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Influence of School-Based Sickle Cell Screening on Sickle Cell Trait Detection among Secondary School Students in Nigeria

Abstract

Sickle cell trait remains an important genetic health consideration in Nigeria, where the sickle cell gene is relatively common and individuals carrying the trait may be unaware of their carrier status. Although individuals with sickle cell trait generally do not have sickle cell disease, knowledge of carrier status is important for genetic counselling, informed reproductive decision-making, family planning, and increased awareness of the risk of having children affected by sickle cell disease when both biological parents carry relevant haemoglobin variants. Secondary school students represent an important population for early identification because screening during adolescence can provide health information before marriage and childbearing and can support informed future reproductive decisions. However, many adolescents may not know their haemoglobin genotype because of limited access to screening, inadequate awareness, financial barriers, parental concerns, geographical limitations, and insufficient integration of genetic health services into school health programmes. School-based sickle cell screening provides an opportunity to bring haemoglobin genotype testing closer to students through organized school health programmes, health campaigns, and collaboration between schools and healthcare providers. Early detection of sickle cell trait may facilitate genetic counselling, health education, appropriate documentation of genotype status, and referral for confirmatory testing where necessary. Against this background, this study investigates the influence of school-based sickle cell screening on sickle cell trait detection among secondary school students in Nigeria. The study will be anchored on the Health Belief Model, Theory of Planned Behavior, and the Health Systems Framework. The Health Belief Model explains how students' and parents' perceptions of susceptibility to sickle cell-related genetic risks, perceived benefits of screening, perceived barriers, and cues to action may influence participation in school-based sickle cell screening. The Theory of Planned Behavior explains how attitudes toward genotype testing, perceived social expectations, and perceived control over participation may influence students' willingness to undergo screening and obtain knowledge of their genotype status. The Health Systems Framework emphasizes service delivery, health workforce, health information, medical products and technologies, financing, and accessibility as essential components of effective school-based genetic screening programmes. Collectively, these theoretical perspectives provide a suitable framework for explaining how school-based sickle cell screening may influence sickle cell trait detection among secondary school students in Nigeria. The study will adopt a quantitative cross-sectional analytical or quasi-experimental research design. The study population will comprise students enrolled in selected public and private secondary schools across Nigeria. A multistage sampling technique will be used to select states, local government areas, communities, schools, classes, and eligible students. School-based sickle cell screening will be measured using indicators such as availability of screening programmes, screening coverage, frequency of screening activities, number of students screened, availability of trained healthcare personnel, haemoglobin genotype testing, screening equipment, health education, parental consent and participation, accessibility of testing services, and referral arrangements. Sickle cell trait detection will be assessed using indicators such as haemoglobin genotype test results, identification of students with sickle cell trait, previously unknown genotype status, confirmation of screening results where appropriate, genetic counselling referral, documentation of genotype status, and linkage to relevant health education or counselling services. Data will be collected using structured questionnaires, school screening registers, laboratory genotype testing records, student health records, referral registers, and relevant programme documents. Descriptive statistics will be used to summarize students' characteristics, screening coverage, genotype findings, and patterns of sickle cell trait detection. Inferential statistical techniques, including chi-square tests, correlation analysis, and logistic or multiple regression analysis, will be used to determine the influence of school-based sickle cell screening on sickle cell trait detection. Where appropriate, sickle cell trait detection rates before and after implementation of school-based screening activities may be compared to determine changes associated with the intervention. Diagnostic tests will also be conducted to assess the reliability, validity, and robustness of the findings. The study is expected to find that school-based sickle cell screening has a significant positive influence on sickle cell trait detection among secondary school students in Nigeria. Students who participate in school-based sickle cell screening are expected to have a higher likelihood of having previously unknown sickle cell trait identified than students without access to such services. School-based screening may facilitate early identification of haemoglobin genotype status and provide opportunities for genetic counselling, reproductive health education, family awareness, and appropriate documentation of genotype results. Conducting screening within schools may reduce geographical, financial, and time-related barriers and increase access to genotype testing among adolescents who may otherwise not undergo screening. Early knowledge of sickle cell trait status may also encourage students and families to seek appropriate counselling and make informed reproductive decisions later in life. Conversely, inadequate screening coverage, shortage of trained healthcare personnel, limited laboratory facilities, financial constraints, low awareness, parental concerns, stigma, and weak referral and confirmatory testing systems may reduce the effectiveness of school-based sickle cell screening. The study therefore expects accessible and well-organized school-based sickle cell screening to contribute significantly to improved detection and awareness of sickle cell trait among secondary school students in Nigeria. The study is expected to contribute to the literature on school-based sickle cell screening, sickle cell trait detection, adolescent health, genetic health education, haemoglobin genotype screening, reproductive health, school health services, preventive healthcare, and public health in Nigeria. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, Federal Ministry of Education, National Primary Health Care Development Agency, state ministries of health and education, secondary schools, healthcare providers, genetic counsellors, laboratory professionals, community health workers, development partners, and policymakers regarding strategies for improving early identification of sickle cell trait among adolescents. The study will also provide evidence-based recommendations for expanding school-based sickle cell screening programmes, improving access to reliable haemoglobin genotype testing, strengthening genetic health education and counselling, increasing availability of trained healthcare and laboratory personnel, improving confirmatory testing and referral systems, protecting students' confidentiality, promoting informed reproductive health decisions, and integrating sickle cell screening into comprehensive school health programmes across Nigeria.

Keywords: School-based sickle cell screening, sickle cell trait detection, secondary school students, haemoglobin genotype, sickle cell trait, genetic screening, genetic counselling, adolescent health, school health services, reproductive health, Nigeria, public health.