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A COMPARATIVE STUDY OF SICKLE CELL DISEASE AND RHESUS FACTOR COMPARABILITY AMONG COUPLES

CHAPTER ONE

INTRODUCTION

1.1 BACKGROUND TO STUDY

The prevalence of sickle cell anemia and Rhesus factor comparability have increased overtime time in Nigeria; thus causing an increase in mortality rate among children especially those below twenty (20) years of age (Kulkarni, 2007). It is widely believe that the causes of sickle cell anemia and Rhesus factor incompatibility is due to a high level of ignorance on the dangers posed by these disease. The federal government of Nigeria through the NGOs and the media has put in so much effort on awareness campaign on how to control the occurrence of these diseases especially for the young ones that are about the ages of getting married. Sickle cell disease (SCD) can simply be defined as a hereditary disorder in which an individual has inherited two abnormal Hb genes, at least one of which is responsible for the production of sickle Hb (HbS) (Creary et al., 2007). The most common clinical phenotype is the homozygote, i.e. HbSS, also known as sickle cell anaemia. Compound heterozygotes include HbSC, SD, SO-Arab and Sbthal, which are all collectively (in addition to SS) referred to as SCD. The sickle-shaped red blood cells described by Herrick caused several complications, including chronic anemia, vaso-occlusive pain episodes, ischemic organ damage, infections, small stature, and delayed puberty (Barakat et al., 2008). For many generations sickle cell disease has been a prevalent disorder in Nigeria. Reports show that sickle cell disease was a well-known disorder in most states in Nigeria and that the natives in Nigeria had several local names for this disease before it was discovered in America (Reid & Rodgers, 2007).

According to Modell B, (2007) stated that the HbS gene became prevalent in different parts of the world following selective pressure because the heterozygote (HbAS) is protected against some of the deleterious effects of malaria. Therefore, SCD is found at its highest frequencies in parts of the world where malaria is or was endemic. In the same vein, Fleming AF, (2008) stated that because of slave trade and recent migrations, it is now found even more widely including in Europe and the USA. Nonetheless, the prevalence is highest in tropical Africa and, indeed, the country with the highest burden is Nigeria where the trait occurs in 25–30% and sickle cell anaemia occurs in approximately 2% of all births

The most common features of SCD are chronic haemolytic anaemia and recurrent vaso-occlusion. The latter is responsible for the painful crises that characterise the disease. There is also a chronic vasculopathy triggered by free heme resulting in nitric oxide scavenging and upregulation of adhesion molecules in reticulocytes, neutrophils and endothelial cells (Wood KC, 2008). This is further complicated by a procoagulant state following the activation of platelets. There is smooth muscle dystonia and eventual hyperplasia, which contributes to vascular occlusions (Morris CR, 2009). This explains the plethora of features and complications seen in SCD. The major cause of mortality in childhood is overwhelming bacterial infections especially due to encapsulated organisms, principally pneumococcus. On the other hand Rh is short for Rhesus blood group system. The Rh blood type contains parts called antigens including the D antigen. If the D antigen is present, a person is considered to be Rh positive. If the D antigen is absent, the person is said to be Rh negative. About 85% of Nigerians have an Rh positive blood type, while the remaining 15% are Rh negative. The Rhesus factor is very important to the human body; however there might variation in compatibility which results to Rhesus disease.

A study of Rh disease deepens our understanding of historical infant mortality in general and perinatal mortality in particular. The decline of infant mortality in Nigeria started around 1800, which is earlier than in most other countries. At that time, rates were very high even if the Nigerians as well as other African countries levels were low in international comparison (Edvinsson et al. 2008). However there have been several awareness campaigns on the sickle cell disease and Rhesus factor comparability among couples in Nigeria. The use of mass media and other medium may help in the dissemination of information on sickle cell and Rhesus factor among couples in Nigeria.

1.2 STATEMENT OF PROBLEM

Sickle cell disease and Rhesus factor issue has been prevalent in Nigeria for a very long time now. Families and friends have lost lives to these ailments as a result of lack of awareness on the preventive measures to be taken to control the ailments. The federal government of Nigeria has channeled lots of funds to the medical centers in Nigeria to help salvage the situation but the incidence is still on the increase. Take yenegoa and portharcourt for example, there are several factors that can lead to the increase in sickle cell disease and Rhesus factor disease; Viz:

1.  high level of illiteracy

2.  lack of awareness campaign on the effect of sickle cell disease and Rhesus factor among couples

3.  low standard of living  

4.  poor medical facilities and

5.  lack of counseling before marriage

 It is to this regard that the researcher desire to carry out a comparative study on sickle cell disease and Rhesus factor awareness campaign using mass media.

1.3 AIM AND OBJECTIVES OF STUDY

The main aim of the research work is to carry out a comparative study of sickle cell disease and Rhesus factor comparability among couples in Yenegoa and Port Harcourt. Other specific objectives of study are:

1.  to examine whether media campaign has a role to play in the level of awareness on sickle cell and Rhesus factor among couples in Yenegoa and port Harcourt

2.  to examine whether counseling before marriage will help control the prevalence of sickle cell and Rhesus factor among couples in Nigeria

3.  to determine whether low standard of living will increase the mortality rate among children with sickle cell disease

4.  to determine the effect of Rhesus factor and sickle cell on child mortality rate in Yenegoa and port Harcourt

5.  to determine the extent to which availability of drugs and medical facilities controls sickle cell disease and Rhesus factor in Yenegoa and Port Harcourt

1.4 RESEARCH QUESTIONS

The study came up with research questions so as to ascertain the above stated objectives. The research questions for the study are:

1.  What is the difference in effectiveness of media campaign on sickle cell and Rhesus factor?

2.  Does media campaign play a role in the level of awareness on sickle cell and Rhesus factor among couples in Yenegoa and Port Harcourt?

3.  Does counseling before marriage help control the prevalence of sickle cell and Rhesus factor among couples in Nigeria?

4.  What is the effect of standard of living on mortality rate among children with sickle cell disease?

5.  to determine the effect of Rhesus factor and sickle cell on child mortality rate in Yenegoa and port Harcourt

6.  To what extent does availability of drugs and medical facilities controls sickle cell disease and Rhesus factor in Yenegoa and Port Harcourt?

1.5 STATEMENT OF RESEARCH HYPOTHESIS

Hypothesis 1

H0: there is no significant the difference in effectiveness of media campaign on sickle cell and Rhesus factor

H1: there is significant the difference in effectiveness of media campaign on sickle cell and Rhesus factor

Hypothesis 2

H0: Rhesus factor and sickle cell have no significant effect on child mortality rate in Yenegoa and port harcourt

H1: Rhesus factor and sickle cell have significant effect on child mortality rate in Yenegoa and port harcourt

1.6 SIGNIFICANCE OF STUDY

The study on a comparative study of sickle cell disease and Rhesus factor comparability will be of immense benefit to couples in Yenegoa and Port Harcourt and the media because the study will compare the effectiveness of media campaign on sickle cell and that of Rhesus factor. The study will also serve as a source of literature for other researchers that desire to carry out similar research on the above topic. Finally the study will contribute to the body of existing literature and knowledge in this field of study and provide a basis for further research

1.7 SCOPE OF STUDY

The study on a comparative study of sickle cell disease and Rhesus factor comparability will be limited to the media house and the couples in Yenegoa and Port Harcourt. The study will cover for a period of seventeen years (2000-2017).

1.8 LIMITATION OF STUDY

The only problem the researcher had in getting information from the respondents on sickle cell and Rhesus factor was the unwillingness of the respondents to give information about their health status. The might affect the information provided by the respondents but the researchers however was able to get good information as regard the research topic by making the respondents feel safe with whatever information they provided to the researcher.

1.9 DEFINITION OF TERMS

Sickle cell: A group of disorders among couples in Yenegoa and Port Harcourt that cause red blood cells to become misshapen and break down

Rhesus factor: Rhesus factor in accordance to the study isan antigen occurring on the red blood cells of couples in Yenegoa and Port Harcourt (around 85 per cent) and some other primates

Antigen: a toxin or other foreign substance which induces an immune response in the body, especially the production of antibodies

Genetic counseling: Communication process between health care provider and client that emphasizes and provides accurate and up-to-date information about a genetic disorder in a sensitive and supportive, non-directive manner (SCDAA, 2005).

Hemoglobin: Chemical substance (an iron containing protein) of the red blood cell, which carries oxygen to the tissues, and gives the cell its red color (SCDAA, 2005).

Hemoglobin A (HbA): Hemoglobin is composed of two alpha globins and two beta globins, normally produced by children and adults (Jones, 2008, p. 119).

Hemoglobin C trait (AC): Inheritance of one gene for the usual hemoglobin (A) and one gene for hemoglobin (C). A person who has the hemoglobin C Trait (AC) is a carrier of the hemoglobin C gene, and is not affected by the gene (SCDAA, 2005).

Hemoglobin C disease: A person has both HbS and HbC and is often referred to as “HbSC.” Hemoglobin C causes red blood cells to develop. Having just some hemoglobin C and normal hemoglobin, a person will not have any symptoms of anemia. However, if the sickle hemoglobin S is combined with the target cell, some mild to moderate anemia may occur (UMMC, 2010).

Hemoglobin E disease: Similar to sickle cell-C disease except that an element has been replaced in the hemoglobin molecule under certain conditions, such as exhaustion, hypoxia, severe infection, and/or iron deficiency

Sickle cell trait: A person carrying the defective gene, HbS, but also has some normal hemoglobin HbA. Persons with the sickle cell trait are usually without symptoms of the disease, but mild anemia may occur under intense, stressful conditions, exhaustion, hypoxia (low oxygen), and/or severe infection. The sickling of the defective hemoglobin may occur and result in some complications associated with sickle cell disease.