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KNOWLEDGE AND ATTITUDE AS CORRELATE OF ADDHERENCE TO PREMARITAL SICKLE CELL SCREENING AMONG ADULT STUDENTS’ OF NNAMDI AZIKIWE UNIVERSITY AWKA, ANAMBRA STATE

NURSING SCIENCE PROJECT TOPICS AND MATERIALS

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.

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