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EFFECT OF PERCEPTION AND PRACTICE OF EARLY DIAGNOSIS OF SICKLE CELL DISEASE ON THE ACHIEVEMENT OF SECONDARY SCHOOL STUDENTS IN PANKSHIN LGA

ABSTRACT

Early sickle cell disease (SCD) diagnosis has shown promise in combating SCD in many countries. The aim of this study was to assess Effects of perception and practice of early diagnosis of Sickle Cell Disease on the achievement of secondary school students in Pankshin LGA. The study employed descriptive survey design. The population of the study comprises of 200 physicians and the parents/guardians of students with sickle cell disease both from public and private hospitals located within Panshin Local Government Area of Plateau State with 120 sampled respondents. Four research questions and one hypothesis guided the study. Structured questionnaire with twenty (20) items from the four research questions was used as instrument of data collection and were analyzed using statistical mean and the hypothesis was testing at 0.05 level of significance using chi-square. The result revealed that, there has still been a growing public anxiety about the complications pose by Sickle Cell Disease among children, with Nigeria having the highest burden of the disease which is between 1% and 2% of newborns born annually with the medical condition. And that a well-informed understanding of the effects of this disease will promote provision of support and early diagnosis. Therefore, parents/guardians of Sickle Cell Disease patients should have well informed knowledge of the significant of early diagnosis of the disease which will promote their ability to cater for their wards. The study also reveals that an improved understanding of risk factors for school performance in students with Sickle Cell Disease (SCD) and the potential impact of SCD on academic functioning will contribute to the limited literature on school performance in students with SCD and provide targets for interventions that could enhance school health professionals’ ability to address educational needs. The study concludes that, Children with Sickle Cell Disease (SCD) are confronted with disease, environmental, and psychosocial challenges that can impact academic achievement. Disease complications for these children include neurocognitive impairment due to chronic anemia and/or stroke, difficulty participating in class due to pain or fatigue, and health-related symptoms that can result in school absence. The study recommends among others that, Federal government through the health sector should provide an avenue for stakeholders concerns to work together, this is because academic functioning is optimized when parents, school administrators and teachers, physicians, and mental health professionals ‘work together and are educated on the cognitive outcomes of SCD.

TABLE OF CONTENTS

CHAPTER ONE

INTRODUCTION

1.1       BACKGROUND OF THE STUDY –           –           –           –           –           –           1

1.2       STATEMENT OF THE PROBLEM         –           –           –           –           –           3

1.3       AIM AND OBJECTIVES OF THE STUDY         –           –           –           –           5

1.4       RESEARCH QUESTIONS –           –           –           –           –           –           –           5

1.5       HYPOTHESES         –           –           –           –           –           –           –           –           6

1.6       SIGNIFICANCE OF THE STUDY            –           –           –           –           –           6

1.7       SCOPE AND DELIMITATION OF THE STUDY          –           –           –           6

1.7       OPERATIONAL DEFINITION OF TERMS       –           –           –           –           7

CHAPTER TWO

                                                    REVIEW OF LITERATURE

CHAPTER THREE

RESEARCH METHODOLOGY

3.0       INTRODUCTION    –           –           –           –           –           –           –           26

3.1       RESEARCH DESIGN         –           –           –           –           –           –           26

3.2       POPULATION AND SAMPLE      –           –           –           –           –           26

3.2.1    Population      –           –           –           –           –           –           –           –           26

3.2.2    Sample            –           –           –           –           –           –           –           –           27

3.3       SAMPLING TECHNIQUES          –           –           –           –           –           28

3.4       INSTRUMENT (S) FOR DATA COLLECTION –           –           –           28

3.4.1    Description of the Instrument         –           –           –           –           –           28

3.4.2    Procedure for Instrument Development     –           –           –           –           29

3.5       VALIDITY AND RELIABILITY OF INSTRUMENT   –           –           30

3.5.1    Validity          –           –           –           –           –           –           –           –           30

3.5.2    Reliability      –           –           –           –           –           –           –           –           30

3.6       PROCEDURE AND DATA COLLECTION        –           –           –           30

3.7       METHOD OF DATA ANALYSIS –           –           –           –           –           31

CHAPTER FOUR

RESULT AND DISCUSSION

4.1       PRESENTATION OF BIO DATA –           –           –           –           –           33

4.2       ANALYSIS OF RESEARCH QUESTIONS         –           –           –           34

4.3       HYPOTHESES TESTING  –           –           –           –           –           –           42

4.4       DISCUSSION OF THE FINDINGS           –           –           –           –           43

CHAPTER FIVE

SUMMARY, CONCLUSION, AND RECOMMENDATIONS

5.1       SUMMARY OF THE FINDINGS  –           –           –           –           –           47

5.2       CONCLUSION           –           –           –           –           –           –           –           48

5.3       RECOMMENDATION         –           –           –           –           –           –           48

5.4       LIMITATION OF THE STUDY        –           –           –           –           –           49

5.5       SUGGESTIONS FOR FURTHER STUDIES –           –           –           –           50

REFERENCE           –           –           –           –           –           –           –           51

APPENDIX I:            –           –           –           –           –           –           –           53

APPENDIX II:          –           –           –           –           –           –           –           54

APPENDIX III          –           –           –           –           –           –           –           57

APPENDIX IV          –           –           –           –           –                       –           58

CHAPTER ONE

INTRODUCTION

1.1       BACKGROUND OF THE STUDY

Sickle Cell Disease (SCD) is a common genetic disorder of man that is caused by a mutation in the β-globin gene (Rees and Gladwin, 2018). Individuals homozygous for the sickle hemoglobin gene (HbS) have the most severe form of the disease known as sickle cell anemia. Patients with SCD exhibit clinical variability both within individuals and across groups of patients. SCD is a disorder of public health concern especially in sub-Saharan Africa (SSA) where approximately 75% of the global 312,000 births of affected newborns occurred in 2010. Besides, between 50 and 80% of affected children in this part of the world die before adulthood (Howes, Piel, & Patil, 2018). According to the Global Burden of Diseases (GBD), in 2010, sickle cell disorders accounted for 0.42 deaths per 100,000; 28.69 years of life lost (YLLs) per 100,000 and 53.21 years lived with disability (YLDs) per 100,000, adding up to 81.9 disability-adjusted life years (DALYs) per 100,000 (Murray, 2012). Nigeria has the highest burden of the disease where between 1% and 2% of newborns are born annually with the medical condition. It is also an important cause of childhood morbidity and mortality in the country (Apata, 2017).

World Health Organization (WHO) (2015) estimated that 70% of SCD deaths in Africa are preventable with simple, cost-effective interventions such as early identification of SCD patients by newborn screening (NBS) and subsequent provision of comprehensive care. Adoption of these practices have led to the achievement of significant reduction in SCD mortality with more than 90% of affected children now surviving through adulthood in some parts of the world. On the contrary, most countries in SSA where the huge burden of the disease reside still lag behind in the implementation of these cost-proven measures that have worked in the developed countries; hence, the continued high SCD morbidity and mortality rates in Africa. SCD is expressed differently for each adolescent. SCD pain is unpredictable and can be caused by a number of factors including infection, changes in air temperature, lower oxygen levels, and stress. Some youth have relatively few SCD pain episodes and medical complications, while others require daily medications and/or intensive treatments (e.g., regular blood transfusions) to manage the disease. As a result, adolescents with severe forms of SCD may miss school due to pain episodes that must be managed at home, protracted pain episodes (i.e., crises) that require hospitalization. For adolescents whose treatments result in frequent school absence, academic performance is often compromised (Schwartz, Radcliffe, & Barakat, 2009; Thies, 1999). Missing school can have significant impact on educational attainment in adolescents with SCD.

Parents and guardians of sickle cell disease patients perception of the effect of early diagnosis of sickle cell disease on the achievement of secondary school students is their ability to understand, to see, become aware, as well as to have an insight of effective measures to be taken to curtail this medical issue, the philosophy about the disease as well as effective practices to be implemented in provision of medical assistance in order to support the sickle cell disease patient so as to improve their academic performance in school (Apata, 2017). Early sickle cell disease (SCD) diagnosis has shown promise in combating SCD in many countries as well as Nigeria and Pankshin LGA inclusively. Few studies describe effective educational interventions for this population (Day & Chismark, 2006 for a review). Students with SCD who are struggling academically may be eligible to receive educational support services through provisions in the Individuals with Disabilities Education Act (IDEA) of 2004 under the “other health impaired” category (National Dissemination Center for Children with Disabilities, 2012). Yet, Herron Bacak, King and DeBaun (2003) surveyed 39 adolescents with SCD aged 14-19 who had a stroke or three or more hospitalizations in a year and found that only 70% of those with stroke and 13% of those with high rates of hospitalizations had an individualized education plan (IEP) or received an evaluation for one. Additionally, all study participants had missed an average of 15 days of school or more (during the previous school year) and 28% of those with stroke had been retained at least one grade level suggesting that some adolescents with SCD may not be receiving the proper supports and accommodations needed to succeed academically. Ensuring that youth with SCD receive appropriate supports and accommodations or an evaluation for special education services is crucial for improving the educational achievement of these students.

It is upon this background that the researcher deems it fit to investigate into to the effect of perception and practice of early diagnosis of Sickle Cell Disease on the achievement of secondary school students in Pankshin LGA.

1.2       STATEMENT OF THE PROBLEM

The problem under investigation is the quality of knowledge holds by the parents/guardians of the Sickle Cell Disease patients in respect to practices and early diagnosis on the effects of sickle cell disease on student’s academic performance. Sickle Cell Disease comes with high burden to the patients leading to poor achievement in school with parents/guardians of the patient having less understanding of the early diagnosis practices in curtailing these problems cause by this disease.

In recognition of the high burden of sickle cell disease in Nigeria, the Federal Government of Nigeria (FGN) (2014) has recently taken some practical steps to lessen this burden. These include the initiation of a staggered regional-based newborn screening (NBS) programme in 2012 by starting a stepwise NBS programme beginning with six centres (one centre located in each of the six geopolitical zones of the country) and this was followed up with the launch of the national guideline for SCD management and control in 2014 (Olatunya and Adekile, 2017). However, there has not been attempt to evaluate how these measures have impacted SCD in the country since their introduction. Given that physicians and parents are major stakeholders in the effective implementation of any government health policy, it is important that their views and practice of the new policies are assessed.

Despites the efforts of Federal Government of Nigeria in lessening this burden, there is still risks for academic problems due to school absenteeism as academic progress is further hindered by the neurocognitive complications that can accompany sickle cell disease (SCD) (Apata, 2017). Children with SCD are at risk for cerebral vascular infarcts, or strokes, which may result in neurocognitive morbidity (Quinn, Rogers, McCavit, & Buchanan, 2010; Scantlebury, Mabbott, Janzen, Rockel, Widjaja, Jones, Odame, 2011). Sometimes they undergo what are referred to as silent strokes, strokes that can only be detected through Magnetic Resonance Imaging (MRI), not neurologic exam. These silent strokes can result in neurocognitive deficits that may impair reading, language, visual motor processing, memory, attention, and other executive functions which are critical for learning and educational success (Scantlebury et’al., 2011).

1.3       AIM AND OBJECTIVES OF THE STUDY

The general purpose of this study is to investigate into the effect of perception and practice of early diagnosis of sickle cell disease on the achievement of secondary school students in Pankshin LGA. Specifically, the study sought to:

1. Find out the perception of parents/guardians regarding early diagnosis of sickle cell disease in Pankshin LGA
2. determine the effect of early diagnosis on SCD Patients
3. determine the effect of sickle cell disease on the achievement of secondary school students in Pankshin LGA.
4. suggest ways of managing with the aim of combating sickle cell disease in Pankshin LGA

1.4       RESEARCH QUESTIONS

The following research questions guided the study:

1. What is the perception of parents/guardians regarding early diagnosis of sickle cell disease in Pankshin LGA?
2. What is the effect of early diagnosis on SCD Patients?
3. What is the effect of sickle cell disease on the achievement of secondary school students in Pankshin LGA?
4. What are the effective ways of managing and combating sickle cell disease in Pankshin LGA?

1.5       HYPOTHESES

The following null hypotheses were formulated to guide the study and were tested at 0.05 level of significance.

1. There is no significant effect of sickle cell disease to patients on the achievement of secondary school students in Pankshin LGA.
2. There is no significant effect of early diagnosis on SCD Patients.

1.6       SIGNIFICANCE OF THE STUDY

The study will educate the teachers on the potential impact of SCD on academic achievement of students with SCD.

The study will help health practitioners to enlighten parents and change their perception on SCD.

The study will be of immense benefits to the students through creating and increasing their perception on SCD so as to promote their academic performance.

To the parents, it will create and improve their understanding of the prevalence, causes and effect of sickle cell disease among their children so as to provide guidance and support to their children to promote their performance in school.

1.7       SCOPE AND DELIMITATION OF THE STUDY

The scope of the study covers the effect of perception and practice of early diagnosis of sickle cell disease on the achievement of secondary school students in Pankshin LGA. The researcher encounters some constraints which limited the study;

1. Availability of research material:The research material available to the researcher is insufficient, thereby limiting the study
2. Time:The time frame allocated to the study does not enhance wider coverage as the researcher had to combine other academic activities and examinations with the study.

1.7       OPERATIONAL DEFINITION OF TERMS

Terms that are related to the study are defined below in order to remove somatic ambiguity in their usage.

Effects: It simply refers to a change which is a result or consequence of an action or other cause.

Perception: It simply refers to the ability to see, hear, or become aware of something through the senses. In this study, it refers to the way in which the effect of sickle cell disease is regarded, understood, or interpreted.

Early diagnosis: It refers to methods to determine in patients the nature of a disease or disorder at its early stage of progression.

Sickle Cell Disease (SCD): Sickle cell disease is a group of inherited red blood cell disorders that affect hemoglobin, the protein that carries oxygen through the body and it also results in an abnormality in the oxygen-carrying protein haemoglobin found in red blood cells

Student: Is something or someone that is consider to learning. In this research, it refers to a learner with sickle cell disease.

Student’s Achievement: It refers to the extent to which learners have attained their short or long-term educational goals. In this study, it refers to those goals that have been attained by learner with sickle cell disease.

Secondary Schools: It refers to a school intermediate between elementary school and college and usually offering general, technical, vocational, or college-preparatory courses. In this research, it refers to the level of education use by the researcher to assess the effect of perception and practice of early diagnosis of sickle cell disease on the achievement of secondary school students in Pankshin LGA.