TABLE OF CONTENT
Title page – – – – – – – – i
Certification page – – – – – – – ii
Approval page – – – – – – – iii
Dedication page – – – – – – – iv
Acknowledgement – – – – – – – v
Table of contents – – – – – – – vi
List of tables – – – – – – – viii
List of figures – – – – – – – ix
Abstract – – – – – – – – x
CHAPTER
ONE-INTRODUCTION
Background of the study – – – – – – 2
Statement of the problem – – – – – – – 4
Purpose of the study – – – – – 5
Research questions – – – – – – 5
Significance of the study – – – – – – 6
Scope of the study – – – – – – 6
Operational definition of terms – – – – 7
CHAPTER
TWO – REVIEW OF RELATED LITERATURE
Conceptual review – – – – – – – 8
Concept of sickle cell disorder – – – – – 8
Concept of premarital sickle cell screening – – 10
Knowledge of premarital sickle cell screening – – 11
Attitude towards premarital sickle cell screening – 12
Adherence
to premarital sickle cell screening – – – – 13
Factors
that promote adherence to premarital sickle cell screening – 13
Factors
that promote non adherence to premarital sickle screening – 14
Theoretical review – – – – – – 16
Theory of reasoned action – – – – – 16
Empirical review – – – – – – 18
Summary of reviewed literatures – – – – 21
CHAPTER
THREE – RESEARCH METHOD
Research design – – – – – – – 22
Area of the study – – – – – – – 22
Population of the study – – – – – 23
Sample – – – – – – – 23
Sampling procedure – – – – – 24
Instrument for data collection – – – – – 24
Validity of instrument – – – – – – 25
Reliability of instrument – – – – – 25
Ethical consideration – – – – – 26
Procedure for data collection – – – – – 26
Method of data analysis – – – – – 26
CHAPTER
FOUR-PRESENTATION AND INTERPRETATION OF DATA
Summary of the findings – – – – – – 45
CHAPTER
FIVE-DISCUSSION OF FINDINGS
Discussion of findings – – – – – 46
Implication of the study to nursing – – – – 50
Limitations to the study – – – – – 51
Suggestion for further studies – – – – – 51
Summary – – – – – – – 51
Conclusion – – – – – – – 52
Recommendation – – – – – – 53
References – – – – – – – 54
Appendix – – – – – – – 56
LIST OF TABLES
Number Title
page
Table 1 – Sample size selected from each department. – – 23
Table 2 – Demographic characteristics of respondents. – – 28
Table 3 – Level of knowledge of PSCS among unmarried
adult students – – 30
Table 4 – Level of knowledge about premarital sickle
cell screening
among married adult students – – – – 32
Table 5 – Attitude of unmarried adult students towards PSCS — 34
Table 6 – Attitude of married adult students towards PSCS – – 36
Table 7 – Willingness to do the test among unmarried – – 37
Table 8 – Where premarital PSCS should be done – – – 38
Table 9 – Reasons for not intending to go for premarital sickle cell screening among unmarried adults – – – – 38
Table 10 – Adherence to premarital sickle cell screening
among married – – 39
Table 11 – Reasons
for not adhering to PSCS among married adult students – 40
Table 12 – Relationship between level of knowledge and intention to adhere to PSCS among unmarried adult students – – 41
Table 13 – Relationship between level of knowledge and intention to adhere to PSCS among unmarried adult students – 42
Table 14 – Relationship between attitude and willingness to adhere to premarital sickle cell screening among unmarried adult students. – – 43
Table 15 – Relationship between attitude and willingness to adhere to premarital sickle cell screening among married adult students.- 44
LIST OF
FIGURES.
Number
Title
page
Figure
1 :
Diagrammatic
representation of the theory of reasoned action
and planned behaviour – – – – – – – 17
ABSTRACT
Premarital sickle cell screening is a test done to
screen intending couples in order to determine their genotype before marriage.
This study investigated the knowledge and attitude of adult students of Nnamdi
Azikiwe University (NAU), Awka as correlate of adherence to premarital sickle
cell screening. A cross sectional
descriptive research design was used for the study. A sample size of 370 adult
students was drawn from an estimated population of 10,400 through a proportional,
stratified, sampling technique. Data were collected using a researcher
developed questionnaire. Data were analyzed descriptively using frequencies,
percentages, mean and standard deviations. Chi-square test was used to test the
hypotheses. Findings revealed that the participants had high knowledge about
premarital sickle cell screening. There was also positive attitude by the
participants towards pre-marital sickle cell screening. Reasons for not going
for the test by few married adult students were lack of knowledge of premarital
sickle cell screening and its consequences to an affected individual, while the
unmarried stated their reasons to be fear of exposing ones genotype to the
public and fear of stigma following an affected individual. The percentage of
unmarried adult that indicated willingness to go for screening test were higher
than the percentage of married adults that adhered to premarital screening. There
was no significant relationship between knowledge and adherence to premarital
sickle cell screening among married and unmarried adult students. There was
significant relationship between attitude and adherence to premarital sickle
cell screening among unmarried adult students; however no significant
relationship was found among married adult students. Based on the findings, it
was concluded that university students can serve as advocates for creating
awareness on premarital sickle cell screening due to their high knowledge.
There is need for enlightment campaign to address the issue of stigma and
discrimination about sickle cell disorder.
CHAPTER ONE
INTRODUCTION
Background
to the study
One of the biggest health challenges to the
human race is sickle cell disorder (WHO, 2008). It is a genetic disorder transmitted from
parents to their offsprings. The disorder is associated with many challenges
resulting from frequent hospitalization of the affected individual. Despite
major advances in our understanding of the molecular pathology,
pathophysiology, and causes of the inheritable disorders, thousands of infants
and children are dying through lack of appropriate preventive measures such as
lack of premarital sickle cell screening by intending couples to know their
genotype before marriage (Akowe, 2010).
According to World Health Organization (WHO, 2008),
sickle cell disorder contributes to 5%
of under five deaths on the African continent; more than 9% of such deaths
occur in West Africa and up to 16% of under-five deaths in individual West
African countries. Akinyanju, (2009),
states that about one hundred and fifty thousand children are born each year
with sickle cell diseases and about 2-3% of Nigerians live with the disease
while 25-30% of Nigerians carry the gene that can give rise to sickle cell
disease (SCD) . It is estimated that by the year 2025, a total number of 50,000
children born in Nigeria will be affected with sickle cell disorder, and this
poses a great concern , (George, 2011). In
order to prevent this disorder, sickle cell screening and testing have been
recommended for couples before marriage (Akinyanju, 2009)
Premarital sickle cell screening/testing has
been defined by different people in different ways, Littleton and
Engebretson (2010), see it as a
process for screening couples going into marriage
for genetic and blood transmitted diseases to prevent any risk of transmitting
diseases to their children. Gharaibe and Mater (2009), see it as an
important tool used by intending couples to control, minimize and prevent
sickle cell disorders. Invariably
sickle cell testing serves as a tool for diagnosis of SCD, it also provides
individual couples with an accurate understanding of sickle cell inheritance
and what it means to be at risk. In addition,
information about premarital sickle cell screening and counseling has become
part of marriage course counseling and regular medical practice. It has also helped to achieve desired level
of knowledge and a change in attitude.
However, this is not always the case as many people go into marriage
without having insight into their genotype especially in developing countries
where diagnosis is usually made when the individual presents in the clinic with
severe complications, (Akinyanju, 2009).
Undertaking premarital sickle cell screening and counseling may depend
on individual’s knowledge of sickle cell disorder.
Knowledge about premarital sickle cell
screening can be gained through information from educational programmes. This
in turn establishes a health awareness program in order to explain the benefits
of premarital sickle cell screening to the public and increase their awareness
on the serious consequences of sickle cell disorder. Knowledge gained about
premarital sickle cell screening will help to prevent SCD and the prevention
will depend on the attitude of couples towards the screening. Attitude
according to encyclopedia dictionary is a set way of thinking or feeling
typically reflected in a person’s behaviour. It is the totality of those states
that lead to a point towards some particular activity of the organism,
(Ferguson, 2010). Attitude to premarital sickle cell screening
can be a dynamic element in human behaviour, and it can be positive or
negative. People who have positive
attitude about the benefits associated with premarital sickle cell screening
may like to adhere to premarital screening, according to Lockock and Joe
(2009), may affect their adherence to premarital
sickle cell screening.
Adherence to premarital sickle cell screening
is an act of sticking to behaviour, or the process of engaging in an activity
for the purpose of mastering or improving on it. People may agree to comply to premarital
sickle cell screening when they see that the behaviour will yield positive
results, like reducing the risk of having children with sickle cell disease. On
the other hand, individuals may fail to adhere to sickle cell screening due to
reasons such as fear of stigma, emotional or financial consequences and or
reliability of the test result. (Lockock & Joe, 2009).
Premarital screening helps to educate people
about inherited disorders. Although, WHO has repeatedly recommended several measures
for the prevention of genetic diseases including sickle cell diseases through health education and
improvement of community knowledge and attitude towards the control of this
hereditary genetic diseases (WHO, in Awatif, 2006), adherence to premarital
sickle cell screening is still very low (Al kindi, Salha & Al kendi, 2012).
It has been recommended that it is time we
start ascertaining the compatibility of
intending couples to make marriages work better and on a more realistic
grounds by way of premarital screening and testing, WHO, (2008). There is need
to encourage the practice of premarital sickle cell screening. Prevention of sickle cell disorder and risk
minimization through screening and carrier identification remains the only
realistic approach to reduce the impact of the disease especially in an adult
population. Tertiary institutions have large concentration of adult population
and they form important sub groups of the population since they are at a
relatively high level of education and in the manageable age group. The study
targeted this group of students at Nnamdi Azikiwe University Awka, Anambra
State, since there was no available data for Anambra State on premarital sickle
cell screening.
Statement of the Problem
KNOWLEDGE AND ATTITUDE AS CORRELATE OF ADDHERENCE TO PREMARITAL SICKLE CELL SCREENING AMONG ADULT STUDENTS’ OF NNAMDI AZIKIWE UNIVERSITY AWKA, ANAMBRA STATE
