A

RESEARCH ON

AWARENESS OF SICKLE CELL DISEASE AMONG

STUDENTS IN

BAWKU SENIOR HIGH SCHOOL IN THE UPPER

EAST REGION OF GHANA

BY

TAHIRU AMALUG SALAM

i
 ABSTRACT

Sickle cell disease (SCD) is one of the most prevalent genetic disorders among the African
descent. SCD is associated with intermittent excruciating pain, increased morbidity and
mortality yet has received less recognition in the public domain. This study aimed to elicit
student’s knowledge and attitude towards SCD. A cross-sectional descriptive study design
which was quantitative in nature was used and a stratified sampling technique was used to
sample 100 students from Bawku Senior High School of which they responded to
questionnaires which were analysed using the Statistical Package for Social Sciences (SPSS)
version 21. The study revealed a significant relationship between respondents’ attitude towards
an SCD person and gender (p=0.002) and age (p=0.01). Also, 55% of respondents have ever
heard of sickle cell disease. Yet, only 40% of respondents could define SCD correctly as a
hereditary blood disorder with 41.8% noting that they know people with SCD. On attitudes
towards SCD, 91.9% are yet to test their sickling status with reasons for not testing were that
they are afraid the test results will not be in favour of their choice (55.6%) whilst 11.1% do not
want to interfere with God’s will and family refusing marriage respectively. Respondents had
behaviours such as eat with an SCD person (50%), invite an SCD person to your birthday party
(63%), study with an SCD person (65.7%), accept an SCD person as room-mate (46%), make
friends with people with SCD (56%), SCD people should not be enrolled in school (30%),
people with SCD should be isolated (39.4%). On SCD influencing choice of spouse, 63% of
respondents undergo premarital counselling with a reason of preventing transmission of
diseases to offspring (62.5%), ensure that partner is healthy (14.1%) and to ensure fitness for
marriage (17.2%). Also, 47.8% revealed that they will end the relationship after a genetic
screening with a probable SCD birth whilst 34.3% said they will continue with the relationship
because they believe in the will of God. This study concludes that high school students of
Bawku has a relative low knowledge about SCD and could not define SCD, neither do they
know the genotypic cause, mode of transmission nor diagnosis. Due to their low knowledge,
they have not done sickling test but have a relatively good attitude towards people with SCD.
The study recommends that reproductive health outreach programmes targeted at adolescents
should be continuously made available through the radio and other emerging social media such
as facebook, twitter to relate suitably with the information and communication technology era.

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 CHAPTER ONE

INTRODUCTION

1.1 Background of the study

The human red blood cells are very important components of the human circulatory system

necessary for the exchange of gases in the body and it is when these cells undergo structural

changes leading to their malfunctioning that Sickle Cell Disease (SCD) may occur (Zdanovicz,

2003). SCD is a hereditary condition of several different variants with the most common type

being Haemoglobin S (Hb S) which is different from the normal haemoglobin usually

designated as Hb A. In Hb S, glutamic acid, an amino acid situated at the sixth position of the

beta globin chain in the normal haemoglobin molecule is substituted by valine (Chan & Moore,

2008). Individuals with two Hb S genes suffer a chronic blood disorder referred to as Sickle

Cell Anaemia (Afolayan & Jolayemi, 2011). Persons who carry one normal gene and one Hb

S gene are said to have the sickle cell trait (SCT) and referred to as carriers are usually

asymptomatic and unaware of their genetic makeup. Clinical manifestations in persons with

SCD crises include arthralgia, anorexia, fatigue, splenomegaly as well as destructive and

painful bone and joint problems (Chan & Moore, 2008).

The World Health Organization estimated that 5.2% of the world’s population and more than

7% of pregnant women present variants of SCD of which 40% is the Hb S type. The World

body further revealed that the socioeconomic impact of SCD on affected persons, families,

communities and nations is enormous since recurrent sickle cell crises adversely affects the

patient’s life, in relation to education, work and psychosocial development. For instance, the

management of a sickle cell patient in a hospital in the Democratic Republic of Congo cost US

$1000, an amount way beyond the income of majority of Africans (WHO, 2010).

There is currently no cure for SCD hence experts have suggested various strategies to control

this disease which include among others, prenatal diagnosis (PND), selective abortion,
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preconception/premarital genetic testing and counselling, education for SCT parents as well as

a holistic management of persons with SCD (WHO, 2010). The WHO further noted that

although there are no figures on the comparative cost analysis on the management of SCD in

Ghana, for developing countries, preconception genetic screening and counselling seems the

cheapest option. This suggestion is emphasized by the SCD strategy for the WHO African

Region which seeks to increase individual and community awareness about SCD and

strengthen primary prevention, reduce disease incidence, morbidity and mortality and improve

quality of life. For persons to readily opt to undergo genetic screening and counseling, they

must in the first place possess good knowledge of SCD and its effects which will enable them

appreciate the full consequences of having children who may suffer SCD (Afolayan &

Jolayemi, 2011).

Sickle cell disease (SCD) remains one of the most common genetic blood disorders among the

African populace. It is estimated that about 400,000 children with SCD are born globally each

year with almost 300, 000 children in the Africa continent alone (Boadu & Addoah, 2018).

About 25% of Africans are carriers of the abnormal hemoglobin gene and estimated 2% of

neonates are born with SCD annually in Ghana (Edwin et al., 2011). It is reported that about

30% or 5 million out of the total of about 25 million Ghanaians carry the Sickle Cell Trait

(Konotey-Ahulu, 2011).

Sickle cell trait is known to show a protective effect against malaria, and this may be the reason

why SCD is highly prevalent among the Africa populace (Bartolucci, 2014). This genetic

disorder (SCD) is as a result of abnormality in the synthesis of B-globin chain of hemoglobin

molecule. This abnormality results from the substitution of a polar amino acid, glutamic acid,

with a non-polar amino acid, valine, in the 6th position of on chromosome 11 (Moheeb et al.,

2007). Under low oxygen tension, this single point mutation causes red blood cells to assume

the shape of a “sickle” and leads to complications including tissue infarction, anemia, priapism,

splenomegaly and reduced dietary intake (Stuart & Nagel, 2004). Marriage is a lifetime

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commitment between partners with the sole aim of companionship, support and procreation

(Moronkola & Fadairo, 2006). The process of choosing a partner is sometimes challenging

especially when considering their health status. Bearing children in marriage brings great joy

but also compelling responsibility that places great demand on couple’s time and finance

especially when coupled with chronic disease conditions such as SCD. Odunvbun, Okolo &

Rahimy (2008) reported that more than half of married couples enter into marriage unaware of

their haemoglobin genotypes. This may account for the reported 2% annual births of children

with SCD in most developing countries. Children are born with SCD possibly because parents

may have entered into marriage without prior knowledge of their sickling status. Knowledge

about SCD prior to marriage is essential especially in tertiary institutions where many young

adults are in the reproductive age and consider campus as a domain for choosing their life

partners. This is also important to make the students aware of the possible genotypes of their

children so as to reduce incidence of SCD. Student’s attitude and beliefs towards SCD is one

of the contributing factors that is important to plan educational programme as well as determine

level of stigmatization towards patients affected with SCD. The current study is therefore

designed to document the awareness of high school students on sickle cell disease at Bawku.

1.2 Statement of the Problem

SCD is geographically distributed in tropical areas but it is becoming a global issue because of

population migration as a result of globalization (Piel et al., 2013). The increasing trend of

SCD throughout the world is highlighted by the implementation of universal screening by

countries like United States of America, United Kingdom and France in order to address the

resulting challenges and prevention of SCD in a multicultural populace. In the United States of

America, early identification of SCD through new‑born screening has improved survival by

preventing sepsis through the use of prophylactic penicillin (Meier, 2012). Thus, it is important

to upgrade knowledge and awareness, diagnosis and management of this disease in middle and

low in‑come countries as this will directly impact high income countries (Hoppe, 1998).

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Advances in health care allowed American children with SCD to live through adulthood

(Quinn, 2010) but this is antithesis in most low‑income countries. In Ghana, new‑born

screening performed in Kumasi indicated that 23% of the infants tested carry a gene associated

with SCD and 1 in 55 of all babies born have SCD (Ohene-Frempong, 2018).

Furthermore, the most organized and consistent information on SCD in Ghana is from centers

in Accra and Kumasi with limited public education (Dennis‑Antwi et al., 2011). In this study,

the researcher ascertained the awareness of SCD among students of Bawku Senior High School

in the Upper East Region of Ghana.

1.3 Purpose of the Study

The purpose of the study or the research is to investigate into the knowledge of adolescents

on the contraction of STIs and also to suggest ways and means to help prevent the contraction

of STIs in adolescents

1.4 Significance of the Study

Sickle cell disease continues to be a global health problem that presents major challenges to

our health care systems. Hence, at the completion of this study, the knowledge base of students

on SC will be improved. It will also serve as a reference to the government of Ghana, especially,

the Ministry of Health, Ghana Health Service to formulate new policies on genetic screening

programs. It also adds up to the knowledge on SCD.

1.5 Objective of the study

Main Objective

The general objective of the study was to assess the knowledge of students on sickle cell

disease.

Specific Objectives

1. To assess the knowledge level of students on SCD in Bawku Senior High School.
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 2. To find students attitudes towards SCD.

3. To find out how SCD influences their choice of spouse.

1.6 Organisation of the Study

This dissertation is divided into five chapters. Chapter one provides introduction and

background and statement of the problem under study, the purpose of the study, objectives as

well as research questions and the significance of the study. It also provides the conceptual

and operational definitions of terms used in this study. Chapter two presents the literature

review relevant to the study, while chapter three gives the methodology utilized in the study.

The chapter also explains the ethical considerations undertaken including the conceptual and

theoretical framework of the study. Chapter four presents the findings of the study and

discussions thereof. Chapter five presents the conclusion and recommendations from this

study.

1.7 Operational Definitions

For the purpose of this study the following terms were defined: -

Sickle cell disease (SCD): is an autosomal recessive genetically transmitted

haemoglobinopathies responsible for considerable morbidity and mortality

Sickle cell anemia (SS): An inherited disorder of the red blood cells in which the hemoglobin

is different from the normal hemoglobin. This unusual hemoglobin results in the production

of unusually shaped cells and is referred to as “HbSS.” It is the most common and severe form

of the sickle cell variations

Skills: This is the acquired ability to do something well.

Sexual: connected to the physical activity of sex.

Sex: Physical activity between two people in which they touch each other’s sexual organs and

may include sexual intercourse.

Symptom: A change in your body or mind that show that you are not well or healthy.
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 CHAPTER TWO

LITERATURE REVIEW

2.1 Overview on Sickle Cell Disease (SCD)

The first formal description of SCD took place over 100 years ago. November 2010 made it

100 years since a Chicago cardiologist Dr. James Herrick provided the first conventional report

of SCD. This first reported case involved a 20 year-old male dental student from the island of

Grenada in the Caribbean who was attending the Chicago College of Dental Surgery. After

becoming a dentist, he returned to Grenada where he was a successful dentist until he died of

SCD complications at the age of 32 (Sergeant, 2010). Three months later, the second formal

case was reported regarding a 25- year-old female who was being treated at the Medical

College of Virginia for several years. The third case involved another female at the age of 21

as well as a report on her father. The father’s fresh blood came back normal but then when

tested again on blood that was stored and observed several days later, came back as abnormal

red cells. This initial illustration of the ‘sickle test’ led to confusion between the disease and

carrier status. This case also indicated that SCD might be hereditary (Sergeant, 2010). The

fourth case involving a 21-year old male patient at John Hopkins Hospital was the first time

that the term ‘sickle cell anemia’ was used. Given the African origin in all four patients, the

misconception that SCD only affected this group evolved. However, SCD was found in areas

without an African origin, including the Arabian Gulf, India, Greece, Turkey, Italy and Sicily

(Sergeant; 2001; Sergeant, 2010). Thirty years following the fourth case of SCD, yielded

increasing number of cases. It was later found that there was a connection between individuals

with SCT and protection from malaria (Desai, 2004; Sergeant, 2010). People with SCT were

immune to malaria and this contributed to the high number of SCT cases found in areas with

high prevalence of malaria (Sergeant, 2010).

Hemoglobin electrophoresis which became available around 1954 led to identification of other

types of SCD including Sickle Cell-Hemoglobin C (SC) Disease, the Sickle Cell-Beta

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Thalassemia’s and the rarer types, HbS/D Punjab and HbS/O Arab (Sergeant, 2010). There are

various forms of SCD. Sickle Cell Anemia (SS), generally the most severe type, occurs when

a sickle gene (S) is inherited from each parent. Sickle-Hemoglobin C Disease (SC), a generally

less serious type, occurs when a sickle gene (S) is inherited from one parent and an abnormal

hemoglobin gene (C) from the other parent. Sickle Beta Thalassemia (ST) occurs when a sickle

cell gene (S) is inherited from one parent and a beta thalassemia gene from the other parent

(T). There are two forms: Beta-Plus Thalassemia (ST+), generally more severe, and Sickle

Beta-Zero Thalassemia (ST0), less severe (Center for Disease Control (CDC), 2011; Sickle

Cell Disease Association of America Inc. (SCDAA), 2012). Sickle Cell Trait (SCT) occurs

when normal hemoglobin (A) is inherited from one parent and abnormal hemoglobin (S) from

the other. Individuals with SCT are usually healthy with no symptoms; however, they can

transmit the SCT to their offspring (CDC, 2011). A hemoglobin gene is inherited from each

parent. Thus, if one parent has SCD and the other has normal hemoglobin, their children will

only inherit SCT. However, if one parent has SCD and the other has SCT, with each pregnancy

there is a 50% possibility (1 in 2) of passing on SCD or SCT. If both parents have SCT, there

is a 25% chance (1 in 4) to pass on SCD with each pregnancy (SCDAA, 2005) and 50% chance

of SCT (Treadwell, McClough, & Vichinsky, 2006).

Pain crises, caused by vasoocclusion, are the trademark of SCD and affect most people with

the disease (Creary et al., 2007; Gustafon et al., 2006; Meier & Miller, 2012). Vasoocclusion

occurs when the sickled red blood cells (RBC) obstruct the other blood cells resulting in an

inadequate supply of blood to the organs (Creary et al., 2007). The initial pain episode generally

occurs as swelling in the hands and feet (hand-foot syndrome or dactylitis) resulting from

decreased oxygen caused by blocked blood vessels. Moreover, almost 50% of children with

SCD get dactylitis by the age of two. For children with SCD, approximately 50 to 60% of all

emergency room visits and 60 to 80% of hospitalizations are due to pain crises (Gustafon,

2006; Meier & Miller, 2012).

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Additionally, studies indicate that acute pain is the main cause of hospitalization for people

with SCD of all ages; however, it occurs more often in teens and young adults (Dorsey &

Murdaugh, 2003; Elander, 2006; Jenerette, Funk, & Murdaugh, 2005; NHLBI, 2010).

Furthermore, frequent reoccurrences of acute pain are related to premature death in SCD

patients over 20 years old (Rees et al., 2010). Several factors including dehydration, extreme

temperatures, infection, and low oxygen levels (high altitudes) can trigger SCD crises (Creary

et al., 2007).

Psychosocial problems affecting individuals with SCD and their families generally develop

from the effect of pain and other SCD symptoms on individuals’ daily lives. Moreover,

people’s attitudes about SCD and towards those with the disease can also lead to psychosocial

problems (Anie, Dasgupta, Ezenduka, Anardo & Emodi, 2007). Due to lengthy school absences

from pain crises and frequent hospitalizations, children and adolescents with SCD have a

greater risk of unsuccessful school performance than their healthy peers (Adegoke & Kuteyi,

2012; Brown et al., 2010; Jisieke, 2007).

SCD also affects family relationships. The difficulty in caring for a child with SCD may result

in little or no attention to other family members and challenges for family members to

participate in desirable activities (Brown et al., 2010). Caring for a child with SCD created a

tense and hostile environment, arguments or altercations among family members, and marital

problems (Brown et al., 2010; Gold et al., 2011). Parents, for instance, must assume the

responsibility of caring for the child with SCD, but also need to balance other responsibilities

associated with the rest of the family, work, and their own emotional welfare. Healthy siblings

of children with SCD are also affected by the distress and interruptions to daily activities that

the disease puts on a family (Gold et al., 2011). SCD can also affect family functioning and the

interactions between parents, siblings, and children may disintegrate (Jisieke, 2007).

SCD was also found to have detrimental effects on family finances. Frequent pain crisis in

adults with SCD may disrupt their social and economic status (Jisieke, 2007). Financial stress
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may be associated with frequent hospitalizations and along with other stressors associated with

disease can interfere with the coping capability among people caring for someone with SCD

(Brown et al., 2010). Additionally, the diminished health condition of a child with SCD has

been connected to the parents’ decreased capability of holding a job (Brown et al., 2010).

Adults are frequently unemployed, without health insurance and are unable to attain public

assistance or disability insurance.

Moreover, when employed, it is usually unpredictable and without health insurance benefits

(Jisieke, 2007). Adegoke and Kuteyi (2012) found a high level of financial burden of SCD on

the caregivers and family members. More than half of the caregivers indicated that the costs of

the child’s disease had detrimental effects on the family’s essential needs such as food and rent.

In addition, approximately 70% of the caregivers in the study lost income or financial benefits

because of time spent caring for their children with SCD (Adegoke & Kuteyi, 2012). The time

spent in caring for a child with SCD resulted in financial problems leading families to get loans,

which were sometimes difficult to repay. (Brown et al., 2010).

2.2 Knowledge Level of High School Students on SCD

In Owolabi and colleagues (2011) study of secondary students in Nigeria, less than half

(48.7%) knew their carrier status. The study found a relationship between students’ knowledge

of their carrier status and age 15 and older.

On the contrary, Alao et al. (2009) found no relationship between age and students level of

knowledge about SCD. Owolabi et al. (2011) also found a relationship between students’

knowledge of their carrier status, being in a senior class, mother’s educational level, knowledge

of SCD transmission, being taught about SCD in school, ever heard about SCD, watching

someone suffering from SCD, and loosing family to SCD.

In a study by Olarewaju et al. (2013) conducted with secondary school students in Nigeria,

most of the participants knew about SCD and its inheritance; half of the participants even knew

9
someone with the disease. However, participants were less knowledgeable about the

symptoms, diagnosis, and preventive measures. Even though most of the participants (89.6%)

agreed that everyone should know their carrier status, only 59.2% knew their carrier status

(Olarewaju et al., 2013).

In a cross-sectional survey design, Moronkola and Fadairo (2006) study of University students

in Nigeria found that although more than half (76.6%) of the students knew their carrier status

and 23.4% of the students did not know their carrier status (Moronkola & Fadairo, 2006). In

another cross-sectional study of university students in Makurdi, Nigeria, Alao, Araoye, and

Ojabo (2009) found that although all the students indicated that they had heard of SCD at some

point, most (82%) knew that SCD was a hereditary disease and most (89.1%) of the students

knew how the disease was transmitted, only 47% had good knowledge about the disease. The

study showed that family history was associated with knowledge about SCD. For instance,

students who had a relative with SCD had better knowledge compared to those without an

affected relative. However, the study found no relationship between students’ knowledge of

their own carrier status and having a relative affected by the disease. Only 47% of the students

knew their carrier status and only 48.7% of students with an affected relative, were aware of

their carrier status (Alao et al., 2009).

A study of trainee teachers, who were students at the University of Rivers State University of

Education in Nigeria, showed that although only (1.8%) reported that they had never heard of

SCD, some students believed SCD was caused by evil spirits (19%) or bad food (27%) and

could be cured by spiritual healers (27%). Females had better knowledge about SCD compared

to males (Ani, Oranda, Kinanee, Ola & Kramer, 2012).

Also an undergraduate study in Ekiti State University in Nigeria, the researchers revealed that

the majority of students (97.8%) had heard about SCD. However, only (34.4%) understood

the nature of SCD and a little over 50% of the participants knew their carrier status (Olubiyi et

al., 2013).
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2.3 Students Attitude and Perceptions on SCD

A study conducted with trainee teachers who were university students in Southern Nigeria,

showed that participants had negative attitudes towards their classmates with SCD. Only (24%)

of the students believed their peers would invite a fellow classmate with SCD to their birthday

party and (31.9%) believed most of their peers would engage in study sessions with a fellow

classmate with SCD. Fifteen to fifty-three percent of the students believed that other students

would not associate with their peers with SCD. The study found that gender and perceived

negative family attitudes significantly influenced stigmatizing attitudes towards SCD. Males

had more negative attitudes towards their peers with SCD compared to females and

stigmatizing attitudes increased with the person’s perceive family negative attitude. A

significant proportion of participants believed that their family members perceived SCD as

something to be ashamed of (43.6%) kept secret (32%), and would oppose friendships with

anyone with SCD (32%) (Ani, et al., 2012).

Olarewaju et al. (2013) study of Nigerian secondary students showed that although a greater

number of participants (66.9%) indicated that carrier status would not affect their decision to

marry, (43.1%) said it was a significant factor to consider. Moreover, 22.3% of the participants

reported that they would not marry someone who had SCD. In terms of what couples should

do if they find out that they are both carriers of SCD, most participants (51.9%) indicated that

couples should seek genetic counselling and make an informed decision, (24.1%) did not know,

(23.4%) end the relationship, and (0.7%), stay in the relationship and deal with the

consequences (Olarewaju, et al., 2013).

In another study of premarital couples attending an outpatient clinic for premarital SCD

screening in Nigeria, Nnaji et al. (2013) found a relationship between decision to end the

marriage and the denomination of each couple. A greater number of participants from Catholic

churches (78.6% females; 77.3% males), followed by Anglicans (69.2% females; 66.7% males)

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and Pentecostals (55.6% females; 55.9% males) reported that they would end the relationship

and not marry their partners if both turned out to be SCD carriers (Nnaji et al., 2013).

Abioye-Kuteyi et al. (2009) on the other hand found that participants would continue a

relationship even after finding out that both partners are SCD carriers as many as (50%) of the

participants decided not to end their relationships even when both partners were carriers. These

findings demonstrate the importance of knowing carrier status before starting a relationship.

2.4 Genetic Counselling and Screening Practices

Parents who receive genetic counselling and support learn how to assess respiratory distress,

fever, jaundice, and splenomegaly, which are early major complications of SCD. (Claster &

Vichinsky, 2003). Research has confirmed that the follow-up genetic counselling rates for

infants with sickle cell disease and other hemoglobinopathies ranges from 35% to 60%

nationwide. These low rates indicate that many families are not complying with follow-up

procedures for infants with sickle cell disease.

Cultural views, social and economic barriers, guilt, and health beliefs may contribute to the

lack of interest and support for sickle cell testing and genetic counselling (Gustafson et al.,

2007; Yang, Andrews, Peterson, Arvind, & Cepeda, 2000). Articles on prenatal sickle cell

screening education suggest that many factors contribute to the lack of follow-up counselling

and screening.

These factors include anticipatory anxiety on the parents’ part about learning that their infant

has a sickle cell hemoglobinopathy, denying and avoiding the possibility that their child might

be born with sickle cell disease, and fear of being responsible for causing the disease (Yang et

al., 2000). In addition, Hill (2001), the author of Care Giving in African-American Families:

Caring for Children with Sickle Cell Diseases, discussed that fathers are usually less likely to

know they are carriers of the sickle cell trait and are more than likely to deny their contribution

to passing on the disease.

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The lack of awareness of newborn screening programs is another key factor that contributes to

low follow-up rates. The follow-up rate for newborn screenings may increase significantly only

if the parents of infants with sickle cell hemoglobinopathies become informed and aware of the

significance of the screening program during prenatal education sessions (Yang, Andrews,

Peterson, Arvind, & Cepeda, 2000). Hill (2001) stated that many mothers experience feelings

of helplessness and fear because of the SCD diagnosis. Hill (2001) concluded that mothers

receive little information from physicians regarding how to care for their SCD children. This

information further demonstrates a lack in awareness of SCD as a result of poor patient-

physician relationships.

2.4 Summary

In order to address the gaps mentioned above, this study will attempt to include a diverse

sample of high school students from different departments. The study will contribute to the

existing literature by exploring factors that have received less attention such as SCD

knowledge, beliefs, attitudes, and screening behaviors especially among a more diverse sample.

In addition, this study will investigate factors that influence knowledge, beliefs, attitudes, and

screening behaviors. The researcher hopes to provide important information for program and

policy development in the area of SCD prevention. Also a Chi Square analysis is needed to

clarify the relationship between genetic screening behaviours and gender, age and educational

levels in our youthful population.

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 CHAPTER THREE

RESEARCH METHODOLOGY

3.1 Research Design

Research design according to Walliman (2011), is the overall plan to which the respondents of

a proposed study are selected, as well as the means of data collection or generation. Tailor

(2005) also defined research design as a blueprint for conducting research and entails a detailed

plan with which the research is undertaken. The research utilized a cross-sectional survey

which was descriptively quantitative in nature. With respect to Best & Khan (2006), in a cross

sectional study, all the measurements for a sample member is obtained at a single point in time,

although recruitment may take place across a longer period of time. In this study, each caregiver

responded to a questionnaire once, with recruitment taking place in March 2019. Cross

sectional studies are generally quick, easy, and cheap to perform. They are often based on a

questionnaire survey. Hence in this study, a structured questionnaire was used in collecting

data from respondents.

3.2 Research Setting

The study was conducted at the Bawku Senior High School in Bawku. Bawku is the

administrative capital of the Bawku Municipality; one of the 13 MMDAs in the Upper East

Region of Ghana.

The Bawku municipal has a total land area of 247.23720 sq.km and it is located approximately

between latitudes 11o 11” and 100 40” North and longitude 0o 18” W and 0o 6” E in the north

eastern corner of the region. It shares boundaries with Pusiga District to the North, Binduri

District to the South, Garu-Tempane District to the East and Bawku West to the West.

The Municipality has a population of 98,538 persons, with the males being 47,254 (48.0

percent) and females 51,284 (52.0 percent). The municipality is underlain mainly by Birrimian

and granite rock formation. It is located at the highest point of the Upper East Region. In areas

14
bordering the basins of the White Volta River and its tributaries, the relief is generally low and

slightly undulating with heights of 120-150 metres above sea level. The rest of the municipality

consists of a series of plateau surfaces. This being remnants of prolonged periods of weathering

and erosion of the scattered hills. The average height of the plateau is 400 metres above sea

level, but isolated peaks rise beyond 430 metres as in the case of Zawse hills. Outcrops of rocks

are also found in many areas.

As with the whole of the Upper East Region, the Bawku Municipality is part of the interior

continental climatic zone of the country characterized by pronounced dry and wet seasons. The

two seasons are influenced by two oscillating air masses. First is the warm, dusty and dry

harmattan air mass, which blows from the north easterly direction across the whole

municipality from the Sahara Desert.

The soil is Varempare series which is mainly sandy loams associated with hornblende and

granites. They are quite permeable with moderately good water retention capacity and are

suitable for the cultivation of cereals and legumes. Hence almost all the inhabitants are farmers.

The predominant group is the Mole Dagbani with the major ethnic groups being Kussasis,

Mamprusis, Bissas and Moshies with the traditional head being the Bawku Naba. However,

there are quite a number of migrants from other parts of the country especially the south (most

of whom are civil servants) and the neighbouring countries like Togo and Burkina Faso. Ethnic

heterogeneity has had implications for harmony in the municipality. It is expected however,

that inter-marriages among the diverse ethnic groupings will provide the impetus for peaceful

co-existence.

The main sources of lighting in the town are electricity and kerosene lamp whilst the three main

sources of water in the district are pipe borne water, Bore-hole/Pump/Tube well and Protected

well.

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The most common toilet facility used are the public toilet (KVIP) and pit latrine whilst the

most widely used method of solid waste disposal is by public dump in open space.

3.3 Target Population

This is the total membership of a defined set of subjects from whom the study subjects were

selected and to whom the findings of the study will be generalized (Kothari, 2004). Therefore,

the target group for this study were high school students and who are married or not married

and are members with student identification cards.

3.4 Sampling Size and Technique

3.4.1 Sample Size

Sampling size is the total number of sampling units that will actually be sampled from the

target population (Rothwell, 2009). Choosing a representative sample for a finding for a

particular study can be used in generalizing for the whole population. The sample size

determination method that will be used for computing the sample size for the study is given as;

n = N/1+N (∝2) where n is the sample size for the study population; N is the sample frame

while ∝ is the error margin (10% error margin is considered since it is widely regarded as the

appropriate error margin for social researches). The sample size is 100.

3.4.2 Sampling Technique

According to Mugenda and Mugenda (2001) “Generally the sample size depends on factors

such as the number of variables in the study, the type of research design, the method of data

analysis and the size of the accessible population”. This study used stratified sampling since

the population embraces a number of distinct categories of teacher qualifications. This helped

in including the students of all departments as well as levels of course of study. There is general

science, business, general arts, home economics students in the study area. Each of these

categories of student’s qualifications was sampled as an independent sub-population out of

which individual student was randomly selected from each class per their course. According to

16
Lilian (2006), the sample sizes will yield a 5% margin of error and a confidence of 95%. To

select the sample, the research wrote on a piece of paper the numbers then cut into pieces and

put them in a box for randomly selection of the teachers. For example, for general science

students, the research wrote number 1 to 30 then randomly selected the 10 who picked number

1 to 10. Same process was repeated for the other departments.

3.5 Method of Data Collection

A structured questionnaire will be designed to solicit information on safe sex as well as the

utilisation of sexual and reproductive health services. The questionnaires were given to

respondents and the researcher assisted in explaining the various processes. To minimize non

responses, falsification of information and ensure confidentiality, respondents were assured

that information obtained would be confidential and would be used to improve the management

of their condition as well as for academic purposes. Each respondent answered the

questionnaire separately and independently so that responses were less likely to be affected or

influenced by the presence of others. There were thirty-one items in the questionnaires and all

questions were answered.

3.6 Method of Data Analysis

The data obtained were coded, stored and analyzed using SPSS version 21. Variables

were determined based on the questionnaire and entries of the various individual responses

made into the software application. Analysis were made from the entered responses and

presented in various forms such as tables, pie charts and bar charts. Percentages and frequencies

were calculated for the various responses.

3.7 Validity and Reliability

Validity refers to the degree to which the instrument used measures what it is supposed to

measure (Kothari, 2004). The validity of the questionnaire was enhanced by making sure the

17
respondents were in line with the topic and the literature review hence a questionnaire was

drawn from other health survey from different part of the world. Studies like Boadu &

Addoah, 2018 and Gamit et al., 2014 were used.

Reliability on the other hand is the degree of consistency with which the instrument measures

the attributes under study (Rothwell, 2009). To assess these, the questionnaire was pre tested

by using 10 students of Yamfo Senior School were utilised. Based on the responses that were

gathered, the questionnaire was re-framed before the actual study was carried out.

3.8 Ethical Consideration

Mouton (2001) is of the view that the ethics of science looks into the wrongs and rights during

a research study. As such, globally, all researchers, regardless of research designs, sampling,

techniques and choice of methods, are subjected to ethical considerations (Gratton & Jones,

2010). This basically deals with the moral standards that the researcher considered in all

research methods in the stages of the research design.

An institutional consent was sought from the Headmaster of Bawku Senior High School after

a formal request which details the objectives and relevance of the study were sought.

The consent of participating students was sought after explaining the study to respondents and

confidentiality of data was ensured throughout the study.

3.9 Limitations of The Study

1. This study was limited by restricting it to only one institution; because other students

in other institutions may share different opinions.

2. The study focused on senior high students and therefore generalization of the findings

for out of the school youth may not be feasible.

3. The study outcome depended on the truthfulness and openness of respondents as the

information sought was considered personal and sensitive.

18
 CHAPTER FOUR

RESULTS AND DISCUSSION

4.1 Results

4.1.1 Demographic Data of the Respondents

From Table 1, majority of respondents (64%) were within the ages 16-18years and had a high

male population of 61%. The study as well recruited most respondents from the lower class

thus SHS1 (49%) with 64% being Christians.

Table 1: Socio-Demographic characteristics of the respondents

Socio-Demographics Frequency (N=100) Percent (%)

Age of respondent
13-15years 2 2.0
16-18years 64 64.0
Above 18years 34 34.0

Gender
Male 61 61.0
Female 39 39.0

Level of Senior High School

SHS 1 49 49.0
SHS 2 32 32.0
SHS 3 19 19.0

Religion
Christian 64 64.0
Muslim 35 35.0
Traditional 1 1.0

Source: Field Survey, (2019)

19
Source: Field Survey, (2019)

Figure 1: Ethnic Background of Respondents

Figure 1 gives an indication of respondents’ ethnic background with majority (45%) being

Kusaases.

20
Source: Field Survey, (2019)

Figure 2: Respondents’ Course of Study

Respondents were drawn from diverse course of study and Figure 2 shows that 31% were

offering General Science followed by 23% and 22% who offered General Arts and Home

Economics respectively.

21
4.1.2 Knowledge and Awareness of Sickle Cell Disease

Source: Field Survey, (2019)

Figure 3: Respondents’ Heard of Sickle Cell Disease

From Figure 3, 55% of respondents have ever heard of sickle cell disease

22
Source: Field Survey, (2019)

Figure 4: Respondents’ Source of Information

Respondents heard of Sickle Cell Disease trough health workers (16%), the television (11%),
family (7%) and friends (6%).

23
Source: field Survey, (2019)

Figure 5: Stratification of Respondents Age against Hearing of SCD before.

Figure 5 gives a stratification of respondents’ age against respondents hearing SCD before.

Across all the ages, SCD knowledge was present but was prominent among respondents above

15 years.

24
Source: field Survey, (2019)

Figure 6: Stratification of Respondents Gender against Hearing of SCD before

Figure 6 gives a stratification of respondents’ gender against respondents’ ever heard of SCD

before. The male respondents were more prominent but with number of female respondents

recruited, one is tempted to believe that female respondents know of SCD more than their male

counterparts.

25
Source: field Survey, (2019)

Figure 7: Stratification of Respondents Educational status against Hearing of SCD

before

Figure 7 gives a stratification of respondents’ educational status against respondents ever

hearing SCD. In this study, the seniors in the upper class rather turned out not to have

knowledge about SCD.

Table 2: Respondents Knowledge and Awareness of SCD

Variable Frequency Percent (%)

(N=100)
SCD is
A disease that causes the red blood cell to become sickled 16 29.1
A hereditary blood disorder that causes the affected 22 40.0
individual to fall sick often
A sexually transmitted disease 3 3.0
No idea 14 25.5

26
 Know anyone suffering SCD
Yes 23 41.8
No 32 58.2

Who is this person

Sister 1 4.3
Mother 1 4.3
Friend 11 47.8
Relative 4 17.4
School mate 5 21.7
Community member 1 4.3

SCD is a lifelong condition

Yes 31 56.4
No 24 43.6

SCD is a disease for

Children 7 12.7
Youth 3 5.5
Old aged people 1 1.8
Everyone is equally to get 44 80.0

Mode of transmission
Inherited 30 54.5
Witchcraft/curses 2 3.6
Through infection 21 38.2

SCD is diagnosed using

Blood test 36 65.5
No idea 19 34.5

Cure for SCD available

Yes 31 57.4
No 23 42.6

Source: field Survey, (2019)

As indicated in Table 2, 40% of respondents could define SCD correctly as a hereditary blood

disorder with 41.8% noting that they know people with SCD. Respondents (54.5%) said SCD

is inherited whilst 38.2% said its through infection with 80% noting that it can affect everyone.

Yet, 43.6% said SCD is not a lifelong condition. They further revealed that blood test is used

in diagnosing SCD (65.5%) whilst 57.4% of respondent thinks that SCD is curable
27
Table 3: Knowledge on Genotype

Variable Frequency Percent (%)

(N=100)
Genotype that causes SCD
AA 9 16.4
AS 2 3.6
SS 10 18.2
I don’t know 34 61.8

Know your genotype

Yes 13 24.1
No 41 75.9

Source: field Survey, (2019)

In this study, Table 3 revealed that respondents genotype SS (18.2%) is the cause of SCD whilst

61.8% do not know of any genotype.

28
Source: field Survey, (2019)

Figure 7: Respondents views on symptoms of SCD

From Figure 7, respondents revealed that people with SCD have symptoms such as Bone pains

(32.7%), joint pains (18.2%), feeling sick often (16.2%) and sickness that comes whenever the

weather is cold (14.5%).

4.1.3 Attitudes Towards Sickle Cell Disease

Table 4: Respondents’ Attitudes Towards SCD

Variable Frequency (N=100) Percent (%)

Ever tested for SCD
Yes 8 8.1
No 91 91.9

People with SCD should be isolated

29
 Yes 39 39.4
No 60 60.6

People with SCD should not be enrolled in schools

Yes 30 30.0
No 70 70.0

Make friends with people with SCD

Yes 56 56.0
No 44 44.0

Accept an SCD person as room mate

Yes 46 46.0
No 54 54.0

Study with an SCD person

Yes 65 65.7
No 34 34.3

Invite an SCD person to your birthday party

Yes 63 63.0
No 37 37.0

Eat with an SCD person

Yes 50 50.0
No 50 50.0

Source: field Survey, (2019)

On attitudes towards SCD, 91.9% are yet to test their sickling status and had behaviours such

as eat with an SCD person (50%), invite an SCD person to your birthday party (63%), study

with an SCD person (65.7%), accept an SCD person as room-mate (46%), make friends with

people with SCD (56%), SCD people should not be enrolled in school (30%), people with SCD

should be isolated (39.4%).

30
4.1.3.1 Distribution of Respondents response to STD not dangerous with selected

demographic characteristics

Table 5: Demographic characteristics of respondents against STD not dangerous

Educational Eat with an

Gender Age status/level SCD person
Gender Pearson
.148* .542** 1 .222**
Correlation
Sig. (2-tailed) .039 .000 .002
N 100 100 100 100
Age Pearson
.074 1 .542** .181*
Correlation
Sig. (2-tailed) .301 .000 .011
N 100 100 100 100
Educational status/level Pearson
.148* .532 1 .023
Correlation
Sig. (2-tailed) .039 .000 .781
N 100 100 100 100
Eat with an SCD person Pearson
.222** .181* .023 1
Correlation
Sig. (2-tailed) .002 .011 .781
N 100 100 100 100
*. Correlation is significant at the 0.05 level (2-tailed).
**. Correlation is significant at the 0.01 level (2-tailed).
Source: field Survey, (2019)

From Table 5, there was a significant relationship between respondents’ attitude of eating with

an SCD person and gender (p=0.002) as well as age (p=0.01).

4.1.4 SCD Influence Choice of Spouse

On SCD influencing choice of spouse, 63% of respondents undergo premarital counselling

with a reason of preventing transmission of diseases to offspring (62.5%), ensure that partner

is healthy (14.1%) and to ensure fitness for marriage (17.2%).

31
Table 6: Respondents’ views on SCD Influencing their Choice of Spouse

Variable Frequency (N=100) Percent (%)

Undergo premarital counselling

Yes 63 63.0

No 37 37.0

Reason for counselling

To prevent transmission of diseases to my 40 62.5

offspring

To ensure that my partner is healthy 9 14.1

To ensure fitness for marriage 11 17.2

To prevent transmission of diseases to me 3 4.7

I don’t have a reason 1 1.6

Source: field Survey, (2019)

4.1.4.1 Reason not to undergo premarital genetic screening

From Table 7, 55.6% of respondents revealed that they are afraid the test results will not be in

favour of their choice whilst 11.1% do not want to interfere with God’s will and family refusing

marriage respectively.

32
Table 7: Respondents’ views on SCD Influencing their Choice of Spouse

Variable Frequency (N=100) Percent (%)

Afraid that the test results will not be in favour 20 55.6
of my choice

Don’t want to interfere with God’s will 4 11.1

Afraid that a positive test will prevent 2 5.6

continuation of romantic relationship

Family will refuse marriage 4 11.1

I don’t have a reason 6 16.7

Source: field Survey, (2019)

4.1.4.2 State of Relationship after premarital genetic screening

From Table 8, 47.8% revealed that they will end the relationship after a genetic screening with

a probable SCD birth whilst 34.3% said they will continue with the relationship because they

believe in the will of God.

Table 8: Respondents’ Decision after a Genetic Screening with a Probable SCD Birth

Variable Frequency (N=100) Percent (%)

End the relationship 32 47.8

Continue relationship due to emotional reasons 1 1.5

Continue relationship due to family pressure 1 1.5

Continue the relationship because I believe in 23 34.3

God

I don’t know what to do 10 14.9

Source: field Survey, (2019)

33
4..1.4.3 Distribution of Respondents response to child ailment with selected demographic

characteristics

From Table 9, there was a relationship between respondents’ age and action to take after a

genotype test (p=0.04).

Table 9: Demographic characteristics of respondents correlated against Religion

Educational
Gender Age status/level Action taken
Gender Pearson
1 .074 .148* .025
Correlation
Sig. (2-tailed) .301 .039 .725
N 100 100 100 68
Age Pearson
.074 1 .542** .144*
Correlation
Sig. (2-tailed) .301 .000 .043
N 100 100 100 68
Educational status/level Pearson
.148* .542** 1 .040
Correlation
Sig. (2-tailed) .039 .000 .576
N 100 100 100 68
Action taken Pearson
.025 .144* .040 1
Correlation
Sig. (2-tailed) .725 .043 .576
N 100 100 100 68
*. Correlation is significant at the 0.05 level (2-tailed).
**. Correlation is significant at the 0.01 level (2-tailed).

Source: field Survey, (2019)

34
4.2 Discussions

Sickle cell disease causes serious emotional, psychosocial, and economic problems for

sufferers and their parents or caregivers (Afolayan & Jolayemi, 2011). This section of the

studies discusses the results collated form respondents in tandem with previous scholars.

4.2.1 Demographic Characteristics

The study had 45% of respondents being Kusaasis as well as a high male population of 61%.

This supports the Ghana Statistical Report in 2014 which revealed that the Bawku Municipality

is dominated with the Kusaasi clan yet still suffers the gender inequality of formally educating

the girl child. This gender inequality has had a toll on the sector of the country and hence it

will be demeaning on whether a woman can be motivated enough to go in for a genetic test and

decide to choose the kind of spouse she can live with without facing the probability of giving

birth to a sickle cell child. The North has been known to likening everything to fate rather than

resulting to medical and technological advancement making it difficult for these young ones to

at their age be abreast with pre-marital counselling ideas because at this age they start falling

in love and will want to explore and get married soon.

4.2.2 Knowledge about SCD

The results of this study showed that majority of respondents (55%) have heard of SCD mainly

through health workers (16%), the television (11%), family (7%) and friends (6%). In line with

this study, health workers and family were the first source of information on SCD in the Middle

East countries of Oman and Saudi Arabia (Al-Farsi et al., 2014; Ibrahim et al., 2011).

Contrarily, Moronkola had a high source of information being the mass media and likened this

to cultural differences. The Nigerian state in which his study was conducted being a secular

state permits free discussion of issues of sexuality in the mass media unlike in Islamic states of

Saudi Arabia and Oman as well as the Northern part of Ghana which is also an Islamic dense

society. The moderate overall knowledge score of 55% is higher than those recorded among

35
Nigerian local government workers in Ile Ife and youth corps in Lagos (Abioye-Kuteyi et al.,

2009; Olatona et al., 2012). Other studies in the UK and Nigeria recorded higher knowledge

level between 75% - 86% (Osbourne, 2011; Adeyemo et al., 2007).

Gender and age were the socio-demographic factors that significantly influence knowledge of

respondents. The effects of gender on knowledge of SCD could be attributed to the fact that

females while having family members attending antenatal clinics during pregnancy were tested

and educated on SCD. A study in Saudi Arabia reported female science students possessed

higher knowledge on SCD than their non-science counterparts (Ibrahim et al., 2011).

Respondents of this study further revealed that genotype SS (18.2%) is the cause of SCD whilst

61.8% do not know of any genotype. They as well revealed that people with SCD have

symptoms such as Bone pains (32.7%), joint pains (18.2%), feeling sick often (16.2%) and

sickness that comes whenever the weather is cold (14.5%). Similarly, Gamit et al (2014)

revealed that approximately 90% of respondents didn’t know the cause of disease and only 52

(18 %) were counselled about this disease with more than 95% of the participants were unaware

regarding their haemoglobin status that causes sickle cell.

4.2.3 Attitude Towards SCD

This study recorded that 63% of respondents will undergo premarital screening and counselling

on SCD yet only 8.1% of respondents knew their own sickling status. The overall attitude of

respondents towards SCD such as eat with an SCD person (50%), invite an SCD person to your

birthday party (63%), study with an SCD person (65.7%), accept an SCD person as room-mate

(46%), make friends with people with SCD (56%), SCD people should not be enrolled in school

(30%), people with SCD should be isolated (39.4%) is rather poor. Similar poor attitudes

towards SCD were reported in Oman, US and Nigeria (Ohaeri & Shokunbi, 2001; Al-Farsi et

al., 2014; Long et al., 2011).

36
In this study, respondents age and gender had a significant relationship with respondents’

attitude with p=0.004 and p=0.002 respectively. Similarly, age, gender, religious affiliation just

as reported in other countries did not influence a person’s attitude towards SCD (Abioye-

Kuteyi et al., 2009; Olatona et al., 2012; Al-Kindi et al., 2012). Several reasons could be

responsible for the poor attitude of respondents in this study despite their moderate knowledge

level. Critical knowledge areas that may change the behaviour of the respondents such as the

epidemiology, incurability, adverse effect of disease on life expectancy of SCD sufferers were

knowledge areas respondents were most deficient in.

4.2.4 Influence of Genetic Screening on Choice of Spouse

On SCD influencing choice of spouse, 55.6% of respondents revealed that they are afraid the

test results will not be in favour of their choice whilst 11.1% do not want to interfere with

God’s will and family refusing marriage respectively. Also, 47.8% revealed that they will end

the relationship after a genetic screening with a probable SCD birth whilst 34.3% said they will

continue with the relationship because they believe in the will of God. This study therefore

shows that prospective Ghanaian couples are negligent and do not consider the consequences

of having children with blood disorder. Just as was reported in Oman and Nigeria, factors such

as love, beauty, ethnicity, parental influence, and socioeconomic status rather greatly influence

the choice of partners, relegating issues of genetic incompatibility to the background

(Osbourne, 2011; Oludare & Ogili, 2013; Al-Kindi et al., 2012). Possessing knowledge about

a disease is said to influence behaviour adaptation if it is paired with the belief that a behaviour

change will positively contribute to good health (Long et al., 2011). The positive correlation

between knowledge and attitude in this study was clearly demonstrated in respondents from

the health sector and those with tertiary education possessing better attitude towards SCD.

Therefore, provision of more information on SCD through the media, empowering religious

leaders with appropriate knowledge to influence their followers’ marriage decisions in relation

to SCD, training of health workers and provision of accessible testing and counselling centres;

37
strategies recommended by the WHO if adopted by countries will reduce the incidence of SCD

among the population. For some respondents to decide to continue with relationships even

when genetic incompatibility is detected due to love emotions means, public education alone

would not lead to the drastic reduction of this disease but some compulsory and fee free

premarital counselling and screening must be pursued by all nations especially those in Africa

since mandatory Pre-marital counselling and screening programme have reduced the incidence

of SCD in several countries (Al-Farsi et al., 2014).

38
 CHAPTER FIVE

SUMMARY, CONCLUSION AND RECOMMENDATIONS

5.1 Summary

Sickle cell disease (SCD) is one of the most prevalent genetic disorders among the African

descent. SCD is associated with intermittent excruciating pain, increased morbidity and

mortality yet has received less recognition in the public domain. There is growing evidence on

the need to increase awareness to reduce the disease incidence. This study aimed to elicit

student’s knowledge, beliefs and attitude of SCD. A cross-sectional descriptive study design

which was quantitative in nature was used and a stratified sampling technique was used to

sample 100 students from Bawku Senior High School of which they responded to

questionnaires which were analyzed using the Statistical Package for Social Sciences (SPSS)

version 21. A Pearson’s correlation test was done to test variables with a significance of p value

of ≤0.05 being considered statistically significant.

The study revealed a significant relationship between respondents’ attitude of eating with an

SCD person and gender (p=0.002) as well as age (p=0.01) as well as respondents’ age and

action to take after a genotype test (p=0.04). Also, 55% of respondents have ever heard of

sickle cell disease. Respondents heard of Sickle Cell Disease through health workers (16%),

the television (11%), family (7%) and friends (6%). Yet, only 40% of respondents could define

SCD correctly as a hereditary blood disorder with 41.8% noting that they know people with

SCD. Respondents (54.5%) said SCD is inherited whilst 38.2% said its through infection with

80% noting that it can affect everyone with 43.6% said SCD is not a lifelong condition. They

further revealed that blood test is used in diagnosing SCD (65.5%) whilst 57.4% of respondent

thinks that SCD is curable but noted that people with SCD have symptoms such as Bone pains

(32.7%), joint pains (18.2%), feeling sick often (16.2%) and sickness that comes whenever the

weather is cold (14.5%). In this study, 18.2% of respondents said genotype SS is the cause of

SCD whilst 61.8% do not know of any genotype.

39
On attitudes towards SCD, 91.9% are yet to test their sickling status with reasons for not testing

were that they are afraid the test results will not be in favour of their choice (55.6%) whilst

11.1% do not want to interfere with God’s will and family refusing marriage respectively.

Respondents had behaviours such as eat with an SCD person (50%), invite an SCD person to

your birthday party (63%), study with an SCD person (65.7%), accept an SCD person as room-

mate (46%), make friends with people with SCD (56%), SCD people should not be enrolled in

school (30%), people with SCD should be isolated (39.4%).

On SCD influencing choice of spouse, 63% of respondents undergo premarital counselling

with a reason of preventing transmission of diseases to offspring (62.5%), ensure that partner

is healthy (14.1%) and to ensure fitness for marriage (17.2%). Also, 47.8% revealed that they

will end the relationship after a genetic screening with a probable SCD birth whilst 34.3% said

they will continue with the relationship because they believe in the will of God.

5.2 Conclusion

This study concludes that;

There is a relationship between an individuals’ age, gender and attitude towards SCD.

High school students of Bawku has a relative low knowledge about SCD and could not define

SCD, neither do they know the genotypical cause, mode of transmission nor diagnosis. Due to

their low knowledge, they have not done sickling test but have a relatively good attitude

towards people with SCD.

Finally, the study reveals that, genotype premarital counselling will not necessary have any

influence on the choice of spouse of an individual due to their religiosity (believe in the will of

God).

40
5.3 Recommendations

Based on the findings of this study, the following are recommended;

1. Reproductive health outreach programmes targeted at adolescents should be

continuously made available through the radio and other emerging social media such

as facebook, twitter to relate suitably with the information and communication

technology era.

2. Government, stakeholders and other non-governmental agencies should support clinics

by providing sickling test on an affordable rate.

3. The Ministry of Health should intensify its campaign on SRH services and the

importance of sickling tests.

4. Mass genotypic counselling education programmes should be embarked at the

community level thus at market square, churches and the mosques.

5. Enough education (both formal by educational authorities and informal by the family

settings) should be made to bridge the gender gap between males and females.

Behavioural Change Communication strategies should be geared towards correcting the

perceived gender stereotypes which transcends into sexual relations. Adolescents

should be made aware of the fact that every sexual being has unalienable and indivisible

sexual rights and is not secondary to another person by reason of differences in socio-

demographic and economic status.

6. Further studies should be conducted on the effects of having an SCD person within a

household.

41
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 COLLEGE OF HEALTH YAMFO

DEPARTMENT OF PHYSICIAN ASSISTANT MEDICAL

INFORMED CONSENT

TOPIC: AWARENESS OF SICKLE CELL DISEASE AMONG STUDENTS IN

BAWKU SENIOR HIGH SCHOOL IN THE UPPER EAST REGION OF GHANA

Good Morning/Afternoon, My name is Mr Tahiru Amaru Salam, a student at the Yamfo

College of Health. I am conducting a study on the above topic. I would like to seek your
permission and consent before conducting this study. I would be very glad if you accept my
request to volunteer as a participant in my study.

Being in the study is your choice: The purpose of this form is to obtain your consent to
participate. If you choose to participate, a questionnaire will be administered to you and the
interview will take between 10 and 20 minutes to complete. Participation is entirely voluntary
and you can choose not to answer any individual question or all of the questions or withdraw
from the study at any time. However, I hope you will participate in this interview since your
views are very important.

Risks and benefits of the study: Apart from the inconveniences caused by taking part of your
time, the process is safe and there are no foreseeable risks involved. I will try as much as
possible to make sure that we save on your time. There are no direct benefits to you by choosing
to participate in this study. However, the results of this study will be communicated back to the
health facility for necessary action by the health authorities. The results will solely be used in
writing my dissertation as part of requirements by the university.

Data security and confidentiality: All information obtained will be used in confidence for
the sole purpose of this research only and it will be strictly confidential and data password
protected only accessed by the Researcher.

Do you therefore agree to take part in this study? YES [ ] NO [ ].

46
 COLLEGE OF HEALTH YAMFO

DEPARTMENT OF PHYSICIAN ASSISTANT MEDICAL

APPENDIX II: QUESTIONNAIRE

Dear participant, having consented to partake in this study, I would therefore appreciate if
you answer the following questions truthfully by ticking [ ] in the spaces provided or writing
the appropriate answer.

Thank You.

INSTRUTIONS: (For all the sections involved please tick or write the appropriate
response).

SECTION A: SOCIO-DEMOGRAPHIC CHARACTERISTICS OF RESPONDENT

Please fill the following information about yourself. Tick [] as appropriate

1. What is your age in years?

[ ] 13 - 15 [ ] 16 - 18 [ ] >18

2. Gender

[ ] Male [ ] Female

3. Which religion do you belong to?

[ ] Christian [ ] Muslim [ ] Traditionalist [ ] No Religion

Other (please specify)…………………………………

4. What is your ethnic background?

[ ] Akan [ ] Dagbani [ ] Ewe [ ] Ga-Adangbe [ ] Gurunsi

[ ] Guan [ ] Gurma [ ] Bissa Others, please

specify………………………

5. What level of Senior High School (SHS) are you?

[ ] SHS - 1 [ ] SHS - 2 [ ] SHS - 3

6. Course of study

47
 [ ] General Science [ ] General Art [ ] Visual art [ ] Business

[ ] Home Economics [ ] Agricultural Science [ ] Technical

SECTION B: KNOWLEDGE AND AWARENESS OF SICKLE CELL DISEASE (SCD)

7. Have you heard of SCD?

[ ] Yes [ ] No

8. If YES, from where?

[ ] Family [ ] Friends [ ] Health worker [ ] Television [ ] Radio

[ ] Internet [ ] Newspaper Others, please specify.

9. What is SCD?

[ ] A disease that causes the red blood cell to become sickled

[ ] A hereditary blood disorder that causes the affected individual to fall sick often

[ ] A sexually transmitted disease

[ ] I don’t know

10. Do you know anyone suffering from SCD?

[ ] Yes [ ] No

11. If yes, who has the condition? (Select all that apply)

[ ] Father [ ] Mother [ ] Brother [ ] Sister [ ] Friend [ ]

Relative

[ ] School mate Other specify ……………………………………………………

12. Is SCD a lifelong condition?

[ ] Yes [ ] No

13. Which of the following is a symptom of SCD? (Please select all that apply)

a) Chest pain [ ]

b) Bone pain [ ]

c) Joint pain [ ]

d) Swollen hands and feet [ ]

48
 e) Persons falling sick often [ ]

f) Sickness that comes with cold weather [ ]

g) Difficulty breathing [ ]

Others, specify………………………………………………………………………………

14. Who gets SCD?

[ ] Children [ ] Youth [ ] Old aged people [ ] Everyone is equally to

get

Others,

specify………………………………………………………………………………….

15. How does one gets SCD?

[ ] Inherited [ ] Witchcraft/curses [ ] Through infection

Other specify …………………………….

16. How SCD is diagnosed?

[ ] Blood test [ ] Urine test [ ] I don’t know

17. Is there a cure for SCD?

[ ] Yes [ ] No

18. Which genotype causes sickle cell disease?

[ ] AA [ ] AS [ ] SS [ ] I don’t know

19. Do you know what your sickle genotype is?

[ ] Yes [ ] No

SECTION C: ATTITUDE TOWARDS SCD

20. Have you ever tested for SCD?

[ ] Yes [ ] No

21. People with SCD should be isolated from others?

[ ] Yes [ ] No
49
22. People with SCD should not be enrolled in schools?

[ ] Yes [ ] No

23. Would you make friends with people with SCD?

[ ] Yes [ ] No

24. Will accept person living with SCD as your room mate?

[ ] Yes [ ] No

25. Will you study with person living with SCD?

[ ] Yes [ ] No

26. Will you invite a person living with SCD to your birthday party?

[ ] Yes [ ] No

27. Will you eat with a person living with SCD?

[ ] Yes [ ] No

28. Would you undergo premarital genetic counselling?

[ ] Yes [ ] No (If No, go to question 30)

29. If YES, why?

[ ] To prevent transmission of diseases to my offspring

[ ] To ensure that my partner is healthy

[ ] To ensure fitness for marriage

[ ] To prevent transmission of diseases to me

[ ] I don’t have a reason

30. Why would you NOT undergo premarital genetic screening?

[ ] Afraid that the test results will not be in favor of my choice

[ ] Don’t want to interfere with God’s will

[ ] Afraid that a positive test will prevent continuation of romantic relationship

[ ] Family will refuse marriage

[ ] I don’t have a reason

50
31. What would you do about your relationship if premarital genetic screening reveals that you

might produce children with SCD? (Select all that apply)

[ ] End the relationship Continue relationship due to emotional reasons

[ ] Continue relationship due to family pressure

[ ] Continue the relationship because I believe in God

[ ] I don’t know what to do

32. To aid education on SCD, what do you think would be the best way to educate your

community on SCD?

…………………………………………………………………………………………………

…………………………………………………………………………………………………

…………………………………………………………………………………………………

…………………………………………………………………………………………………

……………………

THANK YOU!

51