INTRODUCTION

Head and neck cancer is a malignant neoplastic lesion affecting the mucosa of the upper aero-digestive tract; this tract is made up of the nasal cavity, para-nasal sinuses, pharynx, mouth, larynx, trachea, and oesophagus.^1,2 The aetiology/risk factors of HNC include tobacco, alcohol, poor nutrition and diets, poor oral health, oral sex, ultraviolet radiation, and exposure to harmful chemical substances.^1-9 However, among these aetiological/risk factors, tobacco, alcohol, and oral sex are the three major ones.¹⁰

Head and neck cancer is a killer disease and it is the tenth most common cancer worldwide,¹¹ as well as the sixth most common cause of cancer-related deaths globally.^10,12 Every year, more than 500,000 cases of HNC are newly diagnosed¹³; also HNC incidence rate varies by sex, age, race, subtype, country, and anatomic site.¹⁴ Pertinently, the incidence rate of HNC among young people is rising over the years, and more and more able-bodied youths are dying from HNC disease globally.^15,16

In Nigeria, the prevalence of the three major HNC risk factors (oral sex, tobacco use, and alcohol use) among youth in secondary schools is on the alarming side.^17-19 For instance, available studies on the prevalence of oral sexual practices among secondary school students in Nigeria showed that as high as 65.5% of secondary school students in one of the Nigeria major cities have positive lifetime history of oral sexual practices.¹⁸ Similarly, lifetime prevalence rates of tobacco use and alcohol drinking among secondary schools students in some places in Nigeria is as high as 32.5% and 66%, respectively.^17,19 Based on the above, it can be concluded that many Nigerian youth, more especially the senior secondary school students, are at risk of developing HNC disease later in life should they continue in their risky behaviours.

The knowledge of secondary school students in Nigeria on HNC aetiological/risk factors is very crucial to future HNC prevention, as many of them are at risk of developing the disease later in life if they continue in their risky behaviours. Unfortunately, the knowledge of HNC aetiological/risk factors among secondary school students in Nigeria is still very poor.^20,21 However, the only available Nigerian study on school-based HNC education had it documented that HNC education can have significant positive impact on the knowledge and attitude of Nigerian secondary school students towards HNC disease and HNC prevention strategies.²⁰ Also, in the study, it was reported that HNC education can effectively motivate secondary school students in becoming HNC peer educators. However, this aforementioned study did not explore the impact of HNC education on the attitudes of Nigerian secondary school students towards non-peer education on HNC; the study was also delimited to a South-Western Nigerian group of students only.²⁰

In light of the above, there is a need to conduct a scientific research to explore the knowledge of secondary school students in other parts of Nigeria on HNC risk factors/aetiology and symptoms and also evaluate the impact of HNC education on their knowledge of HNC aetiological/risk factors and symptoms, and also its impact on their attitudes towards HNC peer and non-peer education. Hence, this (pilot) study aims to assess the impact of HNC education on secondary school students in Birnin Kebbi, North-Western Nigeria, on their knowledge of HNC and attitudes towards HNC peer and non-peer education.

MATERIALS AND METHODS

This pilot study was an interventional study conducted among senior secondary school students in two conveniently selected secondary schools in Birnin Kebbi, Kebbi State, North-Western Nigeria: Nagari College and Army Day Girls Secondary School. Nagari College is a boys-only school while Army Day Girls Secondary School is a girls-only school. However, both schools were public schools. A total of 20 students in the senior classes were recruited from each of the participating schools; hence a total of 40 students were used as the study sample.

The instruments used for data collection in this study were a pre-test and a post-test paper questionnaire developed from review of online literatures^20,21. The pre-test questionnaire obtained information on the participants’: socio-demographic characteristics, knowledge of HNC, and attitudes toward HNC peer and non-peer education. However, the post-test questionnaire obtained information on the participants’: socio-demographic characteristics, knowledge of HNC, assessment of the HNC education activity, and attitudes toward HNC peer and non-peer education.  

Importantly, visual teaching aids were also used in the course of the HNC educational activity (i.e. health talk). These teaching aids include white board, marker, and cleaner. A well-labelled annotated diagram of the cross-section of the head and neck region of the human body was drawn on the white board to aid the educational activity.

The data collection process was done in a classroom. Prior to the conduction of the study, permission to carry out the study in the selected schools was officially obtained from the management of the respective schools. Also, the study was approved by the National Teachers’ Institute Birnin Kebbi Study Centre, Birnin Kebbi, Nigeria.  The data was collected separately from the participating schools; i.e. the schools were visited separately. On the day the study was carried out in each of the schools, the students in the most senior class, designated “Senior Secondary class (SS) 3”, were gathered together and they were informed about the purpose and benefits of the study. They were also informed that their participation was strictly confidential, and voluntary.

Random sampling technique was then used in the selection of 20 participants per school. After the selection, participants were asked if they were willing to participate in the study. All participants agreed to participate and they all gave verbal informed consent. After the above had been done, the participants were moved to a classroom where they were given a re-briefing about the purpose of the study. Thereafter, they were given a pre-test questionnaire to fill. After all the participants had filled their pre-test questionnaires, they were given a health talk (average duration: 35 minutes) on HNC by the primary investigator (a dentist), using teaching aids. The content of the health talk was drafted from the public information on HNC provided on the official website of Cancer.Net²². In the health talk on HNC, the participants were educated, using simple terms, on the meaning of HNC, the aetiology/risk factors of HNC, as well as HNC symptoms. They were also advised to always visit a dentist/physician in case they have any oral health-related problem that persists for more than three days. After the health talk had been given, they were asked to ask questions on issues related to HNC and the health talk, of which some asked questions. All relevant questions were answered and treated appropriately. After the question-and-answer session, they were all issued a post-test questionnaire to fill. 

All issued questionnaires were returned filled. No questionnaire was discarded because all were properly filled out. Data obtained was computed into the SPSS version 20 Software for analysis. Frequency distributions of all variables were determined and bivariate analyses, using Chi Square test was done to compare relevant variables; a p-value of <0.05 was used to determine the level of statistical significance.

RESULTS

The mean (±SD) age of the participants was 17.13 (±1.604) years. Half (50%) of them were students of Nagari College, 50% were females, 75% were from the Hausa tribe, and 77.5% were Moslems (Table 1).

Our baseline survey showed that the majority (82.5%) of the participants were aware of HNC, of which a higher proportion of them were females (Table 2). After a health talk on HNC was given, our end-line surveyed showed a general increase in the participants’ knowledge on HNC aetiological/risk factors and its symptoms (Tables 3 & 4).

Furthermore, our survey data shows that the HNC health talk was very educative (Figure 1), very interesting (Figure 2), and also a source of motivation, significantly motivating the participants in educating their schoolmates, friends, and distant relatives (Table 5).

Table 1. Socio-demographic characteristics of the participants

*Army Day Girls Secondary School; **Nagari College; “N/A” – Not applicable

Table 2. Comparison between school of participants and awareness on HNC

^#Only the data of the participants that responded to the cross-tabulated variables were computed in this statistics; *Army Day Girls Secondary School; **Nagari College; “n” – Total number of eligible respondents per category

Table 3. Comparison of responses of participants on HNC aetiological/risk factors, before and after the health talk on HNC

*Only the data of the participants that responded to the cross-tabulated variables were computed in these statistics; “n” – Total number of eligible respondents per category; “SD” – Strongly disagree; “D” – Disagree; “Agree”; “SA” – Strongly agree

Table 4. Comparison of responses of participants on HNC symptoms, before and after the health talk on HNC

*Only the data of the participants that responded to the cross-tabulated variables were computed in these statistics; “n” – Total number of eligible respondents per category; “IDK” – I don’t know;

 Table 5. Comparison of attitudes of participants towards HNC peer education, before and after the health talk on HNC

*Only the data of the participants that responded to the cross-tabulated variables were computed in these statistics; ***No statistics were computed because variables were constant.