This document provides an introduction and background to a study on sickle cell anemia (SCA) in Jos North, Nigeria. It discusses SCA as a genetic blood disorder with high morbidity and mortality. The incidence, prevalence, diagnosis and treatment of SCA in Jos North is examined. Improving outcomes for children with SCA through early diagnosis, prophylactic therapy and bone marrow transplants is discussed. The research problem is identified as a lack of knowledge among residents about SCA implications and the need for screening before marriage. The study aims to educate residents on SCA and identify carriers to reduce disease transmission risk. The scope covers selected primary health centers in Jos North.

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CHAPTER ONE
INTRODUCTION
1.1 BACKGROUND TO THE STUDY
Sickle cell Anaemia (SCA) is a genetic disorder affecting red blood cells with high
morbidity and mortalty rates the nations has recognized (SCA sickle cell Anaemia) as a
global public health concern and and the world health organization (WHO)
recommends that 50% of member states will have established SCA (Sickle cell
Anaemia) control programs by 2020 (world health organization) 2006 WHO.
In Nigeria, the federal ministry of health with the collaboration of world health
organization plays avital roles forward the control of the sickle cell anaemia.
The incidence, prevalence, morbidity and mortality the current diagnosis and
treatment and recommendations for practice,policy and research to improve health
outcomes of the children with sickle cell Anaemia (SCA)2002 at Nigeria in jos north.
The have been significant improvement in the morbidity and mortality rates for
children with SCA in high resource countries such as united states due to factors such as
early diagnosis through newborn screening programs,, prophylactic therapy, and bone
narrow transplant many of these interventions can confer the same benefits to SCA
patients in Nigeria by (Aygun & Odame,2012) in 2008.
Newborn screening for SCA, developing partnerships between high resource countries
and countries in Africa to support training of healthcare workers, research and sharing of
knowledge can help to reduce the SCA burden in Nigeria.

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Nigeria has the largest population of people with SCA in the world with over 150,000
babies with the serious condition every year according to Mr lanre Alege. A pharmacist
at the university of Ilorin teaching hospital. Mr Lanre also said it was estimated that
only five percent of the children with SCA live past the age of 10 in Nigeria compared to
over 96 percent surviving into the adult hood in the united kingdom and the united
states. USA.
In jos north, the plateau state ministry of health with the collaboration of united nations
international children fund (UNICEF) sentitised the community on the implication of the
sickle cell anaemia by free diagnosis through newborn seceening programs 2012.
Sickle cell anaemia occurs when a person ‘inherits the abnormal copies of
the haemoglobingene. One from each parent, this gene occurs in chromosome II several
subtypes exist depending on the exact mutation in each haemoglobin gene an attack can
be set off by temperature changes, stress dehydration and high attitude. A person with a
single abnormal copy does not usually have symptoms and is said to have sickle cell
tract such people are also refered to as carriers diagnosis is by blood antest and some
countries test all babies at birth for the disease. Diagnosis is also possible during
pregnancy the allele responsible for sickle cell anaemia can be found on the short arm of
chromosome II more specifically 11p 15.5 by white more and knafi (2005).
A person who reserves the detective gone from both father and mother develops the
disease. A person who reserves one detective and one healthy allele remains healthy. But
can pass on the disease and is known as carrier or hetetrozygotes, heterozygote are still

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able to contract malaria but their symptoms are generally less severe (Ahmad etal.,
2008).
Sickling of the red blood cells on a blood film can be induced by the addition of
sodium metabi sulfite. The presence of sickle haemoglobin can also be demonstrated
with the “sick solubility test” A mixture of haemoglobin s (Hbs) in a reducing solution
(such as sodium dittionite) gives a turbid appearance where as normal Hb gives a clear
solution.
A test was first in the medical literature by the America physician James B. Herrick
in 1910 in 1949 the genetic transmission was determined by E.A Beet and J.V Neel. in
1954 the protective effect against malaria of suckle cell trait.
1.2 STATEMENT OF THE RESEARCH PROBLEM
The dwellers of jos north are facing a lot of challenges after getting married to the wrong
partners or couple due to the lack of knowledge on the sickle cell anaemia (SCA) or
disease.
Most of SCA carriers are marrying the same carriers as like them without going for
medical check-up (medical test) for them to know their status. This lead to giving birth
to SCA as SS.
Most of the dwellers of jos north are not going for medical test before marriage, thereby
facing a lot of problems in marrying carriers as AS+AS.
Medical test is necessary before marriages, so that the risk of spraging the disease can
reduce. The risk of transmitting diseases is very common.

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It is with the light of the above at this study seek to investigate the prevalance at
S.C.A among children 3-7 years in the study areas.
1.3 RESEARCH QUESTION
1- What are the implications of sickle cell anaemia in children between the ages of 3-7
years in the study area?
2- What are the diseases that help to avoid blood transfusion without screening in the
study area?
3- How does the sickle cell anaemia help to avoid marriage before test?
4- How to identify the carriers?
1.4 AIM AND OBJECTIVES OF THE STUDY
Aim
The aim of the research work is to educate the dwellers of jos on the implications of the
sickle cell anaemia as well as its precaution of the disease.
Objectives of the study
1- To educate the dwellers of jos north on the implication of sickle cell disease and the
presentation of the disease.
2- To identify the marriage partner.
3-To examine the blood before transfusion.
4-To identify the carriers by genotype test and blood test.

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5-To helps the dwellers of the community to know their genotype and blood group.
1.5 SIGNIFICANCE OF THE STUDY
The significant of prevalence of sickle cell anaemia in jos north, results from a birth
cohort study indicate the necessity for newborn screening.
This research work helps to cheating awareness on the consequences and
implication of sickle cell disease SCD in jos north. also helps the dwellers of the area in
knowing whom to marry and whom not to be marry be genotype and blood test.
The research project well helps the area to know the following;
A- Sickle cell disease
B-Causes
C-Prevention
D- Sign and symptoms.
And especially to our various hold with the community in the study area.
1.6 SCOPE OF THE STUDY
This study is limited to jos north L.G.A areas;
A-Ali-Kazaure primary health care (PHC)
B-Abba Na shehu primary health care (PHC)
C-Anguwan Rogo primary health care (PHC)

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D-Dogon Agogo priamary health care (PHC)
The scope of the research work covers some primary health care. Carriers couples as
well as individuals.

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CHAPTER TWO
INTRODUCTION AND LITERATURE REVIEW
2.1 Introduction
Sickle cell anaemia or sickle cell diseases is an inherited disease that affects the
production of hemoglobin (HEE-uh-gloh-bin) hemoglobin is the component of the red
blood cells that carriers oxygen from the oxygen-rich environment of the lungs to the
relatively oxygen-poor environment of other body tissues. In sickle cell disease ,the
hemoglobin is abnormal. In the bodys tissues. Where the oxygen level is low. The
abnormal hemoglobin sticks together to form climps, which causes the normally disc-
shaped red blood cells to become shaped like crescents or sickles. These malformed
cells obstruct the small-blood vessels (capillaries) this obstruction causes recurring
painful episodes called sickle cell pain orises. The interrupted blood flow can cause
tissue change.
The abnormal hemoglobin that causes sickle cell anaemia is called “hemoglobin
S” as stated before, sickle cell anaemia is an inherited disease. Carried as an autosomal
resessive traits. This means that both parents must carry the hemoglobin S gene. And
each child would then have one chance in four of having sickle cell anaemia.
Other conditions are grouped with sickle cell disease, including beta thalassemia
and hemoglobin SC disease. Which occur when hemoglobin S is inherited from one
parent. A who inherits hemoglobin S from one parent and normal hemoglobin a from the

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other parent will have sickle cell trait. An individual with sickle cell trait or one of these
other conditions usually will have no symptoms. if symptoms are present, they are likely
to have be very mild occasionally, a person with these conditions will have symptoms
similar to sickle cell anaemia. The course of sickle cell anaemia varies from patients to
patients.
2.2 Meaning
Sickles cell anaemia (SCA) is a genetic blood disorder affecting red blood cells, with a
high morbidity and mortality rates sickle cell haemoglobin (Hbs) is a structural variant
of normal adult haemoglobin (HbA) (Chakravorty & Welliams,2015).
Sickle cell anaemia (SCA) includes a series of pathological genotypes resulting
from the inheritance of HbS. SCA affects 20-25 million people globally and 50-80% of
infants born with SCD in Africa due before the age of 5years (Aygun and Odame,2012).
It’s estimated that 240,000 children are born with SCA annually in sub-saharan Africa
(Makani etal, 2011).
Sickles cell Anaemia is a inheritances diseases, from the person’s parent. It’s also
estimated that 137 children are born with the diseases annually in jos north local
government area plateau state. (Dr, Haruna Sati, HOD Diagnosis university of jos
teaching hospital jos Juth).
The United Nations general assembly has recognized SCA as a global public
health concern due to the morbidity and mortality caused by the diseases and significant
social and economic impact that results. (United Nation General Assembly, 2009).

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2.3 Causes
It is a genetic disease normally inherited from the parents of the body. It’s results in an
abnormality in the oxygen- carrying protein haemoglobin (hemoglobin S) found in red
blood cells sickle cell disease occurs when a person inherits the abnormal copies of the
haemoglobin gene one from each parent. This gene occurs in chromosome II several
subtypes exist. Depending on the exact mutation in each haemoglobin gene.
A person with a single abnormal copy does not usually have symptoms and is said to
have sickle-cell tract that person also referred to as carriers AS. The diagnosis is by a
blood test. Diagnosis is also possible during pregnancy. (Odame etal, 2012).
Sickle cell anaemia(Sickle cell disease) is a disorder of the blood caused by an inherited
abnormal hemoglobin (the oxygen- carrying protein within the red blood cells) the
abnormal hemoglobin causes distorted (Sickled) red blood cells. The sickled red blood
cells are fragile and prone to rupture (www.webcrawler.com).
2.4 Prevention
Effective management of SCA revolves around genetic counseling, neonatal screening
and early diagnosis; prophylaxis with immunizations.
Bone marrow transplantation in a selected segment of patients is the only
proven cure for sickle cell Anemia (SCA) to date (Walters etals,2001) but this is an
explensive treatment and in 2004 sergement and Ndugwa noted that this option is not

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feasible as a public health approach in low resource countries (Seryeant and
Ndugwa,2004).
Sickle cell anaemia as an inherited disease passed from parent to offspring.
According to the Ndugwa 2004.
Knows whom to marry
AA ++ AS can marry
AS + SS cannot marry
AA + AA can marry
SS + SS cannot marry
AS + AS cannot marry
2.5 Signs and Symptoms
Sickle cell anemia usually manifests early in childhood. Complaints may include the
following;
i- Acute and chronic pain in any body part: the most common clinical manifestation of
SCA is vaso- occlusive ensis pain crises are the most distinguishing clinical feature
SCA.
ii- Bone pain: The long bones of the extremitics are often involved often due to bone
marrow infarction.
iii- Anemia: universally present chronic and hemolytic in nature.

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iv- Aplastic onsis: Serious complication due to infection with B19V.
v- splenic sequestration characterized by the onset of life- threatening anemia with rapid
enlaregement of the spleen and high reticulocyte count.
vi- Infection: organisms that pose the greatest danger include encapsulated respiratory
bacteria particularly streptococcus pneumonia, adult infections are pnedominately with
gram- negative organisms especially salmonella.
vii- Growth retardation: delayed sexual maturation,being under weight.
viii-Acute chest syndrome: young children present with chest pain,fever,cough tachynea,
leukocytosis and pulymonary infiltrates in upper lobes, adults are usually a febrile
dyspnece with severe chest pain, with multiple bar / lower lobe disease.
A- Dermatologic involvement, legulcers are a chronic painful problem.
B- Gi involvement chole lithiasis is common in children liver may becom involved.
C- Cardiac involvement: Dilation of both ventricles and left atrium.
D- Ophthalmologic involvement: Ptosis,retinal vascular changes, proliferative retinitics.
E- C.N.S (control nervous system) involvement most severe manifestation is stroke
(Jame.B. Herrick in 1910).
F- A yellowish colour of the skin known as youndice or whites of the eyes, known as
leteris that occurs when a large number of red-blood cells hemolyse.

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CHAPTER THREE
RESEARCH AND METHODOLOGY
3.1 Introduction
This chapter deal with the methodology adopted for this study which include the
research designed, population of the research of study, sampling technigues and sample
size,method of data collection, instr ument of data collection, method of data
presentation and analysis.
3.2 Research Design
The research designed used for study was a sample examined Odame (2012) stated
that through investigation and examing existed disease prevailing, circumstances beliefs,
attitude or ongoing process (incase and policees). The main purpose of applying the or
examined method research therefore, is to enable the researcher investigate into the
nature or existing circumstances, attitude, belief or ongoing process of prevalence of
sickle cell anemia or disease in some selected primary health care in jos north local
government area, plateau state.
3.3 Population of the Study
The population of this study involves all the primary health cares in jos north local
government area, plateau state but due to some problem or one reasons to the other the
research work will cover some of the selected primary health care in jos north local
government area. Therefore the research work covers four primary heath cares in the
area.

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3.4 Sampling Technigues and Sample Size
Some part of the local government area was taken as a sample which consists as the
most populated areas. Some part of the local government area sampled inorder to get
desired information.
Four copies of questionnaires were given to each primary health care’s staffs
(nurses) in four healthcare making a total of sixteen copies.
3.5 Method of Data Collection
The project obtained information from the distribution of questionnaires, friends
relatives, parents, (mothers and father) Doctors, nurses, leaners and carriers were
assisting me in distribution and collection of the questionnaires bacle to me while some
are distributed and collected by me.
Some filled and returned immediately but some requested more time to
thank fill and return the copy given to them a period of 1-2 weeks was given due to time
factor, the researcher had appropriate explained in the questionnaire to the respondents
some couples brought to explanation on how to answer the question in the questionnaire
and returned the completed questionnaires to the researcher.
3.6 Instrument of Data Collection
The instruction used for data collection while conducting the research are two and
they are questionnaire and interview the essence of using questionnaires is to establish
special fact about the research work.

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Hence they are expected to respond to questions that are specifically
designed to determine the prevalence of sickle cell disease of the research work
questionnaire always have the tendency of limiting the extent to which one will freely
express his view on issue under consideration.
3.7 Method of Data Presentation and Analysis
In the research work data were be presented in such a way that will make it simple to
the respondents, and the researcher.
Data analysis, all the data collected were serutinised and tabulated for easy
interpretation, they were analysed according to the responses of the nurses the frequency
counts of these responses were recorded and the sample percentage was used to analyze
the data collected.
Each table containing the topic of the project under study undreath each table
there is discussion for more clarification.

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CHAPTER FOUR
DATA ANALYSIS
4.1 Introduction
The data collected through the use of questionnaires is here by tabulated analysed and
discussed the data presented according to the sections of questionnaires.
4.2 Data Presentation and Analysis
As I ready mentioned in chapter three that sixteen (16) copies of questionnaires were
properly distributed to the doctors, nurses, patients carriers (ss) clearners as well as the
residents return back. Thus those questionnaires distributed to the above mentioned
respondents were presented and analysed under the following tables: the keys
S.D=Strongly Disagree D=Disagree N=Neutral, A=Agree S.A=Strongly Agree.
Table 1: To identify the carriers (ss) in the area:
Respondents Frequency Percentages
S.D 20% 20%
D 0% 10%
N 0% 20%
A 10% 10%
S.A 20% 40%
Total 50% 100%

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Sources: field secence of 2018.
The aboved table shows clearly that the percentages of the respondents that strongly
agree (S.A) is 40% that means the doctors, nurses as well as the residents can identify
the carriers at the study area.
Table 2: To identify the death rate of children between the age of 3-7 in the study area.
Respondents Frequency Percentages
S.D 0% 0%
D 0% 0%
N 10% 20%
A 20% 30%
S.A 20% 50%
Total 50% 100%
The source: field secence of 2018.
The above mentioned table shows clearly that the death rate of the children with
disease is increasing best on the respond from the doctors, nurses, as well as the
residents at 50% (percentages) every year in the study area.

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Table 3: To identify and know whom to marry in the study area.
Respondents Frequency Percentages
S.D 20% 40%
D 10% 10%
N 10% 30%
A 10% 20%
S.A 0% 0%
Total 50% 100%
Sources: field secence of 2018.
The table above mentioned or shows clearly that the respondents total or strongly
disagree of whom to marry in the study area because of their beliefs and culture it shows
that 40% out of 100% (Percentages) are strongly disagree in the study area.
4.3 Recommendation
At this point for us to have effective and qualitetive prevention of spread sickle cell
anaemia or diseases respectively within jos north local government area, plateau state.
The following should be considered;
1- Conference, Seminars and workshop should be organized for the couples, parents, as
well as nurses, cleaners, doctors, to have knowledge about the sickle cell anaemia.
2- The government should also encourage the societies in medical testing.

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3- The government should also provide a counselor in primary health care so that the
couples, parent, patients should knows the important of medical test before marriage.
4- There is need for the government to establish a policy of medical certificate before
marriage.
5- The hospital counselors should be restricted on such activities sickle cell anaemia and
others gene diseases.

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REFERENCE
An America physician James, B., Herrick in 1910 in 1949 also Supported by E.A,
Beet, and J.V, Neel., (1954).
Ayugun, and Odame., (2012) in 2008.
University of jos Teaching Hospital Juth, in a paper presented the Statistics of Patient,
(Carriers (ss) ) of Sickle Cell Anaemia by Mr lanne, Alege., A (A Pharmacist).
Walters etals., 2001.
World Health Organisation (W.H.O) Seminar on the cases of Sickle Cell Disease, 2006.

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CHAPTER FIVE
SUMMARY, CONCLUSION AND RECOMMENDATION
5.1 Introduction
This chapter consists of the summary of the whole project. The conclusion and
recommendations done to both carriers (Patients) ss. Nurses, and residence of jos north
local government area, plateau state.
5.2 Summary of Findings
The purpose of this research was to find out the prevalence of sickle cell anaemia
(Disease) among children between the age of 3-7years within a jos north local
government area in some selected primary health care jos north, plateau state.
The researcher made close investigation as regard to the prevalence of sickle cell
anaemia in the following areas.
(A) The level of awareness of the sickle cell disease (Anaemia) in jos north local
government area.
(B) The level of medication to the carriers (ss).
(C) The transmitting of sickle cell disease from parent to their offspring.
(D) The degree of involvement of the government in preventing and treating patient.
(E) The interest of the residents in genotype test.

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In view of the above mentioned, were by questionnaires are properly administered to the
carriers,(ss).Nurses, Couples, Doctors, and residents of sampled area.
This project was made up of five (5) chapters, the chapter one comprised of introduction
of the entire work which give a brief history of tsanyawa local government areas aim
and objectives of the project were stated. Significances of the study, scope and
limitation of the project were clearly explained.
Chapter two (2) consists of literature review which comprises of the brief historical
development of sickle cell anaemia, prevention, causes, sign and symtoms of sickle cell
anaemia.
Chapter three (3) described the methodology which explained the research design
area of study, population of the study, sample and sampling technique, data presentation
and interpretation instrument of the study which was a questionnaire, method of data
collection were sixteen (16) copies of questionnaires given to doctors, nurses, cleaners,
patients, couples in the sampled area study and fourteen copies were returned to the
researchers, method of data analysis was also explained.
Chapter four (4) contains data analysis which tables are used showing frequency
counts and percentages of each respondent.
Chapter five (5) it deals with a brief summary of the whole work. The conclusion
of the major findings of the research and recommendations done by researchers to the
doctors, nurses, carriers (ss) cleaners and recommendation for further research.

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5.3 Conclusion
The investigations were able to find out a prevalence of sickle cell anaemia in
children between the age of 3-7yrs. In the area of reference. It has been revealed by the
investigation that the programmes in affected with a prevalence of sickle cell anaemia in
children with a numbers of problems which include in adequate finding of government,
illiteracy lack of awareness, inadequate support of genotype test from couples parent,
absence of medical tests before marriages. Inadequate support from couples lack of
involvement of cousellors to others hospital activities such as couselling, societal
general anentation and societal misperception among others.
Thus it could be difficult for the programme toeffectively run in the government
mentioned above. Therefore there is need to eradicate transmission of sickle cell
anaemia in jos north local government area, plateau state.