclusion of health education on SCD in school curriculum if SCD control strategies are to yield any significant results and if the Healthy People 2020 priority objective is to be achieved. Increased efforts to promote greater collaboration between health workers and school teachers, in addition to utilization of various media outlets, may optimize awareness and knowledge among students.
The limitation of this study is that it is a single-site study. A multicenter study will improve the size of the respondents and thus the generalization of study findings.
We thank the Health Research Ethics Committee of UNTH for giving the approval to carry out this study. We thank also the school authority of the Federal Government College, Enugu, for giving clearance for the study. Our gratitude goes also to the Guidance and Counseling Unit of the school for their co-operation. We cannot fail to acknowledge the students for their contribution through willingness to participate in the study.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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