CHAPTER ONE

INTRODUCTION

1.1 Background of the Study

Sickle cell anaemia is an inherited blood disorder that can affect an individual's physical health, psychological state, social relationships, and overall quality of life. It occurs when a person inherits the haemoglobin S gene from both parents, resulting in the production of abnormal haemoglobin that can cause red blood cells to become rigid and sickle-shaped under certain conditions. These abnormal cells may obstruct blood vessels, restrict the flow of oxygen to body tissues, and contribute to episodes of severe pain, anaemia, and organ complications. People living with sickle cell disease may also experience recurrent infections, fatigue, hospital admissions, and other health challenges that require continuous medical attention. The condition is therefore not simply a physical illness but one that may affect several dimensions of an individual's wellbeing (Federal Ministry of Health [FMOH], 2022).

Although sickle cell anaemia is a lifelong condition, appropriate medical management, psychological support, and access to healthcare can help affected individuals pursue their educational, occupational, and personal aspirations. Improvements in the management of sickle cell disease have made it increasingly important to consider outcomes beyond the control of physical symptoms. These outcomes include emotional stability, life satisfaction, social participation, academic engagement, and the ability to manage everyday responsibilities. A comprehensive approach to care should consequently address both the medical and psychosocial experiences of people living with the condition.

Sickle cell disease is a major public health concern, particularly in sub-Saharan Africa, where a substantial proportion of affected individuals are born. Nigeria carries a particularly high burden of the disease, making it an important national health and social welfare concern. The Nigerian national guidelines on sickle cell disease emphasise the need for appropriate clinical management, early identification, continued monitoring, and comprehensive support for affected individuals. The guidelines also recognise the broader consequences of the condition, including psychological difficulties, social stigma, educational disruption, and reduced quality of life (FMOH, 2022).

The experience of living with sickle cell anaemia can be especially demanding for university students because they must manage their health while meeting academic expectations and adapting to the social environment of higher education. University life often requires students to attend lectures, complete assignments, participate in practical activities, prepare for examinations, and maintain relationships with peers and lecturers. For students living with sickle cell anaemia, these responsibilities may become more difficult during episodes of pain, fatigue, illness, or hospitalisation. The unpredictability of these experiences can interfere with attendance, academic preparation, concentration, and participation in university activities.

Recent research conducted among Nigerian undergraduates has documented the ways in which sickle cell disease can affect students' academic experiences, emotional wellbeing, and interpersonal relationships. Adeleke et al. (2025) found that students living with the condition experienced disruptions to academic activities associated with recurrent pain crises, as well as frustration, emotional distress, and difficulties arising from stigma and strained social relationships. The study also identified social support from friends and family as an important source of encouragement for some participants. These findings demonstrate that the wellbeing of students with sickle cell disease is influenced not only by their physical symptoms but also by the psychological and social circumstances in which they pursue their education.

Psychological factors are particularly important in understanding how students respond to the demands of living with a chronic illness. These factors may include perceived stress, anxiety, depressive symptoms, coping strategies, self-esteem, resilience, and perceptions of personal control. Such characteristics can influence how students interpret their illness, respond to pain, manage uncertainty, seek assistance, and maintain their academic and social activities. For example, persistent anxiety about the possibility of another pain crisis may affect a student's confidence and participation in everyday activities. Similarly, prolonged emotional distress may make it more difficult to maintain motivation, concentration, and positive social relationships. These relationships should be examined carefully because psychological wellbeing can be influenced by physical symptoms, treatment experiences, financial circumstances, and the support available to the student.

Stress is a relevant psychological factor because students with sickle cell anaemia may experience pressure arising from the need to balance health management with academic responsibilities. The uncertainty surrounding the occurrence of pain crises or other complications may create additional concerns about missing lectures, falling behind academically, or failing to meet deadlines. Students may also worry about how classmates and lecturers perceive their condition. When such pressures are persistent, they may contribute to emotional exhaustion, anxiety, and reduced satisfaction with university life. Appropriate coping strategies and supportive educational environments may help students manage these pressures more effectively.

Anxiety and depressive symptoms are also important considerations in the wellbeing of individuals living with sickle cell disease. Recurrent pain, uncertainty about future health, limitations in daily activities, and concerns about academic progress may contribute to emotional difficulties. Some students may experience fear concerning the severity of their illness, while others may feel frustrated by the need to depend on medication, healthcare professionals, or assistance from family members and friends. Psychological difficulties may, in turn, influence how students perceive their health and participate in academic and social activities. This makes the identification and appropriate management of emotional distress an important aspect of comprehensive sickle cell care.

Coping mechanisms constitute another important psychological consideration. Coping refers to the cognitive and behavioural strategies individuals employ to manage stressful experiences and the demands associated with challenging circumstances. Students living with sickle cell anaemia may cope by following medical advice, planning their academic activities around their health needs, seeking emotional support, practising relaxation techniques, or maintaining constructive relationships with trusted individuals. Some may also draw strength from personal beliefs, family encouragement, and peer relationships. However, coping strategies differ from one individual to another, and their effectiveness may depend on the nature of the stressor, the individual's resources, and the support available.

Adeleke et al. (2024), in a qualitative study of Nigerian undergraduates living with sickle cell disease, explored the participants' experiences in relation to academic life, interpersonal relationships, mental health, and healthcare utilisation. Their findings highlighted the challenges students face in managing the condition while pursuing higher education, alongside their efforts to adapt and remain committed to their academic goals. The researchers emphasised the importance of appropriate healthcare, community awareness, and support systems for students affected by the disease. These findings support the need to investigate the psychological circumstances that may strengthen or undermine student wellbeing.

Social support is closely connected to psychological wellbeing because it can provide emotional reassurance, practical assistance, and a sense of belonging. Students who receive understanding and encouragement from friends, roommates, classmates, lecturers, and family members may find it easier to manage the demands of their condition. For instance, supportive peers may help a student obtain lecture notes during an illness-related absence, while understanding lecturers may provide appropriate guidance concerning missed academic activities. Such support may reduce feelings of isolation and help students maintain their educational goals. Conversely, discrimination, negative stereotypes, rejection, or a lack of understanding may contribute to emotional distress and reluctance to disclose health-related difficulties.

Stigma remains a relevant concern for people living with sickle cell disease because misunderstandings about the condition can influence social attitudes and interpersonal relationships. Some individuals may hold inaccurate beliefs about the causes, transmission, or implications of the disease. These misconceptions may lead to inappropriate treatment of affected individuals, unnecessary fear, social exclusion, or discrimination in relationships. Students who anticipate negative reactions from their peers may conceal their health status or avoid seeking assistance when they need it. Such experiences may further complicate the management of their physical and psychological wellbeing. Providing accurate information about sickle cell disease and encouraging supportive attitudes are therefore important components of creating inclusive university environments.

The psychological wellbeing of students living with sickle cell anaemia should also be understood in relation to their access to appropriate healthcare. Regular clinical assessment, suitable treatment, health education, and access to psychosocial services can help students manage the demands associated with their condition. The Nigerian national guidelines recognise psychosocial support and non-pharmacological approaches as relevant components of comprehensive sickle cell disease management (FMOH, 2022). This approach acknowledges that medical treatment alone may not address every difficulty experienced by individuals living with the disease. Psychological counselling, appropriate coping interventions, and supportive relationships may complement clinical care and improve the overall experience of affected students.

Evidence from intervention research also suggests that psychological support may be beneficial for students living with sickle cell disease. A study published in the International Journal of Disability, Development and Education examined a group-based cognitive behavioural therapy programme for Nigerian university students affected by sickle cell disease. The reported outcomes included reductions in anxiety and depressive symptoms, alongside improvements in coping and social functioning (Effect of a Group-Based Cognitive Behavioural Therapy Program, 2022). Such findings highlight the potential value of integrating psychological support into services for university students living with chronic illnesses.

Babcock University, situated in Ilishan-Remo, Ogun State, provides the setting for the present study. As students navigate the academic and social demands of university life, those living with sickle cell anaemia may experience psychological challenges associated with pain, uncertainty, academic expectations, social interactions, and the management of their health. Understanding these experiences is important for identifying areas where appropriate student support may be needed.

Although research has increasingly recognised the psychosocial and academic implications of sickle cell disease among Nigerian undergraduates, further investigation within specific university settings remains useful. Students may differ in their psychological experiences, coping abilities, social support, and access to healthcare. Examining the psychological factors associated with their wellbeing at Babcock University may therefore provide institution-specific information that can support student counselling, health education, and appropriate welfare initiatives.

Against this background, the present study examines the psychological factors influencing the wellbeing of students living with sickle cell anaemia at Babcock University, Ilishan-Remo, Ogun State. It focuses on the relationship between psychological experiences and the overall wellbeing of affected students, with attention to the emotional and social circumstances that may influence their daily lives and academic participation. The study is intended to contribute to a better understanding of the needs of students living with the condition and the forms of support that may help them maintain their psychological wellbeing while pursuing higher education.

1.2 Statement of the Problem

Sickle cell anaemia presents a continuing challenge to the wellbeing of affected individuals because of its recurrent symptoms, potential complications, and need for ongoing medical management. For university students, the burden of the condition may extend beyond physical discomfort to include emotional distress, academic disruption, social difficulties, and concerns about the future. Although students living with sickle cell anaemia may be capable of pursuing their educational aspirations, the demands of managing the condition alongside university responsibilities can create circumstances that affect their psychological wellbeing.

One major concern is the possibility that recurrent pain crises, fatigue, illness-related absences, and hospital visits may interfere with students' academic activities. University education requires sustained concentration, regular participation, time management, and the ability to meet academic deadlines. When students experience unexpected health difficulties, they may struggle to maintain their usual routines or participate fully in educational and social activities. These challenges may lead to frustration, anxiety, reduced confidence, or dissatisfaction with university life, particularly when adequate academic and emotional support is unavailable.

Recent Nigerian research has provided evidence of the psychosocial and academic difficulties experienced by undergraduates living with sickle cell disease. Adeleke et al. (2025) reported that recurrent pain crises disrupted academic activities and contributed to emotional distress among students interviewed in a private university setting. The study also identified stigma, strained interpersonal relationships, and the positive contribution of support from family members and colleagues. Similarly, Adeleke et al. (2024) highlighted the complex experiences of undergraduates managing sickle cell disease while pursuing their education. Although these studies provide useful evidence, their findings do not automatically establish the psychological experiences of students at Babcock University.

Another concern is the possible influence of psychological factors such as stress, anxiety, depressive symptoms, coping strategies, resilience, and perceived social support on students' wellbeing. Students may differ in how they interpret their condition, manage uncertainty, respond to pain, and seek assistance. Some may develop constructive coping strategies and maintain supportive relationships, while others may experience emotional difficulties or feel isolated because of their health status. These differences make it important to investigate the psychological factors associated with wellbeing rather than assuming that all students living with sickle cell anaemia experience the condition in the same way.

Social attitudes and misconceptions may further complicate the situation. Students who encounter stigma, discrimination, or inadequate understanding from their peers may become reluctant to disclose their condition or seek assistance during periods of illness. A lack of understanding among members of the university community may also contribute to inappropriate expectations concerning attendance, participation, or academic performance during illness-related difficulties. Where supportive arrangements are limited, affected students may find it more challenging to balance their educational responsibilities with their healthcare needs.

Despite growing recognition of these concerns, there remains a need to understand the psychological factors associated with the wellbeing of students living with sickle cell anaemia within the specific context of Babcock University. Evidence from other universities provides a useful foundation, but institutional environments, available support systems, student experiences, and individual coping resources may differ. Without institution-specific evidence, it may be difficult to determine which psychological concerns deserve particular attention and how appropriate student support services should be designed.

The problem addressed by this study is therefore the need to examine the psychological factors influencing the wellbeing of students living with sickle cell anaemia at Babcock University, Ilishan-Remo, Ogun State. The study seeks to establish the relationship between relevant psychological factors and students' wellbeing and to provide evidence that may inform counselling, health education, social support, and student welfare initiatives. Its findings may contribute to the development of a more supportive academic environment for students managing sickle cell anaemia.

1.3 Research Objectives

The general objective of this study is to examine the psychological factors influencing the wellbeing of students living with sickle cell anaemia at Babcock University, Ilishan-Remo, Ogun State.

The specific objectives are to:

1. Examine the relationship between perceived stress and the wellbeing of students living with sickle cell anaemia at Babcock University.

2. Determine the relationship between anxiety and the wellbeing of students living with sickle cell anaemia at Babcock University.

3. Assess the relationship between depressive symptoms and the wellbeing of students living with sickle cell anaemia at Babcock University.

4. Examine the relationship between coping strategies and the wellbeing of students living with sickle cell anaemia at Babcock University.

5. Determine the relationship between perceived social support and the wellbeing of students living with sickle cell anaemia at Babcock University.

1.4 Significance of the Study

This study is expected to be beneficial to students living with sickle cell anaemia, university administrators, lecturers, student counsellors, healthcare professionals, researchers, and other stakeholders concerned with student welfare. Its significance lies in the potential contribution of its findings to understanding the psychological experiences of students managing the condition within a university environment.

Students living with sickle cell anaemia: The study may increase understanding of the psychological challenges associated with managing sickle cell anaemia while pursuing higher education. Its findings may encourage affected students to recognise the importance of emotional wellbeing, constructive coping strategies, appropriate healthcare, and supportive relationships. The study may also help identify areas in which students could benefit from counselling, peer support, and improved access to relevant health services.

University management: The findings may provide university administrators with information about the psychological and social needs of students living with sickle cell anaemia. Such information may assist in developing appropriate student welfare policies, health awareness programmes, and support arrangements that recognise the challenges associated with chronic illness. The results may also encourage cooperation between academic departments, student affairs units, counselling services, and healthcare providers.

Lecturers and academic advisers: The study may help lecturers and academic advisers better understand the difficulties students with sickle cell anaemia may experience during periods of illness. Improved awareness may encourage appropriate communication, reasonable academic support within institutional policies, and constructive engagement with affected students. The findings may also help academic staff recognise the importance of avoiding stigmatisation and ensuring that students are treated fairly.

Counsellors and mental health professionals: The study may provide useful information for counsellors and mental health practitioners working with students affected by chronic illness. By identifying psychological factors associated with wellbeing, the findings may inform counselling programmes, stress-management interventions, coping-skills development, and appropriate referrals for students who require further psychological assessment or care.

Healthcare professionals: Doctors, nurses, and other healthcare providers may benefit from a better understanding of the psychological and academic experiences of university students living with sickle cell anaemia. The findings may reinforce the importance of considering emotional wellbeing and social circumstances alongside physical symptoms during the management of the condition. They may also support communication between healthcare providers and university support services, where appropriate and with the student's consent.

Family members and friends: The findings may help family members, roommates, classmates, and friends appreciate the value of understanding, encouragement, and practical assistance for students living with sickle cell anaemia. Increased awareness may help reduce misconceptions and encourage supportive interactions that promote emotional wellbeing and participation in university life.

Researchers and students: The study may contribute to existing literature on health psychology, chronic illness, student wellbeing, and sickle cell disease in Nigeria. It may provide a reference for future research examining psychological adjustment, coping strategies, social support, academic participation, and quality of life among university students living with chronic health conditions.

Society at large: The study may contribute to public awareness of the psychological and social dimensions of sickle cell anaemia. By drawing attention to the experiences of affected students, it may encourage more informed attitudes towards people living with the condition and support broader efforts to reduce stigma and promote inclusion.

References

Adeleke, O. T., Olasinde, Y. T., Folaranmi, O. E., Ayuba, Y. L., Agelebe, E., Rufai, M. M., Adeleke, O. V., Adeoye, O. E., Olabode, A. T., Ajala, D. E., and colleagues. (2024). A qualitative enquiry into lived experience and coping strategies of undergraduates with sickle cell disease in Nigeria. BMC Public Health, 24, Article 3388. https://doi.org/10.1186/s12889-024-20927-6

Adeleke, O. T., Folaranmi, O., Olasinde, Y., Ayuba, L., Adeleke, O. V., Ojo-Rufai, M. M., Agelebe, E., Adeoye, O. E., Olabode, A. T., Ajala, D. E., and colleagues. (2025). Unveiling the psychosocial and academic implications of living with sickle cell disease among undergraduates in a private university in Nigeria. Frontiers in Public Health, 13, Article 1531161. https://doi.org/10.3389/fpubh.2025.1531161

Effect of a group-based cognitive behavioural therapy program on the psychological wellbeing, quality of life and coping of students with sickle cell disease in Nigeria. (2022). International Journal of Disability, Development and Education. https://doi.org/10.1080/1034912X.2020.1755422

Federal Ministry of Health. (2022). National guideline for the control and management of sickle cell disease (2nd ed.). Federal Ministry of Health, Nigeria. https://www.health.gov.ng/wp-content/uploads/2025/06/SCD-Guideline-Final-2nd-Edition.pdf