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