ABSTRACT
Existing health programmes in Nigeria for young people mostly target children below 5 years. Both quantitative and qualitative techniques were used to assess perspectives of male and female adolescents on common diseases they experience and medicines used for treatment during a three month study in a boarding secondary school in Owerri, Imo State of Nigeria. Malaria was named and ranked as the most severe and frequently experienced disease followed by diarrhea. High body temperature, headache and loss of appetite are some of the symptoms recognized during illness. Pharmaceuticals including paracetamol, fansidar, flagyl, pro-cold and ampicillin were used for treatment of illnesses. These are administered by the school nurse or by self medication and were obtained mainly from drug shops. The healthcare needs and priorities of adolescents are infectious diseases which they could readily identify. This underscores the need and relevance of implementing school based health programmes in secondary schools in Nigeria.
CHAPTER ONE
INTRODUCTION
1.1 Background to the study
Adolescence is sometimes viewed as a transitional state, during which youths begin to separate from their parents but still lack clearly defined role in society. It is regarded as an emotionally intense and often stressful period (National Teachers Institute, 2002). However, it should be noted that adolescence is typically a time for experimenting with risky behaviours, despite good parenting practices and role modeling (Ezedum, 2001, 2002, 2003). In both developed and developing countries adolescents can face overwhelming problems, among them early pregnancy, substance abuse and violence, making them more vulnerable to life-threatening diseases and conditions. Adolescents comprise 20% of the total world population, 85% of whom live in developing countries (International Clinical Epidemiology Network, 2005). Majority of secondary school boys and girls in Nigeria are adolescents. They represent a significant segment (44.8%) of the country’s population (United Nations Development Program, 2001). Reports suggest that adolescents, who also include those in Nigeria, face numerous challenges, which could be inimical to their health (Lee, Liao, Lee, Lu, & Chou, 1997; U.S. Department of Health and Human Services, 2003).
Health has been conceptualized in many ways. For example, it is viewed to mean optimal personal fitness for all fruitful and creative living (Cornacchia, 1991). It is also conceptualized to means a state of complete physical, mental and social well being and not merely the absence of disease or infirmity (World Health Organization, 1948). The above conceptualization implies that health operates in the three dimensions of human make-up namely: physical, mental and social. Consequent upon this therefore, issues on health problems could demand that the three aspects of human life be considered.
Physical dimension of health signifies the ability to perform tasks, and the basic process allows the individual to make intelligent decisions regarding his or her behaviour and the tasks him or her undertakes (Udoh, Fawole, Ajala, Okafor, & Nwana, 1987). Mental dimension of health is a state of well being in which the individual realizes his or her abilities, can work productively and fruitfully and is able to contribute to the development of his or her community (Okafor & Okafor, 1998). On the other hand, social dimension of health is the capacity of the individual to make social contacts and relationships with an ever widening circle of people and to derive pleasure and satisfaction from each of these people (Adeoye, 1981).
From the foregoing, it could be seen that the three dimensions of health are interrelated and must work in harmony for an individual to attain optimal health for effective living. Therefore, any disharmony in one or all the three dimensions of health could give rise to a myriad of health problems. Health problems are a departure from normal state of being, which are characterized by malfunctioning of the vital processes accompanied by marked symptoms and definite physical signs (Richard & Wagman, 2004). These health problems could be classified into physical, mental and social (Selkrik & Chinoweth, 2001) and have been observed among adolescent secondary school students elsewhere (Okoro & Ekoko, 2003).
Obollo-Afor education zone is located in one of the rural settings in Enugu State, Nigeria. It is considered a rural setting because it has no regional water and electricity supply. It is worth noting that one of the busiest highways leading to the northern parts of Nigeria transverses the education zone. Obollo-Afor, the headquarters, is likened to a gateway to many major cities in northern Nigeria. Its location affords most lorry drivers traveling to the northern parts of Nigeria the opportunity of stopping over, often times, to take advantageof some gullible female secondary school students. Nigeria’s federal ministry of health had at one time declared Obollo-Afor a volatile area, where cases of social vices including illicit drug use, alcoholism, among others; capable of exposing susceptible individuals to a myriad of physical, mental and social health problems, is high and these risk behaviours have been observed among adolescents. Risk behaviours such as alcohol, cigarette, and marijuana use threaten physical and mental health and may increase the likelihood of engaging in other anti- social behaviours. For example, besides the psychological detriments, cigarette use often precedes marijuana and alcohol use and is concurrent with other risk behaviours such as fighting (Davis, 1999; U.S. Department of Health and Human Services, 1991) and secret cult activities.
Studies over the years documented various aspects of health problems among adolescent students in both developed and developing countries (Aaro, Laberg, & Wold, 1993; Anglin, Naylor, & Kaplan, 1996; Balogun, 1980; Cole, Allen, & Green, 1980; Igbanugo & Onibokun, 1993; Melgosa, 2001; Pastore & Techoco, 2004). However, none of these studies was conducted among secondary school students in Obollo-Afor education zone of Enugu state. Secondly, none of these studies considered gender as an important variable in susceptibility of health problems among students. The present study therefore was designed to determine the health problems among adolescent boys and girls in secondary schools in Obollo-Afor education zone of Enugu State. Three hypotheses, which stated that there would be no significant difference (p < .05) in the: (1) physical health problems, (2) mental health problems and (3) social health problems between boys and girls were postulated for verification.
The study is considered important because the data provided might guide health educators in initiating interventions that might help students avoid health-risk behaviours capable of exposing them to health problems. When students avoid health-risk behaviours they might attain an appreciable level of good health. Good health is basic to productive and efficient schoolwork by students. Students also need good health to make the best use of their talents in school, whereas health problems would detract from their potentials.
1.2 Statement Of Problem
School based health programme is a very important medium for addressing the health needs of children and adolescents. The World Health Organization stipulates that school health programmes should include HIV/AIDS and sexually transmitted diseases, violence and injury, unintended pregnancy and poor reproductive health, helminth infection, poor nutrition and food safety, poor sanitation and water control, lack of immunization, poor oral health, malaria, respiratory infections, psychological problems, alcohol, tobacco and illicit drug abuse (WHO, 1997). The World Bank and the United Nations Children’s Fund however have an essential public health package for school programmes which includes treatment of worm infections and micro nutrient deficiency and provision of health education (World Bank, 1993; UNICEF, 1995). Although health education is learnt as a subject in many Nigerian primary and secondary schools, the implemen- tation of school based health programmes has not been effective. Most health programmes are directed towards saving under five children from so called killer diseases through immunizations and other mechanisms such as the roll back malaria programme. Underlying this focus on younger children is the general idea that those above five years would have developed significant immunity to communicable diseases (WHO, 2000a; WHO, 2000b). Because of this adolescent group are most times neglec- ted, more disturbing is the fact that therapies are readily accessible in Nigerian markets, even on the streets without prior medical consultation (Adome et al., 2000).
The core question to this study therefore becomes how adolescents perceive and seek therapy for the common illness that they suffer.
This study is premised on the fact that from adolescence (12 years), a person’s thinking becomes logical and adolescents can interpret changes in their bodily experience and act upon it (7). The study sought to determine common diseases at school and medicines used to restore normality. Sub-questions were on: a) How adolescent’s experience common illnesses, (b) how they manage their conditions, (c) how they know they are ill, (d) how they determine severity of illness episodes, (e) which medicines they use for illnesses, (f) what criteria they use in medicine selection, and (g) where they get the medicines.
Based on secondary school student’s own perspective on health and healthcare, this study suggests the implementation of school based health programmes in schools and serious consideration of adolescents when planning health programmes. Moreover the need to introduce sexual health education in secondary schools is underscored.
1.3 Objective of the study
The main objective of the study is to examine the prevalence, causes and control of vunerable diseases among junior secondary school student in nigeria ( a case study of three common diseases). specifically the study aims:
a) To determine how the adolescent’s experience common illnesses
b) To examine how they manage their conditions
c) To examine how they know they are ill
d) To know how they determine severity of illness episodes
1.4 Research Question
a) How adolescent’s experience common illnesses
(b) how they manage their conditions
(c) how they know they are ill
(d) how they determine severity of illness episodes
(e) which medicines they use for illnesses
(f) what criteria they use in medicine selection
(g) where they get the medicines.
1.5 significance of the study
The result of the study will be useful, as baseline information in the design of educational interventions aimed at equipping secondary school students with knowledge and skills for taking responsibilities for their personal hygiene. Personal hygiene is comprehensive; embracing the care of all the parts of the body, therefore carrying out this study will provide a platform for improving the School Health Education Programmes for secondary schools in Nigeria. The findings from this study will also be useful in carrying out well planned, implemented and evaluated School Health Programmes with personal hygiene integrated into all the stages. The outcome of the study will also be a useful tool in promoting team work when carrying out intervention programmes on health in secondary schools.
Furthermore, the outcome of the study will reveal gaps in knowledge as well as inappropriate practices and perceptions which further research could be used to explore. Such an exploration will have an ultimate goal of generating adequate information overtime for guiding evidence based policy formulation relating to personal hygiene in school settings.
1.6 Scope/Limitation of the study
The study was carried out from May to August 2007 at a mixed boarding secondary school in Owerri, Imo State, Nigeria. This school was selected on purpose due to the principal’s willingness for the study to be conducted in his school, the status of the school as a mixed boarding school (boys and girls) and its easy accessibility. Furthermore, the selected school’s typical conditions reflect the general pattern of a good number of schools both in urban and rural areas.
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