KNOWLEDGE, ATTITUDE AND CONTROL PRACTICES OF SICKLE CELL DISEASE AMONG YOUTH CORPS MEMBERS IN BENIN CITY, NIGERIA

A.S. Adewoyin1, A.E. Alagbe2, B.O. Adedokun3, and N.T. Idubor1

  1. Dept. of Haematology & Blood Transfusion, University of Benin Teaching Hospital, Benin City, Edo State.
  2. Department of Haematology, University College Hospital, Ibadan, Oyo State.
  3. Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Nigeria.

Abstract

Background: Sickle cell disease (SCD) is a major public health problem in Nigeria. Carrier prevalence is about 25% and it affects about 2 – 3% of the Nigerian population. The disease runs a chronic course, characterized by recurrent ill-health, progressive organ damage and shortened life-span. There is a need for SCD control through public education and other preventive measures.

Objectives: This study aimed at assessing the level of knowledge regarding SCD among a cross-section of new tertiary graduates in Nigeria, as well as factors influencing their knowledge. It also describes their attitudes and patterns of control practices engaged by the respondents regarding SCD.

Methods: This was an analytic, cross-sectional study among 370 new tertiary graduates (youth corps members) in Benin City, Nigeria. Bio-data, data on knowledge, their attitude and control practices of sickle cell disease were obtained using a structured questionnaire. Association between the mean level of knowledge and other variables such as age, gender, course of study, etc were tested using one way analysis of variance.

Results: Most of the study participants were aged 22 – 29 years. A large proportion (63.5%) of the respondents was females. Only 17.8% of the respondents had a good knowledge of SCD despite high level of awareness (98.4%). Those who studied courses related to medical sciences had significantly higher mean knowledge score. About 94.6% of the respondents knew their SCD carrier status and 80.8% were willing to avoid carrier marriages. Only 38.1% will accept prenatal diagnosis/selective abortion if locally available.

Conclusion: Most participants demonstrated moderate level of public health knowledge regarding SCD in Nigeria. Considering the relative lack of prenatal diagnostic services, low acceptability of selective abortion among the respondents, sub-optimal care of affected persons and poor access to haemopoeitic stem cell transplantation (HSCT) in our environment, stronger efforts should be directed and sustained at primary prevention through public education and screening regarding SCD.

Keywords: Knowledge, Attitude and practice, Sickle cell disease, New tertiary graduates, Youth corps members.

Correspondence:

Dr. A.S. Adewoyin
Dept. of Haema. & Blood Transfusion,
University of Benin Teaching Hospital,
Benin City, Edo State
E–mail: drademola@yahoo.com
Phone: +234 7033966347

Introduction

Sickle cell disease (SCD) is one of the commonest monogenetic diseases worldwide.1,2 Its greatest burden lies mainly in Sub-Saharan Africa, Mediterranean regions, Middle East and South-East Asia.3,4 In Nigeria, about 20 to 30% of the population are carriers of the sickle cell trait.3,5,6 Sickle cell disease affects about 2 to 3% of the Nigerian population.6,7

Sickle cell disease is an inherited haemolytic anaemia that results from homozygous or compound heterozygous inheritance of the sickle haemoglobin gene.8 It is characterized by the tendency of sickle haemoglobin to polymerise and deform the red cell to a sickle or crescent shape, thereby resulting in a characteristic vaso-occlusive phenomenon, chronic haemolysis and progressive organ damage.8 Sickle haemoglobinopathies have different genotypes. The archetypal sickle cell disease is the Haemoglobin SS disease, otherwise called sickle cell anaemia. Other sickle cell disease phenotypes include the compound heterozygous states such as haemoglobin SC disease and Haemoglobin S-Thalassemia syndromes.8,9 In sickle cell disease, there is a marked inter- and intra-individual variability in terms of disease manifestations. Disease manifestation may begin as early as 6 months of life, which coincides with the switch of fetal haemoglobin to adult Haemoglobins.9

Regarding treatment of SCD, a few disease modifying interventions are currently in use. Routine general prophylactic and other corrective measures has led to a marked improvement in life expectancy and quality of life among sickle cell disease patients in developed nations. However, in Nigeria, available evidence suggest that care of affected persons is largely sub-optimal.10 Haemopoietic stem cell transplantation (HSCT) is the only potentially curative therapy for sickle cell disease. This form of therapy is often limited to selected patients with severe disease who have a matched sibling donor and are aged less than 17 years.11,12 However, this form of treatment is either locally unavailable or unaffordable by eligible patients in Nigeria. Other local challenges with HSCT include lack of sufficient local expertise, inadequate health infrastructure, lack of political will and low socio-economic status of the patients.13 Other recognized practices in the treatment of sickle cell disease such as hydroxyurea therapy and chronic blood transfusions are also faced with challenges such as inefficient blood banking services and high cost of treatment.14,15 Without any reasonable intervention, life expectancy is significantly reduced as a result of the numerous life-threatening acute complications as well as chronic morbidities associated with the disease8,9 SCD therefore places a major psychological, financial and social burden on patients, their care-givers and society at large. Furthermore, there are very few centres with facilities for prenatal diagnosis in Nigeria.24 Suffice to say that current control measures of sickle cell disease in Nigeria are palpably meager in the face of the enormous burden of this disease.

There is a pressing need to focus on primary prevention of SCD through public health education and other control measures. Good knowledge regarding SCD is required for individuals especially carriers to make informed decisions about their reproductive life and other health related choices. As well, the burden of social stigma regarding SCD is reduced. This study therefore seeks to evaluate the extent of health knowledge of sickle cell disease among a cross-section of recent tertiary graduates in Nigeria, as well as their attitude to sickle cell disease. It also seeks to explore current practices engaged in the control of SCD in the study population. The association between their level of knowledge and different socio-economic groups, their sources of information and haemoglobin phenotype status were also investigated.