PERCEIVED STRESS FACTORS AND COPING MECHANISMS AMONG MOTHERS OF CHILDREN WITH SICKLE CELL DISEASE IN IBADAN-IBARAPA HEALTH ZONE, OYO STATE

Abstract

Managing a chronically ill child, such as one with sickle cell disease (SCD), poses much hardship and stress on family members, especially mothers who are the primary caretakers of the of affected children. The psychological and physical distress suffered by these mothers may directly influence their own health status, their child care role and subsequently the prognosis of the child. The present study was therefore conceived as an attempt to identify the factors that might produce stress among mother' of children with SCD, to document the level of stress experienced by these mothers, to determine the social and demographic variables that may be associated with stress and to elicit the coping styles use to handle stress. The researcher hypothesized that certain demographic factors, including educational level, type of marriage and total number of children with SCD in the family might be associated with measured stress levels. The target population consisted of mothers of children with SCD who attended a sickle cell clinic in a state, federal, private or mission hospital within the Ibadan-lbarapa Health Zone of Oyo State, between June and July 1993. Six such clinics were identified. Each facility was visited on the appropriate outpatient clinic day during the study period, and all mothers in the target group who attended were interviewed. A total sample, of 200 was thereby produced for this cross-sectional study. A survey instrument was developed based on focus group discussion (FGD) sessions wherein mothers of children with SCD identified possible sources of stress. Mothers ranked these, and a list of 30 relevant stressors was produced. A Likert-type scale was developed and pretested among mothers attending a SCD clinic in Ilorin. Information on coping mechanisms covered the following six broad categories of stressors: hospital, financial, family, child, psychological and disease factors. Additional questions gathered demographic data on mothers and their knowledge about the disease. A mean stress score of 59 points from a potential range of 30-90 was obtained. Mothers below 35 years old displayed significantly less stress (58 points average) than older women (61). Those in a monogamous marriage had a significantly lower mean score (57) than women in polygamous homes (61) or single women (63). Mean stress was found to decrease with mothers' level of education from 62 points among the uneducated to 48 among those with post-secondary education. Having more than one child with SCD in the family yielded a higher stress score (67) than haying only one affected child (57). Coping style varied according to the category of stressor. For example, Mothers confront the financial stressors by searching for money. Most accept treatment as a given, although one-third do try to avoid it. The findings emphasize the need to introduce health education and counseling on stress coping mechanisms for affected mothers as well as community health education to prevent this stress-inducing disease within families. Counseling is needed especially for families that have one child with SCD and that are considering having more children. Older, less educated and single mothers are groups that should be targeted for social support interventions such as participation In SCD clubs.