CORRELATES OF PERCEIVED PEER VICTIMIZATION AMONG ADOLESCENTS WITH SICKLE CELL DISEASE IN ABAKALIKI NIGERIA

Abstract

Background: Sickle cell disease is a hereditary haematological disorder that affects the hemoglobin inside the red blood cell (RBC). It is characterized by sickling of the red blood cell leading to obstruction of small vessels, impairment of blood flow, shortened RBC survival, anaemia and other complications. Bullying is defined as a discrete form of proactive antagonism characterized by a power imbalance between the perpetrator and victim that classically involves recurrence. Adolescents with sickle cell disease have markedly lower weights and height than matched controls (for age and gender). Studies have established a positive correlation between low self-esteem and peer victimization. Limited research has been conducted to explore the prevalence or potential experience of peer victimization among adolescents with sickle cell disease, a chronic disorder known to affect physical appearance and maturation among children and adolescents. However, studies have shown that sickle cell disease is associated with a lot of stigma (Horsselenberg et al., 2016; Linda et al, 2017) and a huge psychosocial burden both on individuals with sickle cell disease (Thomas and Taylor, 2002) and their families and caregivers (Adegoke and Kuteyi, 2012). Anecdotal evidence suggests teasing and bullying are common complaints among school-going children with SCD about 23% of the study population (Ohaeri and Shokunbi, 2002). This study is aimed at filling this gap in knowledge on the subject matter. METHODOLOGY: This was a comparative cross-sectional study. The cases were from the sickle cell clinic of the Federal Teaching Hospital Abakaliki (FETHA) while the controls were from Ebonyi State University (EBSU) Secondary School, Abakaliki. The participants were aged 10- 19 years. The groups consisted of 100 cases (47 males and 53 females) and 100 controls (49 males and 51 females). The weight and height of the participants were measured using a weighing scale and stadiometer respectively. All participants were evaluated with the socio-demographic and health questionnaire, the Rosenberg self-esteem scale and the Multidimensional Peer Victimization Scale. Data were analysed using SPSS version 21. Descriptive statistics were used to find the prevalence of peer victimization among the two groups (cases and controls). The cases were adolescents with sickle cell disease who were attending the sickle cell clinic at FETHA while the controls were adolescents with normal haemoglobin types from EBSU secondary school Abakaliki. The difference between the two groups (cases and control groups) for categorical variables like gender, religion, educational level of participants, marital status of parents, mother’s occupation, the family type was obtained using Chi-square. The differences in the mean scores of outcome variables like age, height, weight, peer victimization scores and self-esteem scores were obtained using a t-test. The multiple linear regression and Pearson correlation were used to find the associations between the independent (height, weight, body mass index (BMI), self-esteem) and the dependent variables. All calculations were based on a significance level of p<0.05. Results: The prevalence of perceived victimization among SCD respondents was 18% compared to 14% among the controls group. The mean total victimization scores were significantly higher among the SCD group compared to the control group (15.67 ± 8.11 versus 11.70 ± 6.94, p< 0.05). Both verbal and physical victimization were significantly higher among SCD respondents compared to controls (p<0.05). Victimization was significantly higher among females (p<0.05) than their male counterparts. Victimization was also found to be more among the younger SCD respondents between age range 10-12 years compared to controls of the same age range. Both males and females of the SCD group weighed significantly less than their control counterparts. Bivariate analysis showed a negative correlation between victimization scores and the age of respondents with SCD (Pearson correlations: -0.437, p<0.05). Also, a significant negative value correlation was observed between victimization scores and the weight of respondents with SCD (Pearson correlation: -0.395, p<0.05). The mean total self-esteem score was 27.58 ± 3.32 and was significantly lower among the SCD group compared to the control group (p<0.05). Conclusion: I am a paediatric resident doctor. During my day-to-day practice, I come in contact with patients with sickle cell disease. I became interested in this study because of the numerous psychosocial concerns of my patients including most importantly teasing due to their body size, frequent absenteeism from school, frequent urination and the need to drink plenty of water. This prompted me to conduct this study to determine the correlates of peer victimization among adolescents with sickle cell disease in order to make a case for policymakers to make policies that will protect sickle cell adolescents from victimization and also institute interventions in schools, at home and in faith-based organizations. This study found that adolescents with sickle cell disease were more prone to victimization especially verbal and physical victimization compared to healthy adolescents with normal haemoglobin types. Victimization was also found to be more in those who were smaller in size, younger and females. Though their self-esteem scores were lower than those of healthy controls, it was not found to predispose them more to victimization